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HomeMy WebLinkAboutWater Main Line Extension Agreement Proj No DP25-006 - Basney Enterprises1316 COUNTY -CITY BUILDING 227 W. JEFFERSON BOULEVARD SOUTH BEND, INDIANA 46601-1830 PHONE 574/235-9251 FAx 574/235-9171 CITY OF SOUTH BEND JAMES MUELLER, MAYOR BOARD OF PUBLIC WORKS June 24, 2025 Mr. Chad Hurley Basney Enterprises, Inc. 52203 State Road 933 South Bend, IN 46637 chad(a),basneimports. com RE: Water Mainline Extension Service Agreement Dear Mr. Hurley: At its June 24, 2025 meeting, the Board of Public Works approved the above referenced agreement for the extension of the water main parallel to State Road 933. Enclosed please find the original of the agreement for your signature. Please sign and return the agreement to hhorvath(dsouthbendin.gov. Please retain a copy for your records. If you have any further questions, please call this office at (574) 235-9251. Sincerely, /s/Hillary Horvath Hillary Horvath, Acting Clerk Enclosures HH ELIZABETH A. MARADIK JOSEPH R. MOLNAR GARY A. GILOT MURRAY L. MILLER BREANA N. MIcou WATER MAINLINE EXTENSION SERVICE AGREEMENT This Water Mainline Extension Service Agreement ("Agreement") is made on the 24th_ day of June , 2025 by and between Basney Enterprises, Inc. ("Owner") with an address of 52203 S.R. 933, 46637 and the City of South Bend, a municipal corporation existing under the laws of Indiana, acting by and through its Board of Public Works ("City") in accordance with 170 I.A.C. 6-1.5-40. WHEREAS, Owner desires to extend the public water main in order to provide for private fire suppression for their collision center with the potential for a future additional connection for domestic water service off said water main line; WHEREAS, Owner plans to extend and make additions to the City's existing water main line systems to serve said development as shown on the Exhibit A, attached and incorporated hereto (the "Dedicated Improvements"), and desires certain commitments from City; and WHEREAS, the engineering design for said Dedicated Improvements has been, or will be, accomplished by competent professional engineers registered and licensed in the State of Indiana; and NOW, THEREFORE, in consideration of the obligations, terms and conditions contained herein, the adequacy of which the parties expressly acknowledge, Owner and the City agree as follows: 1. Recitals The parties hereto acknowledge and agree that the foregoing recitals are incorporated herein as a part of this Agreement. 2. Design The Owner shall consult the City and allow the City Engineer or her designee input prior to designating a project engineer who shall be responsible for the engineering design and inspection in connection with the installation of the Dedicated Improvements (the "Project Engineer"). The Owner shall inspect the site during construction to ensure the Project Engineer's conformance to zoning requirements, adequacy of design, and conformance to the City's specifications and standards regarding location, size and depth of line, and quality of construction of the Dedicated Improvements. The Owner shall provide the plans with a City of South Bend cover sheet and specifications for the Dedicated Improvements along with a cost estimate to the City. The Owner shall also provide to the City as -built information certifying that the materials and workmanship including pipes, bedding, and other related materials and work meet the City's specifications and standards. Upon request of the City, the certification shall be substantiated by material affidavits from suppliers and by applicable test results for flow rate, pressure, leaks, bacteria, and other tests required by the City. All construction, engineering, and inspection costs in connection with the Dedicated Improvements shall be borne by the Owner. 3. Construction Inspection The Owner has provided the City with Exhibit A, which depicts drawings of the Dedicated Improvements, which the City acknowledges conforms to the City's standards. The Owner shall allow the City to inspect the Dedicated Improvements during construction to ensure conformance to the agreed standards set forth in Exhibit A, in particular with regard to zoning requirements, adequacy of design, and quality of construction. The Owner shall contact the City's Engineering Department at least two (2) business days in advance to arrange for the attendance of a City inspector at key milestones throughout work. Key milestones may include but not limited to: hydrostatic testing, bacteria testing, hydrant flow tests, and water main taps. The Owner agrees to perform any necessary adjustments as reasonably requested by the City to ensure the Dedicated Improvements are constructed in accordance with Exhibit A. 4. Permits It shall be Owner's sole responsibility and expense to obtain any and all permits associated with the construction and installation of the Dedicated Improvements and to comply with all applicable laws. 5. Engineer's Estimate The Owner has provided an Engineer's Estimate (See Exhibit B, incorporated herein by reference and attachment) for the cost to construct the Dedicated Improvements, including but not limited to, excavation, pipe materials, valves, hydrants, and all other appurtenant materials, supplies and equipment, permit fees, backfill and bedding, pavement, curbs, sidewalks, signs, and restoration of the areas within the proposed R.O.W. 6. Performance Bond Owner shall provide the City with a performance bond for an amount equal to one hundred twenty-five percent (125%) of the construction cost covering all work performed or to be performed pursuant to this Agreement. Owner's failure to provide the performance bond as prescribed herein shall cause this Agreement to be immediately terminated and of no effect, without the requirement of notice. The performance bond shall be provided concurrently with the execution of this Agreement. 7. Maintenance Bond Within ten (10) days of City's acceptance of the Dedicated Improvements, Owner shall provide the City with a maintenance bond equal to ten percent (10%) of the construction cost covering all work performed or to be performed pursuant to this Agreement, and such bond shall remain in effect for three (3) years after dedication as described in Section 9 below. S. Term Except as otherwise provided herein, this Agreement shall continue for a period of sixteen (16) months from the Effective Date of this Agreement, or upon the issuance of the relevant occupancy permit(s), whichever occurs last. 9. Dedication Upon completion of the construction of the Dedicated Improvements substantially as depicted in Exhibit A, the Owner shall also convey an easement and dedicate to the City within such easement the Dedicated Improvements as public infrastructure. It is understood by the Owner that no dedication shall be accepted by the City until all required easements have been conveyed, accepted, and recorded by the City. The Owner shall use its best efforts to work with the City to ensure that the Dedicated Improvements are dedicated to the City in a timely manner. Additionally, prior to dedication, the following must be satisfied: a. All parts and labor must meet the standards and requirements stated in the design specifications as presented to and accepted by the City's Engineering Department. b. Lien waivers must be received with regard to all workmanship and materials used in connection with these improvements. c. The Final Dedication must be furnished to Owner by the South Bend, Indiana Board of Public Works. d. Owner must provide copies of test reports or cut sheets on all materials supplied. e. Owner must provide all tests required by City of South Bend Construction Standards and Specifications or other governing bodies. Owner must provide fire flow test data on new hydrants. f. Owner must provide As -Built drawings in accordance with the City of South Bend Prevailing Specifications for Public Works, which may be found at https: / / southbendin.gov/wp-content/uploads /2020/05/Prevailing-Supplemental- Specifications.pdf Owner's failure to comply with this Section shall be a material breach of this Agreement. 10. System Development Charges For every new connection to the South Bend Municipal Water Works, a system development charge of Four Hundred Seventy -Five dollars shall be collected per ERU. No customer shall be deemed to be less than one (1) ERU. Simultaneously with the execution of this Agreement, the Owner shall pay the City a sum of $475.00 (Four Hundred Seventy -Five dollars and 00/100) for access to the City's water works infrastructure in compliance with Chapter 17, Article 10 Section 80 of the South Bend Municipal Code. A 10% discount shall be applied to the payment if paid in full. It is understood amongst the parties that the Owner will utilize the new water main for fire protection and any future domestic services will be subject to additional System Development Charges as required by City Ordinance, as amended. A copy of the calculation is attached as Exhibit D. 11. Indemnification Owner agrees and undertakes to indemnify and hold the City, and its respective agents, employees, successors, and assigns, harmless from any liability, loss, costs, damages or expenses, including attorneys' fees, which the City may suffer or incur as a result of any claims or actions which may be brought by any person or entity arising out of this Agreement. If any action is brought against the City or its respective agents, employees, successors, or assigns, in connection with this Agreement, Owner agrees to defend such action or proceedings at its own expense and to pay any judgment rendered therein. 12.Insurance Owner, or Owner's contractor, at Owner's sole expense, shall maintain during the term of this Agreement, commercial general liability insurance covering the Owner and the Dedicated Improvements in an amount not less than Five Million Dollars ($5,000,000.00) per occurrence. Owner understands and agrees the amount of insurance does not in any way limit liability under this agreement to $5,000,000. The Certificate of Insurance shall be provided concurrently with the execution of this Agreement and attached as Exhibit E. 13. Assignment This Agreement may not be assigned by the Owner without the express written consent of the City which such consent may be withheld for any reason. Any violation of this limitation shall terminate the City's obligation and forfeit the Owner's rights under this Agreement. 14. Material Breach In the event either party breaches any of the provisions set forth herein, the non -breaching party shall provide written notice of the breach to the breaching party. Upon receipt of the notice, the breaching party shall use its good faith efforts to cure the breach as soon as practical. In the event the breach is not cured within a reasonable amount of time, the non -breaching party may terminate this Agreement and pursue its legal and equitable remedies. 15. Governing Law and Jurisdiction This Agreement shall be construed and interpreted according to the laws of the State of Indiana, including, but not limited to, I.C. § 8-1-2-101.5 and 170 I.A.C. 6-1.5 et seq. and/or 170 I.A.C. 8.5-4 et seq. regarding the dispute resolution process of customer complaints, and shall be enforced in any court of competent jurisdiction in St. Joseph County, Indiana. It is further agreed that all provisions of law now or hereafter in effect relating to water service by the City shall be applicable to this Agreement. 16. Severability Wherever possible, each provision of this Agreement shall be interpreted in such a manner as to be effective and valid under applicable law, but if any provision of this Agreement shall be prohibited by or invalid under applicable law, such provision shall be ineffective only to the extent of such prohibition or invalidity, without invalidating the remainder of such provision or the remaining provisions of this Agreement. 17. Waiver No provision of this Agreement will be deemed waived, unless such waiver will be in writing and signed by the party against which the waiver is sought to be enforced. The waiver will not be construed to be a waiver of any succeeding breach of any such provision, a waiver of the provision itself, or a waiver of any other provisions of this Agreement. No delay or omission on the part of either party to exercise or avail itself of any right, power, or privilege that it has or may have under this Agreement will operate as a waiver of any breach or default. 48. Time Time is of the essence of this Agreement. 19. Entire Agreement This Agreement sets forth the entire agreement and understanding between the Owner and the City as to the subject matter hereof, and merges and supersedes all prior discussions, agreements, and understanding of any and every nature between them. 20. Corporate Authority The person signing on behalf of the Owner represents that he/she has been duly authorized to execute this Agreement on behalf of said Owner. IN WITNESS WHEREOF, the Owner and the City, through their duly authorized representatives, have caused this Agreement to be executed as of the day and year first written above. The parties have read and understand the foregoing terms of this Agreement and do, by their respective signatures hereby agree to its terms. IN WITNESS WHEREOF, the Owner and the Citv. through their dulv authorized representatives, have caused this Agreement to be executed as of the date first written above. The parties have read and understand the foregoing terms of this Agreement and do, by their respective signatures, hereby agree to its terms. OWNER By: Printed: CITY OF SOUTH BEND, INDIANA BOARD OF PUBLIC WORKS ljt 4 Elizabeth A. Maradik, President Gary A. Gilot, Member Murray L. Miller, Member �/ P1 Joseph R. Molnar, Vice President Briana Micou, Member d4i&�fA�WtL/ fi&mn Attest: Hillary Horvath, Acting Clerk Date: 6/24/25 EXHIBIT A DEDICATED IMPROVEMENTS SEE ATTACHED PLANS CITY OF SOUTH [)IF=l PROJECT rA 1) IA14A A RTMENT OF IUBLIC VVORKS WATER DATE i:i TRAFF i:i STREET i:i OTHER WATER MAIN EXTENSION ALONG LASALLE TRAIL BETWEEN DARDEN ROAD AND BRICK ROAD TERMINATING AT 52203 S.R. 933 EXTENSION OF EXISTING PUBLIC 12 IN. DIAM. WATER MAIN 6931 NORTH ALONG LA SALLE TRAIL TOWARD BRICK ROAD. INSTALLATION OF PRIVATE 6" WATER SERVICE FOR FIRE SUPPRESSION TO BASNEY IMPORTS APPROVED BY BOARD OF PUBLIC WORKS ELIZABETH A. MARADIK PRESIDENT JOSEPH R. MOLNAR VICE PRESIDENT GARY A. GILOT MEMBER BREANA N. MICOU MEMBER MURRAY L. MILLER MEMBER THERESA M. HEFFNER CLERK CITY OF SOUTH BEND, ND ANA PREVAILING SPECIFICATIONS LATEST EDITION, TO BE USED WITH THESE PLANS. APPROVED BY PUBL C WORKS STAFF DATE 6/17/2025 ERIC HORVATH, P.E. ACTING CITY ENGINEER KYLE LUDLOW A�mziti� KEN SMITH Mow what's below. Call before you dig. PUBLIC CONSTRUCTION WATER WORKS )L - cc:- BEN,J,'-\ IVI L. J I FiINLL T 06/09/2025 PROFESSIONAL ENGINEER NO. PE12200658 6/17/2025 6/17/2025 LEE• =�P. �j\STEk m No. 12200658 STATE OF MATCH UNE - SEE RIGHT +9 40' ROW U' 3 0 z 0 w 0 oo ID oo NO. I REVISIONS O O O (n N +00-X I O O I I I I I I I I I I v t O -SSH+--SSA I I I I I I I I I Conc. I I I I I 0 m I OE OE I 5' Dia. Base R O M Grass OE OE OE I i7AEP EASEMENT PER PROVIDED DOCUMENT OE OE e OE Conc. n 120.2' OE OE OE 4475 v 4476 c� NI r I 4626 4621 }. m Asph. � I N I I N I 0 Brush `2 IL � 0 I N Asph. O I o - N 1 Story Metal & Block Building o I � f*1 N Misc. Valve I N 31+90 I U) m NO OUTFACE P E I 4601 TRACT ITS -Si ST BASNEY ENTERPRISES, INC., 52203 S.R. 933 4392 c _ 50.4' ST. ID #71-03-24-103-001.000-003 DOC. NO. 1505422 U I O O M5' Dia. BaseO o 5' Dia. Ba ± V N 0 Conc. Con. BM #1 U) c m I 170.4' 0 U N U I U 0 4 80 o 4364 m I U -S --SS--SS--- -SS---S -- �S--T S---SS---SS---SS---SS---SS---SS---SS---SS---SS---SS---SS---SS---SS---SS---SS- - --SS --SS---SSA 0 Asph. m y� v INDIANA & MICHIGAN I / ELECTRIC CO. I 4494 ST. ID #71-03-24- 151-007.000-003 I / I I 4352 " Trash Area r m I �- ST ST ST ST t0 e o I �s 5' Fence V) II T \Sr 4556 30+00 Asph. 0 5' Fence �1-31 M Grass 21+00 K-x O M Brush r + t j MATCH YNFT 7 SEE LEFT BY I DATE .qM 01 m 0 M 5' Dia. Base DETENTION BASIN Aw 2810 Dexter Drive Elkhart, IN 46514 Phone: 574-266-1010 Email: info@sam.biz SANITARY SEWER STRUCTURE DATA: U C a� L� LEGEND REBAR FOUND M(3)N MAG NAIL FOUND eM BENCHMARK SET E- LIGHT POLE ❑0 TRANSFORMER $ POWER POLE C- GUY WIRE ANCHOR © GAS METER © GAS VALVE O WELL LOCATION ® CURB INLET CI CURB INLET © SANITARY MANHOLE OW WATER VALVE ® UNKNOWN MANHOLE DECIDUOUS TREE ST ST ST STORM SEWER ST(D) ST(D) STORM SEWER (SUE LEVEL D) ---SS---SS---SS- SANITARY SEWER W(B) W(B) WATER LINE (SUE LEVEL B) CHAIN LINK FENCE OE OVERHEAD ELECTRIC UE UNDERGROUND ELECTRIC TREE LINE GENERAL INFORMATION 0 20' 40' GRAPHIC SCALE Asph. THE PURPOSE OF THIS SURVEY IS TO COLLECT DATA NEEDED FOR THE DESIGN OF A WATERMAIN EXTENSION. THIS IS NOT A RETRACEMENT SURVEY. THE APPARENT PROPERTY LINES SHOWN ARE BASED ON DEED RECORDS, PLATS, FOUND MONUMENTATION, PRIOR SURVEYS, AND PHYSICAL EVIDENCE. HORIZONTAL AND VERTICAL DATA IS BASED ON A SOLUTION DERIVED FROM GLOBAL POSITIONING SYSTEM (GPS) OBSERVATIONS PROCESSED BY INDOT CONTINUOUSLY OPERATING REFERENCE STATIONS. THE COORDINATE SYSTEM IS US STATE PLANE 1983, NAD 1983 (CONUS), INDIANA EAST ZONE. GROUND ELEVATIONS ARE BASED UPON SAID INDOT SOLUTION AND ARE ON THE 1988 NORTH AMERICAN VERTICAL DATUM (NAVD88). THIS ORTHOMETRIC ELEVATION WAS DERIVED UTILIZING THE MOST RECENT GEOID MODEL (GEOID18). UTILITY NOTES INDIANA 811 WAS NOT CONTACTED. OTHER BURIED UTILITIES MAY EXIST ON THIS SITE THAT ARE NOT SHOWN. ALL SEWER STRUCTURE DATA SHOWN IS BASED ON MEASUREMENTS TAKEN FROM THE RIMS OR GRATES OF THE STRUCTURES. NO ATTEMPT WAS MADE TO ENTER ANY STRUCTURES TO TAKE DIRECT MEASUREMENTS. BENCHMARKS BM #1 GEAR SET IN EAST FACE AEP POWER POLE #J163-520, ELEVATION 718.01 n BM #2 GEAR SET IN EAST FACE AEP POWER POLE #J 1 63-1210. ELEVATION 717.36 SANITARY MANHOLE 3015 SANITARY MANHOLE 4255 RIM 717.40 RIM 716.55 INV 18" PVC N 707.10 INV 18" PVC N 708.65 INV 18" PVC S 707.10 INV 18" PVC S 708.55 INV 6" PVC E 707.00 INV 12" CLAY(?) E 705.75 SHELF 707.80 SHELF 709.35 4' DIA CONCRETE STRUCTURE 4' DIA CONCRETE STRUCTURE SANITARY MANHOLE 4071 SANITARY MANHOLE 4364 RIM 717.04 RIM 718.66 INV 18" PVC N 708.04 INV 12" PVC W 710.16 INV 18" PVC S 708.04 INV 12" PVC E 710.16 SHELF 708.74 SHELF 710.46 4' DIA CONCRETE STRUCTURE SANITARY MANHOLE 4580 SANITARY MANHOLE 4247 RIM 718.63 RIM 716.20 INV 12" PVC W 709.13 INV 18" PVC N 709.20 INV 12" PVC E 709.13 INV 18" PVC S 709.20 SHELF 709.53 INV 4" PVC E 710.70 4' DIA CONCRETE STRUCTURE SHELF 710.20 4' DIA CONCRETE STRUCTURE SANITARY MANHOLE 4621 RIM 719.31 TOP OF SLUDGE 714.71 BOTTOM 711.41 4' DIA CONCRETE STRUCTURE DRAWING FILE: 92688-DESIGN.DWG CERTIFICATION DATE: 06/09/2025 HORIZONTAL SCALE: 1 "=20' VERTICAL SCALE: NONE ENGINEER: Ben Stanley, P.E. TECHNICIAN: SAL LEE m : No. 12200658 : -< STATE OFLAJ 0'. O N A 1.-��``��\ STORM SEWER STRUCTURE DATA CURB INLET 4352 CURB INLET 4494 RIM 717.71 RIM 717.55 INV 12" PVC W 714.91 INV ?" ? W 714.55 INV 6" PVC N 714.91 INV 12" PVC E 714.75 BOTTOM 714.91 INV ?" ? NE 714.45 BOTTOM 714.35 STORM INLET 4392 4' DIA CONCRETE STRUCTURE RIM 717.68 UNABLE TO OPEN STORM INLET 4556 RIM 716.58 STORM INLET 4475 M INLET INV 12" PVC NW 711.38 RIM INV 18" PVC S 710.98 INV 12" PVC S 715.53 BOTTOM 709.08 BOTTOM 715.43 UNABLE TO DETERMINE STR SIZE 2' DIA CONCRETE STRUCTURE STORM INLET 4601 STORM INLET 4476 RIM 718.41 RIM 718.80 INV 12" PVC N 715.21 INV 12" PVC SE 716.50 INV ?" ? W 715.11 BOTTOM 716.3 INV 12" PVC (CAPPED) S 715.21 f 2' DIA CONCRETE STRUCTURE BOTTOM 715.01 3' DIA CONCRETE STRUCTURE STORM INLET 4626 RIM 718.17 INV 12" PVC S 715.07 BOTTOM 714.97 2' DIA CONCRETE STRUCTURE EXISTING CONDITIONS PLAN BASNEY ENTERPRISES, 52203 S.R. 933, PT. NW 1 /4, SEC. 24, T38N, R2E, CLAY TWP., ST. JOSEPH CO., INDIANA JOB NUMBER: 1024092688 SHEET 2 OF 5 MATCH LINE - SEE RIGHT NO. I REVISIONS � 'r ''' ' ANDERSON STREET CONCRETE THRUST BLOCK TO BE L - - - _ _ _ I INSTALLED AT END OF BLIND FLANGE -/ 40' ROW 42 -+-I SS 47-- SS m I / WATER VALVE I / I Grass TOP ELEV.: 716.�3 + II If OE OE I OE , OE OE OE OE e OE WATER TEE #3 STA. 16+94.22 / 51 I I I / Conc. Di Base / I I I/ 120.2' 6'-6" WATER LATERAL / m I I I I \ WATER VA VE I I I I I \ TOP ELEV.: 716.4 f 1 I I I I I N , I119 I \\ I -FIREI HYD. I I I AEP EASEMENT STA: 16+94.271 I I PER I I DOCUMENTDED I I I I I 4626 I I Z N Oown' 0 O O � m cwnw / I' O� I 20+0 Conc. I I �I 0 CD 0 -OE OE I I. I ir LL 1© m ©I EXISTING WELL FOR DOMESTIC USE I I I I I 1 I � I I I Brush I I I I I t I I o ``' o m I I I I i � I I I I I 1\ I I I I I I I N Asph. I I I I � r 1 Story Metal & I Block Building 45° BEND Misc. Valve I I I STA: 31 +47.93 I FIRE SUPPRESSION CONNECTION 31+9 I N / I I NO OU�F d P RE I j 4601 TRACT BASNEY ENTERPRISES, INC., I 52203 S.R. 933 I 45°END B 1 50.4' ST. ID #71-03-24-103-001.000-003 I I STA: 31 + 16 I DOC. NO. 1505422 258'-12 " WATER MAIN I I I N I o 1 I m I I 5' Dio. B►a o � I 11 5' Dip. Bp + N �l i .I o FIRE DEPARTMENT CONNECTION 1 ) I I BM j o ¢on1C 129'-6" WATER SERVICE I I , (n / I� r l I I / 170.4' 45 ° BEND s OE 4475 0 I V) I T 4392 ^oJ I / Conc. - ------ ---- - -------------- /I STA: 30+87.18 N \ ,�� - 0" �Pft / I I 45' BEND STA: 30+61.52- I N I -�-----7-19-- M \ I I 4 80 I 1 \ 0 4364 S --SS_ -SS--- S--�S---I S--os--�---SS--ASS---SS---SS---SS---SS-��ss---SS---ss---ssSS---Ss---Ss---Ss---Ss- SS--�ss---ss�, o I I (n I / Asph. \ c� 0 IIANA & MICHI AN ��' I C) ELECTRIC CO. I I / I / DIAGONAL STRIP PARKING STALL 4494 4 I. ID #71-03-2f- l IN FRONT OF FIRE HYDRANT --71$ - - / 1 51-007.000-00 r 0.)1 ) \ - - ~ Trash i\rea C a LC --A P GATE MUST NOT BE LOCKED / of T T I PRIVATE FIRE HYD. - r - - 4352 - 1,Conc. 1.I � "' I I WATER VALVE I rz �- sT ST Sr ST Sto e � TOP ELEV.: 718.2 f ��7 - _ 5' Fence PAVEMENT REMOVAL I I �S / - AND REPLACEMENT I I \ N \ 1100 SQ.FT. I I \ I sT 556 \ I I 30+00 / I Asph. 21 +51 R1 o0.0' TO FIREcDiffPT. CONN p o I ence Grass \ WATER TEE ' 2 1 WATER ALVE I I STA. 21 +07.7 J CONCRETE THRUST BLOCK TO BE - \ TOP ELEV.: 716.8 f I / - - ,'INSTALLED AT END OF BLIND FLANGE - , - WATER VALVE 12-LF FENCE -TOP ELEV.: 717.3 WATER TEE #1 V m I II TO BE REMOVED( ��o\ STA. 14+41. 16 / / WATER TEE #4 128'-8" WATER SERVICE Conc. I ,STA. 14+39.76 � \ I I/ I I o \ I I I III // I \ m I ` I I I I I I // DETENTION BASIN I I � Brush\ m 1 I ---715- / I 5A ia. Base/ ►T IH LNlf SEE I I I 7z \\` In DATE 2810 Dexter Drive Elkhart, IN 46514 Phone: 574-266-1010 Email: info@sam.biz SANITARY MANHOLE 3015 SANITARY MANHOLE 4255 RIM 717.40 RIM 716.55 INV 18" PVC N 707.10 INV 18" PVC N 708.65 INV 18" PVC S 707.10 INV 18" PVC S 708.55 INV 6" PVC E 707.00 INV 12" CLAY(?) E 705.75 SHELF 707.80 SHELF 709.35 4' DIA CONCRETE STRUCTURE 4' DIA CONCRETE STRUCTURE SANITARY MANHOLE 4071 SANITARY MANHOLE 4364 RIM 717.04 RIM 718.66 INV 18" PVC N 708.04 INV 12" PVC W 710.16 INV 18" PVC S 708.04 INV 12" PVC E 710.16 SHELF 708.74 SHELF 710.46 4' DIA CONCRETE STRUCTURE SANITARY MANHOLE 4580 SANITARY MANHOLE 4247 RIM 718.63 RIM 716.20 INV 12" PVC W 709.13 INV 18" PVC N 709.20 INV 12" PVC E 709.13 INV 18" PVC S 709.20 SHELF 709.53 INV 4" PVC E 710.70 4' DIA CONCRETE STRUCTURE SHELF 710.20 4' DIA CONCRETE STRUCTURE SANITARY MANHOLE 4621 RIM 719.31 TOP OF SLUDGE 714.71 BOTTOM 711.41 4' DIA CONCRETE STRUCTURE DRAWING FILE: 92688-DESIGN.DWG CERTIFICATION DATE: 06/09/2025 HORIZONTAL SCALE: 1 "=20' VERTICAL SCALE: NONE ENGINEER: Ben Stanley, P.E. TECHNICIAN: AAC .... ....i����/ LEE co No. 12200658 : -' STATE OF :•cam , '% �NDIANP .• 'vN�',�: S 0 20' 40' GRAPHIC SCALE BENCHMARKS BM #1 GEAR SET IN EAST FACE AEP POWER POLE #J 163-520, ELEVATION 718.01 BM #2 GEAR SET IN EAST FACE AEP POWER POLE #J 163-1210. ELEVATION 717.36 CURB INLET 4352 CURB INLET 4494 RIM 717.71 RIM 717.55 INV 12" PVC W 714.91 INV ?" ? W 714.55 INV 6" PVC N 714.91 INV 12" PVC E 714.75 BOTTOM 714.91 INV ?" ? NE 714.45 BOTTOM 714.35 STORM INLET 4392 4' DIA CONCRETE STRUCTURE RIM 717.68 UNABLE TO OPEN STORM INLET 4556 RIM 716.58 STORM INLET 4475 INLET INV 12" PVC NW 711.38 RIM INV 18" PVC S 710.98 INV 12" PVC S 715.53 BOTTOM 709.08 BOTTOM 715.43 UNABLE TO DETERMINE STIR SIZE 2' DIA CONCRETE STRUCTURE STORM INLET 4601 STORM INLET 4476 RIM 718.41 RIM 718.80 INV 12" PVC N 715.21 INV 12" PVC SE 716.50 INV ?" ? W 715.11 BOTTOM 716.3 INV 12" PVC (CAPPED) S 715.21 f 2' DIA CONCRETE STRUCTURE BOTTOM 715.01 3' DIA CONCRETE STRUCTURE STORM INLET 4626 RIM 718.17 INV 12" PVC S 715.07 BOTTOM 714.97 2' DIA CONCRETE STRUCTURE PROPOSED UTILITY PLAN SHEET 3 BASNEY ENTERPRISES, 52203 S.R. 933, PT. NW 1 /4, SEC. 24, T38N, R2E, OF 5 CLAY TWP., ST. JOSEPH CO., INDIANA JOB NUMBER: 1024092688 SECTION 5 - WATER WORKS SECTION 5 - WATER WORKS SECTION 5 - WATER WORKS SECTION 5 - WATER WORKS 3 0 z Li w 0 00 ID NO. REVISIONS Excavate for Pipe Bell & Barrel 0.6 O.D. Maximum Trench Width 24" Wider Than O.D. of Pipe ,dr..do Finish Grade Backfill - In Streets, Alleys, or Driving Areas: Backfill Shall be of Select Native Granular Material or B-Borrow Material Free of Debris, Organic Material and Large Stones. Placed in 6" Layers, Solidly Tamped to Sub -Grade of Street Base. Backfill Shall be Compacted to 100% Standard Proctor Density. Backfill - In Easement or Open Areas: Backfill Material Shall be of Select Native Granular Material, Placed in 12" Layers, Free of Debris, Organic Material, and Large Stones. Backfill Shall be Compacted to 95% Standard Proctor Density. Initial Backfill- Select Excavated Material Mechanically Tamped to 95% Standard Proctor Density Removable Flowable Backfill Shall be Placed for all Areas Within 5 Ft. of Pavement to 12" Above Pipe Crown. Above This Limit, Structure Backfill Shall be Used. Bedding Material - Select Excavated Material Mechanically Tamped to 95% Standard Proctor Density Undisturbed Earth NOTES: 1. These trench and bedding details are for pipe structural requirements only. The contractor is solely responsible for safety of operations. The contractor shall slope trench walls, provide protective work boxes, and/or shore and brace all excavations as the contractor determines necessary for safety of operations, and in conformance to IOSHA Regulation 29 C.F.R. 1926, Subpart P for Trench Safety Systems. 2 Fomultiple pipes in same rLine hof ar Place bedding to Spring first pipe across entire trench width. \�`p\\�\P M BOy�/'''''' �\ �;F �'\ ST ERF� J' ' b. Placement of next pipe, re -excavate N 0 trench as needed. Then place bedding = = • = _ - PE10809510 as noted above. ! c. For additional pipes repeat as required. STATE OF w 3. Minimum easement width for water main shall be 15'. '',, FS '' ND I ANP \4 4. Minimum obstruction setback requirement from water main shall be 10'. , Obstructions shall include structures, other utilities, trees, and landscaping.% \��`�` IONAL REF STD SPEC SEC 5-3.2 and 5-3.9 Kara . Boyle , P .D., P.E. Date APPROVED/REVISED BY THE BOARD OF PUBLIC WORKS �UrHs EFFECTIVE DATE: June 26, 2018 CITY OF SOUTH BEND �04 Item Revision Approved Date W ' - STANDARDS FOR DESIGN x 'aa5 AND CONSTRUCTION STANDARD TRENCH DETAIL FOR WATER MAIN IN SUITABLE SOIL 5-6 BY I DATE 4" Min. or as Directed by Engineer Maximum Trench Width 24" Wider Than O.D. of Pipe Finish Grade Backfill - In Streets, Alleys, or Driving Areas: Backfill Shall be of Select Native Granular Material or B-Borrow Material Free of Debris, Organic Material and Large Stones Placed in 6" Layers, Solidly Tamped to Sub -Grade of Street Base. Backfill Shall be Compacted to 100% Standard Proctor Density. Backfill - In Easement or Open Areas: Backfill Material Shall be of Select Native Granular Material, Placed in 12" Layers, Free of Debris, Organic Material, and Large Stones. Backfill Shall be Compacted to 95% Standard Proctor Density. Initial Backfill- INDOT Class II or III Granular Material Mechanically Tamped to 95% Standard Proctor Density Removable Flowable Backfill Shall be Placed for all Areas Within 5 Ft. of Pavement to 12" Above Pipe Crown. Above This Limit, Structure Backfill Shall be Used. Bedding Material- INDOT Class II or III Granular Material Mechanically Tamped to 95% Standard Proctor Density Undisturbed Earth NOTES: 1. These trench and bedding details are for pipe structural requirements only. The contractor is solely responsible for safety of operations. The contractor shall slope trench walls, provide protective work boxes, and/or shore and brace all excavations as the contractor determines necessary for safety of operations, and in conformance to IOSHA Regulation 29 C.F.R. 1926, Subpart P for Trench Safety Systems. 2. For multiple pipes in same trench: a. Place bedding to Spring Line of first pipe across entire trench width. b. Placement of next pipe, re -excavate N 0 trench as needed. Then place bedding = • = _ = • = PE10809510 • as noted above. c. For additional pipes repeat as required. STATE OF O 3. Minimum easement width for water main shall be 15'. - T "!ND I ANP' \4 '',, FS 4. Minimum obstruction setback requirement from water main shall be 10'. ,,,,,A \� Obstructions shall include structures, other utilities, trees, and landscaping. '''s%ONAL 0\`�� \� 6/1 REF STD SPEC SEC 5-3.2 and 5-3.9 Kara . BBooylle , P .D ., P.E. 6 2 Date APPROVED/REVISED BY THE BOARD OF PUBLIC WORKS EFFECTIVE DATE: June 26, 2018 °4�UgE�d CITY OF SOUTH BEND Item Revision Approved Date W STANDARDS FOR DESIGN 'aQ5 x AND CONSTRUCTION STANDARD TRENCH DETAIL FOR WATER MAIN IN UNSUITABLE SOIL 5-7 2810 Dexter Drive Elkhart, IN 46514 Phone: 574-266-1010 Email: info@sam.biz Restri Action Restraints (Typ.) NOTES: 1. Gate valves shall be manufactured by Clow, Mueller, Kennedy, or approved equal. 2. Valve box shall be manufactured by Tyler Pipe Industries Model 664-S or approved equal. 3. Gate valves shall be used on water main pipe 12-inches and smaller. 4. Valve spacing shall be no greater than 1,000 feet. A main line valve shall be placed at each intersection. 5. Valve locations shall be configured to be within 3 Ft. of adjoining fittings. REF STD SPEC SEC 5-2.5(a APPROVED/REVISED BY THE BOARD OF PUBLIC WORKS o+ x EFFECTIVE DATE: June 26, 2018 <, -; �, Item Revision Approved Date = - 1 Kennedy Addition 10/26/2021 TYPICAL GATE VALVE AND BOX DRAWING FILE: 92688-DESIGN.DWG CERTIFICATION DATE: 06/09/2025 HORIZONTAL SCALE: NONE VERTICAL SCALE: NONE ENGINEER: BENJAMIN STANLEY, P.E. TECHNICIAN: AAC Iron Remain \\\\�\\\\\1iIIIII///////// •=PE10809510= • STATE OF Q AND I ANP\� ' TONAL 6/26/18 Kara M. Boyl s, Ph.D., P.E. Date CITY OF SOUTH BEND / �\,\LEE ST'% m : No. 12200658 ' _. ._ STATE OF ; ONAL11W\\\ STANDARDS FOR DESIGN AND CONSTRUCTION STANDARD 5-8 JOB NUMBER: Fire Hydrant (Restrained With Wedge Action Restraints) 6" Gate Valve (Restrained With Wedge Action Restraints) w/ Box 6" x Min. 13" ---\ O x _" x 6" Tee (Restrained With Wedge Action Restraints) / 6" x Min. 24" I I Hydrant Drainage Pit (See Note 2) l i I'. I ELEVATION O PLAN Fire Hydrant (Restrained With Wedge Action Restraints) 6" x Min. 24" - 6" Gate Valve (Restrained With Wedge Action Restraints) w/ Box 6" x Min. 13" _" x " x 6" Tee (Restrained With Wedge Action Restraints) NOTES: 1. Any subgrade disturbed beneath hydrant shall be thoroughly compacted or suitable material shall be furnished, placed and compacted to provide a firm foundation for the hydrant. 2. Hydrant drainage: To prevent freezing of the hydrant barrel if it were not drained, a drainage pit 2'x2'x2' shall be excavated below the hydrant and filled with course gravel or crushed stone mixed with sand to a depth of 6" above the hydrant opening, providing sufficient aggregate void space to more than equal the volume of the barrel. The drainage it should neither be near, nor have a connection to a sewer. p 3. Hydrant painting: Hydrants to be painted red, white and blue per manufacturers paint specs. 4. All pipe, fitting and valve joints shall be restrained with wedge action restraints. Boy''', `• `PE10809510' • STATE OF /ONAL '///IIIIIIIII\\\\ REF STD SPEC SEC 5-2.6 and 5-3.10 Kara . Boyle , P .D., P.E. Date APPROVED/REVISED BY THE BOARD OF PUBLIC WORKS EFFECTIVE DATE: June 26, 2018 4��gE�dx CITY OF SOUTH BEND Item Revision Approved Date W STANDARDS FOR DESIGN "5 AND CONSTRUCTION STANDARD FIRE HYDRANT ASSEMBLY 5-11 1.5" HAC SURFACE 2.5" HAC BINDER 4" COMPACTED INDOT NO.53 AGGREGATE BASE COURSE, CRUSHED CONCRETE, SLAG, OR LIMESTONE 6" INDOT NO.53 AGGREGATE ASPHALT PAVEMENT SECTION FOR MULTIPURPOSE TRAIL NOT TO SCALE CONSTRUCTION DETAILS BASNEY ENTERPRISES, 52203 S.R. 933, PT. NW 1 /4, SEC. 24, T38N, R2E, CLAY TWP., ST. JOSEPH CO., INDIANA SHEET EXHIBIT B ENGINEER'S ESTIMATE Project Number: 1024092688 Project Name: Basney BMW Watermain Extension Project Location: US33 & CR40 Sewer and Water Extension Date: 5/22/2025 4SA11* Engineer's Opinion of Probable Construction Costs City portion only NO. ITEM UNIT QUANTITY UNIT COST TOTAL Water Main, 1 Mob/demob each 1 $5,000.00 $5,000.00 Lateral, and 2 Traffic Control for LaSalle Trail lump 1 $6,500.00 $6,500.00 Fittings 3 12" DI Watermain, installed In.ft. 693 $130.00 $90,090.00 4 Fire Hydrant Assembly w/ Aux. Valve, installed each 1 $8,865.00 $8,865.00 5 12" DI gate valve, installed each 1 $5,375.00 $5,375.00 6 12"x12"x8" DI Tee, installed each 2 $2,335.00 $4,670.00 Sub Total $120,500.00 Total $120,500.00 EXHIBIT C PERFORMANCE BOND .. 1111C I I r 1 I III f I III i I•' IN I M1 BOrld 1Vo.: CBE1058281 Basney Enterprises, Inc located at 52203 State Road 933, South Rend, IN 46637-3849 , as Principal, and The Cincinnati Insurance Company located at 6200 South Gilmore Load, Fairfield, Ohio 45014, existing cinder the laws of the state of Ohio and authorized to do business in the State of , as Surety, are held and firmly bound unto city of South send 9 located at , as Obligee, in the full and just penal sum of One Hundred and Fifty Thousand Six Hundred and Twenty -Five Dollars and Zero Cents ($ $ 150, 625.00 )lawful money of the tTnited States, for the payment of which, well and truly to be made, we hereby bind ourselves, successors, heirs, representatives and assigns. Bend,VHEREAS, the Principal is required to perform certain obligations with the following description. City Water Main Extention�52203 State Road 933 N. SouLh a0001'dlllg t0 the ter'r11S a11d Conditions of the Obligee's per-rnit/contr°act, the satisfactory completion of which is required to be guaranteed by security as a condition of the approval; and WHEREAS, this bond shall become effective on 6/4/2025 and shall continue in effect unless released in writing by the Obligee or cancelled as provided herein. Ill (2) Regardless of the number of years this bond shall remain ir] force, the number° of claims made or the sum of premiums paid, the aggregate liability Of the Surety shall be limited to the penal sum of this bond and reduced by any payment or payments made by the Surety hereunder to the extent of such payment or payments; and (3) The Surety reserves the right to cancel this bond by giving thirty (30) days written notice to the Obligee and on the effective date of such thirty (30) day Cancellation notice, the Sul°ety is it being understood and agreed, however, that the discharged and relieved of any liability, Principal and Surety will be liable for any loss accruing up to the effective date of said cancellation notice, in no event, however, in excess of the penalty of the bond; and (4) Cancellation by the Surety shall not be construed as a default by either the Surety or• the Principal recoverable under this bond, Aligee from all related costs and damages then this obligation shall be null, and void, otherwise to remain 1 full force day of Jun® 9 Owner Nan ai d Ti le: Chad � �Hu ey i ��Oil I •, KNOW ALL MEN BY THESE PRESENTS; That THE CINCINNATI INSURANCE COMPANY and THE CINCINNATI CASUALTY COMPANY, corporations organized under the laws of the State of Ohio, and having their principal offices in the City of Fairfield, Ohio (herein collectively called the "Companies"), do hereby constitute and appoint Kohl Haughee Of SOUTH BEND IN their true and legal Attorneys) -in -Fact, each in their separate capacity if more than one is named above, to sign, execute, seal and deliver on behalf of the Companies as Surety, any and all bonds, policies, undertakings or other like instruments, as follows: One Hundred and Fifty Thousand Six Hundred and Twenty -Five Do $ 150,625.00 This appointment is made under and by authority of the following resolutions adopted by the Boards of Directors of The Cincinnati Insurance Company and The Cincinnati Casualty Company, which resolutions are now in full force and effect, reading as follows: f the Company to execute any and all bonds, policies, undertakings, or other like instruments on behalf of the Corporation, and nay authorize any officer or any such Attorney�ln�Fact to affix the corporate seal; and may with or without cause modify or evoke any such appointment or authority. Any such writings so executed by such Attorneys�in�Fact shall be binding upon the ompany as if they had been duly executed and acknowledged by the regularly elected officers of the Company. RESOLVED, that the signature of the President or any Senior Vice President and the seal of the Company may be affixed by facsimile on any power of attorney granted, and the signature of the Secretary or Assistant Vice -President and the Seal of the Company may be affixed by facsimile to any certificate of any such power and any such power of certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and sealed and certified by certificate so executed and sealed shall, with respect to any bond or undertaking to which it is attached, continue to be valid and binding on the Company. IN WITNESS WHEREOF, the Companies have caused these presents to be sealed with their corporate seals, duly attested by their President or any Senior Vice President this 16th day of March, 2021. . CORPORATE \SEAL` OHIO STATE OF OHIO COUNTY OF BUTLER THE CINCINNATI INSURANCE COMPANY THE CINCINNATI CASUALTY COMPANY )SS: On this 16th day of March, 2021 before me came the above -named President or Senior Vice President of The Cincinnati Insurance Company and The Cincinnati Casualty Company, to me personally known to be the officer described herein, and acknowledged that the seals affixed to the preceding instrument are the corporate seals of said Companies and the corporate seals and the signature of the officer were duly affixed and subscribed to said instrument by the authority and direction of said corporations. Keith C ett, Attorney at Law Notary ublic —State of Ohio My commission has no expiration date. Section 147.03 O.R.C. orAssistantVice-President I, the undersigned Secretary of The Cincinnati Insurance Company and The Cincinnati Casualty Company, hereby certify that the above is the Original Power of Attorney issued by said Companies, and do hereby further certify that the said Power of Attorney is still in full force and effect..31ven under my hand and seal of said Companies at Falffield, Ohio, this day of I June 2025 BN-1457 (3/21) EXHIBIT D SYSTEM DEVELOPMENT CHARGE Estimate for System Development Charges Estimate Provided On: 5/14/2025 Estimate Provided By: Gemma Stanton 52203 SR 933 (Fire Suppression) South Bend, IN **Estimate is based on projected uses and calculations provided by owner/consultant** Values 1.000 Unit Type ERU calculation ERU ERU rounddown 1 ERU Sewer SDC Calculation $1 145 per ERU $ - Water SDC Calculation $475 per ERU $ 475.00 Estimated Amount Due for 52203 SR 933 (Fire Suppression) $ 475.00 Estimated 10% Discounted Total Payment in full $ 427.50 Per the Ordinance of the Common Council of the City of South Bend, System Development Charges are summarized below from Sections 17-79 and 17-80: EXHIBIT E CERTIFICATE OF INSURANCE / A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 06/06/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Healy Group 17535 Generations Drive South Bend, IN 46635 CONTACT NAME: KohlHaughee PHONE 574-271-6000 FAX A/C No Ext : A/C No), ADDRESS: khaughee@healygroup.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Auto Owners Ins. Co. -Home Office 18988 INSURED Basney Imports, Inc. DBA Basney BMW Mazda Basney Motors, INSURERe: Property Owners 32905 INSURER C : Inc Basney Enterprises Inc. 52203 State Road 933 N. INSURER D INSURER E : South Bend, IN 46637 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE LTR ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A ✓ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ✓ OCCUR 5156917100 04/01/2025 04/01/2026 EACH OCCURRENCE $ 1,000,000 DAMAGE TO TED PREMISES(Ea occurrence) $ 500,000 MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ✓ POLICY PRO- JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ✓ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 5156917100 04/01/2025 04/01/2026 COMBId.nl)S GLELIMIT Ea accident $ 1000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ A of UMBRELLA LIAB ✓ OCCUR EXCESS LIAB CLAIMS -MADE DED If RETENTION $ 10000 5156917101 04/01/2025 04/01/2026 EACH OCCURRENCE $ 15,000,000 AGGREGATE $ 15,000,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A A106598682 04/01/2025 04/01/2026 ✓ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of South Bend & St Joseph County ACCORDANCE WITH THE POLICY PROVISIONS. 125 S Lafayette Blvd, Suite 100 AUTHORIZED REPRESENTATIVE South Bend, IN 46601 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD BOARD OF PUBLIC WORKS AGENDA ITEM REVIEW REQUEST FORM Date: 6/17/2025 Name: Gemma Stanton Department of Public Works — Engineering Division BPW Date: 6/24/2025 Phone Extension: 9083 Required Prior to Submittal to Board BPW Attorney X Attorney Name Dept. Attorney ❑ Attorney Name Purchasing ❑ Check the Appropriate Item Type — Re uired or All Submissions ❑ Professional Services Agreement ❑ Contract ❑ Proposal ❑ Open Market Contract ❑ Amendment/Addendum ❑ Special Purchase, QPA ❑ Bid Opening ❑ Bid Award ❑ Req. to Advertise ® Title Sheet ❑ Quote Opening ❑ Quote Award ❑ Reject Bids/Quotes ❑ Proposal Opening ❑ C/O & PCA No. ❑ PCA ❑ Chg. Order, No. ❑ Traffic Control ❑ Resolution ® Other: Water main line ❑ Ease./Encroach Company or Vendor Name New Vendor MBE/WBE Contractor Project Name Project Number Funding Source Account No. Amount Terms of Contract Special Contract Provisions Purpose/Description Information U Yes U If Yes, Approved by Purchasing ❑ No ❑ MBE Completed E-Verify Form Attached ❑ WBE Auto Water Main Extension DP25-006 ❑ Yes ❑ No Agreement for Basney to extend water main parallel to SR 933 For Change Orders Only Amount of ❑ Increase $ ❑ Decrease ) Previous Amount Current Percent of Change New Amount Increase Decrease Increase % Total Percent of Change: Decrease Time Extension Amount: New Completion Date: