HomeMy WebLinkAboutOpening of Quotes - Veteran's Memorial Park Twyckenham Sidwalk 125-077 - Premium Concrete ServicesCITY OF SOUTH BEND, INDIANA
CONTRACTOR'S QUOTE FOR PUBLIC WORK j
PROJECT NAME: Veterans' Memorial Park Twvckenham Drive Sidewalk
PROJECT NO. 125-077
QUOTES DUE April 28, 2026 by 9:00am local time to bpwbids@southbendin.gov
(Must be completed for all quotes. Please type or print)
Date: 4/28/2026 Firm: PREMIUM CONCRETE SERVICES
Address:
City/State/Zip:
Email Address:
712 RICHMOND ST
ELKHART, IN 46516 Telephone Number: (574 ) 264-0196
rbecker@premi umservices.grou p
Agent of Bidder (if Applicable):
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the
public works project of:
VETERANS' MEMORIAL PARK TWYCKENHAM DRIVE SIDEWALK
the City of South Bend, Indiana, in accordance with plans and specifications prepared by:
The City of South Bend, Department of Public Works
and dated 3/25/2026
for the sum of (enter the Total Quote as shown on the Proposal)
ONE HUNDRED SEVENTY-NINE THOUSAND EIGHT HUNDRED FORTY DOLLARS
(Enter Sum of Total Quote plus Alternates shown on Proposal)
179, 840.00
(Numerical)
If alternative quotes apply, the undersigned submits a proposal for each in accordance with the notice. Any
addendums attached will be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as that shown
in the original contract if accepted by the City of South Bend. If the quote is to be awarded on a unit basis, the
itemization of the units shall be shown on a separate attachment.
The above quote is accepted this
Subject to the following conditions:
By
ROB BECKER (Signature)
(Printed Name of Person Signing)
ACCEPTANCE
day of
BOARD OF PUBLIC WORKS
President
Members
O
Version 9/1/2025 Page -15 Public Works Quote
When the prospective Contractor is ramble to certify to any of the statements below, it shall attach an explanation to
this Affidavit.
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT,
CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY
VERIFICATION, NON-DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE
OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS
(Must be completed for all quotes and bids. Please type or print)
STATE OF TN )
SS:
Elkhart- COUNTY )
The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that:
1. Contractor has not, nor has any other member, representative, or agent of the firm,
company, corporation or partnership represented by him, entered into any combination, collusion
or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent
any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made
without reference to any other bid and without any agreement, understanding or combination with
any other person in reference to such bidding. Contractor further says that no person or persons,
firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift,
commission or thing of value on account of such sale; and
2. Contractor certifies by submission of this proposal that neither contractor nor any of its
principals are presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from participation in this transaction by any Federal department or agency;
and
3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in investment
activities in Iran.
a. For purposes of this Certification, "Iran" means the government of Iran and any agency or
instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from
time -to -time.
b. As provided by Ind. Code § 5-22-16.5-8, as amended from time -to -time, a Contractor is
engaged in investment activities in Iran if either:
i. Contractor, its successor or its affiliate, provides goods or services of twenty million
dollars ($20,000,000) or more in value in the energy sector of Iran; or
ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty
million dollars ($20,000,000) or more in credit to another person for forty-five (45)
days or more, if that person will (i) use the credit to provides goods and services in
the energy sector in Iran; and (ii) at the time the financial institution extends credit, is
a person identified on list published by the Indiana Department of Administration.
4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain
any employee or contract with a person that the Contractor subsequently learns is an unauthorized
Version 9/1/2025 Page - 24 Public Works Quote
alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility status of all of
Contractor's newly hired employees through the E-Verify Program as defined by I.C. 22-5-1.7-3.
Contractors documentation of enrollment and participation in the E-Verify Program is included
and attached as part of this bid/quote; and
5. Contractor shall require his/her/its subcontractors performing work under this public
contract to certify that the subcontractors do not knowingly employ or contract with an
unauthorized alien, nor retain any employee or contract with a person that the subcontractor
subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is
participating in the E-Verify Program. The Contractor agrees to maintain this certification
throughout the tern of the contract with the City of South Bend, and understands that the City
may terminate the contract for default if the Contractor fails to cure a breach of this provision no
later than thirty (30) days after being notified by the City.
6. Persons, firms, partnerships, corporations, associations, or joint venturers awarded a
contract by the City of South Bend through its agencies, boards, or commissions shall not
discriminate against any employee or applicant for employment in the performance of a City
contract with respect to hire, tenure, terms, conditions, or privileges of contract or employment,
or any matter directly or indirectly related to contracting or employment because of race, sex,
religion, color, national origin, ancestry, gender expression, gender identity, sexual orientation, or
due to age or disability that does not affect that person's ability to perform the work.
In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials, or
any combination of the foregoing including, but not limited to, public works contracts awarded
under public bidding laws or other contracts in which public bids are not required by law, the City,
its agencies, boards, or commissions will consider the Contractor's good faith efforts to obtain
participation by those subcontractors certified by the State of Indiana as a Minority Business
("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining the lowest,
responsible, responsive bidder.
Contractors seeking the award of a City contract cannot be required to award a subcontract to an
MWBE; however, they may not unlawfully discriminate against said MBE/WBE. On goal -eligible
contracts, Contractors are required to either meet both MBE and WBE utilization goals or
demonstrate that the Contractor has made good faith efforts to obtain participation from MBE and
WBE subcontractors. A finding of noncompliance or a discriminatory practice shall prohibit that
Contractor from being awarded a City contract for a period of one (1) year from the date of such
determination, and such determination may also be grounds for terminating the contact to which
the discriminatory practice or noncompliance pertains.
7. The undersigned Contractor agrees that the following nondiscrimination commitment shall
be made a part of any contract which it may henceforth enter into with the City of South Bend,
Indiana or any of its agencies, boards or commissions.
Contractor agrees not to discriminate against or intimidate any employee or applicant for
employment in the performance of this contract with privileges of employment, or any matter
directly or indirectly related to employment, because of race, religion, color, sex, gender
expression, gender identity, sexual orientation, handicap, national origin or ancestry. Breach of
this provision may be regarded as material breach of contract.
Version 9/1/2025 Page - 25 Public Works Quote
I, the undersigned bidder or agent as contractor on a public works project, understand my statutory
obligations to the use of steel products or foundry products made in the United States (I.C. 5-16-
8-1). I hereby certify that I and all subcontractors employed by me for this project will use steel
products or foundry products made in the United States on this project if awarded. I understand I
have an affirmative duty to notify the City in my bid that my proposal does not include the use of
steel products or foundry products made in the United States. I understand it is my sole obligation
and responsibility to provide a justification to the City, subject to review and approval, why the
cost of United States made steel or foundry products is unreasonable. Prior to award and upon
submission of bid which does not use steel products or foundry products made in the United States,
the City, through its director of public works, shall make a determination if the price of United
States made steel or foundry is unreasonable. I understand that violations hereunder may result in
forfeiture of contractual payments.
I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public
works are true and correct.
Dated this 29_ day of Aph-L 20U
pre,
mium Ow -V,- SrylCeS. VAC
ontractorBidder (Firm)
Sign re of ContractonBidder or Its Agent
Max Yeayeeu - vice ?MSidMV
Printed Name and Titl
Subscribed and swoom to before me this 2 day of ADrr 20 V
My Commission Expires �1 1 L� �Q
Notary Publi
County of Residence DV -hark
KELSEY MARIE STONE
Notary Public
Elkhart County - State of Indiana
Commission Number NP0765931
MY Commission Expires Sep 17, 2033
Version 9/1/2025 Page - 26 Public Works Quote
,tO4�pNH gE,��
QUOTE/PROPOSAL
y PEACF. ��
CITY OF SOUTH BEND
PROJECT NAME Veterans' Memorial Park Twyckenham Drive Sidewalk
PROJECT NO. 125-077
QUOTES DUE April 28, 2026 by 9:00am local time to bpwbids@southbendin.gov
Item
No.
Description
Quantity
Unit
Unit Price
Total Amount
1
Mobilization/Demobilization
1
LS
$ 8,500.00
$ 8,500.00
2
Maintenance of Traffic
1
LS
$ 7 000.00
$ 7,000.00
3
Temporary Erosion Control
1
LS
$4,800.00
$4,800.00
4
Clearing Right of Way
1
LS
$ 9 500.00
$ 9,500.00
5
Remove Tree, 48"
3
EA
$ 2 800.00
$ 8,400.00
6
Concrete Curb, Remove
450
LFT
$15.00
$ 6,750.00
7
Concrete Sidewalk, Remove
440
SYD
$ 20.00
$ 8,800.00
8
Earthwork and Grading
1
LS
$4,400.00
$4,400.00
9
B Borrow (Undistributed)
100
CYD
$ 65.00
$ 6,500.00
10
Compacted Aggregate, No.53
125
TON
$65.00
$8,125.00
11
Concrete Curb, 6"
450
LFT
$ 85.00
$ 38,250.00
12
Concrete Sidewalk, 4"
425
SYD
$95.00
$40,375.00
13
Concrete Curb Ramp
17
SYD
$240.00
$4,080.00
14
Detectable Warning Surface
3
SYD
$ 240.00
$ 720.00
15
Mulched Seeding, Type U
525
SYD
$22.00
$11,550.00
16
Turf Reinforcement Mat
42
SYD
$ 95.00
$ 3,990.00
17
Street Tree
6
EA
$1,350.00
$ 8,100.00
Total Amount of Quote
$179,840.00
Version 9/1/2025 Page - 27 Public Works Quote
Firm: PREMIUM CONCRETE SERVICES
Address: 712 RICHMOND ST
City/State/Zip:
ELKHART, IN 46516 Telephone Number: (574 )264-0196
Fax Number: (574 )266-5392
BY /` ✓/ !
(Signature)
ROB BECKER
(Printed Name of Person Signing)
Version 9/1/2025 Page - 28 Public Works Quote
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CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN -
FORM MBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
This completed form should be included as part of the Bids documents related to City of South Bend Public
Works Projects requiring Good Faith Efforts to obtain MBE participation.
Project Number: 125-077 Date: 4/28/2026
Project Name: Veterans' Memorial Park Twyckenham Drive Sidewalk
Bidder: PREMIUM CONCRETE SERVICES
Contact Person: ROB BECKER Telephone: (574) 264-0196
Address: 712 RICHMOND ST
City: ELKHART State: IN Zip: 46516
Email: rbecker@premiumservices.group
To determine whether a bidder has demonstrated good faith efforts to reach the MBE utilization goal set forth in
the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions,
REQUIRE ALL of the following Good Faith Efforts as listed in the table below`:
EVIDENCE OF GOOD FAITH EFFORTS
MBE LIST(S): The bidder reviewed 1) the City of South Bend's Minority and Women Business Enterprise
Inclusion Program Plan; 2) the list of certified MWBEs provided by the City; and 3) the Indiana Department
of Administration list of Minority and Women Owned Businesses (both certified and non -certified) found
at: htti)://www.in.qov/idoa/.
GOOD FAITH EFFORTS TO OBTAIN MBE PARTICIPATION
The bidder shall initial each item below, as evidence of its good faith efforts to obtain MBE participation
in the awarded contract.
I affirm that I reviewed the City of South Bend's Minority and Women Business Enterprise
2
Inclusion Program Plan and the Indiana Department of Administration's certified list of
Indiana Minority and Women Business Enterprises, found on their website
(hftp://www.in.govfidoa).
I affirm that I have made good faith efforts to select portions of the contract work to be
performed by MBEs, including, where appropriate, breaking out contract work items into
economically feasible units to facilitate MBE participation.
2
I affirm that I have made good faith efforts to solicit through all reasonable and available
means the interest of all MBEs in the scopes of work of the contract.
I affirm that I attended all pre -bid meetings scheduled by the City of South Bend to inform
MBEs of contracting and subcontracting opportunities.
I affirm that I advertised in general circulation and/or trade association publications
concerning subcontract opportunities and allowed MBEs reasonable time to respond to
such advertisements.
I affirm that I performed any and all necessary steps to provide written notices in a manner
lopreasonably
calculated to inform MBEs of subcontracting opportunities and allowed
sufficient time for MWBEs to participate effectively.
I affirm that I followed up on initial solicitations with interested MBEs.
I affirm that I negotiated with interested MBEs in good faith, including providing such MBEs
l✓ �j
with adequate information about the plans, specifications and other requirements of the
ri
subcontract.
I affirm that I have made good faith efforts to assist interested MBEs in obtaining bonding,
lines of credit, or insurance as required by the City or the bidder, where appropriate.
Version 9/1/2025 Page - 31 Public Works Quote
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
I affirm that I have made good faith efforts to assist interested MBEs in obtaining necessary
equipment, supplies, materials, or related assistances or services, where appropriate.
1 affirm that I did not reject any MBEs as unqualified without sound business reasons based
on a thorough investigation of their capabilities.
CONTRACT RECORDS: The bidder has maintained the following records for each MBE that has bid on
the subcontracting opportunity:
1. Name, address, and telephone number;
2. A description of information provided by the bidder or subcontractor; and
3. A statement of whether an agreement was reached, and if not, why not, including any reasons for
concluding that the MBE was unqualified to perform the job.
*Proper demonstration of Good Faith Efforts requires your initials next to all of the above boxes. Any
omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of
South Bend reserves the right to request additional information.
Version 9/1/2025 Page - 32 Public Works Quote
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM WBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
This completed form should be included as part of the Bids documents related to City of South Bend Public
Works Projects requiring Good Faith Efforts to obtain WBE participation.
Project Number: 125-077 Date: 4/28/2026
Project Name: Veterans' Memorial Park Twyckenham Drive Sidewalk
Bidder: PREMIUM CONCRETE SERVICES
Contact Person: ROB BECKER Telephone: (574) 264-0196
Address: 712 RICHMOND ST
City: ELKHART State: IN Zip: 46516
Email: rbecker@premiumservices.group
To determine whether a bidder has demonstrated good faith efforts to reach the WBE utilization goals set forth in
the City of South Bend Public Works Project Specifications, the City and its agencies, boards, or commissions,
REQUIRE ALL of the following Good Faith Efforts as listed in the table below*:
EVIDENCE OF GOOD FAITH EFFORTS
WBE LIST(S): The bidder reviewed 1) the City of South Bend's Minority and Women Business Enterprise
Inclusion Program Plan; 2) the list of certified MWBEs provided by the City; and 3) the Indiana Department
of Administration list of Minority and Women Owned Businesses (both certified and non -certified) found
at: hftp://www.in.gov/idoa/.
GOOD FAITH EFFORTS TO OBTAIN WBE PARTICIPATION
The bidder shall initial each item below, as evidence of its good faith efforts to obtain WBE participation
in the awarded contract.
1 affirm that I reviewed the City of South Bend's Minority and Women Business Enterprise
n
Inclusion Program Plan and the Indiana Department of Administration's certified list of
Indiana Minority and Women Business Enterprises, found on their website
(http://www.in.gov/idoa).
I affirm that I have made good faith efforts to select portions of the contract work to be
n/Z
performed by WI including, where appropriate, breaking out contract work items into
economically feasible units to facilitate MWBE participation.
1 affirm that I have made good faith efforts to solicit through all reasonable and available
il[\
means the interest of all WBEs in the scopes of work of the contract.
I affirm that I attended all pre -bid meetings scheduled by the City of South Bend to inform
WBEs of contracting and subcontracting opportunities.
I affirm that I advertised in general circulation and/or trade association publications
/Z
concerning subcontract opportunities and allowed WBEs reasonable time to respond to
)j
such advertisements.
I affirm that I performed any and all necessary steps to provide written notices in a manner
reasonably calculated to inform WBEs of subcontracting opportunities and allowed
sufficient time for WBEs to participate effectively.
i7
1 affirm that I followed up on initial solicitations with interested WBEs.
I affirm that I negotiated with interested WBEs in good faith, including providing such WBEs
with adequate information about the plans, specifications and other requirements of the
subcontract.
I affirm that I have made good faith efforts to assist interested WBEs in obtaining bonding,
lines of credit, or insurance as required by the City or the bidder, where appropriate.
Version 9/1/2025 Page - 33 Public Works Quote
CITY OF SOUTH BEND
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM WBE-2.0
EVIDENCE OF GOOD FAITH EFFORTS
I affirm that I have made good faith efforts to assist interested WBEs in obtaining
necessary equipment, supplies, materials, or related assistances or services, where
appropriate.
1 affirm that I did not reject any WBEs as unqualified without sound business reasons
based on a thorough investigation of their capabilities.
CONTRACT RECORDS: The bidder has maintained the following records for each WBE that has bid on
the subcontracting opportunity:
1. Name, address, and telephone number;
2. A description of information provided by the bidder or subcontractor; and
3. A statement of whether an agreement was reached, and if not, why not, including any reasons for
concluding that the WBE was unqualified to perform the job.
"Proper demonstration of Good Faith Efforts requires your initials next to all of the above boxes. Any
omissions shall be considered grounds for rejection of the bid by the Board of Public Works. The City of
South Bend reserves the right to request additional information.
Version 9/1/2025 Page - 34 Public Works Quote
ypt TH of
O
CITY OF SOUTH BEND Pf, '
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN
FORM MBE-2.1 mr
MBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring Good Faith Efforts to contact MBEs. It is the bidder's sole responsibility to verify whether any listed
minority or woman business meets the MBE qualifications. Attach additional pages if necessary.
PAGE 1 OF 1
Project Number: 125-077 MBE Participation Goal 2.87%
Project Name: Veterans' Memorial Park Twyckenham Drive Sidewalk
Bidder: PREMIUM CONCRETE SERVICES
By. SENIOR ESTIMATOR 4/28/2026
(Signature) (Title) (Date)
MBE Firm 1ST CLASS LOGISTICS
Owner or Contact at MBE Firm BERNARD COUTEE
Telephone: (574) 993-0071 Fax: Email: 1STCLASSLOGISTICS2013@GMAIL.COM
TYPE OF WORK SOLICITED FOR THIS PROJECT:
TRUCKING/HAULING
RESULTS OF CONTACT WITH THE MBE FIRM:
WILL UTILIZE IF AWARDED
MBE Firm
Owner or Contact at MBE Firm
Telephone: Fax: Email:
TYPE OF WORK SOLICITED FOR THIS PROJECT:
RESULTS OF CONTACT WITH THE MBE FIRM:
Version 9/1/2025 Page - 35 Public Works Quote
�ll'T11 �F,
CITY OF SOUTH BEND 6 1`
MINORITY AND WOMEN BUSINESS ENTERPRISE INCLUSION PROGRAM PLAN ,'•_ _ \'/>'
FORM WBE-2.1
WBE CONTACTED
This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects
requiring Good Faith Efforts to contact WBEs. It is the bidder's sole responsibility to verify whether any listed
minority or woman business meets the WBE qualifications. Attach additional pages if necessary.
PAGE 1 OF 1
Project Number: 125-077 WBE Participation Goal 5.17%
Project Name: Veterans' Memorial Park Twyckenham Drive Sidewalk
Bidder: / PREMIUM CONCRETE SERVICES
By: �,( SENIOR ESTIMATOR 4/28/2026
(Signature) (Title) (Date)
WBE Firm SLUSSER'S GREEN THUMB
Owner or Contact at WBE Firm JOHN WILLIAMSON
Telephone: (800) 762-7442 Fax: Email: JDW@SLUSSERS.COM
TYPE OF WORK SOLICITED FOR THIS PROJECT:
TREES
RESULTS OF CONTACT WITH THE WBE FIRM:
WILL UTILIZE IF AWARDED
WBE Firm STATE BARRICADING
Owner or Contact at WBE Firm JAMES MICHALSKI
Telephone: (574) 287-2078 Fax: Email: STATE BARRICADEI@AOL.COM
TYPE OF WORK SOLICITED FOR THIS PROJECT:
TRAFFIC/BARRICADES
RESULTS OF CONTACT WITH THE WBE FIRM:
WILL UTILIZE IF AWARDED
Version 9/1/2025 Page - 36 Public Works Quote
Document A31OTM - 2010
Conforms with The American Institute of Architects AIA Document 310
Bid Bond
CONTRACTOR:
(Name, legal status and address)
Premium Concrete Services, Inc.
712 Richmond St
Elkhart, IN 46516
OWNER:
(Nanrc. legal status and addrrrssl
City of South Bend
227 W Jefferson Blvd
South Bend. IN 46601
BOND AMOUNT: 5%
SURETY:
(Name, legal status and principal place rjlnevinezv)
Old Republic Surety Company
P. O. Box 1635
Milwaukee, WI 53201-1635
Mailing Address for Notices
Five Percent of Amount Bid
PROJECT:
(,Name, location or addns% and Project urmrber, ij'an}.)
Veterans' Memorial Park Twyckenham Drive Sidewalk, Project No. 12-077
This document has Important
legal consequences. Consultation
with an attorney is encouraged
with respect to its completion or
mo lifiption.
Any singular reference to
Contractor, Surety, Owner or
other party shall be considered
plural where applicable.
The Contractor and Surety arc bound to the Owner in the amount set forth above, for the payment of which the Contractor and Surety bind
themselves. their heirs, executors, administrators, successors and assign% jointly and severally, as provided herein. The conditions of this
Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents, or within such time period
as may be agreed to by the Owner and Contractor, and the Contractor either (I ) enters into a contract with die Owner in accordance with
the terms of such bid, and elves such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in
the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and for the prompt
payment of labor and material furnished in the prosecution thereof; or (2) pays to die Owner the difference, not to exceed the amount of
this Bond between the amount specified in said bid and such larger amount for which the Owner may, in good faith contract with another
party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and ell'ect. The
Surely hereby waives any notice of an ugroemcnl between the Owner and Con (motor to extend the rime in which die Owner nmy accept die
bid. Waiver of notice by tine Surety shall not apply to any extension exceeding sixty (60) days in [lie aggregate beyond the time Ibr
acceptance ofbids speci lied in the bid documents, and the Owner and Contractor shall obtain the Surety's consent tier an extension beyond
sixty (60) days.
If this Bond is issued in connection with a subcontractors bid to a Contractor. the tern Contractor in this Bond shall be deemed to be
Subcontractor and the terns Owner shall be deemed to be Contractor.
When this Bond has been lumished to comply with n slatmory or other legal requirement in the location orthe Project, any provision in
this Bond conflicting with said statutory or legal requirement shall be deemed deleted hereliom and provisions conlimning to such
statutory or other legal requirement shall be deemed incorporated herein. When so I'umished, [he intent is that [his Bond shall be construed
m n slnlulory bond and not as a common law bond.
Signed and sealed this 27th day of April, 2026.
Premium Concrete Services, Inc.
(Principal) (seal)
4umxs)
BY Civ yPhu1- IrrA PrvsidteY
roue)
Old Republic Surety Company
%PLyy 64urely) (Serd) S� f <e�roR�ri
(iJrinlav) Pamela b. Hig 'nbotham 41 _ 3k SEAL
S-00541AS 8/10
* *
* OLD REPUBLIC SURETY COMPANY
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That OLD REPUBLIC SURETY COMPANY, a Wisconsin stock insurance corporation, does make, constitute and
appoint:
Jennifer L. Kasznia
its true and lawful Attomey(s)-in-Fact, with full power and authority for and on behalf of the company as surety, to execute and
deliver and affix the seal of the company thereto (if a seal is required), bonds, undertakings, recognizances or other written obligations in the nature thereof,
(other than ball bonds, bank depository bonds, mortgage deficiency bonds, mortgage guaranty bonds, guarantees of installment paper and note
guaranty bonds, self-insurance workers compensation bonds guaranteeing payment of benefits, or black lung bonds), as follows:
ALL WRITTEN INSTRUMENTS
Principal: Premium Concrete Services, Inc.
Obligee: City of South Bend
and to bind OLD REPUBLIC SURETY COMPANY thereby, and all of the acts of said Attorneys -in -Fad, pursuant to these presents, are ratified and confirmed.
This appointment is made under and by authority of the board of directors at a special meeting held on February 18, 1982.
This Power of Attorney is signed and sealed by facsimile under and by the authority of the following resolutions adopted by the board of directors of the OLD
REPUBLIC SURETY COMPANY on February 18,1982.
RESOLVED that, the president, any vice-president or assistant vice president, in conjunction with the secretary or any assistant secretary, may appoint
at omeys-in-fact or agents with authority as defined or limited in the instrument evidencing the appointment in each case, for and on behalf of the company to
execute and deliver and affix the seal of the company to bonds, undertakings, recognizances, and suretyship obligations of all kinds; and said officers may
remove any such attomey-in-fact or agent and revoke any Power of Attorney previously granted to such person.
RESOLVED FURTHER, that any bond, undertaking, recognizance, or suretyship obligation shall be valid and binding upon the Company
(i) when signed by the president, any vice president or assistant vice president, and attested and sealed (if a seal be required) by any secretary or assistant
secretary; or
(ii) when signed by the president, any vice president or assistant vice president, secretary or assistant secretary, and countersigned and sealed (if a seal be
required) by a duly authorized attorney -in -fact or agent; or
(lip) when duly executed and sealed (if a seal be required) by one or more attomeys-in-fact or agents pursuant to and within the limits of the authority
evidenced by the Power of Attorney issued by the company to such person or persons.
RESOLVED FURTHER that the signature of any authorized officer and the seal of the company may be affixed by facsimile to any Power of Attorney or
certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship obligations of the company: and such
signature and seal when so used shall have the same force and effect as though manually affixed.
IN WITNESS WHEREOF, OLD REPUBLIC SURETY COMPANY has caused these presents to be signed by its proper officer, and its corporate seal to be
affixed this 20th day of September 2022
Dorn„�,,
\� sun"mrv",% OLD REPUBLIC SURETY COMPANY
`re
Assistant Secretary •�, / I
�rk J, President
STATE OF WISCONSIN, COUNTY OF WAUKESHA-SS
On this 20th day of September 2022 , personally came before me, Alan Pavlic
and Karen J Haffner , to me known to be the individuals and officers of the OLD REPUBLIC SURETY COMPANY
who executed the above instrument, and they each acknowledged the execution of the same, and being by me duly sworn, did severally depose and say: that
they are the said officers of the corporation aforesaid, and that the seal affixed to the above instrument is the seal of the corporation, and that said corporate seal
and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority of the board of directors of said corporation.
OTAe
u�'..A40P�.6T
N=q PUEIK
d1Gns�°
My Commission Expires: _September 28, 2026
CERTIFICATE
(Expiration of notary's commission does not invalidate this instrument)
I, the undersigned, assistant secretary
of the OLD REPUBLIC SURETY COMPANY, a Wisconsin corporation, CERTIFY that the foregoing and attached
Power of Attorney remains in full force and has not been revoked; and furthermore, that
the Resolutions of the board of directors set forth in the Power of
Attorney, are now in force.
a W ceM�aN\r'O
as
e{ SEALtiN
27th April 2026
Signed and sealed at the City of Brookfield, WI this day of
(�
ORSC 22262
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