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HomeMy WebLinkAboutBid Opening - Fremont Park Splash Pad Design and Install - Snider Reci G CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK „65' Project Name Fremont Park Splash pad Design & Install Project No. (PB18) For Bids Due 7112/16 PART (Must be completed for all bids. Please type or print) Date: �fIJa�W -7 /J�(7/( Bidder (Firm): �,SnI11J}%Z KX(� F lN� AddressU E54)1f�— CiTelephone nIOQ fN ! D+ 1 phone Number: ( 1&0 ty/State/Zip: �� ,,,!„� r 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: the City of South Bend, Indiana, in accordance with plays 1a"nd specifiic)ations pr paredtby: 5m t do < - 1C.-i.C'r n- am /l�wi`c�!'S�dA s� �J�t'7%--- and dated J c/ I % , Zcyki for the sum of (enter t e Total Bid a shown on the Proposal) to) Ed (Enter sum of Tota Bus Alternates shown on Proposal) (Numerical) The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids 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 bid is to be awarded on a unit basis, the itemization of the units shall be shown on a separate attachment. By �+ � (Printed Name of Person Signing) ACCEPTANCE The above bid is accepted this day of Subject to the following conditions: BOARD OF PUBLIC WORKS Gary A. Gilot, President Elizabeth A. Maradik, Member David P. Relos, Member Therese J. Dorau, Member James A. Mueller, Member Attest: Linda M. Martin, Clerk Version 7/31/2015 Contractor's Bid for Public Works - 2 20 Project Name Project No. For Bids Due RASF RID BID/PROPOSAL CITY OF SOUTH BEND Fremont Splash Pad Design & Install PB18 7112/16 Item Description Quantity Unit Unit Price Total Amount No. 1 Design splash pad 1 2 Complete installation of new splash pad 1 as per specs 3 (see attached spec sheet) 1 4-- 5 BASE BID TOTAL` 1'1 -1.0 00'0 AI TFRNATF ai.-.h.i2� Item Description Quantity Unit Unit Price Total Amount No. 6 }} $ a.�z 907 f,"" 1 ' B 9 10 Bidder (Firm): Address: City/State/Zip: `t�Y/ iPN��TOTAL�� � O oz5 AbLZO% C) /JJrUJ Telephone Number: (11t&) 677-1' kS / otbo 11-1/3361 �q Zbii1 (Signature) n 00,-- (Printed Name of Person Signing) Version 7/31/2015 Contractor's Bid for Public Works - 7 WEST BEND A MUTUAL INSURANCE COMPANY - Bond Number 2327382 Bid Bond KNOW ALL BY THESE PRESENTS, That We, Snider Recreation, Inc. as Principal, and WEST BEND MUTUAL INSURANCE COMPANY, a corporation organized under the laws of the State of Wisconsin and having its principal office in Middleton, Wisconsin, in said State, as Surety, are held and firmly bound unto City of South Bend Board of Public Works 227 W Jefferson Blvd Ste 1316 South Bend IN 4660-as Owner, in the full and just sum of Five Percent ( s %) of amount bid for the payment whereof said Principal binds its heirs, administrators, and executors and said Surety binds itself, its successors and assigns firmly by these presents WHEREAS, said Principal has submitted to said Owner a bid or proposal for Fremont Park Splash Pad Design & Install City of South Bend Indiana NOW THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH that if within Sixty days hereof and in accordance with said proposal a contract shall be awarded to said Principal and the said Principal shall enter into a contract for said work and shall furnish bond with surety as required for its faithful performance then this obligation shall be void, otherwise remain in full force and virtue. Signed and Sealed this 12 day of Witness: i Iz Agency Name: Address: ,20 16 Principal: Snider Recreation, Inc �, (SEAL) NamypedJv-(vM S C, A1'Jk-1, Ce,5 e( 4 Title Sur W s nd al Ins a c Com any B : (SEAL). Name Typed: DENISE A DACEK AttOrrfey-In-Facie Title MACHOR SAGE INSURANCE AGENCY 7379 PEARL ROAD MIDDLEBURG HEIGHTS ,OH 44130 Phone Number: (440) 826-0404 MICHIGAN ONLY: This policy is exempt from the filing requirements of Section 2236 of the Insurance Code of 1956, 1956 PA 218 and MCL 500,2236. NB 0192 02 08 Page 1 of 1 8401 Greenway Blvd, Suite 1100 1 Middleton, WI 53562 1 Phone: (608) 410-3410 1 Fax: (877) 674-2663 1 www.thesliverlining.com WEST BEND A MUTUAL INSURANCE COMPANY- 2327382 Power of Attorney Know all men by these Presents, That West Bend Mutual Insurance Company, a corporation having its principal office in the City of West Bend, Wisconsin does make, constitute and appoint: DENISE A DACEK lawful Attomey(s)-in-fact, to make, execute, seal and deliver for and on its behalf as surety and as its act and deed any and all bonds, undertakings and contracts of suretyship, provided that no bond or undertaking or contract of suretyship executed under this authority shall exceed in amount the sum of: Four Hundred Thousand Dollars ($400,000) This Power of Attorney is granted and is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of West Bend Mutual Insurance Company at a meeting duly called and held on the 21st day of December, 1999. Appointment of Attorney -In -Fact. The president or any vice president, or any other officer of West Bend Mutual Insurance Company may appoint by written certificate Attorneys -in -Fact to act on behalf of the company in the execution of and attesting of bonds and undertakings and other written obligatory instruments of like nature. The signature of any officer authorized hereby and the corporate seal may be affixed by facsimile to any such power of attorney or to any certificate relating therefore and any such power of attorney or certificate bearing such facsimile signatures or facsimile seal shall be valid and binding upon the company, and any such power so executed and certified by facsimile signatures and facsimile seal shall be valid and binding upon the company in the future with respect to any bond or undertaking or other writing obligatory in nature to which it is attached. Any such appointment may be revoked, for cause, or without cause, by any said officer at any time. In witness whereof, the West Bend Mutual Insurance Company has caused these presents to be signed by its president undersigned and its corporate pal to be hereto duly attested by its secretary t�h's 1st day ofNarch, 2009. Attest a iJ�l'pry'� / tJ 15�i r�,OrtPORATN:'M't Ja a J. PaQ 0Kevin A. Steiner Secretary SEAI. •, Chief Executive Officer /President r�: State of Wisconsin ' T` County of Washington ...... On the 1st day of March, 2009 before me personally came Kevin A. Steiner, to me known being by duly sworn, did depose and say that he resides in the County of Washington, State of Wisconsin; that he is the President of West Bend Mutual Insurance Company, the corporation described in and which executed the above instrument; that he knows the seal of the said corporation; that the seal affixed to said instrument is such corporate seal; that is was so affixed by order of the board of directors of said corporation and that he signed, his name thereto by like order. +' NOTARY `;+`: John�F Di'iwell P PUBLIC %? Executive Vice President - Chief Legal Officer y` 2y' Notary Public, Washington Co. WI .�......_.r= p :�FyytSG ' My Commission is Permanent The undersigned, duly elected to the office stated below, now the incumbent in West Bend Mutual Insurance Company, a Wisconsin corporation authorized to make this certificate, Do Hereby Certify that the foregoing attached Power of Attorney remains in full force effect and has not been revdkod and that the Resolution of the Board of Directors, set forth in the Power of Attorney is now in force. Signed and sealed at West Bend, Wisconsin this '2 day of July 2016 hN. ;cORPo TF o , o S�AL� - Dale J. Kent .,, F'. Executive Vice President - fl Chief Financial Officer NOTICE: Any questions concerning this Power of Attorney may be directed to the Bond Manager at NSI, a division of West Bend Mutual Insurance Company 8401 Grccnway Bled. Suite 1100 1 P.O. Box 620976 1 Middleton, WI 53562 1 ph (608) 410-3410 1 www.thenilverlining.com When the prospective Contractor is unable 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.. 0/6 0 ) ) SS: 1{�J A/I'VlA COUNTY ) The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that: 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 alien. Contractor agrees that he/she/it shall enroll in and verify the work Version 7/31/2015 Contractor's Bid for Public Works - 4 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. Contractor's 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 term 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, 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 employment, or any matter directly or indirectly related to employment because of race, sex, religion, color, national origin, ancestry, age, gender expression, gender identity, sexual orientation 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 may consider the Contractor's good faith efforts to obtain participation by those Contractors 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. In no event shall persons or entities seeking the award of a City contract be required to award a subcontract to an MBE/WBE; however, it may not unlawfully discriminate against said WBE/MBE. A finding of a discriminatory practice by the City's MBE/WBE Utilization Board shall prohibit that person or entity 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 for 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. 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). 1 hereby certify that I and all subcontractors employed by me for this project will use steel products or foundry products on this project if awarded. I understand that violations hereunder may result in forfeiture of contractual payments. Version 7/31/2015 Contractor's Bid for Public Works - 5 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 I }l_ day of 20_L6> Subscribed and sworn to before me this 7 M My Commission Expires SANDhAYL DULAYence Notary Public In and for the State of Ohio My Commission Expires December18,2018 Contractor/Bidder (Firm) / Si at "re of Contractor/Bidder or Its Agent /, Printed Name and Title _ day yofoOLk /I , 20 1(, ,�Ndtary Public (/ Version 7/31/2015 Contractor's Bid for Public Works - 6 PART II (For projects of $100,000 or more — IC 36-1-12-4) These statements to be submitted under oath by each bidder with and as part of his bid. Attach additional pages for each section as needed. SECTION I EXPERIENCE QUESTIONNAIRE 1. Attach information regarding projects your organization has completed for the period of one (1) year prior to the date of the current bid. 2. Attach a listing of public works projects currently in process of construction by your organization. 3. Attach information regarding any failure to complete any work awarded to you and the location thereof. 4. Attach references from private firms for which you have performed work. SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE 1. Attach an explanation of your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, complete the project, number of workers, etc. and any other information which you believe would enable the City of South Bend to consider your bid.) 2. Attach a listing of the names and addresses of all subcontractors (i.e. persons or firms outside your own firm who have performed part of the work) that you have used on public works projects during the past five (5) years along with a brief description of the work done by each subcontractor. 3. If you intend to sublet any portion of the work, attach the name and address of each subcontractor, equipment to be used by the subcontractor, and whether you will require a bond. However, if you are unable to currently provide a listing, please understand a listing must be provided prior to contract approval. Until the completion of the proposed project, you are under a continuing obligation to immediately notify the City of South Bend in the event that you subsequently determine that you will use a subcontractor on the proposed project. 4. Attach a listing of equipment you have available to use for the proposed project 5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not, attach an explanation for the rationale used which would corroborate the prices listed. SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the City of South Bend awarding the contract must be specific enough in detail so that said City of South Bend can make a proper determination of the bidder's capability for completing the project if awarded. AiJAR(\C "J\j Li6t.uss Version 7/31/2015 Contractor's Bid for Public Works - 3 . ' 0 \{ // §r & 2 /: k u A§& � EL Ix� 0 c§7 <ar Z;o o(�` §ZS t2LL gme $§!( S2w ■ �.�� ��be §/§ 0LLJ E°u �m�� o0w ,f LL Ro » E§ 0 k I-- iL �,. )0 § +[ S CL `�f \oE )0 ( (\ }Lco j \ q \ § _ = L a \ % \ Ott 11 y CITY OF SOUTH BEND `%, A lc MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY^ 'x DEVELOPMENT PROGRAM FORM MWBE-2.0 EVIDENCE OF GOOD FAITH EFFORTS 1865 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/WBE participation. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business as defined by the Indiana Department of Administration ('9DOA" ). Project Number: (PB18) Date: Project Name: Bidder: Fremont Park S Contact Person: Telephone: Address: IU16r1 K0 111ru OAJ Irolol t'— K— / / � / city: State: /hy Zip: 3 3 __ Email: To determine whether a bidder has demonstrated good faith efforts to reach the MBENVBE 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 MBE/WBE LIST(S): The bidder reviewed the. City of South Bend's Minority and Women Business Enterprise Diversity Development Program, which uses the IDOA approved list of Minority and Women Owned Business as found on their website (http://www.in.gov/idoa). ACTION (ADVERTISEICONTACT): In order for your bid to be deemed responsive, the City of South Bend requires that all perspective bidders complete no less than 2 of the following: 1. Attend all pre -bid meetings scheduled by the City to inform MBE/WBEs of contracting and subcontracting opportunities. 2. Advertise in general circulation and/or trade association publications concerning subcontracting ( opportunities, and allow MBENVBEs reasonable time to respond. v Perform any and all necessary steps to provide written notice in a manner reasonably calculated to inform MBENVBEs of subcontracting opportunities and allowed sufficient time for them to participate effectively. 4� Utilize pre-existing services of available community organizations, small and/or disadvantaged business assistance offices and other organizations that provided assistance in the recruitment and placement of MBENVBE firms. "Bidder must circle or otherwise notate which of the two (2) required actions were performed. GOOD FAITH NEGOTIATIONS: The bidder negotiated in good faith with interested MBENVBEs, _ including providing such MBENVBE's with adequate information aboutthe plans, specifications and other requirements of the subcontract and did not reject MBENVBEs as unqualified without sound business reasons based on a thorough investigation of their capabilities. SMALL CONTRACT(S): The bidder selected specific portions of the work to be performed by MBENVBEs in order to increase the likelihood of meeting the MBENVBE goals (including breaking down contracts into smaller units to facilitate MBENVBE participation) CONTRACT RECORDS: The bidder has maintained the following records for each MBENVBE 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 MBENVBE was unqualified to perform the job. 'Proper demonstration of Good Faith Effort 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 7/31/2015 Contractor's Bid for Public Works - 9 s,C Th CITY OF SOUTH BEND ` Too MINORITY AND WOMEN BUSINESS ENTERPRISE DIVERSITY F DEVELOPMENT PROGRAM FORM MWBE-2.1 MBE/WBE CONTACTED 1tl65 This completed form should be supplied with Bids that pertain to City of South Bend Public Works Projects requiring contacted MBE/WBE to obtain Good Faith Efforts. It is the bidder's sole responsibility to verify whether any listed minority or woman business meets the qualifications of a Minority or Women's owned business. PAGE OF Project Number: (PB18) MBE/WBE Participation Goal MBEM/BE Firm Owner or Contact at MBENVBE Firm Vcj-S-v Telephone: -33. � 1}-V-21 '3(4�ax: Email: TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBENVBE FIRM: . MBE/WBEFirm 3D (1, Owner or Contact at MBEANBE Firm Telephone: '2� -- 7j;5O� 33 ax: Email TYPE OF WORK SOLICITED FOR THIS PROJECT: RESULTS OF CONTACT WITH THE MBENVBE FIRM: Version 7/31/2015 Contractor's Bid for Public Works - 10 ACORH CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) L/ 1 04/20/2016 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 endorsemends). PRODUCER NAME: Denise Deceit, AIS, CISR, CPIA, ADS, CRIS PHONE 440-826-0404 uc NO: 440-826-1013 Machor Sage Insurance Agency E pABESS 1L ddacek@machor.com 7379 Pearl Road INSURERS AFFORDING COVERAGE NAIL$ Middleburg Heights, OH 44130 INSURER A: Fr n Insurance INSURED Snider Recreation Inc. INSURER B: James C Snider INSURER C: 10139 Royalton Rd Ste K INSURER D: North Royalton, OH 44133-4473 INSURER E: NSURER F: COVERAGES CERTIFICATE NIIMRFR- mumnnnndDDsnG RFTaCInM MI IIURFR- qn 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 TR rypE OF ADDL SUBR POLICY NUMBER POLICY EFF MMI OIYYYY) POLICYEXP IMM/DDVYYIY1 LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ DAMAGE TO RENT D PREMISES occurrence)$ MED EXP (Anyone person) $ PERSONAL A ADV INJURY $ AGGREGATE LIMIT APPLIES PER: POLICY PRO- ❑ JECT LOG GENERAL AGGREGATE $ GEN'L PRODUCTS - COMPIOP AGO $ $ OTHER: A AUTOMOBILE LIABILITY BA 6085713 12/17/2015 12/1712016 Ee sBcuEeDSINGLE LIMIT It 11000,000 BODILY INJURY (Par person) $ X ANYAUTO ')MED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIRED NON -OWNED AUTOS ONLY X AUTOS ONLY PROPERTY DAMAGE Per accitlent $ $ UMBRELLA/JAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DEO RETENTION$ $ WORKERS COMPENSATION PER OTH- ANDEMPLOYERS'IJABILITY YIN TATUT OR E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNERJEXECUTIVE OFFICERNEMBER EXCLUDED] NIA E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) Yes, desam a under E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N more space is required) Verification of Insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Verification of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE CORPnRATInN All rinhfo a --rl ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Printed by DAD on Apnl 20, 2016 at 01:02PM SNIDE-2 OP ID: CS '4� o CERTIFICATE OF LIABILITY INSURANCE DATE 012016Y) 06/20/2016 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 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 Cooper Insurance Service, Inc Playground Book P.O. Box 638 Lapel, IN 46051 CONTACT Steve B. Carraway NAME: n"c°N Eae:765-534-3152 ac No): 765-534-2067 E-MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC# Steve B. Carraway INSURER A: Scottsdale Insurance Co. 41297 INSURED Snider Recreation, Inc. 10139 Royalton Rd, Ste K INSURER B: Cleveland, OH 44133 INSURER C: INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: RFVI.CInM NI IMRI:P- 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 INSURANCEINSO ADDLrUBRPOLICY POLICY NUMBER EFF MM/DDIYYYY POLICY UPLTR MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE aOCCUR RBH0000626 06/23/2016 06/23I2017 EACH OCCURRENCE $ 1,000,00 PREMISES Eacccunence $ 100,00 MED EXP(Any one person) $ 1,00 PERSONAL S ADV INJURY $ 1,000,00 GEN'L AGGREGATE U MIT APPLIES PER: POLICY JET LOC OTHER: GENERALAGGREGATE S 2,000,00 PRODUCTS-COMP/OP AGG E 2,000,00 Prof Liab $ 1,000,00 MOBILELIABILITY LLOWNED SCHEDULED UTOS AUTOS AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT Ea accidentNYAUTO $ BODILY INJURY(Per person) $ FHIRE BODILY INJURY Per accident ( )D $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LWB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEO I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? ❑NIA (Mandatory In NH) If Yes, describe under DESCRIPTION OF OPERATIONS below STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more apace is required) For Informational Purposes Only FIPOCLO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2014 TION. All riahts reserved ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD Bureau of Workers' Ohio Compensation 30 W. Spring St. Columbus, OH 43215 Certificate of Ohio Workers' Compensation This certifies that the employer listed below participates in the Ohio State Insurance Fund as required by law. Therefore, the employer is entitled to the rights and benefits of the fund for the period specified -This certificate is only valid if premiums and assessments, including install- ments, are paid by the applicable due date.To verify coverage, visit www.bwc.ohio.gov, or call 1-800-644-6292. This certificate must be conspicuously posted. Policy number and employer Period specified below 1703597-0 07/01/2016 through SNIDER RECREATION INC 06/30/2017 10139 ROYALTON RD STE K N ROYALTON, OH 44133 www.bwc.ohio.gov da Issued by: Acting Administrator/CEO You can reproduce this certificate as needed. Ohio Bureau of Workers' Compensation Required Posting Effective Oct. 13, 2004, Section 4123.54 of the Ohio Revised Code requires notice of rebuttable presumption. Rebuttable presumption means an employee may dispute or prove untrue the presumption (or belief) that alcohol or a controlled substance not prescribed by the employee's physician is the proximate cause (main reason) of the work -related injury. The burden of proof is on the employee to prove the presence of alcohol or a controlled substance was not the proximate cause of the work -related injury. An employee who tests positive or refuses to submit to chemical testing may be disqualified for compensation and benefits under the Workers' Compensation Act. Bureau of Workers' Ohio I Compensation You must post this language with the Certificate of Ohio Workers' Compensation ID-10 orAI ncon ,n_.. .. rY:// x CITY OF SOUTH BEND, INDIANA CONTRACTOR'S BID FOR PUBLIC WORK aas x CHECKLIST FOR BIDDERS Project Name Fremont Splash Pad Design & install Project No. (PB18) For Bids Due 7/12/16 From time to time the South Bend Board of Public Works finds it necessary to reject a bid because it does not comply with statutory requirements. In preparing your bid, please use the following checklist in order to make sure that your bid is done in the proper manner. Proper bid security included. The bidder has the option of providing either a Certified Check or Bid Bond. / Bid prepared on the City of South Bend Contractor's Bid for Public Work Form, completely V executed. Contractor's Non -Collusion and Non -Debarment Affidavit, Certification Regarding Investments with Iran, Employment Eligibility Verification, Non -Discrimination Commitment, and Certification of use of United States Steel Products or Foundry Products. Proof of MBEM/BE Participation Goal Form [MWBE-1.0]. If minimum participation goal is not met, also provide Evidence of Good Faith Efforts Form [MWBE-2.0] and MBE/WBE Contacted, Form [MWBE-2.1]. Acknowledge Receipt of Addendum(s) included with the bid. d All required additional information is included with the bid. Proposal statements and other affidavits all signed by the proper party with name either printed or typed underneath signature. v This checklist submitted with the Bid. This checklist is provided for bidder's use in assuring compliance with required documentation; however, it does not include all specifications requirements and does not relieve the bidder of the need to read and comply with the specifications. Bidder: Il YC Au"Cyi / n(L Date: .J�L �L By Authorized Representative: Signature: Print Name & Title: Version 7/31/2015 Contractor's Bid for Public Works - 1