HomeMy WebLinkAboutBid Opening - Horton Emergency Vehicles - Two (2) More or Less 2016 or Newer Refurbished Medic Units - Medic 11O44o'J eF
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BID NAME:
FOR BIDS DUE:
Spec AA - Two (2) More or Less 2016 or Newer Refurbished Medic Units
July 26, 2016; 9:30 a.m., Local Time
Bidder 1
Date: 7-a2Sa01b (Firm): gado
Address: 3800 A%dk,wo// .! 4,.ee� r:
City/State/Zip: (ems—�,�.OL S3ia3 Telephone Number: Cr7y ) tll&- 4C7&,6
Agent of Bidder (if Applicable):
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
STATE OF
(Must be completed for all quotes and bids. Please type or print)
SS:
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.
5
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:
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
eligibility status of all of Contractor's newly hired employees through the E-Verify
Program as defined by LC_ 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 persons 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). I 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.
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 a2S day of 3ii k. 20J b
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Contracto 'dder (Fir)
--
Signature of ContractorBidder or Its Agent
RIvee - Wi�a- r — k 504
Printed Name and Title
Subscribed and sworn to before me this dS dayVf J U. 201
My Commission Expires 10' a29-� X ND A a
Notary Public
County of Residence S+.�OS�
(To be completed only by ContractorsBidders claiming to be a `local Indiana business"pursuant to I.C. 36-1-12-22)
11NLI1llINH Luq-AL
CLAIM
A 'local Indiana business "refers to any of the following:
(I) A business whose principal place of business is located in an affected county.
(2) A business that pays a majority of its payroll (in dollar volume) to residents of affected counties.
(3) A business that employs residents of affected counties as a majority of its employees.
(4),4 business that makes significant capital investments in the affected counties as defined in rules adopted by the political
subdivision.
(5) A business that has a substantial positive economic impact on the affected counties as defined by criteria in rules adopted by
the political subdivision.
An "affected county" refers to St. Joseph County, Indiana, or the following counties located adjacent to St. Joseph County:
Elkhart County, Marshall County, Starke County and LaPorte County
There are the following price preferences for supplies purchased from a local Indiana business:
• 5%for a purchase expected by the purchasing agency to be less than $50, 000
• 3%, for a purchase expected by the purchasing agencv to be at least $50, 000 but less than $100, 000.
• 1 %for a purchase expected by the purchasing agency to beat least $100, 000.
Date:
Pursuant to I.C. 36-I-12-22, claims a local Indiana business
preference for Project (Project # ) located within the City of
South Bend, St. Joseph County, Indiana.
❑ The location of the principal place of business is
❑ St. Joseph County, Indiana
❑ The following county located adjacent to St. Joseph County, Indiana:
❑ The majority of the business's payroll for the 12 months prior to the date of this Bid is to residents of St.
Joseph County, Indiana or the adjacent county noted above.
❑ The majority of the business's employees for the 12 months prior to the date of this Bid are residents of
St. Joseph County, Indiana, or the adjacent county noted above.
If the business is deemed to be the apparent lowest, responsible, responsive bidder, then it shall provide
supporting documentation for the 12 month period prior to the date of the Bid of (i) the total payroll
amount paid to all employees of the business, and (ii) the total payroll amount paid to employees who are
residents of St. Joseph County and the adjacent county noted above.
WHEN SUPPL YING SUPPOR TING PA YR OLL RECORDS, BIDDER SHALL REDACT ALL
SOCL4L SECURITYNUMBERS.
Dated this day of , 20
Contractor/Bidder (Firm)
Signature of Contractor/Bidder or Its Agent
Printed Name and Title
ri
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SPECIFICATIONS
CITY OF SOUTH BEND
I865
BID NAME: Spec AA —Two (2) More or Less 2016 or Newer Refurbished Medic Units
FOR BIDS DUE: July 26, 2016; 9:30 a.m., Local Time
Pursuant to notices given, the undersigned offers bid(s) to the City of South Bend in accordance
with the following attachment(s) which specify the class or item number or description, quantity,
unit, unit price.
SPEC AA — TWO (2) MORE OR LESS 2016 OR NEWER REFURBISHED MEDIC
UNITS
It is the intent of these specifications to describe a vehicle or piece of equipment for the City of
South Bend. The unit shall be bid as a fully equipped complete unit as set out in the attached
specifications. No partial or split bids will be accepted. Unit to be bid with and without trade-in
if applicable. Vendor to complete bid proposal contained in this bid specification and attach to
the submitted bid.
These are minimum specifications. Any variation from the specifications must be spelled out on
a separate deviation list in order for the bid to be valid. Any items not listed on the deviation
sheet will be assumed to be part of the unit.
Proprietary products or specific manufacturers may be referenced herein. Such references are
only made to demonstrate minimum scope, quality, and style of the equipment desired_
Equipment that is bid pursuant to these specifications shall be of equal quality and size, or
greater, to those referenced, and are subject to approval by the South Bend Board of Public
Works.
Vendor shall provide all information requested in specifications to qualify for bid. If information
on brochure submitted does not completely cover specifications requested, it shall be typed and
attached to brochure.
If an alternate is included within these specifications, please be advised that, alternate items
placed in the specifications are to determine the best configuration of the item within a budgeted
amount and may be included in the award criteria. If the Board elects to award one or more (s),
the base bid price and the alternate bid price(s) will be totaled and compared for all bidders
offering the final configuration. Award will be made based on the lowest responsible/responsive
bid prices submitted for the base bid with selected (s), if applicable. Failure to submit a bid on
an alternate may result in the entire bid being non -responsive, depending on the final
configuration of the product.
Payment will be processed once the unit is inspected and accepted as to meeting the
specifications by the Division of Central Services. This will include all manuals and warranty
documentation.
N
Bidder must state as accurately as possible an intended delivery date from the date of the
bid award. Due to the age of the City's existing fleet, it is imperative that the unit's be
delivered as quickly as possible. Stated delivery lead time may be included as an integral
part of our bid selection process. FOB Central Services. The unit and all related paperwork is
to be delivered to:
Central Services Division
1045 West Sample Street
South Bend, Indiana 46619
All Certificates of Origin/Title Work shall list the owner as:
The City of South Bend
1045 West Sample Street
South Bend, Indiana 46619
The Board will award the bid to the lowest responsible and responsive bidder. If the bid is not
awarded to the lowest bidder, the factors used to justify the awards will be stated in writing at the
request of any bidder.
The Board reserves the right to reject any and/or all bids or portions thereof and to waive any
irregularities or informalities.
Chassis:
20,000. G.V.W,R., Geared Speed 84 MPH.
yE /NO
Front Axle:
I -Beam Type: 8,000 lb capacity. King pin bushings to be
YES O
brass.
Rear Axle:
Bidder responsible for correct axle width to fit module,
ONO
17,500 lb capacity, Ratio: 4.56.
Front
8,000 lb. capacity, heavy duty shock absorbers.
VSNO
Suspension:
Spring pins rubber bushings, maintenance free.
Rear
Air Ride optimized suspension; 12,000 lb. capacity, 5.3"
(DNO
Suspension:
ride height, with shock absorbers.
Sty 1;«J
Engine:
Diesel powered, 250 HP, 660 lb. ft. torque. (Maximum).
(!DNO
Engine block heater 120 volt/1,250 watt. Block heater
socket receptacle type; mounted below driver's door. Air
cleaner to be dry type single element. Engine control,
remote mounted provision for; includes wiring for body
builder installation of PTO controls; with ignition switch
control Throttle, hand control engine speed control;
electronic, stationary variable speed; mounted on steering
wheel. Must have 5 year 200,000 mile warranty that
10
includes turbo, fuel injectors, and complete fuel system.
Includes:
*Gauge, Air Cleaner Restriction - Air Cleaner Mounted
*Cruise Control - Electronic; Controls Integral to Steering
Wheel
*Wet Type Cylinder Sleeves
*Engine Shutdown - Electric, Key Operated
*Governor - Road Speed, Electronic
*Engine Oil Drain Plug - Magnetic
*Oil Filter, Engine - Spin -On Type
*Engine Oil Change System - 30 Quart Capacity
*Damper, Crankshaft - Viscous
*Fan - Optimized Position
*Fuel Filter - Engine Mounted
*Fuel Water Separator
Transmission: Automatic: (2500 EVS Series) 6 speed (package 119), OE /NO
w/overdrive, less retarder, 64 teeth/20 degree pressure
angle 6.9 pitch spur gear. Oil filter, mounted on
transmission. Transmission temp gauge, dash mounted,
auxiliary oil cool.
Includes:
*Transmission Oil Pan - Magnet in Oil Pan
*Oil Filter, Transmission - Mounted on Transmission
*Synthetic Oil
*Allison P-3 extended service coverage - 5 year unlimited
miles shall be included.
Electrical: 12 volt 270 AMP alternator with self -diagnostic regulator YES O
system. 3 = 1950 CCA maintenance free 12 volt 1950
CCA batteries. Body building wiring back of cab at frame,
includes sealed connectors for tail/amber turn/marker/back
up/accessory power/ground and sealed connector for
stop/turn. AM/FM radio, CD changer, weather band,
clock w/alarm, includes multiple coaxial speakers. Back
up alarm. Cigar lighter, 2 electric horns. Multi speed
windshield wipers w/delay. Circuit breakers w/manual
reset (main panel) SAE type III with trip indicators,
replaces all fuses except 5 AMP fuses.
Includes:
*Fuses, Electrical SAE - Blade - Type
*Turn Signal Switch - Self -Cancelling, Headlight Dimmer
(w/Flash-To-Pass Feature)
*Parking Light - Integral w/Front Turn Signal and Rear
Tail Light
11
*Stop, Turn, Tail & B/U Lights - Dual, Rear, Combination
w/Reflector
*Starter Switch - Electric Key Operated
*Turn Signals, Front - Flush Mounted Include Reflectors
and Auxiliary Side Turn Signals, Solid State Flashes.
*Data Link Connector - In Cab For Vehicle Programming
and Diagnostics
*Windshield Wipers - Single Motor, Electric, Cowl
Mounted
*Windshield Wiper Switch - 2 Speed Integral w/Turn
Signal Switch w/Wash and Intermittent Feature.
*Wiring, Chassis - Color Coded and Continuously
Numbered
Frame:
Frame rails high strength low alloy steel (80,000 PSI yield)
YES O
9.125" x 3.062" x 0.312" (231.8 mm x 77.8 mm x 8.O mm)
388.4" (9864 mm) maximum OAL; for LP chassis.
855,000 RBM, 10.7 Section Modulus
Wheel Base:
169", CA: 101.9, Axle to Frame: 63
YE O
Cooling:
Radiator HD (Modine) aluminum, 2 row, cross flow, over
(YDNO
under system, 516 sq. in. louvered, w/270 sq. in. charge air
cooler. 3.5" core. Heater and air conditioner. Bug screen
between grille and radiator.
Tires:
Front: (2) 245/70R19.5 G647RSS (Goodyear) 12 ply.
YE O
Rear: (4) 245/70R19.5 G622RSD (Goodyear) 537 12 ply.
Steering:
Power assist, tilting column, 2 spoke, 18" diameter wheel
ES O
Cab:
Conventional steel or aluminum.
E O
Includes:
*Premium Interior Trim
Arm Rest - (2) Molded Plastic, Smoke Gray, One Each
Door. Arm Rest Right Side of Divers Seat and Left Side
Passenger Seat
*Floor Covering - Rubber, Black
*Coat Hook - Located on Rear Wall, Centered Above Rear
Window
*Grab Handle, Cab Interior - (1) "A" Pillar Mounted,
Passenger Side
*Grab Handle, Cab Interior - (2) `B" Pillar Mounted, One
Each Side.
*Step - (2) One Step Per Door
*Glass, All Windows - Tinted, Power Windows
*Chrome Front Bumper
*Gauge Cluster - Enghsh w/English Electronic
12
*Front Tow Hooks
*Stationary Grille
*Odometer Display - Miles, Trip, Miles, Engine Hours,
Trip Hours, Fault Code Readout
* Warning System - Low Fuel, Low Oil Pressure, High
Engine Coolant Temp, and Low Battery Voltage (Visual
and Audible)
*Gauge Cluster Gauges - (5) Engine Oil Pressure
(Electronic), Water Temperature (Electronic), Fuel
(Electronic), Tachometer (Electronic), Voltmeter
*Gauge, Oil Temp, Allison Transmission
*Seat, Drive - (National) Air Suspension, High Back
w/Integral Headrest, Vinyl, Isolated, w/2 Position Front
Cushion Adjustment, 6 to 17 Degree Seat Back
Adjustment, Air Lumbar Support
*Air Suspension Dump Valve
*Exterior Grab Handles - w/Anti Slip Rubber Inserts, Both
Left and Right Sides
*Mirrors - Exterior, Both Heated and Powered wBright
Finish on Mirrors and Brackets. (2) (Lang Mekra)
Rectangular, 7.44" x 14.84", Brackets Breakaway Type,
w/102" Wide Spacing, w/7.44" sq. Convex Both Sides.
*Seat Belt - 3 Point, Lap and Shoulder Belt Type
*Seat, Passenger - (National) Air Suspension, High Back
w/Integral Headrest, Vinyl, Isolated, w/2 Position Front
Cushion Adjustment, 6 to 17 Degree Seat Back
Adjustment, Air Lumbar Support
*Instrument Panel - Center Section, Flat Panel
*Air Conditioner - (International Blend Air) w/Integral
Heater & Defroster
*Refrigerant - Hydro fluorocarbon HFC-134A
*Heater Hoses - Premium
*Fresh Air Filter for HVAC
Gray w/Black Netting Over Storage Pockets
* "A" Pillar Cover - Molded Plastic, Smoke Gray
*Head liner - Printed Cloth
*Instrument Panel Trim - Molded Plastic, Drawbridge
Gray w/Black Center Section, Hidden Cup Holder and Ash
Tray (Pull -Out)
*Dome Light, Cab - Rectangular, Center Mounted,
Integral to Console Door Activated, Timed Theater
Dimming.
*Sun Visor - (2) Padded Vinyl Integral to Console w/Toll
Ticket Strap and w/Integral Extenders
Door - (1) Molded Plastic, Smoke
13
Full -Length, Driver Door.
*Cab Interior Trim Panels - Molded Plastic, Full Height,
All Exposed Interior Sheet Metal is Covered
*Door Trim Panels - (2) Molded
JY;EO
Wheels:
Polished aluminum front and rear inner and outer.
Exhaust:
Single, horizontal muffler and short tail pipe, aluminized
YES O
steel; frame mounted left side at 45' angle.
Brakes:
Air brakes ABS (Bendix anti -lock brake system) full
YES 0
vehicle wheel control system (4 channel) air dryer,
automatic drain valve w/heater for air tank. Front, air cam
S-cam; 15.0" x 4.0'; includes 20 sq. in. MGM long stroke
brake chambers. Rear, air cam 16.5" x 7.0"; includes
MGM TR3030 long stroke brake chamber and heavy duty
spring actuated parking brake, 13.2 CFM air
Chassis Add-
Roadmaster front #1209-116 and rear #1209-106 HD sway
YE /NO
Ons:
bars. New Grover Emergency Stutter Tone Air Horns
include air line, fittings and valve. New cast products
SAD/SAP3805-09M2-1 siren speakers through the front
bumper. New auto reset back-up alarm with cancel switch.
New 125" ADP RH side running board/cab step, LH side
battery with slide out tray and cab steps. New brushed
stainless steel DEF tank shroud/cover. New 125"
aluminum switch, siren and radio console/map box line X
covered (color match to cab interior). New Federal Signal
PA300 200 watt siren.
Module Body
Remount Tl Medtech modular body. Includes: new cab to
YES O
Exterior:
module accordion boot, body to chassis mounting pucks
and modification for side body fuel fill. Remove all
exterior doors, hinges, lights and accessories. New
windows (2) rear entry doors fixed mirror tint, (1) side
entry door sliding with mirror tint and (1) side body minor
tint. Paint — sand blast module, repair corrosion, repair
with PPG 6 step process of base of base coaticlear coat,
wet sand and buff to high gloss finish. Module base color:
red (paint code: PPG#907239) match chassis red cab color:
L2684EB red elite BC. Remove and polish all stainless
steel door hinges. Reinstall with 3M corrosion barrier
between hinge/door and hinge/body. New Trimark door
handles (4) keyed locking, (1) non -locking interior. New
compartment door lower rotary latches (12) adjust and
insure timing on all. New module entry door rotary latches
(6) adjust and insure timing on all. New doorjamb Nader
pins (18). Inspect all compartments for proper venting and
drainage. Replace all exterior compartment and entry door
14
a closed cell automotive door seal. New
odel #VS-24-9 retractable side door entry step.
comer guards, kick plate panels, stone guards,
F_
cluding stainless steel door sill thresholds for all
FN
ents. New heavy duty rear bumper steel sub -
aluminum diamond plate bumper pods and
urfaced flip -up step. Provide and install new
frame mounted heavy duty tow hooks. New black rubber
fenderettes. New polished extruded aluminum "C"
channel rub rails. New cast license plate bezel with LED
to lights (high polished). New cast products fuel fill bezel'
(high polished) with brushed stainless steel spillway. New
cast products rear door grabber hold opens (2 sets). New
brite finished aluminum drip rails.
Heat and A/C:
New ACC high output heating and AC unit. Heat BTU:
E O
43,600 AC BTU: 32,000 CFM: 620.
Electrical:
Test and reuse electrical system (including rear switch
YE O
panel). New front cab switch panel including all switches.
New TST commander 357 battery timer switch, hour
meter, voltage/AMP inductive pick-up. New
chassis/engine harness color coded SXL or GXL insulated
wiring in heat resistant automotive loom. New Kussmaul
20-1050 Lifestar inverter/charger with LSIR inverter and
LSCR charger panels. Replace interior hi/lo Halogen
domes to new TecNiq 8" 31 LED hi/lo domes (6).
Replace interior 39" fluorescent lights with new TecNiq
18" LED panel lights (4). (Each light includes an
individual switch).
Department 2
Reinstall department mobile radios and intercom system
YES O
Way Radios:
(1) front console (1) primary action area.
DOT and
New Bullseye LED ICC lights with chrome guard (14) (7)
CYES O
Emergency
amber (7) red. New Whelen 700 chrome bezels for
Lighting:
existing LED grille lights. New Whelen 700 series red
super LED intersection lights with chrome bezels (2).
New Whelen 900 series super LED front body lights (7)
R/W/R/W/R/W/R (removed front light bar). New Whelen
900 series super LED upper rear body lights (3) R/A/R.
(Remove rear light bar). New Whelen 900 series LED
gradient opi-scene and load lights with chrome flanges (8).
Whelen 5 nun ship-lites in "C" channel rub rails (3) each
side RAW/R. New Whelen light chrome flanges (6) 900
series (4) 700 series (8) 600 series. Polish all light lenses
to like new appearance.
Module
Remove old floor covering material, replace with new
YES O
Interior:
Lonseal floor, Lonplate II — gunmetal #424. Replace all
15
vinyl with new EVS seamless vacuum formed, including
set bottoms, backrest cushions and trim. Color: Gunmetal.
New EVS 1880 hi back seamless, child safety seat with 3
point belting harness with new SB-2-2 position swivel
base. New stainless steel entry door thresholds includes
rear and side with safety grip tape. New stainless steel
lower module entry door panels (3). Provide and install a
new safety net at head of squad bench. Provide and install
new retaining net on ALS cabinet opening. Inspect all
cabinet walls, seats, cabinet hardware for missing screws
and rivets, adjust and replace as necessary. Provide and
install a Smithworks 12 volt IV warming plate.
Medical
Test oxygen system, lines and outlets. Repair any leaks.
OKO
Equipment:
Provide and install a new S-Scort VX-2 suction unit with
charging retention bracket.
Graphics:
Department lettering, door seals, striping, SOL's and (2)
YES O
3M diamond grade, full rear body Chevron.
Color:
Cab red, Chassis White
O
Quantity:
Two (2) more or less.
O
Trade -In:
Med 4, 2010 Freightliner Ambulance,
O
VIN# 1 F VAC WDT9ADAU 1912
Med 11, 2010 Freightliner Ambulance,
V IN# 1 F VAC WDT7ADAU 1911
Alternate 1: Liquid Spring
Rear Kneeling
Suspension:
A Liquid Spring rear hydraulic strut suspension shall be
(ONO
installed in lieu of the standard rear OEM air bag
suspension. The suspension company shall be QS 9000
and ISO 9001 certified for excellence. The liquid
suspension shall be rated at 12,000 pounds GAWR and
installed per Liquid Spring Directions. Suspension
Installation instructions and drawings shall be followed.
All guidelines regarding chassis and axle capacity ratings
as published by chassis manufacturer shall be adhered to.
Mechanical
The control arms shall be connected to a replacement front
Suspension
hanger that features upper and lower control arm pivot
yE O
Components:
points and a connection point for a heavy duty sway bar.
Both Liquid Spring struts shall be positioned directly aft of
the axle and outboard of frame rails. The designed ride
height shall maintain original suspension's drive -line
geometry.
Tracking Bar:
The suspension shall utilize a lateral control rod (tracking
(PNO
bar) to maintain side to side axle position related to the
chassis frame. Wear shoes, mounted to the sides of the
frame rails are not acceptable.
Hydraulic
All hydraulic lines, fittings, reservoirs and valves shall be
yES O
protected against "stone pecking". Abrasion covers, such
16
System:
as nylon convolute loom over the lines are required. The
entire assembled system shall be tested for leaks at every
fitting connection point.
Mechanical
All fasteners related to the suspension assembly are
Quality
considered critical. All fasteners shall be tightened to the
yES O
Assurance:
manufacturer's recommended torque by the primary
installation mechanic. A secondary mechanic shall "put a
wrench" and re -torque ALL of the fasteners and then spray
a contrasting color of paint onto the heads and nuts of each
fastener.
Suspension
A suspension jounce clearance study shall be performed
Jounce Study:
throughout the full range of suspension travel to ensure
yE O
adequate clearance of suspension, frame and brake
components. Test results shall be documented and
supplied in the owner's manual.
Kneeling
The rear suspension shall kneel when the triggering device
Feature
is activated AND an enable switch, located in the cab
E NO
Enable:
console is activated.
Kneeling
The kneeling feature shall activate in PARK position only -
Feature
Feature
The kneeling feature shall NOT activate in any forward or
O
Activation:
reverse gear. The above rear suspension shall kneel when
the trailing rear access door is opened.
17
BID NAME:
FOR BIDS DUE:
45pUTit B�ti
O {'
i
BID/PROPOSAL '
CITY OF SOUTH BEND
IryfiS
AA — Two (2) More or Less 2016 or Newer Refurbished Medic Units
Description
Year/Make/Nlodel
Unit Price
Year
Make/Model — Trade In
Unit Price
2010
Med 4, Freightliner Ambulance,
VIN#1FVACWDT9ADAU1912
$
2010
Med 11, Freightliner Ambulance,
VIN#1FVACWDT7ADAU1911
$
Alternate #
Description
Cost
Total
1
Liquid Spring
$
$
Estimated number of days for delivery from award date.
Bidder (Firm):
Address:
MC
City/State/Zip: O t1 < < 1 -0 t -t o
Telephone Number: Fax Number:
BOARD OF PUBLIC WORKS
Gary A. Gilot, President
David P. Relos, Member
James Mueller, Member
I
(Signature)
"41+ g�7 r,-
(Printed Name)
18
(Title)
Elizabeth A. Maradik, Member
Therese J. Doran, Member
Attest: Linda M. Martin, Clerk
4SpUTHgF
p ryL
� f
L
CITY OF SOUTH BEND
INSTRUCTIONS TO BIDDERS
ieus
BID FORMS AND EXECUTION
A. Bidders are expected to examine the Drawings, Specifications, Proposal and all Instructions.
Failure to do so will be at the Bidder's risk.
B. Each Bidder shall furnish all information required by the Notice, Instructions to Bidders and
Specifications. Bids must be made on the form provided. The Bidder shall sign the Proposal
and Non -Collusion Affidavit, which is a part of the provided form, where indicated, provide a
notary signature and provide all other information required.
C. The Bidder shall sign the Proposal in the following manner. If the Proposal is made by an
individual, his/her name and post office address must be shown. If made by a partnership or
joint venture, the name and post office address of each member of the partnership or joint
venture must be shown. If made by a corporation, the Proposal must be signed by an officer
of the corporation or by a representative duly authorized by the corporation to execute the
Proposal in its behalf.
2. SEALED BIDS ONLY
A. Bids, Proposals, Guaranty, and other required documents must be submitted in a sealed
envelope marked on the outside with the general classification of material bids, i.e. `Bid for
Computer Equipment," "Bid for Front End Loader," or `Bid for Office Supplies."
B. When samples are required, such samples shall be delivered or shipped at the bidder's
expense to the address specified in the Invitation to Bid. Samples must be shipped
separately from bid documents and labeled clearly with the Bidder's name, address and the
commodity or equipment classifications and documents, the item (and item number, if any),
and Material Safety Data Sheets (if applicable). All samples must be representative of the
commodities or equipment which will be supplied by the successful Bidder. All samples will
become the property of the City of South Bend and none will be returned, unless otherwise
stated in the Specifications.
C. In the event of an inconsistency between provisions of the contract documents, the
inconsistency shall be resolved by giving precedence in the following order:
3. ORDER OF PRECEDENCE
A. Bid Form attached Proposal
B. Amendments to Specifications
C. Specifications
D. Special Provision
E. Instructions to Bidders
F. Notice to Bidders
4. DELIVERY OF BIDS
A. Bids must be delivered to the Office of the Board of Public Works, 13rh Floor, County -City
Building, Room 1316, 227 West Jefferson Boulevard, South Bend, Indiana 46601 (574) 235-
9251, by the time specified (local time) in the Notice to Bidders. If not delivered personally,
the sealed envelope containing the Bid must be mailed to the following address:
City of South Bend
Clerk of the Board of Public Works
1316 County -City Building
227 West Jefferson Boulevard
South Bend, Indiana 46601
19
B. The Post Office Department will be considered agent of the Bidder in delivering the bid. The
City will not be responsible for deliveries. Any Bids received after the time specified will
be returned unopened.
C. Bids will be opened and read publicly at the time and place designated in the Notice to
Bidders. Bidders, their authorized agents, and the public are invited to be present.
D. Bidders may bid on one (1) or more item, provided however, that the bid submitted for each is
delivered in a separate, sealed envelope, with the envelope clearly labeled on the outside
as to the specific item for which the bid is being submitted. Bidders may submit separate bid
bonds for each item being bid upon OR may submit one (1) bid bond equal to 10% of the
combined total of all bids submitted.
E. The Board may reject any bid that does not conform to these requirements as non-
responsive.
5. ADDENDA — NO VERBAL INTERPRETATIONS
A. No inquiries by Bidders relative to interpretation of Plans, Specifications, Special Provisions,
or other Bidding Documents will be answered verbally. If any prospective Bidder is unable or
unwilling to comply with one or more requirements of the bidding document, such Bidder
should so inform the Board of Public Works in writing. Upon receipt of such information,
consideration will be given to the advisability of issuing an Addendum which would thereupon
become applicable to all Bidders. Any such inquiry must be submitted at least seven (7) days
prior to the bid opening date in order to give the Board sufficient time to consider any
necessary Addendum. All answers to such inquiries, in the form of Addenda, will be furnished
to all prospective Bidders who have registered with the City. All Bidders are required to
acknowledge receipt of any Addenda by inserting the Addendum number and the issuing date
on executed Proposals.
6. REJECTION OF PROPOSALS CONTAINING ALTERATION ERASURES INCOMPLETE BIDS
AND ETC.
A. Proposals shall be rejected if they show any alteration of form, additions not called for,
conditional or alternate bids (except when and insofar as are invited), incomplete bids,
erasures or irregularities of any kinds.
B. All blank spaces for bid prices must be filled in, in ink, with the unit price and total price for
each item (This does not apply to divisible bids). In case of incorrect totaling of amounts and
where the unit price and the extension thereof do not agree, the unit price for each item shall
govern, and the City is authorized to correct all erroneous extension and totals for the purpose
of comparing bids.
7. TRADE DISCOUNTS
A. Trade discounts shall not be shown separately, but shall be incorporated in the Bidder's unit
price, unless otherwise specified.
8. VEHICLE BIDS
A. Bidders may bid on one (1) or more vehicles, provided however, that the bid submitted for
each vehicle is delivered in a separate, sealed envelope, by vehicle, with the envelope clearly
labeled on Bidders may bid on one (1) or more vehicles, provided however, that the bid
submitted for each vehicle is delivered in a separate, sealed envelope, by vehicle, with the
envelope clearly labeled on the outside as to the specific vehicle for which the bid is being
submitted. Bidders may submit separate bid bonds for each vehicle being bid upon OR may
submit one (1) bid bond equal to 10% of the combined total of all vehicle bids submitted.
B. The Board may reject any bid that does not conform to these requirements as non-
responsive.
9. TAX EXEMPTIONS
A. The City of South Bend is exempt from the payment of federal excise and transportation taxes
levied under the provision of the Internal Revenue Code. It is also exempt from the Indiana
20
State Gross Retail Tax (sales tax). The City will furnish the successful Bidder with any
certificate of exemption required.
10. WITHDRAWAL OF BIDS
A. Withdrawal of bids will be allowed only in those cases in which a written request to withdraw a
bid is received by the Board of Public Works prior to the date and hour for receiving and
opening bids. In such cases, the same will be returned to Bidder unopened.
11. ESCALATOR OR CONTINGENT CLAUSES
A. The use of escalator clauses or other contingent clauses by the Bidder is prohibited, unless
requested or permitted by the Invitation to Bid. No Proposal shall contain nor be
accompanied by any writing purporting to limit or qualify the City's right to accept such
Proposal or purporting to alter such Proposal or any Contract which may be executed
pursuant thereto.
12. PRICES MUST BE DELIVERED PRICES
A. The bid price shall be a delivered price. All materials shall be shipped F.O.B. destination as
specified in the Invitation to Bid. No fuel surcharges accepted.
13. AWARD — WAIVER OF TECHNICALITIES
A. The Award of Bid, if any award be made, will be made within sixty (60) calendar days after the
opening of Proposals to the lowest responsible and responsive Bidder who's Proposal
complies with all the requirements prescribed, exclusive of technicalities waived. Until the
final award of the Bid, however, the right is reserved by the City to reject any and all
Proposals and to waive technical errors.
14. SPLITTING OF AWARDS/DIVISIBLE BIDS
A. Bids will be awarded on the basis of the total dollar amount for all items in the Proposal unless
the bid is described by the City as a Divisible Bid. The City may award a Divisible Bid to the
lowest responsible and responsive Bidder for each item or class of items as indicated in the
bid documents.
15. BIDDER QUALIFICATION
A. The City may require any Bidder to submit evidence of qualifications, and may consider any
evidence of the financial, technical, and other qualifications and abilities of the Bidder. The
City will not award a Contract to a Bidder who, in its opinion, is not fully qualified on the basis
of financial resources and responsibility, possession of adequate equipment, personnel,
experience, and past record of performance to perform the obligations to be undertaken
competently and without delay.
16_ PURCHASE ORDERS
A. A Purchase Order will be issued to the successful Bidder after formal acceptance of the bid is
made by the City.
17. NEW MANUFACTURE
A. Unless otherwise specified in the Invitation to Bid, the items offered shall all be new and the
latest model of manufacture.
18. SOURCE OF SUPPLY
A. If the Bidder is not a manufacturer, the source of supply must be shown and all sub-
contractors must be identified.
19. PACKAGING
A. All items shall be delivered strongly packed and marked according to accepted commercial
practice unless otherwise directed in the Specifications. No charge shall be made for
containers and the City shall have no obligation to return containers unless otherwise
provided by the Specifications or Special Provisions. Any items not received in good
condition will be rejected.
20. INSPECTION OF GOODS
A. The City of South Bend reserves the right to inspect and have any goods tested after delivery
for compliance with the specifications. Notice of latent defects, which would make the item
21
unfit for the purposes for which they are required, may be given at any time within one year
after discovery of the defects.
B. All items rejected must be removed immediately by the Contractor at the expense of the
Contractor. If the Contractor fails or refuses to remove the rejected items, they may be sold
by the City of South Bend.
C. In some cases, at the discretion of the City, inspection of the commodities or equipment will
be made at the factory, plant, or other establishment where they are produced before
shipment.
D. The above provision shall not be construed in limitations of any rights the City may have
under any laws including the Uniform Commercial Code.
21. ASSIGNMENTS
A. No person to whom a Contract has been awarded may assign his interest in the Contract
without the consent, in writing, of the City.
22. CANCELLATION
A. The City of South Bend reserves the right to cancel any Contract for failure or refusal of
performance, fraud, deceit, misrepresentation, collusion, conspiracy, or any other misconduct
on the part of the Contractor.
23. DEDUCTION OF DAMAGES
A. If the City cancels the contract for any cause, it shall deduct from whatever is owed the
Contractor on the Contract or any other Contract, any amount sufficient to compensate the
City for any damages suffered by it because of the Contractor's wrongdoing.
24. METHOD OF INVOICING FOR PAYMENT
A. Contractor shall bill the City of South Bend
1. On regular invoice form giving a complete and detailed description of the goods delivered,
including purchase order number.
2. If the Contractor allows a discount, the period of time in which the City must make
payment to qualify for the discounts shall be computed from the date the City received the
invoice (completely filled out), or the date the goods are delivered and accepted,
whichever may be later, and shall not be less than twenty (20) days.
3. If more than one shipment is made under the Contract and on the same purchase order,
the City will make partial payments on a basis that is agreeable to both parties.
25. OWNERSHIP OF GOODS
A. The goods which are the subject of the Contract shall remain property of the Contractor until
delivered to and accepted by the City of South Bend.
26. ESTIMATED QUANTITIES
A. If the quantity set forth in the Notice to Bidders and Proposal is approximate and represents
the estimated requirements of the City for a specified period of time, the unit price and the
extended total price thereof shall be used only as a basis for the evaluation of bids. The
actual quantities necessary may be more or less than the estimate, but the City shall neither
be obligated nor limited to any specific amount. The City will, if at all possible, restrict
increases to twenty percent (20%) of the estimated quantity and will, if at all possible, restrict
decreases to twenty percent (20%) of the estimated quantity.
27. TERM "OR EQUAL"
A. Where the term "OR EQUAL" is used in these Specifications, the Bidder deviating from
specified item shall file with his/her bid a letter fully explaining and justifying his/her proposed
article or equal. The City of South Bend shall be the sole judge in determining if the "OR
EQUAL" offered meets the Specifications.
22
28. INDEMNIFICATION CLAUSE
A. The Contractor agrees to indemnify, defend, and hold harmless the City of South Bend, its
agents, officers, and employees from all costs, losses, claims and suits, including court costs,
attorney fees, and other expenses, arising from or out of the negligent performance of this
Contract by the Bidder or because or arising out of any defect in the goods, materials or
equipment supplied by the Bidder.
NOTE: Incoming mail does not reach the Board of Public Works until after 9:30 a.m. If
you are sending your bid via Federal Express or another overnight source, please
confirm that your package will arrive before the bid opening time and date.
23
�SpUTH BF�
O;
1316 COUNTY -CITY BUILDING .Q PHONE 574/235-9251
227 W.JEFFERSON BOULEVARD U O FAX 514/235-9171
SOUTH BEND, INDIANA 46601-1830 w a TDD 574/ 235-5567
s�
Y F
1865
CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBLIC WORKS
Date: July 8, 2016
To: All Bidders
From Linda M. Martin, Clerk, Board of Public Works
Subject Addendum Number: 1
Project Name: Spec AA — Two (2) More or Less 2016 or Newer Refurbished Medic Units
Project
Number:
ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM
Date Received:
This addendum is being forwarded to you for the above referenced project.
Please sign below and acknowledge receipt of this Addendum
by faxing this sheet to the Board of Public Works at (574) 235-9171
within 48 hours of receipt. A copy MUST also be included with your
bid package upon submittal.
THIS ADDENDUM MAY AFFECT YOUR BID.
Note:
The attached documents are hereby added to the Specifications and Contract
Documents and become a part of herein.
Company:
Authorized Si
Date: f�a� _
City of South Bend
Spec AA — Two (2) More or Less 2016 or Newer Refurbished Medic Units
for bids due July 26, 2016; 9:30 a.m., Local Time
ADDENDUM NO. 1
Date: July 8, 2016
To: All Plan Holders
From: Linda Martin, Clerk of the Board
You must acknowledge receipt of this addendum by signing the first page and returning a copy
with your bid.
The following information is to be added to the specifications:
On page 15, under Module Interior, please replace the specification with the paragraph below,
adding the highlighted copy.
Module Remove old floor covering material, replace with new YES O
Interior: Lonseal floor, Lonplate II — gunmetal #424. Replace all
vinyl with new EVS seamless vacuum formed, including
set bottoms, backrest cushions and trim. Color: Gunmetal.
New EVS 1880 hi back seamless, child safety seat with 3
point belting harness with new SB-2-2 position swivel
base. New stainless steel entry door thresholds includes
rear and side with safety grip tape. New stainless steel
lower module entry door panels (3). Provide and install a
new safety net at head of squad bench. Provide and install
new retaining net on ALS cabinet opening. Inspect all
cabinet walls, seats, cabinet hardware for missing screws
and rivets, adjust and replace as necessary. Provide and
install a Smithworks 12 volt IV warming plate. Vendor to
replace "Cot Antlers and Side Locking Bar Mechanism"
with the following cot fastening system.
Stryker Model #6392 unit to include the inductive
charging system. Due to compatibility issues with the City
of South Bends current Stryker Pro Cots no other fastening
systems will be considered.
END OF ADDENDUM NO. 1
SALES AGREEMENT
3800 McDowell Road Phone 517416-5888 Horton Emergency Vehicles is Pleased to offer
Grove Cry, Ohio 43123 Fax ( this Custom Vehicle Quotation for Your Consideration
asTxH E-mail bob.burgh@hodanambulancecom
DATE: 712612016
Contact Nam
EMS Chief Andy Myer
Company Name City of South Bend Fire Department
Street Address
1222 South michi an Street
Chy, ST ZIP
South Bend, Indiana 46601
Res Ph#
Call#
Ema{I: amyerasouthbendln.go,
Bus Ph# 674 236-7662
Fax#
STANDARD EQUIPMENT
see speafcations and Dmwinas tar Details
UNITTYPE
CHASSISI
BRAND
COLOR
MODEL
VIN
HORTONJOSNUMBER
GM
1
FRlnr
ton
Horton
Red
Means
I
TBD
EQUIPMENT
Base Una Cost:
E191,26T.00
Chassla Cast
$0.00
LINE ITEMI
QTY
I DESCRIPTION
UNIT PRICE
AMOUNT
SEE HORTON SPECIFICATION AND DRAWINGS FOR
STANDARD AND ADDITIONAL OPTIONS
OPTIONS:
1
0
Add Liquid Spdng Suspension
10,646.00
$0.00
2
0
Provide and Install 911 Seats In Cab
1,250.00
$0.00
9
$0.00
4
$0.00
6
$O.W
6
$0.00
7
$0.00
6
$0.00
9
So.00
10
$0.00
17
$0.01)
12
PER UNIT COST AS SPECIFIED
DELIVERY IS DEFINED AS 210 DAYS ARO FOR 1ST ARTICLE
SUBTOTAL
Make all checks payable to Horton Emergency Vehicles OPTIONS
If you have any questions, please feel free to contact us. TOTAL
THANK YOU FOR YOUR RUSINESSI
$191,267.00
E0.00
$t91,267.00
Payment to be made as follows:
100% DUE UPON DELIVERY
NOTE: All customers to register their vehicles with their respective local Department of Motor Vehicles
and pay applicable sales tax at that time.
WARRANTY:
MANUFACTURERS' LIMITED WARRANTY ON ALL EQUIPMENT, PARTS AND MATERIALS.
A. LABOR AND MATERIALS: Horton Ambulance shall furnish the Ambulance listed as specified, with Me price and delivery quoted herein, are
based on materials which were in our inventory and in the inventory of our suppliers at the time m this proposal and are subject to prior sale.
Delivery quotes are contingent on fimely confirmation him Customer Any variations to material listed will result in a cost change.
Change Order Fees may apply
B. ARBITRATION: If any controversy or dispute arises under, out of, or in relation to any "a provisions hereof which cannot be settled by
Me parties within 15 days after the same shall arise, such controversy or dispute shall be submitted for arbitration in the State of Ohio in
accordance with Me Mies Of Me American Ar omphi n Association Sn arblh'ator(s) in a=oO anee W sneh Mies shall
determine any dispute or controversy submitted to arbitration in accordance with Me provisions of Me section.
The arohnitions) may award any relief which he or she shall deem proper in Me circumstances, without regard to Me relief which
would otherwise be available to any party hereto in a coon M law or equity including, without limitation, an award of money damages, specific
performance, injunctive relief and/or declaratory relief. The aware and findings dfMe arbitrators shall be condushm and binding upon all Me
parries hereto, whether or not all pates hereto participate in the arbitration proceeding, and judgment upon Me award may be entered in any
court of competent jurisdiction upon Me application of any party.
Any party may in@ate an arbitration proceeding hereunder, all costs Of which (inducting filing fees, fees payable to impostors, court
reporters' fees, transcript costs and counsel fees) shall be recovered by the prevailing party. No party hereto shall commence any arbitration
proceeding hereunder other than in good faith, or take any action other than in good faith which requires another party hereto to commence
such arbitration hearing and, in Me event any party is determined in arbitration to have so acted other Man in good faith, he or it shall bear all
casts of Me such proceeding.
C. REPRESENTATION OF SOLVENCY: Buyer represents Mat buyer is solvent and has assets suficient to meet all M its finanaal obligations,
and that it is current an all offs financial obligations. Buyer fuller represents that it can and will meet all its financial obligations to seller on
time. Buyer understands seller relies on this promise and that any breach is material and substamial and to the essence of the contract.
D. FORCE MAJEURE Seller shall not be responsible for delay, nondelivery, failure to complete installation or construction, or default in
shipment or other performance, in whale or in part if occasioned by strike, war, not, or revolutions, or for any delay in transportation due to
demands or embargoes of the United States government or any other government, or nondelivery or delays through fire, foods, dmugms,
accidents, insurrections, lockouts, breakdown of machinery, commandeering of vessels carrying goads, or for lass or damage in transit, or
detention of or delay in vessels resulting directly or indirectly from ads of God, perils of the sea, stoppage d labor, shortage of tamers, or
refusal of any necessary license of government restrams considered as'Yorce majeues" or any other unavoidable cause other than sellers
own negligence. In no case shall seller be responsible after delivery d goods in good order or conditioning to Me center or carriers "a point
of shipment
E. CUSTOM ORDERS: Buyer understands Mat a custom -ordered vehicle is specific to Buyers needs. Any deposit received for a custom order
is non-refundable once Engineering has begun, material has been purchased or the vehicle begins production.
YOU MAY CONSIDER THE PRICE QUOTED FIRM FOR WRITTEN ACCEPTANCE WITHIN 30 DAYS OF THE DATE OF OUR PROPOSAL.
Thank you for your interest in having Horton Ambulance provide you with our quotation for this
purchase. Ifyou have any questions or comments regarding this sales agreement please contact us.
Sincerely,
Robert Burgh
Horton Ambulance
ACCEPTANCE OF PROPOSAL:
I have read, understand and agree to Me terms, conditions and specifcations described herein and
euthome Renegade Specialty Vehicles to go forward with this order.
By:
Signature of Customer
Date
lWlieu tine prospective Contractor is unable to certify to airy of the statements below, it shall attach all e-vnlnnntion to t/lis 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)
STATEOFIn i 0. )
) SS:
Sf� COUNTY )
The undersigned Contractor, being duly sworn upon his/leer/its oath, affirms tinder 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, fums, 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 Lid. Code § 5-22-16.5-5, as amended from
time -to -time.
b. As provided by Lid. Code § 5-22-16.5-8, as amended fiom 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
Non -Collusion Nun -Debarment Affidavit Non Iran Forth
the energy sector in h•an; 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 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 commmissions 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.
Non -Collusion Non -Debarment Affidavit Non Iran Form
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). I 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.
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 *2-1— day of.� Iy , 201j.
f-fge�gy "� ks
Contractor/Bidder Firm
SOLaContractor/Bidder or Its Agent
QhIL—NSM
Printed Name and Title
Subscribed and sworn to before me this e2s day _JLJ 20 ?o
My Commission Expires /y' ;— - I to ( A-[
-
Notary Public
County of Residence S;7,
♦ 9EAL *a* Fil,�e O riw
Non -Collusion Nan -Debarment Affidavit Non Iran Fomr
CERTIFICATE OF LIABILITY INSURANCE FDATE(MMDO/YY Y)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER./1
HIS
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
^'PRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
_,PORTANT: 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 LOckton Companies CONTACT
Three City Place Drive, Suite 900 PHONE
A/C No FAX
St. Louis MO 63141-7081 E-MAIL ac No
(314)432-0500 ADDRESS:
INSURERS AFFORDING COVERAGE NAIL9
INSURER A: First S ecial Insurance Co oration 34916
INSURED Horton Enterprises, Inc. INSURER B:
1330397 Halcore Group Inc., Leader Industries 5 2
INSURER C:AXIS SMIplus Insurance COmpart 26620
Horton Emergency Vehicles p
American Emergency Vehicles INSURER D: Travelers Pro eity Casualty Co of America 25674
3800 McDowell Road INSURER E: The Charter Oak FITe Insurance Company 25615
INSURER F: North American Specialty Insurance Co 29874
COVERAGES HOREN60 CFRTIFTCATC MI uaoeo.
iU»U•eUI REVISION NUMBER: XXXXXXX
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 TFRMS
EXCLUSIONS AND CONDITIONS nP BI Iru Dni irH=c ,
INSR
- ---... __._.--.
ADD
SUBS
�•••",� ��..�. �.n., nr.v� Doery
neuuctu BY
PAID CLAIMS,
LTR
TYPE OF INSURANCE IN
D D
POLICY NUMBER
POLICY EFF
MM/DD
POLICY IXP
A
X COMMERCIAL GENERAL LIABILITY
Won LIMITSN
CLAIMS -MADE OCCUR
IAI
N
IRG2001384-01
7/1/2014
7/I/2015 EA HO R 000
AG
PREMSES(Ezt occurrence) $ 300000
MED EXP An one em.n $ 0 00
PERSONAL 8 ADV INJURY $ 1,000,000
GEN'L AGGREGATE DMITAPPLIES PER:
X POLICY ❑ JE � ❑ LOG
GENERAL AGGREGATE $ 40 O O
PRODUCTS-COMP/OPAGG $ 400 O
OTHER:
AUTOMOBILE LIABILITY N
N
Y8I04052R029P1-IX14
7/1/2014
b
7/I/2015
X ANYAUTO
(Ea accitlent) $ 1 00 00
ALL OWNED SCHEDULED
BODILY INJURY (Per mrson) $ XXxxxxX
AUTOS
NON -OWNED
BODILY INJURY Per accident $ }�'
HIRED AUTOS AUTOS
PROPERTY DAMAGE $ ]IXXXXXX
X Gam e Kee s*
Comp/Coll Ded s 1,000
C UMBRELLA LIAR X OCCUR N
F
N
EAU781897012014
7/I/2014
7/1/2015 EACH OCCURRENCE $ 5000000
X EXCESS LIAR CLAIMS -MADE
EXS200016500
7/I/2014
7/1/2015
AGGREGATE $ 0 0 00
DED RETENTIONS
E cessLiar.
WORKERS COMPENSATION E
$ 2 0 0
AND EMPLOYERS'LIABILITY YINN
TC20-UB-118D4882-14
7/I/2014
7/I/20I5 X STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDEDP �N/A
E.L. EACHACCIDENT $ 1000000
(Mandatory in NH)
Ifyes, describe under
E.L.DISEASE-EAEMPLOYE $ 1000000
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT $ 1,000,000
D PROPERTY
N
N
KTJ-CMB-4072-R69-2-14
7/1/2014
7/1/2015 $150,000,OOO Blanket Property Limit
Replacement CosUAgreed Value
deductible
DESCRIPTION OF OPERATIONS, nrennue ..muv., .. ..............
Additional
THIS CERTIFICATE CONFERS NO ADDITIONAL INSURED RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE IS PROVIDED FOR
INFORMATIONAL PURPOSES ONLY.
10936407
HORTON EMERGENCY VEHICLES
3800 MCDOWELL ROAD
GROVE CITY OH 43123
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ACnRn 95 MMer011
'.� ••.�•••= o••... V, ara 1egrsreMC1 MarKS OTAGURD
reserved.