HomeMy WebLinkAboutBid Packet,JAMES BRAINARD, MAYOR
LETTER OF TRANSMITTAL
Date: April 7, 2016
To: Jacob Quinn
Clerk Treasurers Office
From: Jeremy Kashman
City Engineer
Dept. of Engineering
RE: Bid Packets for Project #16 -SW -02 Emerson Road Storm Sewer
Reconstruction
Jacob, enclosed please find four (4) bids for Project #16 -SW -02 Emerson Road
Storm Sewer Reconstruction. Lowest bidder is first.
Contractor Bid
Yardberry Landscape $1,373,532.00
Atlas Excavating $1,638,426.00
Crider & Crider $1,659,000.00
Morphey Construction $1,938,294.00
Eagle Valley, Inc. $1,969,875.00
DEPARTMENT OF ENGINEERING
ONE CIVIC SQUARE, CARMEL, IN 46032 OFFICE 317.571.2441 FAX 317.571.2439
EMAIL engineering@carmel.in.gov
To Mr. Jeremy Kashman, P.E.
City of Carmel Engineering
One Civic Square
Carmel, IN 46032
WE ARE SENDING YOU
Attached
_ Shop _
Drawings
_ Copy of _
Letter
CROSSROAD ENGINEERS, P.C.
3417 S. Sherman Drive
Beech Grove, IN 46107
Phone: 317-780-1555
Fax: 317-780-6525
LETTER OF TRANSMITTAL
Date:
Project:
April 8, 2016
Emerson Road Storm
Sewer Reconstruction &
Carmel View Drainage
Prints Samples Specifications
Change Order
Copies:
Date: Description:
1
4-6-2016 Emerson Road Storm Sewer Reconstruction Original Bids
1
4-6-2016 Carmel View Drainage Improvements Original Bids
THEY ARE TRANSMITTED AS CHECKED BELOW:
For Approval Approved as submitted _ Resubmit _ blueline sets w/binder
X For your use Approved as noted Resubmit _ Xerox sets w/binder
X As requested Returned for corrections Return corrected prints
For bids due 20
Remarks: please acknowledge the receipt of these materials by signing below.
Transmitted
A'�bk'�
Received
BID PROPOSAL SUMMARY PAGE
Complete the following. iriformation and place as the cover page to
your bid packet.. Insert all documents into an envelope with project
name and your company name clearly marked on the outside. Seal
the envelope.
Company:
Project Name:
o S -A -b rSewerc
Date Submitted:
Base Bid
Amount:
Local Preference Law
I am claiming Local Preference (Circle One) YES ONO
(All required documentation will be required in.a post -bid submittal)
PART 3
CONTRACT ITEMS AND UNIT PRICES
[This Part to be used only for Bidding on
Unit Price Contracts for the Contract Items shown]
Base Bid Itemized Proposal
16-02 Emerson Road Storm Sewer Reconstruction
STORM SEWER
Item #
Item
Quantity
Unit
Unit Cost
Total Cost
1
Mobilization / Demobilization, Storm
Sewer
1
LS
y 5 06, a�
L45 OW, GE)
2
Maintenance of Traffic, Storm Sewer
1
LS
Zy °92t
27. poo, o')
3
Clearing Right of Way, Storm Sewer
1
LS
7-0
ac) opo. 00
4
Curb Removal and Replacement,
Storm Sewer
250
LFT
oa
q0
p .00
5
Sidewalk Remove and Replace, Storm
Sewer
35
SYS
�-�mo
ga�S,(D
6
Curb Ramp Remove and Replace,
Storm Sewer
21
SYS
2 Som'
5a5a op
7
Sign, Remove and Reset
4
EA
00 00
y 00. QD
8
Fence, Remove and Reset
72
LFT
Zo 00
y(). DD
9
Remove and Reset, 3" Caliper Tree
437 Emerson Rd.
1
EA
00
35-0
10
PCCP for Drive Patching - 6"
170
SYS
(jc OQ
11
Concrete Cap for Street Cut Repair -
12", Storm Sewer
320
SYS
77 ��
;A uLfacb
12
Flowable Fill for Street Cut Repair,
Storm Sewer
325
CYS
0.0
l00
Cppp
13
HMA Surface, 9.5 mm, 1.5", Storm
Sewer
50
TON
00
/70
. 00
14
HMA Intermediate, 19.0 mm, 2.5",
Storm Sewer
10
TON
/00040
L
15
Compacted Aggregate, No. 53 Stone
147
TON
7-600
0
16
Compacted Aggregate for Driveways
20
TON
3000
po
17
8" PVC
26
LFT
7-5 Q 4
b• o
18
12" RCP
939
LFT
o ��
U5. -73t>. Olb
19
15" RCP
414
LFT
')S `'
3o RDA oa
20
24" RCP
221
LFT
gs
1�5. a0
21
30" RCP
523
LFT
% f -cSa
C2b''3.60
22
36" RCP
607
LFT
'Z6 -
N), 00
23
Inlet, T e 'J'/'M'
14
EA
21500
3 u0. OD
24
Inlet, T e 'E'
2
EA
7,5-00 • •
Q.00 (50
25
Inlet, T e 'B'/'C'
2
EA
2 4f Oo
26
Manhole, T e 'C'
16
EA
?j Zoo ° °
15) �p,op
27
Manhole, T e 'J'
11
EA
Soo ° °qj.
goo, OD
28
Manhole, T e 'K'
4
EA
(p coop °
a 00
29
Manhole, T e 'K, Doghouse
1
EA
Coca o°
o
5c�D
30
Stormwater Quality Unit
1
EA
f800°0
35 &b,bb
31
Underground Detention System
1
LS
32
Mechanically Core Existing Structure
Storm
2
EA
,b
.2SOO
33
Structure Backfill for Storm Sewer
3544
CYS
26, "'0
mot,
34
Topsoil undistributed
762
CYS
41S'0 0
3 qb. oa
35
Mulched Seeding, Storm Sewer
4571
SYS
Z Co
ply
36
EC Measures
1
LS
to/ °O0 .,
loluW.oD
37
Flowable Fill for Existing Storm
Sewer
40
CYS
/ Coo
l.� Lko.00
38
Cap Existing Pipe, Storm Sewer
14
EA
.30000
39
36" Red Valve CheckMate Slip -In
Tideflex Inline Check Valve
1
EA
oa
p4O
3 cOD• ba
40
Existing Building Demolition
1
LS
gO pQO
Storm Sewer Subtotal
11 D 56vc
SANITARY SEWER
41
Mobilization / Demobilization,
Sanitary Sewer
1
LS
�O O
C)j 00O
42
Maintenance of Traffic, Sanitary
Sewer
1
LS
1o9
3 000
3 to
43
Clearing Right of Way, Sanitary
Sewer
1
LS
o 0
/d o00
1 0. ()D
44
Curb Removal and Replacement,yO
SanitarySewer
80
LFT
o o
o�
45
Sidewalk Remove and Replace,o
SanitarySewer
4
SYS
0
to
46
Curb Ramp Remove and Replace,
SanitarySewer
14
SYS
Z
47
Concrete Cap for Street Cut Repair -
12", SanitarySewer
350
SYS
0 0
.?7
0� �Q� . D1)
48
Flowable Fill for Street Cut Repair,
Sanitary Sewer
752
CYS
�o
Ila
ru,
49
HMA Surface, 9.5 mm, 1.5", Sanitary
Sewer
30
TON
ZG�
pp, 6-0
50
Sanitary Manhole, Type 1
1
EA
0-100 DD
51
Sanitary Manhole, Doghouse
1
EA
-j96DZD
52
15" SDR 26 Sanitary Sewer (12'- 14',
including backfill)
419
LFT
a9
5 Cj�a•o�
53
Mechanically Core Existing Structure,
Sanitary
1
EA
���"
�Q CA
54
Cap Existing Pie
1
EA
3000
30o,oa
Sanitary Sewer Subtotal
Total Itemized Proposal
373 53a, eO
BID -6
r
BIDDER'S ITEMIZED PROPOSAL
AND DECLARATIONS
City'of Carmel
Instructions To Bidders:
This form shall be utilized by all Bidders. Except as otherwise specifically provided, all Parts
shall be fully and accurately f lled in and completed and notarized.
Project: Emerson Road Storm Sewer Reconstruction
Project #16-02
Proposal For Construction of : The construction of •2,664 feet of proposed. storm sewer
along Emerson Road, York Drive, and Park Lane, including
asphalt and concrete drive approach replacement, and street
patching for storm crossings, removal and .replacement of
existing curb, sidewalk, and curb ramps, removal of existing
pipe and storm structures, and existing pipe capping and
filling. Also, the installation of a mechanical stormwater
treatment unit and underground detention system at the
downstream . outlet- of the proposed storm sewer
reconstruction. Alsdincluded within the project will be 419
LFT of 15 -inch sanitary sewer relocation within Yd Ave.
SW.
Date: a_Wb
To: City of Carmel, Indiana, Board of Public Works and Safety
PART 1
BIDDER INFORMATION
(Print).
Lav -A5'
1.1 Bidder Name:
.:
1.2 Bidder Address: Street Address:�RyCao N)
City: State: Zip: CQ�I
Phonelb J-6'�2 5-"7 d 3 Fax:
1.3 Bidder is a/an [mark one]
Individual Partnership
Foreign (Out.of State) Corporation; State:
Joint Venture Other
1.4
Indiana Corporation .
[The following must be. answered if the Bidder or any of its partners or joint venture
parties is a foreign corporation. Note: To do business in oi with the City of Carmel,
Indiana, foreign. corporations must register with the Secretary. of the State of Indiana as
required by the Indiana General Corporation Act as stated therein and expressed in the
Attorney General's Opinion #2 dated January 23,,I 1,9,58.]!
1 Corporation Name:
.2 Address: GggD rc 1,000 Ar-0&�, P v q(,,2D17
.3 Date registered with State of Indiana: l
.4 Indiana Registered Agent:
Name:
Address:
M
. PART 2
BID PROPOSAL
2.1 Base Bid
The undersigned Bidder proposes to . furnish all necessary labor, machinery, tools,
apparatus, materials, equipment, service and other necessary supplies, and to perform and
fulfill all obligations incident thereto in strict accordance with and within the time(s)
provided by the terms and conditions of the Contract Documents for the above described
Work and Project, including any and all addenda thereto, for the Unit Prices applicable to
the Contract Items as stated in Part 3 hereof (Itemized Proposal), which Unit Prices, when
multiplied by estimated unit quantities for such Contract Items, total
Dollars ($ 4 3 )3r S32° ).
2.3 The .Bidder acknowledges that evaluation of the lowest Bid shall be based on such price
and further acknowledges that the unit quantities listed in Part 3 of this Proposal are
estimates solely for the purpose of Bid evaluation and Contract award, and are not to be
construed as exact or binding. The Bidder also understands'' that all Work which may
result on the Contract shall be compensated for on a Unit Price basis and that the
OWNER and ENGINEER cannot and do not guarantee the amount. or quantity of any
item of Work to be performed or furnished under the Contract. The Bidder further
understands that a Contract will be awarded by evaluating the Base Bid if the Owner
wishes to execute.
Y ?
PART 4
CONTRACT DOCUMENTS AND ADDENDA
4.1 The Bidder agrees to be bound by the terms and provisions of all Contract Documents as
defined in the Standard General Conditions and incorporates such Contract Documents
herein by reference.
4.2 The Bidder acknowledges receipt of the following addenda:
ADDENDUM NUMBER' DATE
I
PART 5
EXCEPTIONS
Instructions To Bidders:
5.1 The Bidder shall fully state each exception taken to the Specifications or other Contract
Documents in Section 5.3 of this Part.
5.2 Bidder is cautioned that any exception. taken by Bidder and deemed by OWNER to be a
material qualification or variance. from the terms of the Contract Documents may result
in this Bid being rejected as non-responsive.
5.3 Exceptions:
BID -8
FART 6
FINANCIAL STATEMENT
6.1 Attachment of Bidder's financial statement is mandatory. 1iy Bid submitted without
said financial statement as required by statute shall thereby be rendered invalid.. The
financial statement provided hereunder to OWNER must be specific enough in detail so
that OWNER can. make a proper determination of the Bidder's capability -for completing
the Work/Project if awarded. Information on Bidder's company and financial statement
shall be consistent with the information requested on the State Board of Accounts Forms
#96a and # 102, entitled "Standard Questionnaires and Financial Statement for Bidders".
i
BID -9
l
PART 7
ADDITIONAL DECLARATIONS
7.1 Bidder certifies for itself and all its subcontractors compliance with all existing laws of
the United States and the State of .Indiana prohibiting the discrimination against any
employee or applicant for employment or subcontract work in the performance of the
Work contemplated by the Agreement with respect to hire, tenure, terms, conditions, or
.privileges of employment or any matter directly or indirectly related to employment or.
subcontracting because of race, religion, color, sex, handicap, national origin, ancestry,
age, disabled veteran status- or Vietnam era veteran status. The City of Carmel reserves
the right to collect a penalty as provided in IC 5-16-6-1 for any person discriminated
against.
7.2 The Bidder certifies that he/she has thoroughly examined the site of the Project/Work and
informed himself/herself fully regarding all conditions under which he/she will be
obligated to operate and that in any way affect the Work, and knows, understands. and.
accepts the existing conditions. The Bidder further certifies that he/she has thoroughly
reviewed. the Contract Documents, including all Addenda, and has had the opportunity to
ask questions and obtain interpretations or clarifications concerning Contract Documents.
BID -10
. PART 8
NON -COLLUSION 'AFFIDAVIT
The individual person(s) executing this Bid Proposal, being first duly sworn, depose(s) and
state(s) that the Bidder has not directly or indirectly entered into a combination, collusion,.
undertaking or agreement with any other Bidder or person (i) relative to the price(s) proposed
herein or to be bid by another person, or (ii) to prevent any person from bidding, or (iii) to induce
a person to refrain from Bidding; and furthermore, this Bid Proposal is made and submitted
without reference to any other bids and without agreement, understanding or combination, either
directly or indirectly, with any persons with reference to such bidding in any way or manner
whatsoever.
PART. 9
SIGNATURES
[Signature by or on behalf of the Bidder in the spaces provided below shall constitute execution
of each and every Part of this Itemized Proposal.and Declarations Document. SIGNATURE
MUST BE PROPERLY-NOTARIZED.J
Bidders Name Y&
Written Signature:
Printed Name: G
Title: �W"/-
IN
Important - Notaty Signature and Seal Required in the Space Below
STATE OF in-
NOTMY
REE
SS:
SM
MADISON roUNT"X STATE. OF.MIDIANA
COUNTY OF ! �/ MY COMMISSION EXPIRES NOVEMBER 08, 2821
COMMISSION No 64WM
Subscribed and sworn to before me this �. /day of I GLVCA---.l
20
My commission expires:
Residing in
(Signed) /
Printed:��
County, State of
azQ
BID -11
J
POST BID SUBIVHTTAL
SEE ITB SECTION 6.4
MANUFACTURERS LIST
Instructions To Bidders:
The Bidder shall enter, in the spaces provided below; the name of the manufacturer of.
equipment that the Bidder proposes to furnish for each item -of equipment listed in the
Manufacturers List, which follows. The Bidder shall enter the name of only one
manufacturer for each listed equipment item. Failure to enter a manufacturer's name for
each listed equipment item may render the Bid non-responsive if it is determined that
such omission is material by affording -the Bidder a substantial advantage over other
Bidders.
Upon award of a contract, each listed equipment item shall be furnished- by the named
manufacturer, unless. changes are specifically authorized. Equipment substitutions will be
permitted only with the OWNER'Sprior consent.
Preliminary acceptance of equipment listed by .the manufacturer's name shall not in any
way constitute a . waiver of the Drawing and Specification requirements covering such
equipment. Acceptance will be based on full conformity with the Drawings and
Specifications covering the equipment.
Equipment Item (Contract Items)
Vim' F;1�1a,
POSTBID-i
Manufacturer
POST BID SUBMITTAL
SEE SECTIONS ITB 6.5
SUBCONTRACTORS LIST
Instructions To Bidders:
The Bidder shall enter the names and the type of work to be done in the Subcontractors
List which follows for each Subcontractor that the Bidder proposes to use for the Work
who will be providing work for an agreed price of five percent (S%) or greater of the
amount Bid as stated above in Part 2.
Only one Subcontractor shall be listed for each work item. Vpon award of a contract, the
named Subcontractors shall be employed to perform the work, unless changes . are
specifically authorized by the OWNER. Failure to furnish all information requested may
render . the Bid non-responsive if it is determined that such omission' is material by
affording the Bidder a substantial advantage over other Bidders.
Except as otherwise specifically stated by. the Bidder in this Part, omission of any names
of Subcontractors herein shall constitute an affirmative representation and statement that
the Bidder proposes to use his own work forces for most of .the Work such that he will
have no Subcontractors providing work in the amount of five percent (5%) or greater of
the amount Bid.
Subcontractor Name Work price
CT I fdDo —
0
(use additional sheets if necessary)
POSTBID-2
BID BOND
City of Carmel
Instructions To Bidders
Bidders may use this form or other form containing the same material conditions and provisions as
approved in advance by OWNER/Obligee. .
Bidder/Surety must attach a signed, certified and effective dated copy of the Power of Attorney or
Attorney -In -Fact establishing the authority of the person(s) signing this Bid Bond on behalf of the Surety.
Surety Company executing this bond shall. appear. on the most current list of "Surety Companies
Acceptable on Federal Bonds, " as specified in the US.. Treasury Department Circular 570, as amended,
and be authorized to transact business in the State of Indiana.
KNOW ALL MEN BY THESE PRESENTS, that the undersigned
"Bidder':
and
"Surety": [Name]
[Address]
a corporation chartered and existing under the laws of the State of
and authorized to do . business in the State of
Indiana;
are held and firmly bound unto the City of Carmel, Indiana ("Oblige") in the full and just sum equal to ten
percent (10%) of the price stated in the Bid Proposal described in Part 2, including accepted alternates, if
any, to be paid upon demand of the Oblige, together with interest at the maximum legal rate from date of
demand and any attorney fees and court costs incurred by Oblige to enforce this instrument, to which
payment well and truly to be made we bind ourselves, our heirs, executors, administrators, successors,.
and assigns, jointly and severally and firmly by these presents. Ten percent (10%) of the price stated in
the Bid Proposal is $
WHEREAS, the Obligee has solicited Bids for certain Work for or in fizrtherance of construction of
public improvements described generally as
Emerson Road Storm Sewer Reconstruction
Project #16-02
The construction of 2,664 feet of proposed storm sewer along Emerson Road, York Drive, and
Park Lane, including asphalt and concrete. drive approach replacement, and street patching
for storm crossings, removal and replacement of existing curb, sidewalk, and curb ramps,
removal of existing pipe and storm structures, and existing pipe capping and filling. Also, the
installation of a mechanical stormwater treatment unit and underground detention system at
the downstream outlet of the proposed storm sewer reconstruction. Also included within the
project will be 419 LFT of IS -inch sanitary sewer relocation within 31 Ave. SW.
pursuant to plans, specifications and other `.`Contract Documents" included as. parts of and designated by
such solicitation; and
WHEREAS, the Bidder has submitted to the Obligee a Bid Proposal to perform such Work.
NOW THEREFORE: The conditions of this obligation are such that if the Bid Proposal be accepted,
with or without conditions, the Bidder shall within such time thereafter as prescribed by the Contract
Documents (i) fulfill all conditions of such award that remain to be fulfilled, (ii) execute a Contract in
accordance with the Bid Proposal and in the form and manner required by the Contract Documents, and
(iii) thereafter provide all bonds, and other Documentation required by the Contract Documents to be
delivered to Obligee prior to commencing Work, including without limitatio:3 a sufficient and satisfactory
Performance Bond and Payment Bond payable to Obligee, each in an amount of one hundred percent
(100%) of the total Contract price. as awarded and in form and with surety satisfactory to said Obligee,
then this obligation to be void; otherwise to be and remain in full force and virtue in law,' -and the Surety
shall, upon failure of the Bidder to comply with any or all of the foregoing requirements within the time
specified above and as prescribed by the Contract Documents, immediately pay to the Obligee, upon
demand, the amount hereof, in good and lawful money of the United States of America, not as a penalty,
but as liquidated damages.
IN TESTIMONY THEREOF, the Bidder and Surety have caused this instrument to be duly signed and
sealed this day of ; 20 . .
This Bid Bond shall bind the undersigned Surety whether or not also signed by the Bidder.
"Bidder" "Surety"
By: By:
Printed: Printed:
Countersigned:
Irk
1
MAINTENANCE BOND
City of Carmel
Instructions:
Successful Bidder must use this form or other form containing the same material conditions and
provisions as approved in. advance by OWNER.
Date of Bond must not be prior. to date of Contract. If CONTRACTOR 'is` a Partnership, all partners
should execute bond.
Surety company executing this bond shall appear on the. most, current list of "Surety Companies
Acceptable on Federal Bonds, " as specified in the U.S. Treasury Department Circular 570, as amended,
and be authorized to transact business in the State of Indiana.
KNOW ALL MEN BY THESE PRESENTS: that
"CONTRACTOR":
and
"Surety": [Name]
[Address] ,
a corporation_ chartered and existing under the laws of the State of
and authorized to do business in the State of
Indiana;
are held and firmly bound unto the City of Carmel, Indiana hereinafter called OWNER, in the penal sum
of Dollars, ($ ) in lawful money of the.
United States, for the payment of which sum well and truly- to. be made, together with interest at the
maximum legal rate from date of demand and any attorney fees and court costs incurred by Obligee to
enforce this instrument, we bind ourselves, successors; and assigns, jointly and severally, firmly by these
presents.
WHEREAS, the CONTRACTOR has entered into a certain Agreement with the OWNER, dated as of the
day of , 2.0 , by which CONTRACTOR has agreed to perform and
furnish certain Work for or in furtherance of construction of public improvements described generally as
Emerson Road Storm Sewer Reconstruction
Project #16-02
The construction of 2,664 feet of proposed storm sewer along Emerson Road, York Drive, and
Park Lane, including asphalt and concrete drive approach replacement, and street patching
for storm crossings, removal and replacement of existing. curb; sidewalk, and curb ramps,
removal of existing pipe and storm structures, and existing pipe capping and filling. Also, the
installation of a mechanical stormwater treatment unit and underground detention system at
the downstream outlet of the proposed storm sewer reconstruction. Also included within the
project will be 419 LFT of I5 -inch sanitary sewer relocation within 3rd Ave. SW.
which Agreement, and the "Contract Documents" as referred to therein, are hereby incorporated herein by
reference;
WHEREAS, CONTRACTOR has installed and completed and met all improvements, installations and
requirements applicable to the above described Work, but said improvements and installations have not
yei been accepted for public maintenance; and
WHEREAS, the OWNER requires a guarantee from the CONTRACTOR, against defective materials and
workmanship in connection with such maintenance.
NOW, THEREFORE, CONTRACTOR warrants the workmanship and all materials used in the
construction, installation and completion of said Work, including all improvements and installations
thereof, to be of good quality and constructed and completed in a workmanlike manner in accordance
with the Agreement and Contract Documents and all local, state `and federal laws, ordinances, rules,
standards and regulations applicable to said Work;
FURTHERMORE, the conditions of the Surety's obligation hereunder are such that if CONTRACTOR at .
his own expense, for a period'of three (3) years after said Work, improvements and. installations are
accepted for public maintenance by the OWNER, shall make all repairs or replacements thereto which
may become necessary by reason of improper or defective workmanship or materials, or any failure
thereof to conform to the provisions of the Agreement or Contract Documents, then Surety's obligation is
C
to be null and void; otherwise such obligation shall remain in full force and effect. Any repairs or
replacements made under this bond shall in like manner be subject to the terms and conditions hereof.
CONTRACTOR and Surety covenant that all action required by law to be taken by them to authorize the
execution and delivery of this bond have been previously taken, that the officers whose signatures appear
below have been fully empowered to execute and deliver this instrument and that once executed and
delivered, it shall represent the lawful and binding obligation of the parties.
IN WITNESS WHEREOF, this instrument is executed in (number) counterparts, each one of.
which shall be deemed an original, this the day, of 220
CONTRACTOR: [name]
By: .
[signature] [printed name]
ATTEST:
[signature]
SURETY: [name]
[signature]
[printed name]
Secretary
Attorney-in-fact
[address]
M
.!
PAYMENT .BOND
City of Carmel
Instructions:
Successful Bidder must use this form or other form containing the same material conditions and
provisions as approved in advance by OWNER.
Date of Bond must not be prior to date. of Contract. If CONTRACTOR is a Partnership, all partners
should execute bond.
Surety company executing this bond shall appear on the most current list of "Surety Companies
Acceptable on Federal Bonds, " as specified in the U.S. Treasury Department Circular 570, as amended,
and be authorized to transact business in the State oflndiana.
KNOW ALL MEN BY THESE PRESENTS:. that
"CONTRACTOR":
and
"Surety": [Name]
[Address]
a corporation chartered and existing under the laws of the State of
and authorized to do business in the State of
Indiana,
are held and firmly bound unto the City of Carmel, Indiana hereinafter.called OWNER, in the penal sum
of Dollars, ($ ) in lawful money of the
United States, for the payment of which sum well. and truly to be made, plus interest at the maximum
legal rate from date of demand and any attorney fees and court costs incurred by Obligee to enforce this
instrument, we bind ourselves, successors, and assigns, jointly and severally, firmly by these presents.
WHEREAS, the CONTRACTOR has entered into a certain Agreement with the OWNER, dated as of the
day of , 20 , by which CONTRACTOR has agreed to perform and
furnish certain Work for or in furtherance of construction of public improvements described generally as
Emerson Road Storm Sewer Reconstruction
Project #16-02
The construction of 2,664 feet of proposed storm sewer along Emerson Road, York Drive, and
Park Lane, including asphalt and concrete drive approach. replacement, and street patching
for storm crossings, removal and replacement of, existing curb, sidewalk, and curb ramps,
removal of existing pipe and storm structures, and existing pipe capping and filling. Also, the
installation of a mechanical stormwater treatment unit and underground detention system at'
PB4
A
the downstream outlet of the proposed storm. sewer reconstruction. Also included within the
project will be 419 LFT of 15 -inch sanitary sewer relocation within 3rd Ave. SW.
which Agreement, and the "Contract Documents" as referred to therein, are hereby incorporated herein by
reference;
NOW, THEREFORE, the conditions of this obligation are such that if the CONTRACTOR shall
promptly make payments of all amounts due to all Claimants, then this obligation shall be void; otherwise
to remain in full force and effect. "Claimant" shall mean any Subcontractor, material supplier or other
person, firm, or corporation furnishing materials or equipment for or performing labor or services in the
prosecution'of the Work provided for in such Agreement, including lubricants, oil, gasoline, coal and
coke, repairs on machinery, and tools, whether consumed or used in connection with the construction of
such work, and all insurance premiums on said work, and for all labor, performed in such work.
PROVIDED, FURTHER, that the said Surety, .for value received, hereby stipulates and agrees:
1. that no defect or irregularity in the contract or in the proceedings preliminary to the letting of the
Agreement will operate to release or discharge Surety;
2. that no change, omission, extension of time, alteration or addition to the terms of the Agreement,
Contract Documents or to any Work to be furnished thereunder, and no delay by the OWNER in
enforcement of the Agreement or this bond shall in any way affect its obligation on this bond, and
it does hereby waive notice of any such change, extension of time, alteration or addition to the
terms of the Agreement, Contract Documents or to. the Work;
that no final settlement between the OWNER and the CONTRACTOR shall abridge any right of
the OWNER hereunder as to any claim that may remain unsatisfied; and
4. that this Payment Bond and Surety shall not be released until one'(1) year after the OWNER's
final settlement with the CONTRACTOR.
IN WITNESS WHEREOF, this instrument is executed in (number) counterparts, each one of
which shall be deemed an original,' this the day of 320
CONTRACTOR: [name]
By:
[signature]
ATTEST:
[signature]
SURETY: [name]
[signature]
[printed name]
Secretary
Attorney-in-fact
[printed name] [address]
PFB-2
PERFORMANCE BOND
City of Carmel
Instructions:
Successful Bidder must use this form -or other form containing the same material conditions and
provisions as approved in advance by OWNER.
Date of Bond must not be prior to date of Contract. If CONTRACTOR is a Partnership, all partners
should execute bond.
Surety company executing this bond. shall appear on the most current list of "Surety Companies
Acceptable on Federal Bonds, " as specified in the U.S. Treasury Department Circular 570, as amended,
and be authorized to transact business in the State of Indiana.
KNOW ALL MEN BY THESE PRESENTS: that
"CONTRACTOR":
and.
"Surety": [Name]
[Address]
a corporation chartered and existing under the laws of the State of
and authorized to do business in the State of
Indiana,
are held and. firmly bound unto the City of Carmel, Indiana hereinafter called OWNER, in the penal sum
of Dollars, ($ ) in lawful money of the
United States, for the payment of which sum well and truly to be made, together with interest at the
maximum legal rate from date of demand and 'any attorney fees and court costs incurred by Obligee to
enforce this instrument, we bind ourselves, successors, and assigns, jointly and severally, firmly by these
presents.
WHEREAS, the CONTRACTOR has entered into a certain Agreement with the OWNER, dated as of the
day of , 20 , by which CONTRACTOR has agreed to perform and
furnish certain Work for or in furtherance of construction of public improvements described generally as
Emerson Road Storm Sewer Reconstruction
Project #16-02
The construction of 2,664 feet of proposed storm sewer along Emerson Road, York Drive, and
Park Lane, including asphalt and concrete drive approach replacement, and street patching
for storm crossings, removal and replacement of existing curb, sidewalk, and curb ramps,
removal of existing pipe and storm structures, and existing pipe capping and filling. Also, the
installation of a mechanical stormwater treatment unit and underground detention system at
PFB-2
to
the downstream outlet of the proposed storm sewer reconstruction. Also included within the
project will be 419 LFT of 15 -inch sanitary sewer relocation within 3rd Ave. SW.
which Agreement, and the "Contract Documents" as referred to therein, are hereby incorporated herein by
reference;
NOW, THEREFORE, the conditions of this obligation are such that if the CONTRACTOR shall well,
truly and faithfully. perform his duties, all the undertakings, covenants, terms and conditions of said
Agreement whether during the original term thereof, and any extensions thereof which may be granted by
the OWNER, with or without notice to the Surety and during any period of guaranty or warranty provided
therein or arising there under, and if CONTRACTOR shall satisfy all claims and demands incurred under
such Contract, and shall fully indemnify and save harmless the OWNER from all costs and damages
which he may suffer by reason of failure to do so, and shall reimburse and repay the OWNER all outlay
and expense which the OWNER may incur in making good any default, then this obligation shall be void;.
otherwise to remain in full force and effect.
PROVIDED, FURTHER, that the said Surety, for value received, hereby stipulates and agrees:
that no defect or irregularity in, the Contract or in the proceedings preliminary to the letting of the
Contract will operate to release or discharge Surety;
2. that no change, omission, extension of time, alteration or addition to the terms of the Agreement,
Contract Documents or to any Work to be furnished thereunder; and no delay by the OWNER in
enforcement of the Agreement or this bond shall in any way affect its obligation on this bond, and
it does hereby waive notice of any such change, _ extension of time, alteration or addition to the
terms of the Agreement, Contract Documents or to the Work;
that no final settlement between the OWNER and the CONTRACTOR shall abridge any right of
the OWNER hereunder as to anyclaim that may remain unsatisfied; and
that this Performance Bond and Surety shall not be released until one (1) year after the OWNER'S final
settlement with the CONTRACTOR.
IN WITNESS WHEREOF, this instrument is executed in (number) counterparts, each one of
which shall be deemed an original, this the day of , 20
CONTRACTOR: [name]
By:
[signature]
ATTEST:
[signature]
SURETY: .. [name] .
[signature]
[printed name]
Secretary
Attorney-in-faot
[printed name] [address] .
PFB-2
1 Engineering Department
Emerson Road Storm Sewer Reconstruction
Project #16-02
AGREEMENT
City of Carmel, Indiana
THIS AGREEMENT is made and entered into by and between the City of Carmel, Indiana,
acting by and through its Board of Public Works and Safety ("OWNER") and.
("CONTRACTOR"), concerning the project ("Emerson Road Storm
Sewer Reconstruction — Project #I6-02') described more particularly in Appendix A
which is attached hereto and incorporated herein by reference.
RECITALS:
A. The OWNER has heretofore caused to be prepared certain plans, specifications and other
documents (collectively' the "Contract Documents") as hereinafter listed pertaining to the
Project, and the CONTRACTOR has filed a bid proposal ("Proposal") to furnish labor,
tools, material, equipment and/or services, and to perform the work ("Work") called for
in the Contract Documents pertaining.to the Project, upon the terms and for the price(s)
therein fully stated and set forth; and
B. The said Contract Documents accurately and fully describe the terms and conditions upon
which the CONTRACTOR is willing to furnish the labor, tools, material, equipment,
services, and perform the Work called for by the Contract Documents and in the manner
and time and for the price(s) set forth therein.
THE OWNER AND CONTRACTOR AGREE AS FOLLOWS:
1.0 Contract Documents
1.1 This Agreement consists of the following Contract Documents all of which are as fully a
part of this Agreement as if set out verbatim herein or attached hereto and the same do in
all particulars become the Agreement between the parties hereto in all matters and things
set forth.herein and described:
a. This Agreement,. including any attachments hereto;.
b. All Addenda issued prior to receipt of bid proposals, whether or not receipt
thereof has been acknowledged by CONTRACTOR in its Proposal;
C. The Specifications;
d. The Additional Requirements;
e. Notice to Bidders;
f. Instructions to Bidders;
g. Plans and Drawings;
h. Performance, Payment and Maintenance Bonds;
A-1
Engineering Department
Emerson Road Storm Sewer Reconstruction
Project # 16-02
i.
CONTRACTOR'S Itemized Proposal and Declarations; and
All -other documents defined as Contract Documents in any of the above listed
documents.
1.2 In resolving conflicts, errors,. discrepancies and disputes concerning the nature, character,
scope and/or extent of Work to be performed or furnished by the CONTRACTOR
hereunder, or other rights and obligations of the OWNER and/or CONTRACTOR, the
provision of a Contract Document expressing the greater quantity, quality or scope of the
Work, or imposing a greater obligation upon the CONTRACTOR, or affording a greater
right or remedy to OWNER, shall govern; without regard to the party who drafted such
provision; otherwise, the Documents shall be given precedence in the order as listed in
paragraph 1.1 herein above.
2.0 Contract Price
2.1 The CONTRACTOR shall, in strict conformity with the Contract Documents, furnish all
necessary labor, tools, materials, equipment, services, assume and fulfill all obligations
and perform all Work required to construct, complete, and make ready for use by the
OWNER at the Unit Prices as quoted in the Proposal for a total contract price not to
exceed $ Base Bid, subject to any additions or deletions
based on actual approved quantities of the respective unit price items, which price the
CONTRACTOR agrees to accept as full payment for all such Work actually, performed
and accepted as described in the "Contract Items and Unit Prices specification" and other
Contract Documents (the "Contract Price"). The CONTRACTOR agrees that each unit.
price shall be deemed full and complete compensation for all direct and indirect costs for
the each respective item of Work, including, without limitation, all materials, labor,
supervision, equipment, transportation, warranties, repairs, replacement, overhead and
profit for the item, complete and in place.
2.2 The above stated Contract Price will be paid to the CONTRACTOR in the manner and at
such times as set forth in the Contract Documents.
3.0 Contract Time
3.1 It is hereby understood and mutually agreed, by and between the CONTRACTOR and
OWNER, that the date of commencement and the time for completion of the Work as
specified in the Contract Documents are essential conditions of this Agreement.
A-2
Engineering Department
Emerson Road Storm Sewer Reconstruction
Project #16-02
3.2 The CONTRACTOR agrees that the Work shall be commenced no later than the date
indicated in the Notice. to Proceed to be provided by OWNER. to CONTRACTOR and
that the Work shall be performed regularly, diligently and without interruption at such a
rate of progress as will insure "Substantial Completion" of the 'Project, including
completion of performance testing and such remedial work as may be required by the
OWNER, by the dates specified in the Contract Documents.
3.3 The CONTRACTOR and OWNER acknowledge and agree that the time allotted by this
Agreement for the performance and completion of the Work is reasonable .and takes into
account any and all risks and adverse conditions which may befall the CONTRACTOR
hereunder.
4. Effective Date
This Agreement shall be deemed effective as of the date and year on which the last of the
parties hereto, or their representative, executes same.
Miscellaneous Provisions
5.1 OWNER'S Property
Any and all documentation (other than original tracings and original calculations)
generated by CONTRACTOR pursuant to this Agreement shall be considered OWNER'S
exclusive property and shall be disclosed only to OWNER and. to no other person without
OWNER'S prior express written consent. CONTRACTOR shall keep confidential all
working and deliberative material pursuant to IC 5-14-3-4.
5.2 Termination
Except as expressly stated to the contrary herein, this Agreement may be suspended
and/or terminated upon such terms as are set forth in Article 14 of the City of Carmel,
Standard General- Conditions for Construction Contracts 2003 (the "General
Conditions"), as incorporated herein by this reference.
In the event any amount allegedly due hereunder is disputed and such dispute is not
resolved to OWNER's satisfaction within ten (10) business days after notice of such
dispute is given to CONTRACTOR, OWNER shall pay such amount as is in dispute,
under protest, into the City Court of Carmel, which Court shall hold such money until
notified ofa resolution signed by both parties hereto or until a final judgment is entered
thereon.
A-3
BID BOND FORM
00430
BID BOND
BIDDER (Name and Address):
Yardberry Landscape Company dba Yardberry Landscaping & Excavating
9940 South 1000 West
Anderson, IN 46017
SURETY (Name and Address):
Merchants Bonding Company (Mutual)
P.O. Box 14498, Des Moines, IA 50306-3498
OWNER (Name and Address):
BID
BOND
City of Carmel
One Civic Square
Carmel, IN 46032
BID DUE DATE: April 6, 2016
PROJECT (Brief Description Including Location):
#16-02 Emerson Rd Storm Sewer Reconstruction
BOND NUMBER: 278111
DATE (Not later than Bid due date):March 30, 2016
PENAL SUM:Ten Percent of Bid Amount 10%
(Words) (Figures)
IN WITNESS WHEREOF, Surety and Bidder, intending to be legally bound hereby, subject to the
terms printed on the reverse side hereof, do each cause this Bid Bond to be duly executed on its
behalf by its authorized officer, agent, or representative.
BIDDER SURETY
Yardberry Landscape Company J
dba Yardbe= Landscaping & Excavating (Seal) Merchants Bonding Company (Mutual) -(Seal)
Bidder's Name and Corporate Seal Surety's Name and Corporate Seal
By: By:VJ4
, b,
Signature and Title Sighatbleand Title
Tim Yarberry (Attach Power of Attorney)
Owner Holly Coffman Attorney -in -Fact
Attest: Attest: j
--16 —
,Lih LAW A SPALEUp r61A 7��ouAdot ->-> (�- � C ,fz-
Signature an <ritle Signature and Title
Note: (1) Above addresses are to be used for giving required notice.
(2) Any singular reference to Bidder, Surety, OWNER or other party shall be
considered plural where applicable.
00430-1
CON 0690 (9/13)
Bid Bond Form
1. Bidder and Surety, jointly and severally, bind themselves, their heirs, executors,
administrators, successors and assigns to pay to OWNER upon default of Bidder the
penal sum set forth on the face of this Bond.
2. Default of Bidder shall occur upon the failure of Bidder to deliver within the time required by
the Bidding Documents (or any extension thereof agreed to in writing by OWNER) the
executed Agreement required by the Bidding Documents and any performance and
payment Bonds required by the Bidding Documents.
3. This obligation shall be null and void if:
3.1. OWNER accepts Bidder's Bid and Bidder delivers within the time required by the
Bidding Documents (or any extension thereof agreed to in writing by OWNER) the
executed Agreement required by the Bidding Documents and any performance and
payment Bonds required by the Bidding Documents, or
3.2. All Bids are rejected by OWNER, or
3.3. OWNER fails to issue a Notice of Award to Bidder within the time specified in the
Bidding Documents (or any extension thereof agreed to in writing by Bidder and, if
applicable, consented to by Surety when required by paragraph 5 hereof).
4. Payment under this Bond will be due and payable upon default by Bidder and within 30
Calendar Days after receipt by Bidder and Surety of written notice of default from
OWNER, which notice will be given with reasonable promptness, identifying this Bond and
the Project and including a statement of the amount due.
5. Surety waives notice of and any and all defenses based on or arising out of any time
extension to issue Notice of Award agreed to in writing by OWNER and Bidder, provided that
the total time for issuing Notice of Award including extensions shall not in the aggregate
exceed 120 days from Bid due date without Surety's written consent.
6. No suit or action shall be commenced under this Bond prior to 30 Calendar Days after
the noticeof default required in paragraph 4 above is received by Bidder and Surety
and in no case later than one year after Bid due date.
7. Any suit or action under this Bond shall be commenced only in a court of competent
jurisdiction located in the state in which Project is located.
8. Notices required hereunder shall be in writing and sent to Bidder and Surety at their
respective addresses shown on the face of this Bond. Such notices may be sent by
personal delivery, commercial courier or by United States Registered or Certified Mail,
return receipt requested, postage pre -paid, and shall be deemed to be effective upon
receipt by the party concerned.
9. Surety shall cause to be attached to this Bond a current and effective Power or
Attorney evidencing the authority of the officer, agent or representative who executed
this Bond on behalf of Surety to execute, seal and deliver such Bond and bind the
Surety thereby.
10. This Bond is intended to conform to all applicable statutory requirements. Any
applicable requirement of any applicable statute that has been omitted from this Bond shall
be deemed to be included herein as if set forth at length. If any provision of this Bond
conflicts with any applicable statute, then the provision of said statute shall govern and
the remainder of this Bond that is not in conflict therewith shall continue in full force and
effect.
11. The term "Bid" as used herein includes a Bid, offer or proposal as applicable.
00430-2
CON 0690 (9/13)
MERC17 tLLV TS� Bond #: 278111
BONDING COMPANY,
POWER OF ATTORNEY
Know All Persons By These Presents, that MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING,
INC., both being corporations of the State of Iowa (herein collectively called the "Companies") do hereby make, constitute and appoint,
individually,
Holly Coffman
their true and lawful Attomey(s)-in-Fact, to make, execute, seal and deliver on behalf of the Companies, as Surety, bonds, undertakings
and other written obligations in the nature thereof, subject to the limitation that any such instrument shall not exceed the amount of:
Five Million ($5,000,000.00) Dollars
This Power-of-Attomey is granted and is signed and sealed by facsimile under and by authority of the following By -Laws adopted by the
Board of Directors of Merchants Bonding Company (Mutual) on April 23, 2011 and adopted by the Board of Directors of Merchants
National Bonding, Inc., on October 24, 2011.
"The President, Secretary, Treasurer, or any Assistant Treasurer or any Assistant Secretary or any Vice President shall have power and
authority to appoint Attorneys -in -Fact, and to authorize them to execute on behalf of the Company, and attach the seal of the Company
thereto, bonds and undertakings, recognizances, contracts of indemnity and other writings obligatory in the nature thereof."
"The signature of any authorized officer and the seal of the Company may be affixed by facsimile or electronic transmission to any Power of
Attorney or Certification thereof authorizing the execution and delivery of any bond, undertaking, recognizance, or other suretyship
obligations of the Company, and such signature and seal when so used shall have the same force and effect as though manually fixed."
In connection with obligations in favor of the Florida Department of Transportation only, it is agreed that the power and authority hereby given
to the Attorney -in -Fact includes any and all consents for the release of retained percentages and/or final estimates on engineering and
construction contracts required by the State of Florida Department of Transportation. It is fully understood that consenting to the State of Florida
Department of Transportation making payment of the final estimate to the Contractor and/or its assignee, shall not relieve this surety company
of any of its obligations under its bond.
In connection with obligations in favor of the Kentucky Department of Highways only, it is agreed that the power and authority hereby given
to the -Attorney -in -Fact cannot be modified or revoked unless prior written personal notice of such intent has been given to the Commissioner -
Department of Highways of the Commonwealth of Kentucky at least thirty (30) days prior to the modification or revocation.
In Wtne§ Whereof, the Companies have caused this instrument to be signed and sealed this 8th day of October , 2015
`o, 4X.. 0
.�:V
.se -o-
STATE OF IOWA +'��''., .• a��''�,'
0.0---6.0
• • O\N� • CO,h;.
m�•
�oRP09 • :�•
: y 1933
MERCHANTS BONDING COMPANY (MUTUAL)
MERCHANTS NATIONAL BONDING, INC.
COUNTY OF Dallas ss. President
On this 8th day of October 2015 , before me appeared Larry Taylor, to me personally known, who being by me sworn did say that
he is President of the MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.; and that the seals affixed
to the foregoing instrument are the Corporate seals of the Companies; and that the said instrument was signed and sealed in behalf of the
Companies by authority of their respective Boards of Directors.
APS. I�WENDY WOODY
v Commission Number 784654
Z ' ° ° ° My Commission Expires
tow;, June 20 2017
Notary Publi , County, Iowa
(Expiration of notary's commission
does not invalidate this instrument)
I, William Warner, Jr., Secretary of the MERCHANTS BONDING COMPANY (MUTUAL) and MERCHANTS NATIONAL BONDING, INC.,
do hereby certify that the above and foregoing is a true and correct copy of the POWER-OF-ATTORNEY executed by said Companies,
which is still in full force and effect and has not been amended or revoked.
In Witness Whereof, I have hereunto set my hand and affixed the seal of the Companies on this 30th day of March 2016
POA 0014 (6/15)
. • �\N... COCA �
: y 1933 ; c;
• J .C1,•
Secretary
tie cr�
CONTRACTOR'S BID FOR PUBLIC WORK - FORM 96
State Form 52414 (R2 / 2-13) / Form 96 (Revised 2013)
Prescribed by State Board of Accounts
PART
(To be completed for all bids. Please type or print)
Date (month, day, year). 03/28/16
1. Governmental Unit (Owner): City of Carmel, Board of Public Works & Safety
2. County: Wabash County
3. Bidder (Firm): Yardberry Landscape Company
Address: 9940 S. 1000 W
City/State/ZlPcode: Anderson, IN 46017
4. Telephone Number: 765-378-5783
5. Agent of Bidder (if applicable): Tim Ya
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete
the public works project of City of Carmel, Board of Public Works &
(Governmental Unit) in accordance with plans and specifications prepared by Crossroad Engineers
#16-02 Emerson Rd Storm Sewer Reconstruction and dated March 2016 for the sum of
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 governmental unit. If the bid is to be awarded on a unit
basis, the itemization of the units shall be shown on a separate attachment.
The contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee,
or applicant for employment, to be employed in the performance of this contract, with respect to any matter
directly or indirectly related to employment because of race, religion, color, sex, national origin or ancestry.
Breach of this covenant may be regarded as a material breach of the contract.
CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS
(If applicable)
I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory
obligation to use steel products made in the United States (I.C. 5-16-8-2). 1 hereby certify that I and all
subcontractors employed by me for this project will use U.S. steel products on this project if awarded.
understand that violations hereunder may result in forfeiture of contractual payments.
The above bid is accepted this
following conditions:
Contracting Authority Members:
Tim Yarb
ACCEPTANCE
day of April 2016 , subject to the
PART II
(For projects of $150, 000 or more — IC 36-1-12-4)
Governmental Unit: City of Carmel, Board of Public Works & Safety
Bidder (Firm) Yardberry Landscape Company
Date (month, day, year): 03/28/16
These statements to be submitted under oath by each bidder with and as a part of his bid.
Attach additional pages for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
What public works projects has your organization completed for the period of one (1) year prior to the
date of the current bid?
Contract Amount
Class of Work
Completion
Date
Name and Address of Owner
118,091.00
Sewer
09/14
City of Fort Wayne
365,914.37
Culvert Rplcmnt
10/14
INDOT
230,264.90
Ped./Bike Trail
10/14
INDOT
253,822.00
Bank Stabilization
10/14
City of Carmel
2. What public works projects are now in process of construction by your organization?
Contract Amount
Class of Work
Expected
Completion
Date
Name and Address of Owner
666,736.50
Ped./Bike Trail
06/15
INDOT
592,695.00
Environ. Mitigation
06/15
INDOT
3. Have you ever failed to complete any work awarded to you? NO If so, where and why?
4. List references from private firms for which you have performed work.
Dan Swails, Indy Parks & Recreation, 317-491-2883
Tim Farley, H Steward Kline & Associate, 765-742-0295
Max Abrell, DCRWD, 765-284-6370
Bob Wiwi, Richmond Sanitary District, 765-983-7477
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
Explain 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 governmental unit to consider your bid.)
2. Please list 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.
If you intend to sublet any portion of the work, state 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 governmental unit in the event that you subsequently determine that you will use a
subcontractor on the proposed project.
4. What equipment do you have available to use for the proposed project? Any equipment to be used by
subcontractors may also be required to be listed by the governmental unit.
5. Have you entered into contracts or received offers for all materials which substantiate the prices used in
preparing your proposal? If not, please explain 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 governing body awarding the contract must be specific enough in detail so that said governing body can make
a proper determination of the bidder's capability for completing the project if awarded.
SECTION IV CONTRACTOR'S NON — COLLUSION AFFIDAVIT
The undersigned bidder or agent, being duly sworn on oath, says that he 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 include 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.
He 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.
SECTION V OATH AND AFFIRMATION
I HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS AND INFORMATION
CONTAINED IN THE FOREGOING BID FOR PUBLIC WORKS ARE TRUE AND CORRECT.
Dated at Anderson
this 28
Yardberry Landscape C
By
Owner
STATE OF Indiana )
ss
COUNTY OF Madison )
of March , 2016
(Name of Organization)
(Title of Person Signing)
/_0yI:V[91TA4:1lit]:I►y,I:10411
Before me, a Notary Public, personally appeared the above-named Tim Yarberry and
swore that the statements contained in the foregoing document are true and correct.
Subscribed and sworn to before me this 28 day of March 2016
My Commission Expires: 11 /06/2021
County of Residence: Madison
4(Aai
o
Notary Pub(c
BETH PEAVM
NOTARY131.19110
SEAL
MADISON COUNTY, STATE OF INDIANA
MY COMMISSION EXPIRES NOVEMBM 00, 20M
COMMISSION NO W913
Part of State Form 52414 (R2 / 2-13) / Form 96 (Revised 2013)
Yardberry Landscape Company
(Contractor)
9940 S 1000 W
Anderson, IN 46017
(Address)
•a,
PUBLIC WORKS PROJECTS
OF
City of Carmel, Board of Public Works & Safety
Filed
Action taken
Yardberry Landscape Company
d/b/a Yardberry Landscaping & Excavating
As of and for the Years Ended
December 31, 2014 and 2013
John R. Sandlin CPA/ABV
Sandlin & Company, LLC
S a n d l i n& Company, LLC John R. Sandlin, CPA/AB V
Certified Public Accountants Jacob J. Goossen, MBA
REPORT OF INDEPENDENT AUDITORS
To the Board of Directors
Yardberry Landscape Company
d/b/a Yardberry Landscaping & Excavating
Anderson, Indiana
We have audited the accompanying financial statements of Yardberry Landscape Company d/b/a
Yardberry Landscaping & Excavating (an Indiana Corporation), which comprise the balance sheets as of
December 31, 2014 and 2013, and the related statements of income, changes in stockholder's equity, and
cash flows for the years then ended, and the related notes to the financial statements.
Management's Responsibilityfor the Financial Statements
Management is responsible for the preparation and fair presentation of these financial statements in
accordance with accounting principles generally accepted in the United States of America; this includes
the design, implementation, and maintenance of internal control relevant to the preparation and fair
presentation of financial statements that are free from material misstatement, whether due to fraud or
error.
Auditor's Responsibility
Our responsibility is to express an opinion on these financial statements based on our audits. We
conducted our audits in accordance with auditing standards generally accepted in the United States of
America. Those standards require that we plan and perform the audit to obtain reasonable assurance
about whether the financial statements are free of material misstatement.
An audit includes performing procedures to obtain audit evidence about the amounts and disclosures in
the financial statements. The procedures selected depend on the auditor's judgment, including the
assessment of the risks of material misstatement of the financial statements, whether due to fraud or error.
In making those risk assessments, the auditor, considers internal control relevant to the entity's
preparation and fair presentation of the financial statements in order to design audit procedures that are
appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of
the entity's internal control. An audit also includes evaluating the appropriateness of accounting
principles used and the reasonableness of significant estimates made by management, as well as
evaluating the overall presentation of the financial statements.
We believe that the audit evidence we have obtained is sufficient and appropriate to provide a reasonable
basis for our opinion.
Opinion
In our opinion, the financial statements referred to above present fairly, in all material respects, the
financial position of Yardberry Landscape Company d/b/a Yardberry Landscaping & Excavating as of
December 31, 2014 and 2013, and the results of its operations and its cash flows for the years then ended
in accordance with accounting principles generally accepted in the United States of America.
SAVA067 f 401 yXio" f, or.-iq'
Anderson, Indiana
April 15, 2015
1106 East 8`h St • Anderson, Indiana 46016 • (765) 608-2366 • Fax (765) 683-9530
American Institute of CPAs • AICPA Tax Division • Indiana CPA Society
LIABILITIES AND STOCKHOLDER'S EQUITY
2014 2013
Current Liabilities
Trade accounts payable
Current portion of long-term debt
Line of credit payable
Note payable to stockholder
Billings in excess of costs and estimated
earnings on contracts in progress
Accrued property tax
Accrued payroll tax and other liabilities
Total Current Liabilities
Long -Term Debt, net of current portion above
Stockholder's Equity
Common stock, no par value, 1,000 shares
authorized, 100 shares issued and outstanding
Retained earnings
Total Stockholder's Equity
Total Liabilities and Stockholder's Equity
$ 198,640 $ 124,062
132,700 120,300
193,167 199,083
24,767 139,526
30,866 -
44,000 43,000
35,151 2,162
659,291 628,133
388,220 242,683
492,238
492,238
747,263
368,000
1,239,501
860,238
-&21&7,.012
$1,731,054
See accompanying notes to financial statements.
3
Yardberry Landscape Company
d/b/a Yardberry Landcaping & Excavating
Statements of Changes in Stockholder's Equity
Years Ending December 31, 2014 and 2013
Balance December 31, 2012
Net income for 2013
Dividends paid
Balance December 31, 2013
Balance December 31, 2013
Net income for 2014
Dividends paid
Balance December 31, 2014
Retained'
Common Stock Earnings Total
$ 492,238 $ 354,006 $ 846,244
13,994 13,994
$ 492,238 $ 368,000 $ 860,238
$ 492,238 $ 368,000 $ 860,238
401,644 401,644
(22,381) (22,381)
$ 492,238 $ 747,263 $ 1,239,501
See accompanying notes to financial statements.
5
Yardberry Landscape Company
d/b/a Yardberry Landscaping & Excavating
Notes to Financial Statements
December 31, 2014 and 2013
NOTE A — SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Nature of Operations
Yardberry Landscape Company d/b/a Yardberry Landscaping & Excavating (a corporation) is
wholly owned by Timothy C. Yarberry. The Company's principal activities include excavation
work, construction, and landscaping services. The Company serves as a general contractor in
projects such as walking trails, playgrounds, playing fields, and highway related construction
activities. Landscaping activities include planting of trees and shrubbery, grading, construction
of footbridges and fencing. The Company's customers are primarily governmental entities. Most
services are performed in central Indiana.
Revenue and Cost Reco nition
Revenues from construction contracts are recognized on the percentage -of -completion method,
measured by the percentage of cost incurred to date to estimated total cost for each contract. That
method is used because management considers expended costs to be the best available measure of
progress on the contracts. Because of inherent uncertainties in estimating costs, it is at least
reasonably possible that the estimates used will change within the near term.
Contract costs include all direct material and labor costs. Selling, general, and administrative
costs are charged to expense as incurred. Provisions for estimated losses on uncompleted
contracts are made in the period in which such losses are determined.
The asset, "Costs and estimated earnings in excess of billings on contracts in progress" represents
revenues recognized in excess of amounts billed. The liability, "Billings in excess of costs and
estimated earnings on contracts in progress," represents billings in excess of revenues recognized.
Trade Receivables
Trade receivables are recorded at net realizable value and are charged off when management
determines they are uncollectible. As of December 31, 2014 and 2013, the Company had trade
receivables past due ninety days or more of $5,902 and $3,702 respectively.
Inventories
Inventories consist of landscaping materials, young trees and shrubbery. When significant,
purchased inventory items are stated at the lower of cost (first -in, first -out method) or market.
The Company also grows young trees and shrubbery for sale to customers. Growing costs are
charged to expense as incurred.
Cash and Cash Equivalents
All short-term investments with an original maturity of three months or less are considered to be
cash equivalents.
Yardberry Landscape Company
d/b/a Yardberry Landscaping & Excavating
Notes to Financial Statements
December 31, 2014 and 2013
Cash balances include a money market fund, which attempts to maintain a constant market value
of $1.00 per share, although the value is not guaranteed. The market value of the money market
fund at December 31, 2014 and 2013 was $811,322 and $686,320, respectively.
NOTE C — ACCOUNTS RECEIVABLE
Accounts receivable at December 31, 2014 and 2013 are as follows:
As of December 31, 2014:
Total Retainage Other
Completed contracts $ 169,133 $ 21,398 $ 147,735
Contracts in progress 253,785 - 253,785
$ 422,918 $ 21,398 $ 401,520
As of December 31, 2013:
Total Retainage Other
Completed contracts $ 220,910 $ 55,926 $ 164,984
Contracts in progress - - -
$ 220,910 $ 55,926 $ 164,984
0
Yardberry Landscape Company
d/b/a Yardberry Landscaping & Excavating
Notes to Financial Statements
December 31, 2014 and 2013
NOTE E — LONG-TERM DEBT
Long-term debt consists of the following notes:
2014 2013
Promissory note to a finance company, with
interest at 3.25% due in monthly installments of
$3,892, including interest, through January 2015,
collateralized by equipment $ - $ 45,895
Promissory note to a finance company, with
interest at 5.99%, due in monthly installments of
$1,734, including interest, through January, 2016,
collateralized by equipment 20,149 39,128
Promissory note to a bank, with interest at 6.00%,
due in monthly installments of $722, including
interest, through June, 2016, with balloon payment
due at that time, collateralized by substantially all
assets of the company and the personal guaranty
of Timothy C. Yarberry 89,214 92,342
Promissory note to a finance company, with
interest at 4.48%, due in monthly installments of
$995, including interest, through February 2017,
collateralized by transportation equipment 23,710 34,330
Promissory note payable to a finance company, with
interest at 3.99%, due in monthly installments of
$1,449, through November 2017, collateralized by
transportation equipment 46,502 61,702
Promissory note payable to a finance company, with
interest at 2.99%, due in monthly installments of
$4,112, through January 2019, collateralized by
equipment 189,510 -
Promissory note payable to a finance company, with
interest at 1.03%, due in monthly installments of
$1,093, through March 2018, collateralized by
equipment 40,845 53,476
Yardberry Landscape Company
d/b/a Yardberry Landscaping & Excavating
Notes to Financial Statements
December 31, 2014 and 2013
NOTE F — LINE OF CREDIT
The Company has a line of credit with First Merchants Bank collateralized by substantially all
assets of the Company and the personal guaranty of Timothy C. Yarberry. The note bears interest
at one percent over the national prime rate, subject to a minimum interest rate of 4.25% in 2014
and 5.5% in 2013. The total financing available under the line of credit was $200,000. The
amount available to be drawn was $6,833 at December 31, 2014 and $917 at December 31, 2013.
NOTE G — SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION
Cash paid for interest expense was $33,007 in 2014 and $31,217 in 2013.
NOTE H — RELATED PARTY TRANSACTIONS
The Company made loans to its sole shareholder, Timothy C. Yarberry, in 2014 and 2013. The
proceeds of the loans were invested in Mr. Yarberry's personally owned brokerage account and
were outstanding for substantially the entire year. There were borrowings and repayments made
by the shareholder throughout the year under the borrowing arrangement. The activity under the
borrowing arrangement is summarized as follows for 2014 and 2013:
The Company earned interest income in 2014 and 2013 of $1,571 and $616, respectively on
amounts loaned to its sole shareholder.
The Company rents real estate from its owner. Rent expense was $15,000 in 2014 and $12,000 in
2013.
NOTE I — SUBSEQUENT EVENTS
Subsequent events were evaluated through April 15, 2015, which is the date the financial
statements were available to be issued.
13
2014
2013
Note payable to stockholder
at the beginning of the year
$ 139,526
$ -
Amounts received from the stockholder
1,504,767
1,221,754
Loans to the stockholder
(1,619,526)
(1,082,228)
Notes payable to stockholder
at the end of the year
$ 24,767
$ 139,526
The Company earned interest income in 2014 and 2013 of $1,571 and $616, respectively on
amounts loaned to its sole shareholder.
The Company rents real estate from its owner. Rent expense was $15,000 in 2014 and $12,000 in
2013.
NOTE I — SUBSEQUENT EVENTS
Subsequent events were evaluated through April 15, 2015, which is the date the financial
statements were available to be issued.
13
S a n d l i n& Company, LLC John R. Sandlin, CPA/ABV
Certified Public Accountants Jacob J. Goossen, MBA
REPORT OF INDEPENDENT AUDITORS ON SUPPLEMENTARY INFORMATION
To the Board of Directors
Yardberry Landscape Company
d/b/a Yardberry Landscaping & Excavating
Anderson, Indiana
Our audits were conducted for the purpose of forming an opinion on the financial statements as a
whole. The information included in Schedules 1 through 4 accompanying the financial statements
is presented for purposes of additional analysis and is not a required part of the financial
statements. Such information is the responsibility of management and was derived from and
relates directly to the underlying accounting and other records used to prepare the financial
statements. The information has been subjected to the auditing procedures applied in the audits of
the financial statements and certain additional procedures, including comparing and reconciling
such information directly to the underlying accounting and other records used to prepare the
financial statements or to the financial statements themselves, and other additional procedures in
.accordance with auditing standards generally accepted in the United States of America. In our
,opinion, the information is fairly stated in all material respects in relation to the financial
statements as a whole.
Anderson, Indiana
April 15, 2015
1106 East 8`h St • Anderson, Indiana 46016 • (765) 608-2366 • Fax (765) 683-9530
American Institute of CPAs • AICPA Tax Division • Indiana CPA Society
Yardberry Landscape Company
d/b/a Yardberry Landscaping & Excavating
Schedule 2
Contracts in Progress at Year End
Year Ended December 31, 2014
R -29394-A Environmental Mitigation
B-35721 Debris Removal From Channel
R -36889-A Bike Trail
17
For the Year Ended
Total Contracts
From
Inception to December 31, 2014
December 31, 2014
Costs and
Billings in
Estimated
Excess of
Estimated
Earnings in
Costs and
Gross
Project
Gross Profit
Revenues
Costs Incurred
Gross
Progress
Excess of
Estimated
Revenues
Costs
Earnings
Number
Contract Price
(Loss)
Earned
To Date
Earnings
Billings
Billings
Earnings
Earned
Incurred
(Loss)
R -29394-A
$ 572,695
$ 322,346
$ 403,184
$ 176,249
$ 226,935
$ 358,442
$ 44,742
$
$ 403,184
$ 176,249
$ 226,935
B-35721
217,960
184,160
217,960
33,800
184,160
195,640
22,320
-
217,960
33,800
184,160
R -36889-A
666,737
166,737
82,580
61,929
20,651
113,446
30,866
82,580
61,929
20,651
$ 1,457,392
$ 673,243
$ 703,724
$ 271,978
$ 431,746
$ 667,528
$ 67,062
$ 30,866
$ 703,724
$ 271,978
$ 431,746
R -29394-A Environmental Mitigation
B-35721 Debris Removal From Channel
R -36889-A Bike Trail
17
Yardberry Landscape Company
d/b/a Yardberry Landcaping & Excavating
Schedule 4
General and Administrative Expenses
Years Ended December 31, 2014 and 2013
19
2014
2013
Officer compensation
$ 50,000
$ 30,000
Other salaries
31,439
25,629
Payroll tax expense
73968
3,340
Advertising
-
1,578
Bidding expense
3,922
6,261
Office expense
19,929
20,781
Insurance
40,723
36,932
Licenses and fees
14,658
13,552
Truck expense
137,364
125,794
Professional fees
17,310
18,257
Property taxes
1,000
8,000
Rent
15,000
12,000
Repairs and maintenance
99,338
45,036
Supplies
6,010
7,138
Utilities
6,803
6,617
Miscellaneous
6,853
33,482
19
References
Reference Name Reference Phone # Company
Max Abrell
765-284-6370
Delaware County Regional Wastewater District
Sonny Anuka
317-258-5140
Indiana Department of Transportation
Phil Boyd
765-282-3845
Halteman Villas
Jeff Carpenter
317-788-4553
City of Carmel, IN
Trent Colglazier
812-752-4945
Indiana Department of Transportation
Pat Conner
317-984-5696
Town of Cicero, IN
Tim Farley
765-742-0295
H. Stewart Kline & Associates
Mike Garcia
260-901-1310
Indiana Department of Transportation
Phil Gurganus
317-803-9094
City of Beech Grove, IN
Jim Myers
317-339-3574
Site & Pipe
John Miller
317-410-4909
DI -2 Indiana
Jeff Peters
317-788-4551
M.D. Wessler & Associates
Matthew Smith
317-423-0935
Strand & Associates
Dan Swails
317-491-2883
City of Indy Parks & Recreation
Bob Wiwi
765-983-7477
Richmond Sanitary District
Matt Smith
317-581-6237
Strand Associates, Indianapolis, IN
Matt Gray
260-427-2794
City of Fort Wanye, IN
Tye Campbell
260-748-7032
City of New Haven, IN
John Clair
317-370-1864
Butler, Fairman & Seufert, Inc.
Scott Siple
317-895-2585
United Consulting, Inc.
Brad Burk
812-584-2048
Indiana Department of Transportation
Jeremy Campbell
317-443-2910
Butler, Fairman & Seufert, Inc.
Mitchell Green
260-704-1453
DLZ Engineering
Dennis Butler
260-471-8964
Indiana Department of Transportation
Job References
Contracted With
Anderson Community School Corp
City of Anderson, IN
City of Carmel, IN
City of Carmel, IN
City of Indianapolis, IN
City of Indianapolis, IN
City of Indianapolis, IN
City of Indianapolis, IN
City of Indianapolis, IN
City of Indianapolis, IN
City of Indianapolis, IN
City of Indianapolis, IN
City of Indianapolis, IN
City of Indianapolis, IN
City of Indianapolis, IN
City of Richmond, IN
City of Shelbyville, IN
City of Tipton
City of Tipton, IN
Community School Corp of So Hancock Co
Country Club Heights
Crider & Crider
Delaware Co Regional Wastewater District
Halteman Villas
Hamilton County
Hamilton County Highway Department
Harrison High School
Herman Associates
INDOT
I N DOT - I R -29367-A
Type of Work
Landscaping
Tree Planting
Demolition
Water Main Extension
Demolition
Canal Basin Landscape Project
Basketball Courts
Playground
Replacing Trees
Landscaping Project
Excavating, Clearing, Demolition
Restoration
Grading Football Field
White River Greenways
Detention Basin/Retrofits
Sanitary Sewer
Drainage Project
Sewer
Drainage
Football Field
Concrete Curbs, Storm Drain & Inlet
Wetland Mitigation
Sewer Extension
Drainage
Rehabilitation
Gabion Installation
Football Field Resurface
Retaining Walls
Pipe Lining
Demolitiom
Location
Contract Amt
Anderson High School
$
101,701.00
East 29th Street
$
3,485.00
$
67,806.80
Old Meridian Street
$
277,400.00
High School Road
$
10,000.00
$
103,000.00
Brookside & Thompson Parks
$
52,400.00
Bowman Park
$
181,716.00
$
9,710.00
86th Street
$
718,001.00
Carson Park
$
296,111.00
Coffin & Eagle Gold Course
$
318,409.00
Douglas Park
$
504,311.00
$
2,000.00
Wetnight East & Derbyshire Creek
$
309,300.00
$
142,822.04
Elliott/Montgomery Streets
$
298,101.00
Various
$
1,814,746.00
Dearborn Street
$
1,514,093.25
New Palestine High School
$
101,400.00
Anderson, IN
White Oaks @ 96th Street
$
161,201.00
Meadowcrest Addition
$
271,491.00
Muncie, IN
$
69,755.00
$
544,482.50
$
52,438.15
$
58,252.00
$
23,356.25
St Rd 30
$
946,211.00
1-465 Indianapolis
$
148,402.80
INDOT - M -26302-B
Debris Removal
INDOT - M -26437-B
Pipe Lining
INDOT - M -29311-A
Pipe Lining
INDOT - R -26123-B
$
INDOT - R -27850-B
Landscaping
INDOT - R -28242-A
Small Structure Replacement
INDOT - R -28522-A
Demolition
INDOT - R -28650-A
Slip Lining
INDOT - Toll Road
Landscaping
Prophetstown State Park
Landscaping
Tippecanoe County
Culvert Project
Town of Cicero, IN
Storm Sewer Project
Town of Fishers, IN
Multi -use Path
Vigo County School Corp
Football Field Crowning
City of Tipton, IN
Sewer Seperation
City of New Haven, IN
Water Main Improvement
City of Fort Wane, IN
Flood Control
City of Fort Wane, IN
Flood Control
Purdue University
Wetland Mitigation
INDOT R -35726-A
Pedestrian/Bicycle Trail
City of Carmel
Bank Stabilization
INDOT R -36889-A
Bike/Pedestrian Trail
INDOT R -29394-A
Environmental Mitigation
INDOT R -34272-A
Pipe Lining
INDOT R -35618-A
Safe Route to School
City of Delphi
WWTP Effluent Pipe Replacement
Town of Fishers, IN
Stormwater Improvement
$ 72,500.00
$ 64,977.50
Crawford County
$
110,953.00
Monon Trail
$
2,418,911.00
Elletsville
$
78,525.00
Fulton County
$
270,903.93
Warrick County
$
10,599.60
Crawfordsville District
$
437,377.00
$
23,678.88
Tippecanoe County
$
93,273.75
$
416,502.95
Jackson Street
$
115,502.50
106th Street, Fishers, IN
$
469,944.00
$
142,935.24
$
1,917,086.81
Rose Avenue, New Haven, IN
$
198,788.60
Allen County, Fort Wayne, IN
$
51,382.00
Allen County, Fort Wayne, IN
$
109,640.00
West Lafayette, IN
$
63,400.00
Hancock County, Pennsy Trail
$
230,264.90
Cool Creek, Carmel, IN
$
253,822.00
Carmel, IN
$
666,736.50
Aurora, IN
$
592,694.00
Berne, IN
$
180,096.00
Berne, IN
$
161,914.00
Delphi, IN
$
675,889.00
Fishers, IN
$
241,525.00
NON -COLLUSION AFFIDAVIT
State Form 4391 (R4 / 1-00)
+eio
STATE OF:
SS:
COUNTY OF 1 f CU
The undersigned, being duly sworn on oath says, that he is the contracting party, or that he is the representative, agent, member, or officer of
the contracting party, that he has not, nor has any other member, employee, representative, agent or officer of the firm, company, corporation or partnership
represented by him, directly or indirectly , entered into or offered to enter into any combination, collusion or agreement to receive or pay, and that he has
not received or paid, any sum of money or other consideration for the execution of the annexed contract other than that which appears upon the face of
the contract.
Signature
Printed name --7
Title
Company
rj
Before me, a Notary Public in and for said County and State personally appeared, -7( v% -
who acknowledged the truth of the statements in the foregoing affidavit on this7 day of 20!
BETH PEAVLER
NOTARY PUBLIC
SEAL
MA OISON COUNTY, STATE OF INDIANA
MY COMMISSION EXPIRES NOVEMBER OS, 20M
COMMISSION NO 00013
E -Verify Affidavit
Pursuant to Indiana Code 22-5-1.7-11, the Contractor entering into a contract with the City is
required to enroll in and verify the work eligibility status of all its newly hired employees through
the E -Verify program. The Contractor is not required to verify the work eligibility status of all its
newly hired employees through the E -Verify program if the E -Verify program no longer exists.
The undersigned, on behalf of the Contractor, being first duly sworn, deposes and states that the
Contractor does not knowingly employ an unauthorized alien. The undersigned further affirms that,
prior to entering into its contract with the City, the undersigned Contractor will enroll in and agrees
to verify the work eligibility status of all its newly hired employees through the E -Verify program.
(Contractor):
By (Written Signature):
IUivY.�
(Printed Name):
(Title):
Important - Notary Signature and Seal Required in the Space Below
STATE OF 1, n di a/w,-, BETH PEAVI.ER
S S : NOTARY PUBUC
COUNTY OF W & S�-
MADISON COUNTY, STATE OF INDW A
MY COMMISSION EXPIRES NOVEMBER o8, 2W
NOM13
] -
Subscribed and sworn to before me this day of ,
20 �l�l
My commission expires: I �PI�' (Signed)
Residing in Ma County, State of �17i1�G2/1�2�