HomeMy WebLinkAboutAll Star Paving, Inc./STREET/$268,000/Path Preservation DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
All Star Paving,Inc.
Street Department-2023
AppropriationTo Exceed
2201 43-502.01 Motor Vehicle Highway Fund; P.O.#109759 APPROVED
Contract Not Exceed$268,000.00 By Sergey Grechukhin at 10.11 am,May 31,2023
AGREEMENT FOR PURCHASE OF GOODS AND SERVICES
THIS AGREEMENT FOR PURCHASE OF GOODS AND SERVICES ("Agreement") is hereby entered into by
and between the City of Carmel, Indiana, acting by and through its Board of Public Works and Safety ("City"), and All
Star Paving, Inc., an entity duly authorized to do business in the State of Indiana ("Vendor").
TERMS AND CONDITIONS
1. ACKNOWLEDGMENT, ACCEPTANCE:
Vendor acknowledges that it has read and understands this Agreement, and agrees that its execution of same
constitutes its acceptance of all of the Agreement's terms and conditions.
2. PERFORMANCE:
2.1 City agrees to purchase the goods and/or services (the"Goods and Services")from Vendor using City
budget appropriation number 2201 2201 43-502.00 Motor Vehicle Highway funds. Vendor agrees to
provide the Goods and Services and to otherwise perform the requirements of this Agreement by
applying at all times the highest technical and industry standards. Vendor will not perform any of the
Services detailed in Exhibit A prior to obtaining a written Notice to Proceed from the City. Upon
receiving a Notice to Proceed,the Vendor shall perform only those Services specifically detailed in the
Notice. If the Vendor desires clarification of the scope of any Notice to Proceed, the Vendor shall
obtain such clarification from the City in writing, prior to performing the service set forth in the Notice
to Proceed. Any services performed without the City's prior express written authorization will not be
compensated.
2.2 The Agreement between the Parties consists of this document, all the Exhibits including any
attachments, technical specifications, plans, references, and/or addendums thereto, City of Carmel
General Conditions, City of Carmel Supplemental Conditions. Vendor acknowledges that it had a
chance to review all the components of the Agreement and agrees to comply with all such components
without reservations or exceptions, unless otherwise agreed by the Parties in writing.
3. PRICE AND PAYMENT TERMS:
3.1 Vendor estimates that the total price for the Goods and Services to be provided to City hereunder shall
be no more than Two Hundred Sixty Eight Thousand Dollars ($268,000.00) (the "Estimate"). Vendor
shall submit an invoice to City no more than once every thirty (30) days detailing the Goods and
Services provided to City within such time period. City shall pay Vendor for such Goods and Services
within thirty-five (35) days after the date of City's receipt of Vendor's invoice detailing same, so long
as and to the extent such Goods and Services are not disputed, are in conformance with the
specifications set forth in Exhibit A and any attachments, references and/or addendums thereto, are
submitted on an invoice that contains the information contained on attached Exhibit B, and Vendor
has otherwise performed and satisfied all the terms and conditions of this Agreement.
3.2 Vendor agrees not to provide any Goods and Services to City that would cause the total cost of the
Goods and Services provided by Vendor to City hereunder to exceed the Estimate, unless City has
previously agreed, in writing, to pay an amount in excess thereof.
4. WARRANTY:
Vendor expressly warrants that the Goods and Services covered by this Agreement will conform to those
certain specifications, descriptions and/or quotations regarding same as were provided to Vendor by City
and/or by Vendor to and accepted by City pursuant to or as part of that certain City of Carmel Street Department
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DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
All Star Paving,Inc.
Street Department-2023
Appropriation#2201 2201 43-502.01 Motor Vehicle Highway Fund;P.O.#109759
Contract Not To Exceed$268,000.00
Bid Proposal Package for "Project 23-STR-05 Path Preservation" received by the City of Carmel Board of
Public Works and Safety on or about May 3,2023,all of which documents are incorporated herein by reference,
and that the Goods and Services will be delivered in a timely, good and workmanlike manner and free from
defect. Vendor acknowledges that it knows of City's intended use and expressly warrants that the Goods and
Services provided to City pursuant to this Agreement have been selected by Vendor based upon City's stated
use and are fit and sufficient for their particular purpose.
5. TIME AND PERFORMANCE:
This Agreement shall become effective as of the last date on which a party hereto executes same ("Effective
Date"), and both parties shall thereafter perform their obligations hereunder in a timely manner. Time is of the
essence of this Agreement.
6. DISCLOSURE AND WARNINGS:
If requested by City, Vendor shall promptly furnish to City, in such form and detail as City may direct, a list of
all chemicals, materials, substances and items used in or during the provision of the Goods and Services
provided hereunder, including the quantity,quality and concentration thereof and any other information relating
thereto.At the time of the delivery of the Goods and Services provided hereunder,Vendor agrees to furnish to
City sufficient written warning and notice (including appropriate labels on containers and packing) of any
hazardous material utilized in or that is a part of the Goods and Services.
7. LIENS:
Vendor shall not cause or permit the filing of any lien on any of City's property. In the event any such lien is
filed and Vendor fails to remove such lien within ten (10) days after the filing thereof, by payment or bonding,
City shall have the right to pay such lien or obtain such bond, all at Vendor's sole cost and expense.
8. DEFAULT:
In the event Vendor: (a) repudiates, breaches or defaults under any of the terms or conditions of this
Agreement, including Vendor's warranties; (b)fails to provide the Goods and Services as specified herein; (c)
fails to make progress so as to endanger timely and proper provision of the Goods and Services and does not
correct such failure or breach within five (5) business days (or such shorter period of time as is commercially
reasonable under the circumstances) after receipt of notice from City specifying such failure or breach; or (d)
becomes insolvent, is placed into receivership, makes a general assignment for the benefit of creditors or
dissolves, each such event constituting an event of default hereunder, City shall have the right to (1)terminate
all or any parts of this Agreement, without liability to Vendor; and (2) exercise all other rights and remedies
available to City at law and/or in equity.
9. INSURANCE AND INDEMNIFICATION:
Vendor shall procure and maintain in full force and effect during the term of this Agreement, with an insurer
licensed to do business in the State of Indiana, such insurance as is necessary for the protection of City and
Vendor from all claims for damages under any workers' compensation, occupational disease and/or
unemployment compensation act; for bodily injuries including, but not limited to, personal injury, sickness,
disease or death of or to any of Vendor's agents, officers, employees, contractors and subcontractors; and,for
any injury to or destruction of property, including, but not limited to, any loss of use resulting therefrom. The
coverage amounts shall be no less than those amounts set forth in attached Exhibit C. Vendor shall cause its
insurers to name City as an additional insured on all such insurance policies, shall promptly provide City, upon
request, with copies of all such policies, and shall provide that such insurance policies shall not be canceled
without thirty (30) days prior notice to City. Vendor shall indemnify and hold harmless City from and against
any and all liabilities, claims, demands or expenses (including, but not limited to, reasonable attorney fees) for
injury, death and/or damages to any person or property arising from or in connection with Vendor's provision
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DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
All Star Paving,Inc.
Street Department-2023
Appropriation#2201 2201 43-502.01 Motor Vehicle Highway Fund;P.O.#109759
Contract Not To Exceed$268,000.00
of Goods and Services pursuant to or under this Agreement or Vendor's use of City property.
Vendor further agrees to indemnify, defend and hold harmless City and its officers, officials, agents and
employees from all claims and suits of whatever type, including, but not limited to, all court costs,attorney fees,
and other expenses, caused by any act or omission of Vendor and/or of any of Vendor's agents, officers,
employees, contractors or subcontractors in the performance of this Agreement. These indemnification
obligations shall survive the termination of this Agreement.
10. GOVERNMENT COMPLIANCE:
Vendor agrees to comply with all federal, state and local laws, executive orders, rules, regulations and codes
which may be applicable to Vendor's performance of its obligations under this Agreement, and all relevant
provisions thereof are incorporated herein by this reference. Vendor agrees to indemnify and hold harmless
City from any loss, damage and/or liability resulting from any such violation of such laws, orders, rules,
regulations and codes. This indemnification obligation shall survive the termination of this Agreement.
11. NONDISCRIMINATION:
Vendor represents and warrants that it and all of its officers, employees, agents, contractors and
subcontractors shall comply with all laws of the United States, the State of Indiana and City prohibiting
discrimination against any employee, applicant for employment or other person in the provision of any Goods
and Services provided by this Agreement with respect to their hire, tenure, terms, conditions and privileges of
employment and any other matter related to their employment or subcontracting, because of race, religion,
color, sex, handicap, national origin, ancestry, age, disabled veteran status and/or Vietnam era veteran status.
12. E-VERIFY:
Pursuant to I.C. § 22-5-1.7 et seq., as the same may be amended from time to time, and as is incorporated
herein by this reference(the"Indiana E-Verify Law"),Vendor is required to enroll in and verify the work eligibility
status of its newly-hired employees using the E-Verify program, and to execute the Affidavit attached herein
as Exhibit D, affirming that it is enrolled and participating in the E-Verify program and does not knowingly
employ unauthorized aliens. In support of the Affidavit, Vendor shall provide the City with documentation
indicating that it has enrolled and is participating in the E-Verify program. Should Vendor subcontract
for the performance of any work under and pursuant to this Agreement, it shall fully comply with the Indiana E-
Verify Law as regards each such subcontractor. Should the Vendor or any subcontractor violate the Indiana
E-Verify law, the City may require a cure of such violation and thereafter, if no timely cure is performed,
terminate this Agreement in accordance with either the provisions hereof or those set forth in the Indiana E-
Verify Law. The requirements of this paragraph shall not apply should the E-Verify program cease to exist.
13. NO IMPLIED WAIVER:
The failure of either party to require performance by the other of any provision of this Agreement shall not affect
the right of such party to require such performance at any time thereafter, nor shall the waiver by any party of
a breach of any provision of this Agreement constitute a waiver of any succeeding breach of the same or any
other provision hereof.
14. NON-ASSIGNMENT:
Vendor shall not assign or pledge this Agreement, whether as collateral for a loan or otherwise, and shall not
delegate its obligations under this Agreement without City's prior written consent.
15. RELATIONSHIP OF PARTIES:
The relationship of the parties hereto shall be as provided for in this Agreement, and neither Vendor nor any
of its officers, employees, contractors, subcontractors and agents are employees of City. The contract price
set forth herein shall be the full and maximum compensation and monies required of City to be paid to Vendor
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DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
All Star Paving,Inc.
Street Department-2023
Appropriation#2201 2201 43-502.01 Motor Vehicle Highway Fund;P.O.#109759
Contract Not To Exceed$268,000.00
under or pursuant to this Agreement.
16. GOVERNING LAW; LAWSUITS:
This Agreement is to be construed in accordance with and governed by the laws of the State of Indiana,except
for its conflict of laws provisions. The parties agree that, in the event a lawsuit is filed hereunder, they waive
their right to a jury trial, agree to file any such lawsuit in an appropriate court in Hamilton County, Indiana only,
and agree that such court is the appropriate venue for and has jurisdiction over same.
17. SEVERABILITY:
If any term of this Agreement is invalid or unenforceable under any statute, regulation, ordinance, executive
order or other rule of law, such term shall be deemed reformed or deleted, but only to the extent necessary to
comply with same, and the remaining provisions of this Agreement shall remain in full force and effect.
18. NOTICE:
Any notice provided for in this Agreement will be sufficient if it is in writing and is delivered by postage prepaid
U.S. certified mail, return receipt requested, to the party to be notified at the address specified herein:
If to City: City of Carmel AND City of Carmel
Street Department Office of Corporation Counsel
3400 W 131st Street One Civic Square
Carmel, Indiana 46074 Carmel, Indiana 46032
If to Vendor: All Star Paving, Inc.
4320 N US Highway 31
Seymour, Indiana 47274
Notwithstanding the above, notice of termination under paragraph 19 hereinbelow shall be effective if given
orally, as long as written notice is then provided as set forth hereinabove within five (5) business days from the
date of such oral notice.
19. TERMINATION:
19.1 Notwithstanding anything to the contrary contained in this Agreement,City may, upon notice to Vendor,
immediately terminate this Agreement for cause, in the event of a default hereunder by Vendor and/or
if sufficient funds are not appropriated or encumbered to pay for the Goods and Services to be provided
hereunder. In the event of such termination, Vendor shall be entitled to receive only payment for the
undisputed invoice amount representing conforming Goods and Services delivered as of the date of
termination, except that such payment amount shall not exceed the Estimate amount in effect at the
time of termination, unless the parties have previously agreed in writing to a greater amount.
19.2 City may terminate this Agreement at any time upon thirty (30) days prior notice to Vendor. In the
event of such termination, Vendor shall be entitled to receive only payment for the undisputed invoice
amount of conforming Goods and Services delivered as of the date of termination, except that such
payment amount shall not exceed the Estimate amount in effect at the time of termination, unless the
parties have previously agreed in writing to a greater amount.
19.3 The City may terminate this Agreement pursuant to Paragraph 11 hereof, as appropriate.
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DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
All Star Paving,Inc.
Street Department-2023
Appropriation#2201 2201 43-502.01 Motor Vehicle Highway Fund;P.O.#109759
Contract Not To Exceed$268,000.00
20. REPRESENTATIONS AND WARRANTIES
The parties represent and warrant that they are authorized to enter into this Agreement and that the persons
executing this Agreement have the authority to bind the party which they represent.
21. ADDITIONAL GOODS AND SERVICES
Vendor understands and agrees that City may, from time to time, request Vendor to provide additional goods
and services to City.When City desires additional goods and services from Vendor,the City shall notify Vendor
of such additional goods and services desired, as well as the time frame in which same are to be provided.
Only after City has approved Vendor's time and cost estimate for the provision of such additional goods and
services, has encumbered sufficient monies to pay for same, and has authorized Vendor, in writing,to provide
such additional goods and services, shall such goods and services be provided by Vendor to City. A copy of
the City's authorization documents for the purchase of additional goods and services shall be numbered and
attached hereto in the order in which they are approved by City.
22. TERM
Unless otherwise terminated in accordance with the termination provisions set forth in Paragraph 19
hereinabove, this Agreement shall be in effect from the Effective Date through December 31, 2023 and shall,
on the first day of each January thereafter, automatically renew for a period of one (1) calendar year, unless
otherwise agreed by the parties hereto.
23. HEADINGS
All heading and sections of this Agreement are inserted for convenience only and do not form a part of this
Agreement nor limit, expand or otherwise alter the meaning of any provision hereof.
24. BINDING EFFECT
The parties, and their respective officers, officials, agents, partners, successors, assigns and legal
representatives, are bound to the other with respect to all of the covenants, terms, warranties and obligations
set forth in Agreement.
25. NO THIRD PARTY BENEFICIARIES
This Agreement gives no rights or benefits to anyone other than City and Vendor.
26. ADVICE OF COUNSEL:
The parties warrant that they have read this Agreement and understand it, have had the opportunity to obtain
legal advice and assistance of counsel throughout the negotiation of this Agreement, and enter into same
freely, voluntarily, and without any duress, undue influence or coercion.
27. IC 5-16-13.
The provisions of IC 5-16-13 are hereby incorporated into this Agreement by reference.
28. DEBARMENT AND SUSPENSION
28.1 The Vendor certifies by entering into this Agreement that neither it nor its principals nor any of its
subcontractors are presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily
excluded from entering into this Agreement by any federal agency or by any department, agency or political
subdivision of the State of Indiana. The term "principal" for purposes of this Agreement means an officer,
director, owner, partner, key employee or other person with primary management or supervisory
responsibilities, or a person who has a critical influence on or substantive control over the operations of the
Vendor.
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DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
All Star Paving,Inc.
Street Department-2023
Appropriation#2201 2201 43-502.01 Motor Vehicle Highway Fund;P.O.#109759
Contract Not To Exceed$268,000.00
28.2 The Vendor certifies that it has verified the state and federal suspension and debarment status for all
subcontractors receiving funds under this Agreement and shall be solely responsible for any recoupment,
penalties or costs that might arise from use of a suspended or debarred subcontractor. The Vendor shall
immediately notify the City if any subcontractor becomes debarred or suspended, and shall, at the City's
request, take all steps required by the City to terminate its contractual relationship with the subcontractor for
work to be performed under this Agreement.
29. IRAN CERTIFICATION.
Pursuant to I.C. § 5-22-16.5, the Vendor shall certify that, in signing this Agreement, it does not engage in
investment activities within the Country of Iran.
29. ENTIRE AGREEMENT:
This Agreement, together with any exhibits attached hereto or referenced herein, constitutes the entire
agreement between Vendor and City with respect to the subject matter hereof, and supersedes all prior oral
or written representations and agreements regarding same. Notwithstanding any other term or condition set
forth herein, but subject to paragraph 16 hereof, to the extent any term or condition contained in any exhibit
attached to this Agreement or in any document referenced herein conflicts with any term or condition contained
in this Agreement,the term or condition contained in this Agreement shall govern and prevail. This Agreement
may only be modified by written amendment executed by both parties hereto, or their successors in interest.
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DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
All Star Paving, Inc.
Street Department-2023
Appropriation#2201 2201 43-502.01 Motor Vehicle Highway Fund; P.O.#1 09759
Contract Not To Exceed$268,000.00
IN WITNESS WHEREOF, the parties hereto have made and executed this Agreement as follows:
CITY OF CARMEL, INDIANA All Star Paving, Inc.
by and through its Board of Public
Works and Safety
By: By:
Not Present
James Brainard, Presiding Officer Authorized Signature
N/A
Date: Kevin Heilman ,+ +PAWN,
a—DocuSigned by:
titArlIt lest, Printed Name
MaryEA+nn°8E.Ae, Member '
���ft ANaa+`a
6/7/2023 President
Date:
�DocuSigned by: Title
004sow 20-2493779
��«te��azea�
Lori .Watson, Member FID/TIN:
Date: 6/7/2023
ATTEST: Date:
May 23, 2023
DocuSigned by:
a.4. 0 U U
Sueoorgang, Clerk
Date: 6/7/2023
is. wtrxt,Depaionnit,Snni_o's_1II Sim P,,y.Inc.(y'd,.yS Sr.i.n.Iy,S "71,232.1-Pyl
T
}
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
Exhibit A
BID TOTAL FOR 23-STR-05 PATH PRESERVATION
TOTAL
23-STR 05 PATH $ 268,000.00
PRESERVATION
Company Name All Star Paving, Inc.
THIS IS TO BE THE FIRST PAGE OF ENTIRE BID.
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
23-STR-05
Path Preservation Project
Project Name: 23-STR-05
Bid Date: 5/3/2023 TOTAL
Final Completion Date: 11/1/2023 AMOUNT: $268.000.00
ITEM # DESCRIPTION UNIT QUANTITY UNIT PRICE AMOUNT
1 Crack Seal(1,000 LBS) LBS 6,000 $6.50 $39,000.00
2 Asphalt Repair(Hand Repair) SQFT 5,000 $4.50 $22,500.00
3 Asphalt Repair(Machine Repair) SQFT 4,000 $5.00 $20,000.00
4 Zero Depth Milling SQFT 1,000� $2.50 $2,500.00
5 Liquid Road SQY 46,000 $4.00 $184,000.00
TOTALS $268,000.00 97240.44,444
All Star Paving, Inc.
4320 N US Hwy 31
PO Box 1109 7.•
Seymour, IN 47274 Kevin R.Heilman,President
812.522.4477 Dated: 3-May-23
Fax: 812.522.4472
FEI N: 20-2493779
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
PROPOSAL PACKAGE
FOR
CITY OF CARMEL,INDIANA
BY AND THROUGH ITS
BOARD OF PUBLIC WORKS AND SAFETY
PROJECT: Street Department
23-STR-05 PATH PRESERVATION
BIDDER SHALL RETURN THIS
ORIGINAL PROPOSAL AND ONE(1)COPY
OF THE ENTIRE PROPOSAL PACKAGE WITH BID
IF THERE ARE ANY QUESTIONS CONCERNING THE CONTRACT
DOCUMENTS,PLEASE CONTACT
MATT HIGGINBOTHAM AT 317-733-2001
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
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 filled in and completed and notarized
Project: Street Department
23-STR-05 PATH PRESERVATION
Proposal For: 23-STR-05 PATH PRESERVATION
City of Carmel
Date: May 3, 2023
To: City of Carmel,Indiana,Board of Public Works and Safety
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
PART 1
BIDDER INFORMATION
(Please Type or Print)
1.1 Bidder Name: All Star Paving,Inc.
1.2 Bidder Address: Street Address: 4320 N US Hwy 31, PO Box 1109
City: Seymour State: IN Zip: 47274
Phone#: ( ) 812.522.4477 Fax#:( )_812.522.4472
1.3 Bidder is a/an[mark one]:
Individual Partnership X Indiana Corporation;
Foreign(Out of State)Corporation; State:
Joint Venture Other:
1.4 [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 or with the City of
Cannel, 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, 1958]
.1 Corporation Name: All Star Paving,Inc.
.2 Address: 4320 N US Hwy 31,Seymour,IN 47274
.3 Date registered with State of Indiana: March 22, 2005
.4 Indiana Registered Agent: N/A
Name:
Address:
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
PART 2
BID PROPOSAL
2.1 Project 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 project, including any and all addenda thereto, for the total sum of
Two Hundred Sixty-Eight Thousand Dollars and 00/100
Dollars ($_268,000.00 ). The Bidder acknowledges that evaluation of
the lowest Bid shall be based on such price. The Bidder further understands that all
work which may result on the Contract shall be compensated for on a lump sum basis
and that the OWNER cannot and does not guarantee the amount or quantity of any
item of work to be performed or furnished under the Agreement.
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
PART 3
CONTRACT DOCUMENTS AND ADDENDA
3.1 The Bidder agrees to be bound by the terms and provisions of all Contract
Documents as defined in the Agreement attached hereto and incorporates such
Contract Documents herein by reference.
3.2 The Bidder acknowledges receipt of the following addenda:
ADDENDUM DATE
NUMBER
#1 May 1, 2023
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
PART 4
EXCEPTIONS
Instructions To Bidders:
4.1 The Bidder shall fully state each exception taken to the specifications or other
Contract Documents in Section 4.3 of this Part.
4.2 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.
4.3 Exceptions:
None
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
CONTRACTOR'S BID FOR PUBLIC WORK - FORM 96
��,,,t( State Form 52414(R2/2-13)/Form 06(Revised 2013)
y Prescribed by State Board of Accounts •
tore
PART I
(To be completed for all bids. Please type or print)
Date(month, day,year): May 3,2023
1. Governmental Unit(Owner): City of Carmel, Indiana
2. County: Hamilton County
3. Bidder(Firm): All Star Paving, Inc.
Address: 4320 N US Hwy 31
City/State/ZlPcode: Seymour, IN 47274
4. Telephone Number: 812.522.4477
5. Agent of Bidder(if applicable): Kris Bernens
Pursuant to notices given,the undersigned offers to furnish labor and/or material necessary to complete
the public works project of City of Carmel-23-STR-05 Path Preservation
(Governmental Unit)in accordance with plans and specifications prepared by
C ty o fCarme 1St rEe tDepa rtnent and dated April 2023 for the sum of
Two Hundred Sixty-Eight Thousand Dollars aml 00/100 $ 268,000.00
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). I hereby certify that I and all
subcontractors employed by me for this project will use U.S. steel products on this project if awarded. I
understand that violations hereunder may result in forfeiture of contractual payments.
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
ACCEPTANCE
The above bid is accepted this day of , subject to the
following conditions:
Contracting Authority Members:
PART II
(For projects of$150,000 or more—IC 36-1-12-4)
Governmental Unit: City of Carmel, Indiana
Bidder(Firm) All Star Paving, Inc.
Date(month, day,year): May 3, 2023
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
1. What public works projects has your organization completed for the period of one(1)year prior to the
date of the current bid?
Completion
Contract Amount Class of Work Date Name and Address of Owner
1,683,700.00 Site Concrete,Sec.Asp,Miff,Site 2022 CIty of Greenwood 2022 Annual Pave&Stop 18 Road
250,000.00 Road Preservation 2022 City of Carrnel,22-STR-05 Path Preservation
600,000.00 Pave,Concrete,Seal Coat 2022 LRAA,20222 Airside Pave Rehab
1,050,000.00 Pave,Con,Road Preservation 2022 Jefferson County 2022 Local
2. What public works projects are now in process of construction by your organization?
Expected
Contract Amount Class of Work Completion Name and Address of Owner
Date
1,840,000.00 EEO Qoiwote.Exc./4PNM M.uCIInaps 2023 Seymour 2022-1 CCMG
1,534,552.17 Asphalt,Concrete,Excavation 2023 City of Madison 2021-2 CCMG,Oak Hill
1,900,000.00 Asphalt,Concrete,Mill 2023 FAWIlhelm,Pleasant Run CCS,Indianapolis
500,000.00 Asphalt, Concrete,Site 2023 Seymour 5th and 6th Grade w/BCMI
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
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.
John Phares - FA Wilhelm
Shelly Chandler- HIS Contractors
Jorgie Demody-Louisville Regional Airport
Matthew Biscan-VA Hospital, Louisville
Eric Coburn -Beaty Construction
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.)
As per plans and specs
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.
AAA Striping-Traffic Markings
Oatt's Trucking -Hauling
Morphey Construction - Electrical Installation
Howard Companies-Asphalt Supplier
Coomes Excavation- Excavation
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
3. 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.
Will provide prior to contract approval (if necessary)
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.
See Attached Sheet
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.
Yes, pricing for all materials has been secured
SECTION ill 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.
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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 Seymour, IN ,this 3rd day of Ma ry , 2023
All Star Pavin , 1 nc.
.:.. (Nam f 0 n2 4on). � ,
-
Kevi rR. Heil man,President 0).
(Title of Person Signing) ea
D .
ACKNOWLEDGEMENT -
STATE OF Indi as _)
COUNTY OF Jackson
)ss
Before me, a Notary Public, personally appeared the above-named Ke y irHe it m a rile s idnt and
swore that the statements contained in the foregoing document are true and correct.
Subscribed and sworn to before me this 3rd day of May
May , 2023
4
. 170/6/- X•o
Wla /Lb?
NotaryPublc .�vN ��11�1+�If'�������,
My Commission Expires:_August 12, 2025 ' ��T•` '..�,-
County of Residence: Jennings Co., IN F. .;G'II:.4)� :°si'rf
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PART 5
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 OWNER must be specific enough in detail so
that OWNER can make a proper determination of the Bidder's capability for completing
the project if awarded.
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
PART 6
ADDITIONAL DECLARATIONS
6.1 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 so discriminated against.
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
PART 7
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.
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B*14
rr.
NON-COLLUSION AFFIDAVIT
11,
# Slate Form 4391(R4/1.00)
�rir1�
STATE OF: Indiana
COUNTY OF Jackson SS:
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.
iiiiMEIVAINV....411411111=1
Title STD',
President
Company •
All Star Paving,inc.
Before me,a Notary Public in and for said County and State personally appeared,_Kevin R.Heilman,President
who acknowledged the truth of the statements in the foregoing affidavit on this 3fd _day of MaY ,20 23.;
signalyrr of Nottarryy Public �.
County of residence Commission expiration date Printed �'y �typed n o}Notary Pubic
Jennings _ 08/12/2025 Tammy L.Magner
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DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
PART 8
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.1
Bidders Name: All Swing,Inc.
Written Signature: • — --'j -
Printed Name: Kevin R. Heilman
Title: President
0441"
Important-Notarr Signature and Seal Required in the Space Below
•
STATE OF Indiana
COUNTY OF Jackson •
Subscribed and sworn to before me this 3rd day of May
2023.
My commission expires: 08/12/25 (Signed)
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Printed: Tammy L.Ma ner .\\%\kpN1))1,,'n,,
Residing in Jackson County, State of Indiana = ;.` `.
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DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
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-ln-Fact establishing the authority of the person(s)signing this Bid
Bond on behalf of the Surety.
The 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 the undersigned
"Bidder":
All Star Paving, inc.
and
"Surety": [Name] Nationwide Mutual Insurance Company
[Address] One West Nationwide Blvd., 1-14-301 Columbus,OH 43215-2220
a corporation chartered and existing under the laws of the State of
Ohio , and authorized to do business in the
State of Indiana,
are held and firmly bound unto the City of Cannel, Indiana ("Obligee") 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 Obligee,
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, 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$ 26_000.00
WHEREAS, the Obligee has solicited Bids for certain work for or in furtherance of
construction of improvements described generally as:
23-STR 05 PATH PRESERVATION
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
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 an Agreement 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 on the project, including without limitation a
sufficient and satisfactory performance bond and payment bond payable to Obligee, each
in an amount of one hundred percent (100%) of the total project Agreement 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 3rd day of May ,2023.
s PikThis BID Bond shall bind the undersigned Surety whether or not also signed by the 4 A.•
Bidder. _fi r pavincLinc._ Nationwide Mutual Insurance Company_
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"Bidder" "Surety" = air :Ir
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Printed:Kevin R. Heilman, President Printed:Josephine G.McKinley, Attorney-in-Fact,_
"Lts. Countersigned:N/A
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DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
Power of Attorney
KNOW ALL MEN BY THESE PRESENTS THAT:
Nationwide Mutual Insurance Company,an Ohio corporation
hereinafter referred to severally as the"Company"and collectively as"the Companies"does hereby make,constitute and appoint:
Josephine G.McKinley
each in their individual capacity,its true and lawful attorney-in-fact,with full power and authority to sign,seal,and execute on its behalf any and all bonds and
undertakings,and other obligatory instruments of similar nature,in penalties not exceeding the sum of: Unlimited
Surety Bond Number: Bid Bond
Principal: AD Star Paving, Inc.
Obligee: City of Carmel, Indiana
and to bind the Company thereby,as fully and to the same extent as if such instruments were signed by the duly authorized officers of the Company;and all acts
of said Attorney pursuant to the authority given are hereby ratified and confirmed.
This power of attorney is made and executed pursuant to and by authority of the following resolution duly adopted by the board of directors of the Company:
"RESOLVED,that the president,or any vice president be,and each hereby is,authorized and empowered to appoint attorneys-in-fact of the Company,
and to authorize them to execute and deliver on behalf of the Company any and all bonds,forms,applications,memorandums,undertakings.
recognizances,transfers,contracts of indemnity,policies,contracts guaranteeing the fidelity of persons holding positions of public or private trust,and other
writings obligatory in nature that the business of the Company may require;and to modify or revoke,with or without cause,any such appointment or
authority;provided,however,that the authority granted hereby shall in no way limit the authority of other duly authorized agents to sign and countersign any
of said documents on behalf of the Company"
"RESOLVED FURTHER,that such attorneys-in-fact shall have full power and authority to execute and deliver any and all such documents and to bind the
Company subject to the terms and limitations of the power of attorney issued to them,and to affix the seal of the Company thereto;provided,however,that
said seal shall not be necessary for the validity of any such documents."
This power of attorney is signed and sealed under and by the following bylaws duly adopted by the board of directors of the Company.
Execution of Instruments.Any vice president,any assistant secretary or any assistant treasurer shall have the power and authority to sign or attest all
approved documents,instruments,contracts,or other papers in connection with the operation of the business of the company in addition to the chairman of
the board,the chief executive officer,president,treasurer or secretary;provided,however,the signature of any of them may be printed,engraved,or
stamped on any approved document,contract,instrument,or other papers of the Company.
IN WITNESS WHEREOF,the Company has caused this instrument to be sealed and duly attested by the signature of its officer the 20th day of August,2021.
Antonio C.Albanese,Vice President of Nationwide Mutual insurance Company
ACKNOWLEDGMENT
♦0,, !! STATE OF NEW YORK COUNTY OF NEW YORK:ss
m ''. Vitt On this 20th day of August,2021,before me came the above-named officer for the Company
;` 1E aforesaid,to me personally known to be the officer described in and who executed the preceding
SEAL i* instrument,and he acknowledged the execution of the same,and being by me duly
951‘'r°0 sworn,deposes and says,that he is the officer of the Company aforesaid,that the seal affixed
'4rplpr�If hereto is the corporate seal of said Company,and the said corporate seal and his signature were
%MG duly affixed and subscribed to said instrument by the authority and direction of said Company.
Stephanie RSt e i New V f
Notary Public.Slate of Now Y r
No.D2MC827o117
Quatfied in New York County Notary Public
Cammisston'Expires October 19.2024 NY Commission Evros
Odour In.2C2A
CERTIFICATE
I,Laura B.Guy,Assistant Secretary of the Company,do hereby certify that the foregoing is a full,true and correct copy of the original power of attorney issued
by the Company;that the resolution included therein is a true and correct transcript from the minutes of the meetings of the boards of directors and the same has
not been revoked or amended in any manner;that said Antonio C.Albanese was on the date of the execution of the foregoing power of attorney the duly elected
officer of the Company,and the corporate seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority of said board
of directors;and the foregoing power of attorney is still in full force and effect.
IN WITNESS WHEREOF I have hereunto subscribed my name as Assistant Secretary,and affixed the corporate seal of said Company this 3rd day of
May 202
Assistant Secretary
BDJ 1(08-21)00
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
DATE: May 3, 2023
TO: City of Carmel, Indiana
RE: CONTRACTOR: All Star Paving, Inc.
BID DATE: May 3,2023
PROJECT: 23-STR-05 PATH PRESERVATION
The purpose of this letter is to advise that should the captioned contractor be the successful bidder, and
enter into a contract for the described work, Nationwide Mutual Insurance Company will
provide appropriate Performance and Payment Bonds, subject to the terms and conditions of the bid of
All Star Paving, Inc.
SURETY COMPANY `A.''.. •. �
Nationwide Mutual Insurance Company rii ,�
/`,:SEAL *�
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By: (..--i())A/ t R A , . � , l/]l /I. ' `ORh.+ „4#
Signature Name Josephine G. McKinley `,4ttorney-in-Fact
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DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
Power of Attorney
KNOW ALL MEN BY THESE PRESENTS THAT:
Nationwide Mutual Insurance Company,an Ohio corporation
hereinafter referred to severally as the"Company"and collectively as"the Companies'does hereby make,constitute and appoint:
Josephine G.McKinley
each in their individual capacity,its true and lawful attorney-in-fact,with full power and authority to sign,seal,and execute on its behalf any and all bonds and
undertakings,and other obligatory instruments of similar nature,in penalties not exceeding the sum of: Unlimited
Surety Bond Number.
Principal: All Star Paving, Inc.
Obligee: City of Carmel, Indiana
and to bind the Company thereby,as fully and to the same extent as if such instruments were signed by the duly authorized officers of the Company;and all acts
of said Attorney pursuant to the authority given are hereby ratified and confirmed.
This power of attorney Is made and executed pursuant to and by authority of the following resolution duly adopted by the board of directors of the Company:
"RESOLVED,that the president,or any vice president be,and each hereby is,authorized and empowered to appoint attorneys-in-fact of the Company,
and to authorize them to execute and deliver on behalf of the Company any and all bonds,forms,applications,memorandums,undertakings,
recognizances,transfers,contracts of indemnity,policies,contracts guaranteeing the fidelity of persons holding positions of public or private trust,and other
writings obligatory in nature that the business of the Company may require;and to modify or revoke,with or without cause,any such appointment or
authority:provided,however,that the authority granted hereby shall in no way limit the authority of other duly authorized agents to sign and countersign any
of said documents on behalf of the Company."
"RESOLVED FURTHER,that such attorneys-in-fact shall have full power and authority to execute and deliver any and all such documents and to bind the
Company subject to the terms and limitations of the power of attorney issued to them,and to affix the seal of the Company thereto;provided,however,that
said seal shall not be necessary for the validity of any such documents."
This power of attorney is signed and sealed under and by the following bylaws duly adopted by the board of directors of the Company.
Execution of Instruments.Any vice president,any assistant secretary or any assistant treasurer shall have the power and authority to sign or attest all
approved documents,instruments,contracts,or other papers in connection with the operation of the business of the company in addition to the chairman of
the board,the chief executive officer,president,treasurer or secretary;provided,however,the signature of any of them may be printed,engraved,or
stamped on any approved document,contract,instrument,or other papers of the Company.
IN WITNESS WHEREOF,the Company has caused this instrument to be sealed and duly attested by the signature of its officer the 20th day of August,2021.
Antonio C.Albanese,Vice President of Nationwide Mutual Insurance Company
ACKNOWLEDGMENT
Ori STATE OF NEW YORK COUNTY OF NEW YORK:ss
/ 4 On this 20th day of August,2021,before me came the above-named officer for the Company
aforesaid,to me personally known to be the officer described in and who executed the preceding
�,*.SEAL:1 instrument,and he acknowledged the execution of the same,and being by me duly
IMMIN!: sworn,deposes and says,that he is the officer of the Company aforesaid,that the seal affixed
/ Alr
hAvi , hereto is the corporate seal of said Company,and the said corporate seal and his signature were
411.1 duly affixed and subscribed to said instrument by the authority and direction of said Company.y. f
Stephanie Rubino McArthurAtre • y mK.✓/L!!.+nRv�
Notary Pudic,Stale of Now York �
No.02MCO270117
Qualified in New York County Naar/Public
,Commission Minims Oct^bar 19.2024_ My Q,mmnsion Expires
October 1a 2024
CERTIFICATE
I,Laura B.Guy,Assistant Secretary of the Company,do hereby certify that the foregoing is a full,true and correct copy of the original power of attorney issued
by the Company;that the resolution included therein is a true and correct transcript from the minutes of the meetings of the boards of directors and the same has
not been revoked or amended in any manner;that said Antonio C.Albanese was on the date of the execution of the foregoing power of attorney the duly elected
officer of the Company,and the corporate seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority of said board
of directors;and the foregoing power of attorney is still in full force and effect,
IN WITNESS WHEREOF II have hereunto subscribed my name as Assistant Secretary,and affixed the corporate seal of said Company this 3rd day of
May
Assistant Secretary
BDJ 1(08-21)00
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
EXHIBIT B
Invoice
Date:
Name of Company:
Address &Zip:
Telephone No.:
Fax No.:
Project Name:
Invoice No.
Purchase Order No:
Goods Services
Person Providing Date Goods/Services Provided Cost Per Hourly Total
Goods/Services Goods/ (Describe each good/service Item Rate/
Service separately and in detail) Hours
Provided Worked
I
I
I
GRAND TOTAL
Signature
Printed Name
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
EXHIBIT C
INSURANCE COVERAGES
Worker's Compensation&Disability Statutory Limits
Employer's Liability:
Bodily Injury by Accident/Disease: $1,000,000 each employee
Bodily Injury by Accident/Disease: $1,000,000 each accident
Bodily Injury by Accident/Disease: $1,000,000 policy limit
Commercial General Liability:
General Aggregate Limit(other than
Products/Completed Operations): $6,000,000
Products/Completed Operations: $5,000,000
Personal & Advertising Injury
Each Occurrence Limit: $5,000,000
Comprehensive Auto Liability(owned, hired and non-owned)
Bodily Injury and Property Damage: $5,000,000 each occurrence
Umbrella Excess Liability
If a commercial umbrella liability policy is used to satisfy the minimum limits of liability
requirements, the combined limits must equal these minimum limits of liability.
DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B
EXHIBIT D
AFFII)A VIT
Kevin R.Heilman
being first duly sworn,deposes and says that
he/she is familiar with and has personal knowledge of the facts herein and, if called as a witness in this
matter,could testify as follows:
1, 1 am over eighteen (IS) years of age and am competent to testify to the facts contained
herein.
2. I am now and at all times relevant herein have been employed by
All Star Paving,Inc. (the"Employer")
in the position of President
3. I am familiar with the employment policies, practices, and procedures of the Employer and
have the authority to act on behalf of the Employer.
4- The Employer is enrolled and participates in the federal E Verify program Documentation
of this enrollment and participation is attached and incorporated herein.
5. The Employer does not knowingly employ any unauthorized aliens.
b. To the best of my information and belief, the Employer does not currently employ any
nnnuthorized aliens.
7. FURTHER AFFIAN 1'SAYETI-I NOT.
EX on the 3rd day of May 2023 , 1
isuz)
•
Off.°1-
Printed: Kevin R.Heilman,President
ntuiula„
I certify under the penalties for perjury under the laws of the United States of America and the State of
Indiana that the foregoing factual statements and representations arc true and correct.
/
Printed: Kevin R.Heil nun,Presi de>I t Ts
(tVi)t§!
000.
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DocuSign Envelope ID: D6ED0996-282A-4E8A-B9F1-B9DFCD49288B Page 1 of 1
INDIANA RETAIL TAX EXEMPT g
City ®f C2nrn1e]I CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 109759
ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,A/P
CARMEL, INDIANA 46032-2584 VOUCHER,DELIVERY MEMO,PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
5/18/2023 376645
ALL STAR PAVING INC Street Department
VENDOR 4320 N US HWY 31 SHIP 3400 W. 131st Street
TO Carmel, IN 46074-
SEYMOUR, IN 47274- Matt Higginbotham (317)733-2001
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
77711
QUANTITY UNIT OF MEASURE T DESCRIPTION UNIT PRICE EXTENSION
Department: 2201 Fund: 2201 Motor Vehicle Highway FND
Account: 43-502.01
1 Each Path Preservation $268,000.00 $268,000.00
Sub Total $268,000.00
c;4111:1 °F AIR
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1 • 1 ies III
Send Invoice To: I
Street Department
3400 W. 131st Street
Carmel, IN 46074- * irii
(317)733-2001 PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT $268,000.00
SHIPPING INSTRUCTIONS *ASP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A
PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN
*SHIP PREPAID. AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
*C.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
*PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL pp
*THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 ,/ c4.._42, t GJ
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
Lee Higginbotham
TITLE Commissioner
CONTROL NO. 1 09759 CONTROLLER