HomeMy WebLinkAboutOmni Electric, LLC/STREET/$26,975/96th St & Gray Rd Electrical InstallBySergeyGrechukhinat11:18am,Aug16,2023
DocuSign Envelope ID: DA9405C4-9096-4B13-9820-7F661D54709D
Omni Electric, LLC
Street Department - 2023
Appropriation #1801 0 43-419.99 2021 TIF Bonds Fund; P.O. #109912
Contract Not To Exceed $26,975.00
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
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.
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DocuSign Envelope ID: DA9405C4-9096-4B13-9820-7F661D54709D
Omni Electric, LLC
Street Department - 2023
Appropriation #1801 0 43-419.99 2021 TIF Bonds Fund; P.O. #109912
Contract Not To Exceed $26,975.00
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
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.
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DocuSign Envelope ID: DA9405C4-9096-4B13-9820-7F661D54709D
Omni Electric, LLC
Street Department - 2023
Appropriation #1801 0 43-419.99 2021 TIF Bonds Fund; P.O. #109912
Contract Not To Exceed $26,975.00
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 itis 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
st3400W131Street One Civic Square
Carmel, Indiana 46074 Carmel, Indiana 46032
If to Vendor: Omni Electric, LLC
2697 South 300 West
Tipton, Indiana 46072
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.
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
S:\\Contracts\\Departments\\Street\\2023\\Omni Electric, LLC Goods and Services.docx:8/1/2023 10:12 AM\]
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DocuSign Envelope ID: DA9405C4-9096-4B13-9820-7F661D54709D
Omni Electric, LLC
Street Department - 2023
Appropriation #1801 0 43-419.99 2021 TIF Bonds Fund; P.O. #109912
Contract Not To Exceed $26,975.00
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. DEBARMENT AND SUSPENSION
26.1 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.
26.2 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.
27. 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.
28. 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.
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DocuSign Envelope ID: DA9405C4-9096-4B13-9820-7F661D54709D
DocuSign Envelope ID: DA9405C4-9096-4B13-9820-7F661D54709D
9/6/2023
9/6/2023
9/6/2023
9/6/2023
750.005,500.002,250.001,475.00Amount17,000.00 25,500.00
x Exempt07/21/23 Ta 26,975.00
OtherProposal
est 131 Street
Proposal to: CityofCarmel3400 WCarmel, IN 46074
Equipment
Labor 17,000.001,475.00 17,000.00otals: ax for Material: e will either do this via one bore from next to P1 cabinet to
Sales TGrand T
Material 8,500.005,500.00750.002,250.00
otal:
Sub T
est
ThisisaproposalfortheCityofCarmelfortheinstallationofconduitandelectricalfromanexistingelectricalP1cabinettotheadjuacentroundaboutof96thStreetandGrayRoad.Estimateddistanceistobenomorethan200feetintotallength.- Bore (1) - 4" conduittoconnecttheexistingelectricalP1cabinettheroundabout. Ifatthistime4" conduitisnotavailable, customerwillallowustouse (2) - 2" conduits. WroundaboutorwewillborefromP1cabinettothesplinterandthentotheroundabout.- Installupto (3) quaziteboxes; onetobeplacedoutsideoftheP1cabinet, onetobeplacedasaconnectionpointinthesplinter (ifwehavetogothispath), andonetobeplacedwithintheroundaboutwheretheconduitwillstop.- 13" x24" x12" QuazitetobeplacedadjacenttoP1cabinet- 12" x12" x12" Quazitetobeplacedwithinthesplinter- 13" x24" x12" Quazitetobeplacedattheendoftheconduitwithintheroundabout- Installthequazitewithintheroundaboutatleast8feetfromthecurb (FinallocationtobeconfirmedbyCarmelStreetDepartment)- Pull 2) runs of #10 THHN from the existing electrical P1 cabinet to the roundabout quazite, termiante the wiring in
Notes:
ax: 7.00 %
Job:230723 96TH & Gray Road(bore) 2697 South 300 WTipton, IN46072765-675-4443Description Sales TOMNIElectricLLCMisc. SuppliesSand(backfilling)Asphalt PatchingLabor/BoringPrivate Locates
DocuSign Envelope ID: DA9405C4-9096-4B13-9820-7F661D54709D
07/21/23
07/21/202309:27 AM
Amount
water
Other
Equipment
Labor
Material
rktobecompletedduringnormalbusinesshours.rk to be completed within 60 days of project approval.
completedinfullbyothers.ExistingP1cabinettohaveanexisting4" sleeveforustoconnectontothatwewilldirecttothequaziteweinstalljustoutsideoftheP1cabinet.CustomertoprovidelocationinsideofCarmelforustodump, cleanout, andrefillthewaterforthevactrailermetertobeprovidedbyCityofCarmel)Omniisnotresponsibleforanyunmarkedundergroundutilities, landscape, finalgrading, grassseeding, ect.Nopermitsareaccountedfortogetlaneclosuresasneededtocompletethisscopeofwork.WoWo
DescriptionOmniProposalContinued...
DocuSign Envelope ID: DA9405C4-9096-4B13-9820-7F661D54709D
City of Carmel Street Department
96th St and Gray Rd Electrical Install
Specifications
The City of Carmel Street Department is requesting quotes for the installation of conduit and electrical
lines from an existing electrical P1 cabinet to the adjacent roundabout of 96th St and Gray Rd.
The estimated distance for this conduit is approximately 200 ft. See the attached aerial for the depiction of
the preferred conduit path. Any deviation must be approved by City of Carmel Street Department.
Contractor must:
Bore one 4” conduit to connect the existing electric P1 cabinet, located at the NW area of the
roundabout, to terminate within the roundabout
Contractor may substitute two 2” conduits for this project
Install three quazite boxes (sized below) at a junction outside the P1 cabinet, a connection point in the
North divider island, and within the center of the roundabout termination point
13” x 24” x 12”: Adjacent to P1 Cabinet
12” x 12” x 12”: Within median (North divider island)
13” x 24” x 12”: Conduit termination point within the roundabout
Install the quazite box within roundabout at least 8’ from the curb (final location to be confirmed by
Carmel Street Department)
Pull two dedicated 120V circuits from inside the electrical P1 cabinet to the inside of the roundabout
quazite box, leaving 10’ of wire coiled inside the P1 cabinet and 10’ of wire coiled at the termination
quazite box
The attached utility map locations are preliminary, and these locations have not been verified by the
Carmel Street Department. The contractor is responsible for line locates before work may begin.
Please price to have work completed 60 days of project approval.
Any questions regarding this quote may be directed to Ryan Murt at 317-733-2014 and
Rmurt@carmel.in.gov. All quotes must be sent by email to cedmondson@carmel.in.gov by noon EST
Friday July 21st, 2023.
mailto:cedmondson@c
armel.in.gov
mailto:Rmurt@car
mel.in.gov
DocuSign Envelope ID: DA9405C4-9096-4B13-9820-7F661D54709D
DocuSign Envelope ID: DA9405C4-9096-4B13-9820-7F661D54709D
MAG
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RIVER RIDGE CROSSING
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DEED INST #2002-0056031
MARION COUNTY BOARD
OF COMM DEDICATION OF
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INST #2001-0151062
96th STREET - LINE "A"1 2 5/
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INDIANA MEMBERS
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DEED OF
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8, T17N,
R4E LOT 2
INST #A201600002308 BANKING ASSOC.
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OF INDIANAPOLIS,DEPT.
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1997-0145287RIVER
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OF INDIANAPOLIS INST #
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RRW OUTLOTS, LP QUITCLAIM DEED
INST #2002-
0158683 OUTLOT #
3 MARION CO.WASHINGTON
TWP.SEC.
17, T17N,
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DEED INST #
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1. All Stationing from
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2. See Roundabout Geometrics
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Use Path27 to Str.
No. 211 Connect
existing 27" Pipe Ex.
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be removed
73, Str. No. EX502
to Str. No. 224
Connect existing 36" Pipe Ex.
MH to be removed
87, Str. No. EX505 13 Curb Construction
Temp. R/W
for 105' Lt. 65 "S-2-
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EASEMENT 2' NON-
ACCESS U.E. EASEMENT 15' L.
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Sewer Installation Temp.
R/W for 36" rcp 60'
Rt. 35 "S-2-A"Ex. P.L. Lt.
10.76 "S-2-A"Ex.
P.L. Lt. 84.55 P.L. "
S-2-A"
to be removed Ex. Inlet & 13'
of 12" Pipe 91 "S-2-A",
Str. No. EX707A
to be removed 97' of 18"
Ex. Pipe NW 23, Str. No. EX504
tobe
removedEx.
Inlet &
10'
of 12" Pipe 06 "S-
2-A", Str. No. EX708to be
removed Ex. Inlet & 30'
of 12" Pipe
20 "S-2-A", Str.
No. EX710 to be romoved
Ex. Inlet & 72' of
15" Pipe 91 "S-2-
A", Str. No. EX707 to
be removed Ex. MH &
82' of 36" Pipe 07 "
S-2-A", Str. No.
EX709R/WR/W R/W
R/WR/Wof 12" Pipe Req'
d Mod. CB Type
K-10 & 17'20, Str.
No. 205 on existing18" RCP Doghouse
MH Type C-4
22, 46' Str. No. 206
on existing 18" RCP Doghouse MH
Type C-4 06,
45' Str. No. 214 on
existing 18" RCP Doghouse MH
Type C-4 71, 45'
Str. No. 210 of 12"
Pipe Req'd Mod. CB
Type K-10 & 26'10,
Str. No. 215 of 12"
Pipe Req'd Mod. CB
Type K-10 & 24'67,
Str. No. 209 of 12"
Pipe Req'd Mod. CB Type
K-10 & 5'00,
Str. No. 213 of 15"
Pipe Req'd MH Type C-
4 & 22'99, 62'
Str. No.
212 of 15" Pipe Req'd
MH Type C-4 & 56'
55, 83' Str. No. 217
of 12" Pipe Req'd
MH Type C-4 & 31'
82, 104' Str. No. 220
of 12" Pipe Req'd
Mod. CB Type K-10 & 9'60, Str.
No. 218 of 12" Pipe
Req'd Mod. CB Type
K-10 & 2'85, Str.
No. 223 36" RCP MH
Type K-4 on existing 87,
57' Str. No. 224
of 12" Pipe Req'd
MH Type C-4 & 25'47,
40' Str. No. 232
of 30" Pipe Req'd
MH Type J-4 & 79'17,
50' "S-2-A"
Str. No. 417 of 12"
Pipe Req'd MH Type
C-4 & 39'89, 41'
Str. No. 233 of 12"
Pipe Req'd Mod. CB
Type K-10 & 9'90,
Str. No. 234 of 12"
Pipe Req'd Mod. CB
Type K-10 & 9'45,
Str. No. 231 of 12"
Pipe Req'd Mod. CB
Type K-10 & 9'15, Str. No. 227
of 15" Pipe Req'd
MH Type C-4 & 29'
19, 47' Str. No. 228 of 12" Pipe
Req'd MH Type C-
4 & 4'27, 55' Str. No.
230 of 12" Pipe Req'd MH
Type C-4 & 39'68,
72' Str. No. 222 of 12"
Pipe Req'd MH
Type C-4 & 38'74,
41' "S-2-A" Str. No.
413 of 12" Pipe
Req'd MH Type C-
4 & 61'74, 54' "S-2-
A" Str. No.
414 of 12" Pipe Req'
d Mod.
CB Type K-10 & 5'76 "S-
2-A", Str. No. 415
of 12" Pipe Req'd Mod.
MH Type C-10 & 21'
53, Str. No. 208
of 12" Pipe Req'd
Mod. MH Type C-10 & 77'
26, Str. No. 229 of
12" Pipe Req'd Mod.
CB Type R-13 & 33'Str.
No. 416 04, 25' "
S-2-A" 27" RCP
Mod. MH Type J-
7 on existing 73, 60' Str.
No. 211 88'R90'R150'R& 10'
of 12" Pipe Req'
d Mod. CB Type
K-10 08,
Str. No. 225 of 12" Pipe
Req'd Mod. MH
Type C-7 & 15'10,
63' Str. No. 226 of 12"
Pipe Req'd Mod.
CB Type R-13 &
25'61, Str. No. 221
Fill 138' of 27" Pipe
to be
removed & Flowable Ex. Inlet & 41'
of
27" Pipe
63 "S-2-
A", Str. No. EX711 to
Str. No. 216 Connect existing 18"
Pipe to be removed Ex. MH & 70' of
18" pipe 29, Str. No.
EX503 of 12" Pipe Req'd
Mod. CB Type
K-10 & 8'60,
Str. No. 219 on existing
18" RCP Doghouse MH Type
C-4 55,
45' Str. No. 216
BMP Structure 75,
58' Str. No. 224A LimitsConst. Gas
Line Do
Not
Disturb
of
12"
Pipe
Req'd Mod. MHType
C-
7 & 62'64, 67' "
S-2-A"
Str.
No. 419 of 12"
Pipe Req'd Mod.
MH Type C-10 &
19'Str. No. 418 47 "
S-2-A",of
12" Pipe Req'd
Inlet
Type J-10 & 29'Str.
No. 419A 78 "S-2-A",NO
CURVE RUN PI
Sta. =
68+
76.
55 "A"CURVE
DATA LEGEND K
13 15 16
14 27 Mulched
Seeding, UF1 C See Typical Cross Sections HMA for Sidewalk,D 22See
TypicalCrossSectionsFull
Depth
HMA
Pavement, Subgrade Treatment Type
II PCCP
for Approaches, 9", on Subgrade
Treatment Type II HMA For
Approaches, on R Curb & Gutter,
Combined, Type III Curb & Gutter,
Combined, Type II MH = Manhole CB = Catch
Basin
23TAF3
Type
D,
Modified
Concrete
Center Curb,
Type
B,
ModifiedConcrete Center
Curb,
165
lb/yd
HMA
Type C, 4,
76,
Surface,
9.
5
mm with2
1Milling,
Asphalt,
1
2
F2
SeeTypicalCross
Sections Concrete
Sidewalk,4" PCCP,
DocuSign Envelope ID: DA9405C4-9096-4B13-9820-7F661D54709D
EXHIBIT B
Invoice
Date:
Name of Company:
Address & Zip:
Telephone No.:
Fax No.:
Project Name:
Invoice No.
Purchase Order No:
Goods Services
Person Providing
Goods/Services
Date
Goods/
Service
Provided
Goods/Services Provided
Describe each good/service
separately and in detail)
Cost Per
Item
Hourly
Rate/
Hours
Worked
Total
GRAND TOTAL
Signature
Printed Name
DocuSign Envelope ID: DA9405C4-9096-4B13-9820-7F661D54709D
EXHIBIT C
INSURANCE COVERAGES
Worker’s Compensation & Disability Statutory Limits
Employer’s Liability:
Bodily Injury by Accident/Disease: $100,000 each employee
Bodily Injury by Accident/Disease: $250,000 each accident
Bodily Injury by Accident/Disease: $500,000 policy limit
Property damage, contractual liability,
products-completed operations:
General Aggregate Limit (other than
Products/Completed Operations): $500,000
Products/Completed Operations: $500,000
Personal & Advertising Injury
Policy Limit: $500,000
Each Occurrence Limit: $250,000
Fire Damage (any one fire): $250,000
Medical Expense Limit (any one person): $ 50,000
Comprehensive Auto Liability (owned, hired and non-owned)
Bodily Single Limit: $500,000 each accident
Injury and property damage: $500,000 each accident
Policy Limit: $500,000
Umbrella Excess Liability
Each occurrence and aggregate: $500,000
Maximum deductible: $ 10,000
DocuSign Envelope ID: DA9405C4-9096-4B13-9820-7F661D54709D
DocuSign Envelope ID: DA9405C4-9096-4B13-9820-7F661D54709D
7/25/2023
OMNI ELECTRIC LLC
TIPTON, IN 46072 -
109912
2697 SOUTH 300 WEST
City of Carmel
ONE CIVIC SQUARE
CARMEL, INDIANA 46032-2584
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL - 1997
INDIANA RETAIL TAX EXEMPT
CERTIFICATE NO. 003120155 002 0
FEDERAL EXCISE TAX EXEMPT
35-6000972
PURCHASE ORDER NUMBER
THIS NUMBER MUST APPEAR ON INVOICES, A/P
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
VENDOR SHIP
TO
PURCHASE ID BLANKET CONTRACT PAYMENT TERMS FREIGHT
EXTENSION
City of Carmel
3400 W 131st St
Carmel, IN 46074-
317) 733-2001
375598
UNITPRICEDESCRIPTIONUNITOFMEASUREQUANTITY
Page 1 of 1
Crystal Edmundson
79426
1801Department:0Fund:2021 TIF Bonds
43-419.99Account:
ElectricalInstallation1 $26,975.00 $26,975.00Each
26,975.00SubTotal
26,975.00
Send Invoice To:
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
SHIPPING INSTRUCTIONS
SHIP PREPAID.
C.O.D. SHIPMENT CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945
PAYMENT
A/P 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
AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
CONTROL NO. 109912
ORDERED BY
TITLE
CONTROLLER
City of Carmel
3400 W 131st St
Crystal Edmundson
Carmel, IN 46074-
Henry Mestetsky Henry Mestetsky
317) 733-2001
Director Director
DocuSign Envelope ID: DA9405C4-9096-4B13-9820-7F661D54709D