Hittle's Landscaping/Street/114,043.13/2016 Mowing - W of MeridianHittle's Landscaping, Inc.
Street Department - 2016
Appropriation #43-504.00; . P.O. #33496
Contract Not To Exceed $114,043.13
AGREEMENT FOR PURCHASE OF GOODS AND SERVICES e
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 Hittle's Landscaping, Inc. an entity duly authorized to do
business in the State of Indiana ("Vendor").
2.
3.
4.
TERMS AND CONDITIONS
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.
PERFORMANCE:
City agrees to purchase the goods and/or services (the "Goods and Services") from Vendor using City
budget appropriation number 43-504.00 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.
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 One Hundred Fourteen Thousand Forty Three Dollars and Thirteen Cents
($114,043.13) (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 sixty (60) 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, 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.
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, 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 acknowledgesthat 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.
[SAC O maa.,\Fn(Illc\Fliulcs Lnndscapiag, Ine -Mowing Wcsl of 31 G—N & S—i— FORM -.+6x:3/14/2016 12:29 PNII
Hittle's Landscaping, Inc.
Street Department - 2016
Appropriation #43-504.00; P.O. #33496
Contract Not To Exceed $114,043.13
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.
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.
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.
IS:\Gnlllracic\Fornls\Hilllcs 4uulsenping. 1-. - M—ing Wcm of 31 G—N & S—i., FORM -.1-3114/2016 12:29 PMI
Hittle's Landscaping, Inc.
Street Department - 201.6
Appropriation #43-504.00; P.O. #33496
Contract Not To Exceed $114,043.1.3
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.
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.
�S:\CwnrnclsNornnW iulc x L ndscnping, Ina - Mowing Wc.,l of 31 Gn«Is R Sa i— FORM •.A-3/14/2016 12:29 PMI
Hittle's Landscaping, Inc.
Street Department - 2016
Appropriation #43-504.00; P.O. #33496
Contract Not To Exceed $114,043.13
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
One Civic Square
Carmel, Indiana 46032
If to Vendor: Hittle's Landscaping, Inc.
11778 Sun Park Drive
Westfield, Indiana 46074
ATTENTION: Dave Funkhouser
AND Douglas C. Haney,
Corporation Counsel
Department of Law
One Civic Square
Carmel, Indiana 46032
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.
IS:\QnIIfnClxNnnnS\Hiulc's Unulacapinc.Ina - MmAng Wcxl"1'31 G-1., SSmi— FORM -A-:3114/2016 12:29 PMI
Hittle's Landscaping, Inc.
Street Department - 2016
Appropriation #43-504.00; P.O. #33496
Contract Not To Exceed $114,043.13
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, 2016 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. IRAN CERTIFICATION: Pursuant to I.C. § 5-22-16.5, the Vendor shall certify that, in signing this document,
it does not engage in investment activities within the Country of Iran.
27. 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.
28. 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.
[S:\CnnvaclsVunnsWiulcs Landscaping, Inc. -Mowing ww of 31G—L, & Soviets FORM-.Ai>L31142016 12:29 PM
Hittle's Landscaping, Inc.
Street Department - 2016
Appropriation #43-504.00; P.O. #33496
Contract Not To Exceed $114,043.1.3
IN WITNESS WHEREOF, the parties hereto have made and executed this Agreement as follows:
CITY OF CARMEL, INDIANA
by and through its Board of Public
Works and Safety
By:
LLQ
Jamas Brainard, res i fficer
Date: �/
Mary A01 Burke,
Date:
Lori S. Watson, ember
Date:
Hittle's Landscaping, Inc.
By:
1
Authorized Signatu(e
I)CkPY' 14A1Zt-__4
Printed N me
Title
FID/TIN:S�—
Last Four of SSN if Sole Proprietor:
ATTEST: % J
Date:
ristine S. Pain 'y?XV rk-Treasu r
Date:
JS:\000 IrntAFarin,\HiulCs Lwd.s ,ping, Inc. - Mowing Wal d31 Gaols C Smi., FORM -A -3/I4/2016 12:29 PA4]
6
APPENDIX A
PROJECT: 2016 -(MOWING WEST OF MERIDIAN
WORK: As described by the Project plans and Contract Documents including, but not limited to:
Provide ground care and maintenance for the rights-of-way, landscape easements and medians of the following:
(AREAS IN RED ARE OUT OF THE RIGHT-OF-WAY, AND MUST BE BILLED SEPARATELY- NEW AREAS ARE
IN BOLD)
96th St. and Commerce Dr. 0.46 Acres
Roundabout, median, divider islands, and R.O.W. turf
Irrigated
20,120 Sq. Ft.
96th and Ditch Rd. 0.04 Acres
Roundabout turf
Irrigated
1,700 Sq. Ft.
96t' St. and Shelborne Rd. 1.72 Acres
Roundabout, median, divider islands, and R.O.W. turf
Irrigated
74,750 Sq. Ft.
96th St. and Spring Mill Rd. 0.18 Acres
Includes Turf at Roundabout and Divider Islands
Irrigated
7,930 Sq. Ft.
96th St. and Towne Rd. 2.5 Acres
Includes Turf at Roundabout and Divider Islands
108,900 Sq. Ft.
99th St, and Commerce Dr. 0.46 Acres
(including Commerce Dr. to 96th St.)
Roundabout, median, divider islands, and R.O.W. turf
20,120 Sq. Ft.
106th St. and Ditch Rd. 0.94 Acres
Roundabout turf, 4 divider islands, and R.O.W.
Includes S.W. corner mulch beds with evergreens
Irrigated
40,821 Sq. Ft.
106th St. and Shelborne Rd. 1.06 Acres
Roundabout, median, divider islands, and R.O.W. turf
46,230 Sq. Ft.
106th St. and Spring Mill Rd. 0.07 Acres
Roundabout turf plus 4 divider islands
Irrigated
3,040 Sq. Ft.
116th St. and Clay Center Rd. 0.42 Acres
Roundabout, median, divider islands, and R.O.W. turf
Irrigated
18,272 Sq. Ft. ^,e7 J_4 ri rte'
EA6 1 i U' b
116th St. and Ditch Rd.
Roundabout turf
Irrigated
51024 Sq. Ft.
116th and Shelborne Rd.
Roundabout, medians, divider islands, and R.O.W, turf
Irrigated
241,248 Sq. Ft.
116th St. – Spring Mill Rd. to U.S. 31
R.O.W. and Medians
130,680 Sq. Ft.
121st St. and Shelborne Rd.
Roundabout
Irrigated
7,995 Sq. Ft.
126th St. and Shelborne Rd.
Roundabout
Irrigated
7,755 Sq. Ft.
126th St. Medians
Shelborne Rd. to Towne Rd.
119,790 Sq. Ft.
131St St. –Illinois St. to Shelborne Rd.
R.O.W. and Medians (579 Trees)
251,777 Sq. Ft.
131st St. and Shelborne Rd.
Roundabout, median, divider. islands, and R.O.W. turf
Irrigated
180,931 Sq. Ft.
136th St. – Oak Ridge Rd. to Ditch Rd.
R.O.W. , Roundabout turf and Medians (407 Trees)
372,285 Sq. Ft.
136th St. and Towne Rd.
Roundabout turf plus 4 divider islands
Irrigated
3,573 Sq. Ft:
Carmel Or. – Illinois St. to Dorset
1 Median (7 Trees)
Not irrigated
3,960 Sq. Ft.
Ditch Rd. –131st to 146th St.
Medians, R.O.W. and Roundabout Turf (120 Trees)
332,975 Sq. Ft.
*Only use a 30" mower around the planting beds"
Illinois St—between 116th St. and 111th St.
Includes Medians and R.O.W.
118,048 Sq. Ft.
Illinois St. -106th St to 111th St.
273,780 Sq. Ft.
0.12 Acres
r
5.54 Acres
3.00 Acres
0.18 Acres
0.18 Acres
2.75 Acres
5.78 Acres
4.15 Acres
8.55 Acres
0.08 Acres
0.09 Acres
7.64 Acres
2.71 Acres
6.3 Acres
2 �r�
Total
Illinois St. -126th St. to south of 116th St. 13.09 Acres
Includes Roundabout, Medians, R.O.W. (623 Trees)
570,301 Sq. Ft.
Illinois St. —131st St. north to 136th St. 5.08 Acres
Includes R.O.W. and Medians
221,142 Sq. Ft.
Oak Ridge Rd. —136th St. to 146th St. 7.36 Acres
Includes Roundabouts, Medians, and R.O.W. (130 Trees)
320,543 Sq. Ft.
Shelborne Rd. Medians 0.60 Acres
126th St. Roundabout, South to Abney Point Dr.
26,136 Sq. Ft.
Shelborne Rd. — North Realignment 0.30 Acres
Includes 1 Median (154 Trees)
12,885 Sq. Ft.
Spring Mill Rd. and Dorset 0.13 Acres
Roundabout turf plus 4 divider islands
Irrigated
5,597 Sq. Ft.
Spring Mill Rd. & Illinois St Roundabout 1.2 Acres
53,902 Sq. Ft.
Spring Mill Rd. —116th St. to 146th St. 21.29 Acres
Includes Roundabouts, Medians and R.O.W. (229 Trees)
927,259 Sq. Ft.
*Only use a 30" mower around the planting beds*
Towne Rd. —116th St. to 141 st St. 5.55 Acres
Includes Medians, R.O.W., and Divider Island (286 Trees)
241,596 Sq. Ft.
Towne Rd. — Between 141st St. and 146th St. 0.22 Acres
Median
9,374 Sq. Ft.
109.74 Acres
Such Project work includes mowing and trimming of turf, the pickup and removal of litter,
fertilization, herbicide application, and the control of weeds within turf along listed roadway
areas. Labor, material and equipment will be supplied by CONTRACTOR. CONTRACTOR
shall be responsible for the timely and acceptable performance of all work necessary to
accomplish the Project described herein. The same hourly mowing rate of pay shall be used for
all additional roads that may be added.
OWNER'S
REPRESENTATIVE:
Dave Huffman
Carmel Street Department
3400 W. 131ST Street
Carmel, IN 46074
q '15
2016 MOWING EAST OF MERIDIAN TOTAL
THIS IS TO BE THE FIRST PAGE OF ENTIRE BID.
L!m;X a`d i; t
TOTAL
BYID AMOUNT
THIS IS TO BE THE FIRST PAGE OF ENTIRE BID.
L!m;X a`d i; t
EXHIBIT B
Invoice
Name of Company:
Address & Zip:
Telephone No.:
Fax No.:
Project lame:
Invoice No.
Purchase Order No:
®ate:
Signature
Printed Name
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
Date/
Hours
Worked
'Total
GRAND TOTAL
Signature
Printed Name
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 Lin -it: $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:
Injury and property damage:
Policy Limit:
Umbrella Excess Liability
Each occurrence and aggregate:
Maximum deductible:
$500,000 each accident
$500,000 each accident
$500,000
$500,000
$ 10,000
EXHIBIT D
AFFIDAVIT
✓` z - a - Le i-\—, being first duly sworn, deposes and says that
he/she is familiar with s ersonal knowledge of the facts herein and, if called as a witness in this
matter, could testify as follows:
.I am over eighteen (18) years of age and am competent to testify to the facts contained
herein.
2. I n no and at all times relevant herein have been employed by
t � `P L.A'ApSe_(t P ► v'LG 1 ,1 G (the `'Employer")
in the position of �`E5 L �C�n l
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.
6. To the best of my information and belief, the Employer does not currently employ any
unauthorized aliens.
FURTHER AFFIANT .SAYETH NOT.
EXECUTED on the C day of 2 , 20 .
�I a
Printed. 1 L�� d�u VLA �2✓l
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 are
tnie and correct.
Printed; ���� ►� �2 �n
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