Municipal & Contractors Sealing Products/Eng/595.175/Adl Serv #1/Small Structure Pipe Lining; Culverts 65, 92, 122, 128 and Storm Sewer Locations A, C, DMunicipal & Contractors Sealing Products
Engineering Department- 2016
Appropriation T#94-650.04 2016 Storm Water Bond: P.O. #34292 e
Contract Not To Exceed 5595,175.00
ADDITIONAL SERVICES AMENDMENT TO
AGREEMENT FOR PURCHASE OF GOODS AND SERVICES
THIS AMENDMENT -.TO THE GOODS AND SERVICES AGREEMENT ("Agreement") entered into by and
.between 'the .City of Carmel and. Municipal & Contractors Sealing Products (the "Vendor"), as City Contract dated
November 4, 2015 shall amend the terms of the Agreement by adding the additional services to be provided by
Vendor consistent with the Scope of Work attached hereto and incorporated herein as Exhibit "A". Furthermore,, the
terms of the Agreement shall be amended to include the E -verify requirement as stated in Indiana Code § 22-54.7 et
seq.; which is attached hereto and incorporated herein as Exhibit "B", as well as the required E -verify Affidavit;
attached hereto and incorporated herein as Exhibit "C'. Also, pursuant to I.C. § 5-22-16.5, Vendor shall certify that in
signing this document,. it does not engage in investment activities within the Country of Iran. The terms and
conditions of the Agreement shall not'otherwise be affected by this Additional Services. Amendment and shall remain
in full force and effect.
rJ
IN WITNESS WHEREOF, the parties hereto have made and executed this Amendment as follows:
0
CITY OF CARMEL, INDIANA Municipal & Contractors Sealing Products
by and through its Board of Public
Works and Safety
By: /
ames Brainard; Pr l ing Off' r
Mary An lurke, MeV/j
Date: 7
1-11.0
0
By: ?A0Z___
Authorized Signature
-�- C br
Printed Name
PrI -C
Title
FID/TIN: -N -- (.( —Ci i G1
Last Four of SS((N if Sole Proprietor:
Date:
j�: Cnd... .`Tad.S•.� A.:Bind.S�:aS'.r:,nw�utiC�tti`tlmaitp3»Gaua:var Rca;inF,PryJn.i: a.Wl S..� Ama�d i•E2--.01E —1, Y\11
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: Small Structure: Pipe Lifting of Culverts 65, 92, 122, & 128 and Storm Sewer
Locations, A, C, & D.
Project Nufnber. 16-$W-08
Proposal,For Construe tion of;:.
The, poe- lining: of the existing small, structure Culvert -65 on West Main Street.
The'pipe lining of the existing -small structure Culvert 92;:on Keystone,Avenue.
The pipe lining of the exWing.small structure Culvert 122 on.Beech Drive.
The pipe lining of thq existing small structure Culvert 12$ on; Beechtree Circle
The pipe lining of the existing storm sewer at Location.A on: Cool Creek Drive.
Thepipe=lining�of the existing storm sewer'atLoeation C n..LakeviewDrive
Vie pipe lining of the exi Vog storm sewer at Location D on Whispering Trail
Date: S 3 . c L..c,
To; City of Carmel, Indiana, Board of Public Works and, Safety
EXH601T.
1CJ7
PART .2
BED PROPOSAL
41 Base Bid
The, undersigned Bidder proposes to furnish all necessary labor, tuachinerYj tools;
apparatus, rnatdri a I Is, oquippent, sot -vice and other necessary sup perform plies, and to p b and
fulfill all obligations incident thereto in strict. accordance. with and within the t rneW
provided by the terms -and conditions of the Contract Do.currients for, the :above: described
Work, and Project, including any and all addenda thereto- for the Unit Prices applicable to,
the
lie C6nttaQt Item ,as stated. ig Paitl hereof, which. Unit Prices, who'll multiplied by
estittated unit.qugntities for such Contralet"Items', total,
Base Bid: .FtYhLr6reA
Dollars:
92.2 General
The Bidder a6knoWledges that evaluation of the lowest B10. shall be based on the total of
the Base and `selected Alternate Bids if applicable-.
gh -o
The -Bidder. acknowledges that the Owner.reserves. the 6 mawafd.theContractfor the.
Base 'Bid alone, for the Base Bidlus selected Alternate P e Bids if applicable
The Bidder ftirther a:ckno-YV edgqs that the unit quantities listed in .Part 3 of 0!!s. Proposal
are estimates . qQ16 for -i and Contract award, and arc not to
y, , le pqrp
ose of Did. evaluatioi ntra v a n r
be consttued as exact, or binding.
The: Bidder further understands that all :Work which may result on the Contract s114.11 be
cQmpensated for on. a Unit Price basis and that the OWNER and ENGINEER cannot and
d formed or:
not guarantee the amount or quantity of any item of Work, to be perforn
'furnished under the Contract.
EXHUT -A
2 e,�3
53
Itemized Proposal Project 16 -SW -08
Small -Structure Pipe Uni . ng of
Culverts 8, 92,.122,_& 118
'and
Storm Sewer Locations A. C, & D
Itein ff
Jtem
Quan ity
Unit
unit Cost Total -Cost.
27
lvlaintaining Traffic, Culvert 128
Subtotal 3101
Location A
29
N150 Lining, [type], Location A, 37"x33"
LF
200
29_
Perpetuation,Ekisting Pipe
EA
2
t560
30
Pipe End Scbtidn
EA
2
Oc
3.1
Riprilp
TON
20
56R5
32
Geotextiles
8 Y -D.'
31
OZI
33
Dewatering; Location -:A
ts.
I
34
Backfill
CYS
35
Mobilization and Demobilization
-LS
36,
RestofAti6n./.Erb,§iO,ri, Control, LocationA
LS
I
'3 7
Video. Insinction, Location A
1:8.
1
3
Maintaining Traffic, Location: A
LS
I
Subtotal" E5,
Location C
'3 9.
Pipe Linin ; (type), Location C 12"
LF
78-
W- 0�4.
40,_
Pi )e Lining; [typej, Location C,.24"
Lr.
61
44 _
Pipe Lining;Lining;[typ6], L66atidlIC, 33"
LF
353
J
O's
M
42�
Pipe, RCP,
tri
77
43;
Backfill
CY&
61
44
Peroetdation, Existing Pie
EA.
4
45
Dewaterhig, Location C;...
L .. S
40
Mobiliz,iti6n.aiid,Demobilizafion
LS
1.
03cp
RGL 01"F�"
4 .7
Restorad6hffirdsion Control, Location C
LS
1
300-d�
-I=
48:
Video Inspection,: Location C
LS
1
a
0
497-1—MaintiffiffigRaffic-,
Locatibn C
LS
I
Uchdon D
-50,_
Pipe Lining; [typel, Location D; 15"
LF
180.
go
Q)OP4
51
Fired End Section, tF
EA
I
C)OL
�52:.
��giprap
TON
6
0"
53
Geotextiles
SYD
16
54
Dewatering, Lobation. D.
LS
I
55
MobflizaloiI. and Deniobilization
CDC
56:
Rcsiorafion/Erosion:.Canirol, Location D
LS
EXHIOT
Municipal & Contractors Sealing Products
Engineering Department - 2016
Appropriation #94-650.04 2016 Storm Water Bond; P.O. #34292
Contract Not To Exceed $595,175.00
EXHMIT `B"
'E, -verify requirement
All terms defined in I.C. § 22-5-1.7 et seq. are adopted and incorporated into this section of the Amendment.
Pursuant to I.C. § 22-5-1.7 et seq., Vendor shall enroll in and verify the work eligibility status of all of its newly -hired
employees using the E -Verify program, if it has not already done so as of the date of this Addendum. Vendor is further
required to execute the attached Affidavit, herein referred to as "Exhibit C", which is an Affidavit affirming that: (i) Vendor is
enrolled and is participating in the E -verify program, and (ii) Vendor does not knowingly employ any unauthorized aliens. This
Addendum incorporates by reference, and in its entirety, attached "Exhibit C." In support of the Affidavit, Vendor shall
provide the City with documentation that it has enrolled and is participating in the E -Verify program. This Agreement
shall not take effect until said Affidavit is signed by Vendor and delivered to the City's authorized representative.
Should Vendor subcontract for the performance of any work under this Addendum, the Vendor shall require any
subcontractor(s) to certify by affidavit that: (i) the subcontractor does not knowingly employ or contract with any unauthorized
aliens, and (ii) the subcontractor has enrolled and is participating in the E -verify program. Vendor shall maintain a copy of such
certification for the duration of the term of any subcontract. Vendor shall also deliver a copy of the certification to the City
within seven (7) days of the effective date of the subcontract.
If Vendor, or any subcontractor of Vendor, knowingly employs or contracts with any unauthorized aliens, or retains
an employee or contract with a person that the Vendor or subcontractor subsequently learns is an unauthorized alien, Vendor
shall terminate the employment of or contract with.the unauthorized alien within thirty (30) days ("Cure Period"). Should the
Vendor or any subcontractor of Vendor fail to cure within the Cure Period, the City has the right to terminate this Agreement
without consequence.
The E -Verify requirements of this Agreement will not apply, should the E -Verify program cease to exist.
[SXonicacts\Prof.Sv s & Good SvcstEngincaua' tg@0161Municipa1 & Conirnctors SG ling Products AM Svc An -0-27-2012 with E -Verify Iangunge.doc:8B2016 4:21 PK
Municipal ,& Coti(ractors Scaling Products
Engineerin(iDepartment
-2016
Appropriatiod 7#94-650.04 201 G.St.orm Water Bond: P.U. #I34292
Contract Not To Exceed .S595.1-75.00
Exhibit "C°
Q6v-+
E-Verify Affidavit
d , Conn or , being first duly sworn, deposes and says that
he/slid is familiar with and has personal -knowledge of the facts herein and, if called as a witness in this
matter, couldtestify as follows;
1. I ant over .eighteen (18) years of age and am competent to testify to the facts contained
herein.
2. I aril now and - at all times relevant herein have been employed by
166& R CAVATGOWS Se&tno, Qmducl (the "Company") in the position
of Ce.5cCiPnt
3. I am familiar %with the employment policies, practices, and procedures of the Company and
Have the authority to act oil behalf.of the Company.
4. The Employer is enrolled and participates in. the federal. E -Verify program and has
provided documentation of such .enrollment and participation to tate City of Carmel,
Indiana.
5. The Company does not knowingly employ any unauthorized aliens.
FURTHER AFFIANT SAYETH NOT.
EXECUTED on the �1' day of U 'l 2C I(O:
Printed:
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 true and correct.
i
Printed:t(Ti" Y1 CSt
IS:+C.ma nd3•nd.5s..kGa.laSr:.t1:.�nce:cvfl:Ulitltu:ii:ipxtw G`n+.+-':`+a 5eslinF i:�•:n::..\eWl ti.•. ,Lau:N� :i-Z:q'_nnl:f:-\'ai(y Un�u;,:.:Nti;4E?u1�i=::1PM1
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Company ID Number: 74219
Client Company ID Number: 631319
Company Facility Address:7740 Reinhold Drive
Cincinnati, OH 45237
County or Parish: HAMILTON
Employer Identification
Number: 311692549
North American Industry
Classification Systems
Code: 221
Administrator.
Number of Employees: 10 to 19
Page 15 of 151 E -Verify MOU for Employer (Client) using a E -Verify Employer Agent I Revision Date 09/01/09
www.d hs.gov/E-Verify
Company ID Plumber: 74219
Client Company ID Number: 631319
The individuals whose signatures appear below represent that they are authorized to enter into
this MOU on behalf of the Employer, the E -Verify Employer Agent and DHS respectively.
If you have any questions, contact E -Verify at 1-888-464-4218.
Approved by:
Employer Municipal & Contractors Sealing Products.
Name (mease Type or Print) Title
Signature Date
E. Verify Employer Agent Selection Management Systems Inc.
Melissa Fleming SEO Specialist
Mama tPlease Type or Print) TWO
Electronically Signed 03/1012013
Signatarc Dam
Department of Homeland Security —Verification Division
Name (Please Type or Print) Title
919nature3 Date
Information RQquired
For the E -Verify E -Verify Employer -Agent Orb
gratie
.Information relating to your Company:
Company Name:Munlcipal & Contractors Sealing Products
Page 14 of 151 E -Verity MOU for Employer (Client) using a E -Verify Employer Agent I Revision Dale 09/01/09
www.dhs.g ov1E-Verify
City®� cfj� ��'jn I'CERTIFICATE
INDIANA RETAIL TAX EXEMPT
NO. 003120155 002 0
Page 1 of 1
PURCHASE ORDER NUMBER
(� JLJjJl JLFEDERAL
EXCISE TAX EXEMPT
34292
ONE CIVIC SQUARE
35-6000972
THIS NUMBER MUST APPEAR ONINVOICES, AIP
CARMEL, INDIANA 46032-2584
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR
CITY OF CARMEL -1997
SHIPPING LABELS AND ANY CORRESPONDENCE
PURCHASE ORDER DATE
DATE REQUIRED
REQUISITION N0.
VENDOR NO-
DESCRIPTION
8/4/2016
357217
Project 16 -SW -08; Contract Date 11.04.15
MUNICIPAL & CONTRACTORS SEALING
PRO City Engineering's Office
VENDOR 7740 REINHOLD DRIVE
SHIP 1 Civic Square
TO Carmel, IN 46032 -
CINCINNATI, OH 45237 -
Kate Lustig
PURCHASE ID BLANKET
CONTRACT
PAYMENT TERMS
FREIGHT
7192
QUANTITY UNIT OF MEASURE
DESCRIPTION
UNIT PRICE EXTENSION
Department: 2200 Fund.- 0 2016 Storm Water Bond
Account: 94-650.04
1 Each ASA 1 -Small Structure Pipe Lining; Culverts 65, 92, 122, 128 $595,175.00 $595,175.00
and Storm Sewer Locations A, C, D
Sub Total $595,175.00
Send Invoice To:
Jill Newport
CrossRoad Engineers, P.C.
3417 Sherman Drive
Beech Grove, IN 46107
G.O./Storm Water Bonds PLEASE INVOICE IN DUPLICATE
DEPARTMENT i ACCOUNT PROJECT PROJECTACCOUNT AMOUNT
PAYMENT $595,175.00
SHIPPING INSTRUCTIONS ' IVP 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 UNOBUGATED 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
'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 f
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY
TITLE
CONTROL NO. 34292 CLERK -TREASURER