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HomeMy WebLinkAbout2011 Pavement of Various AlleysIllinois Department of Transportation COUNTY OF STATE OF ILLINOIS COOK CITY OF EVANSTON (Name of City, Village, Town or Road District) ❑ ESTIMATE OF COST SPECIFICATIONS ® PLAINS MATERIAL PROPOSAL ❑ DELIVER AND INSTALL PROPOSAL ❑ CONTRACT PROPOSAL �j CONTRACT CONTRACT BOND FOR THE IMPROVEMENT OF Proposal ! Contract Cover PROPOSAL SUBMITTED BY A. Lamp Concrete Contractors, Inc. Contractor's Name 1900 Wright Blvd, Street P.O. Box Schaumburg IL 60193 City State Zip Code STREET NAME OR ROUTE NO. 2011 Paving of Various Alleys SECTION NO, PW-AP-1105 TYPES OF FUNDS SA Fund and Other For Municipal Projects Submitted Approved/Passed Date Cit y Manager For County and Road District Projects Submitted/Approved Submitted/Approved Date ❑ Highway Commissioner Rate ❑ County Engineer/Superintendent of Highways Department of Transportation ❑ Released for bid based on limited review Date Regional Engineer Concurrence in approval of award /'Z 20ii 1L� <+ � Director of Public Works Approved as to form M Ceram Farrar 13LR 12210 (Rev.12108108) Corporation Counsel CITY OF EVANSTON BII) FORM SECTION 20300 2011 PAVING OF VARIOUS ALLEYS PW-AP-1105 Bid Number. ] 2-32 1.01 BID TO. - THE CITY OF EVANSTON 2100 Ridge Avenue — Room 4200 Evanston, Illinois 60201 hereafter called "OWNER". r' 1.02 BID FROM: Name: (Hereinafter call "BIDDER") AddressAgM (;)�l i%� 521- Telephone Number: Fax Number: <W % f 1.03 ACKNOWLEDGEMENT: A. The Bidder, in compliance with the Invitation for Bids, having carefully examined the Drawings and Project Manual with related documents and having visited the site of the proposed Work, and being familiar with all of the existing conditions and limitations surrounding the construction of the proposed project, including the structure of the ground, subsurface conditions, the obstacles which may be encountered, local restrictions, and all other relevant matters concerning the Work to be performed, hereby PROPOSE to perform everything required to be performed, and to provide all labor, materials, necessary tools and equipment, expendable equipment, all applicable permits and taxes and fees, and provide all utility and transportation services necessary to perform and complete in a workmanlike manner the Project in accordance with all the plans, specifications and related Contract Documents as prepared by the City of Evanston. B. The undersigned hereby acknowledges receipt of Invitation of Bids, Instruction to Bidders, General Conditions, Drawings, other Contract Documents and acknowledges receipt of the following Addenda: Addendum No.WNS----Dated Addendum No. Dated Addcndum No. Dated Addendum No. Dated 1.05 GENERAL STATEMENTS A. The undersigned has checked all ofthe figures contained in this bid and further understands that the Owner will not be responsible for any errors or omissions made therein by the undersigned. B. It is understood that the right is reserved by the fawner to reject any or all bids, to waive all informality in connection therewith and to award a Contract for any part of the work or the Proj ect as a whole. C. The undersigned declares that the person(s) signing this bid is/are fully authorized to sign onbehalf of tha named f m and to fully bind the named firm to all the conditions and provisions thereof. D. It is agreed that no persons) or company other than the firm listed below or as otherwise indicated hereinafter has any interest whatsoever in this bid or the Contract that may be entered into as a result thereof, and that in all respects the bid is legal and fair, submitted in good faith, without collusion or fraud- E. It is agreed that the undersigned has complied and/or will comply with all requirements concerning licensing and with all other local, state and national laws, and that no legal requirement has been or will be violated in making or accepting this bid, in awarding the Contract to him and/or in the prosecution of the Work required thereunder. F. To be considered a bona fide offer, this bid must be completed in full and accompanied by a bid deposit or a bid bond when required by Contract Documents or Addenda. 1.05 ALTERNATES A_ When alternate bids are required by Contract D ocuments or Addenda thereto, the undersigned proposes to perform alternates for herein stated additions to or deductions from, the stated Based Bid. Additions and deductions include all modifications ofWork or additional Work that the undersigned may be required to perform by reason of the acceptance of alternates. 1.07 AGREEMENT A. By submitting this Bid, the undersigned agrees: 1. To hold this Bid open for sixty (60) days from submittal date. 2. To eater into and execute a Contract with the Owner within fourteen (14) days after receiving Notice of Award from the Owner. 3. To accomplish the work, in accordance with the General Conditions 4. To complete the work by the time stipulated in the General Conditions. B. The Owner reserves the right to reject any and all Bids and to waive any formalities in Bidding. 1.08 SCHEDULE A See General Conditions for required schedule of completion dates. 1.09 PROPOSED PRICES A. The Bidder hereby proposes to furnish all labor, materials, equipment, transportation, and facilities necessary to complete, in a workmanlike manner and in accordance with the contract documents, the contract of work bid upon herein for compensation in accordance with the following prices: 1. BASE BED AMOUNT: (SEE BID SCHEDULE FOR UNIT PRICE BIDS) 1.10 UNIT PRICING LIST The undersigned submits the attached UNIT PRICING LIST (Attachment A) to be performed as shown on the Plans and described in the Specifications, and agrees that items of work not specifically mentioned in the Schedule which are necessary and required to complete the work intended shall be done incidental to and as part of the work for which a unit price is given, and understands that no additional payment will be made for such incidental work. Unit prices for individual line items shall be used for the project's schedule of values, pay applications and will also be used to determine the amount to ADD TO or DEDUCT FROM the contract LUMP SUM PRICE for properly authorized additional or deducted work. In the event of a change to the contract the contractor shall be-lin ited to markup percentages as indicated in Section 01028, 1.05, A. Bidders shall examine plans and determine actual work items and quantities for the work involved for bid analysis by the Owner. %����.' :'3/es�rx �QIEi[i.' . • �� %.+nr ;'r �a ;.��,, � F:"':'•'� , n: L1. 1iCr'• � �^r���"�'; .., t.� ��--yy .. :3„ p ;�Rr._. S•. .. .-�r". %3. ��.,.�„ �.sr.;r:='•?;��I#lt3�QSf,•;. SEE ATTACHMENT "A" 1.11 BID SECURITY Accompanying this bid is a bank draft, bid bond, Cashier's check or Certified check as surety in the am unt ofnot less than five percent (S%) of the Total Bid payable to the City of Evanston. The amount of the check or draft is: $ &� [ If this bid is accepted and the undersigned shall fail to execute a contract and contract bond as required it is hereby agreed that the amount of the check or draft or bidder's bond substituted in lieu thereof, shall become the property of the City and shall be. considered as payment of damages due to delay and other causes suf$•ered by the City because of the failure to execute said contract and contract bond; otherwise said check or draft shall be returned to the undersigned. ATTACH BANK, DRAFT, BANK CASHIER'S CHECK OR CERT HIED CHECK HERE. In the event that one check or draft is intended to cover two or more bids, the amount must be equal to the sum of the bid guarantees of the individual sections covered. If the check or draft is placed on anotherbid, state below where it maybe found, as follows: The check or draft will be found in the bid for. # (Name of Prnjed) (Prajeet N=ber) 1.12 PERFORMANCE/PAYMENT BOND The undersigned bidder agrees to provide Performance Bond and Payment Bond endorsed by interested parties such as the Surety Association of America, the American Institute of Architects (AIA form A312), or the As ocia ed eral Contractors of America QLkpceptable to the jDwner written with in the arric at of 100% of the Contract Sum (Total Base 13id and all accepted alternatives and adjustments), the cost of which is included in the Bid. Cost of bond for change order is percent of change order cost. 1.13 LIQUIDATED DAMAGES The undersigned Bidder understands and agrees to the provision stated under "LIQUIDATED DAMAGES" :in the General conditions and shall be assessed at the specified daily rate for each calendar day or partial calendar day until completion as defined herein. 1.14 MATERIAL SUBSTITUTION SHEET The following is a schedule; of substitute materials I propose to furnish on tbis job, withthe difference in price being added to or deducted from the Base Bid. The Base Bid is understood to include only those items which are definitely specified by trade names or otherwise. I understand that if no price difference is indicated, then the selection of materials is optional with the Owner, and approval or rejection of the substitution below will be indicated prior to signing of Contracts. PRODUCT NAME AND/OR MANUFACTURER . ADD DEDUCT MOM 1.15 DISCLOSURE OF OWNERSHIP IN IBRESTS (SEE ATTACHNMNT B) A. The undersigned duly sworn deposes and says on oath that the bidder has withheld no disclosures of ownership interest and the information provided herein to the best of its knowledge is current and said undersigned has not entered into any agreement with any other bidder or prospective bidder or with any other person, firm. or corporation relating to the price named in said bid or any other bid, nor any agreement or arrangement under which any persons, firms or corporation is to refrain frombidding, nor any agreement or arrangement for any act or omission. in restraint of free competition among bidders and has not disclosed to any person, firm or corporation the terms of this bid or the price named herein. The Bidder must complete the Disclosure of Ownership Thterests form attached hereto as Attachment 13. 1.16 BID SIGNATURE (REQUIRED) A. SOLE PROPRIETOR Signature of Bidder: SUBSCRIBED AND SWORN to before me this day of , 20 Notary Public Commission Expires: B. PARTNERSHIP Signature of AIl Partners: Name above (typed or printed) Name above (typed or printed) Name above (typed or printed) SUBSCRIBED AND SWORN to before me this day of , 20 Notary Public Commission Expires: C. CORPORATION Signature of Authorized Official: Title: Name above i or printe (If other than president, attach a certified copy of that section of Corporate by-laws or other authorization b the Corporation which permits the person to execute the offer for the Corporation..) (Corporate Seal': °4tteSi S e t SUbSCRIB SWORN to befar e this l clay of , 201 C S�- Notary P HC A Commission Expires: -� WAXY RUC, SPATE "J" OfS REs w*-2012 1.17 REFERENCES A. Provide three (3) references for which your fam has completed work of a similar scope in the past: two years in the State of Illinois. 1. Name: Address: Contact Person: Phone: Contract Value: Contract Dates: 2. Name : Address: Contact Person: Phone: Contract Value: Contract Dates: 3. Name : Address: Contact Pelson: Phone: Contact Value: Contract Dates: Village of Glenview Project: 2004, 2005, 2006, 2007, 2008 & 2009 Road Programs Contact: Robert Steele (847) 904-4347 Watermain, Storm Sewers, Sanitary Sewers and Road Work $15,000,000.00 Hancock Engineering Project: 2007, 2008, & 2009 - Schiller Park, Maywood; Norridge, River Grove & Melrose Park Contact: Mark Lucas (708) 865-0300 Water Main, Storm Sewers, Sanitary Sewers, Concrete, Asphalt, and Road Work $20,000,000.00 Baxter & Woodman Engineers 2005, 2006, 2008 & 2009 Projects: South Elgin, Wynstone, and Buffalo Grove, Contact: Mark Dachsteiner (815) 459-1260 Water Main, Storm Sewers, Sanitary Sewers, Concrete, Asphalt and Road Work $8,000,000.00 (combined) City of Evanston Project: 2005, 2006, 2007, 2008, & 2009 C1P Resurfacing Various Streets Contact: Gewalt Hamilton (847)478-9700 Excavation, Concrete Paving, Asphalt Paving, Road Resurfacing & Reconstruction $7,100,000.00 Village of Lombard Project: 2006, 2009 Contact: Ray Schwab (630)620-5740 Stom Sewer, Concrete, Paving, Patching, Landscaping $2,231,633 Village of Skokie Project: 2007, 2008, 2009 Contact: William Bablims (847)933-8232 Demolition, Mill Grinding, Earthwork, Drainage, Concrete, Landscape $6,136,620.00 CERTIFICATION OF BIDDER. REGARDING EQUAL EMPLOYMENT OPPORTUNITY (Only if Contract Exceeds $10,000) INSTRUCTIONS This certification is required pursuant to Executive Order 11246 (34 P.R. 12319-25). The implementing rules and regulations provide that airy bidder orprospective contractor, or any of theirproposed subcontractors, shall state as an initial part of the bid or negotiations of the contract whether it has participated in auyprevioiis contract or subcontract subject to the equal opportunity clause; and, if so, whether it has tiled all compliance reports due under applicable instructions. Where the certification indicates that the bidder has not filed a compliance report due under applicable instructions, such bidder shalt be required to submit a compliance report within seven calendar days after bid opening. No contract shallbe awarded unless such report is submitted. CERTIFICATION OF BIDDER 1 _ Bidder participated in a previous contract or subcontract subject to the Equal Opportunity Clause. Yes No 2. Bidder has filed all cqmphance reports due under applicable instructions. Yes No 3. Have you ever been or are you being considered for sanction due to violation of Executive Order 11246, as amended? _Yes o Name. „'1 (Inc) Title - Signature: Date: PROJECT NAME/ SPECIAL ASSESSMENT NUMBER SA 1506 PROJECT: PW-AP-1105 SCHEDULE OF PRICES (For complete information Covering these items, see plans and specifloations) LOCATION Alley; North of Main Street, East of Grey Avenue SA 1507 Alley; North of Brummel Street, East of Callan Avenue LOW PW-Al-1 107 Alley Improvement Program UNIT UNIT QUANTITY .... ... ........ .......... ...... PRICE PW-AP-1 105 Construction Layout and Staking Lump Sum I (ADD®" 'W PW-AP-1 105 Closed Circuit TV Inspection Lump Sum I 0090- PW-AP-1 105 Pre -construction Surface Video Taping Lump Sum 1 BIDDER'S PROPOSAL FOR MAKING ENTIRE PROPOSAL NOT- ATTACHMENT A TOTAL COST FOR PROPOSAL SCHEDULE OF PRICES PROJECT NO.: S. A. 1506 PAVING OF ALLEY NORTH OF MAIN STREET, EAST OF GREY AVENUE STEM ITEM UNIT QUANTITY UNIT TOTAL NO, PRICE 1 EARTH EXCAVATION CU, YD, 420 2 TRENCH BACKFILL CU. YD, 272 qo— .� 3 SUB -BASE GRANULAR MATERIAL, TYPE B CU, YD. 10 4 GRANULAR CRADLE MATERIAL, CA-11 i TON 167 -� 5 AGGREGATE BASE COURSE, TYPE B, 6" SO. YD. 75 ® r 6 INCIDENTAL HOT -MIX ASPHALT SURFACING TON 15 7 PORTLAND CEMENT CONCRETE PAVEMENT, 8" Sa YD, 1,330 8 STORM SEWERS, 1W, TYPE 1 (R, C. P. / CL V) FOOT 394 -� 9 STORM SEWERS, SPECIAL,10" (D.1. P. ! CL 50) FOOT 362 10 CATCH BASINS, TYPE A, 4' DIAMETER, TYPE 1 FRAME, OPEN LID EACH 1 11 MANHOLE, TYPE A, 4' DIAMETER, TYPE 1 FRAME, OPEN LID EACH 1� c 12 INLET, TYPE A, TYPE i FRAME, OPEN LID EACH 7 � t ],7 ,5 o — 13 MANHOLE TO BE RECONSTRUCTED EACH 1��� 14 COMBINATION CONCRETE CURB AND GUTTER, TYPE B 6.12 FOOT 185 15 _PAVEMENT REMOVAL SQ. YD.. 45 I e . �} 7 5 16 I :DRIVEWAY PAVEMENT REMOVAL SQ. YD. 245 _ •�' 17 COMBINRTION CURB AND GUTTER REMOVAL FOOT 185 18 SIDEWALK REMOVAL SQ, FT, 415 19 PORTLAND CEMENT CONCRETE DRIVEWAY PAVEMENT 6" SO, YD. 185 ` 20 PORTLAND CEMENT CONCRETE SIDEWALK - 5" SQ. FT. 390 1 21 PROTECTIVE SEALER SQ, YD.: 1,515 .�• 22 :CRUSHED STONE, CA -14 TON 30 23 FURNISHING AND PLACING TOPSOIL, 3` SQ. YD. 125 «� 24 SODDING, SALT TOLERANT SQ. YD. 125 25 CLASS B PATCHES, SPECIAL 9" (HES) SO, YD. 15 26 DETECTABLE WARNINGS SO, FT. 25 27 BRICK PAVING - SAND SETTING BED SQ. FT. 80 28 HOT - MIX ASPHALT SURFACE REMOVAL SQ. YD, 55 „ + 29 TREE REMOVAL (6 TO 15 UNITS DIAMETER) UNIT 25 30 TREE REMOVAL (OVER 15 UNITS DIAMETER) UNIT 143 a TOTAL e SCHEDULE OF PRICES PROJECT NO.: S. A. 1507 PAVING OF ALLEY NORTH OF BRUMMEL STREET, EAST OF CALLAN AVENUE ITEM ITEM NO. 1 EARTH EXCAVATION 2 TRENCH BACKFILL 3 SUB -BASE GRANULAR MATERIAL, TYPE B 4 GRANULAR CRADLE MATERIAL, CA-11 5 AGGREGATE BASE COURSE, TYPE B. 4" 6 INCIDENTAL HOT -MIX ASPHALT SURFACING 7 PORTLAND CEMENT CONCRETE PAVEMENT, F T STORM SEWERS, SPECIAL, 6" (D.1. P.1 CL 50 ) 9 STORM SEWERS, SPECIAL, 6" (P.V.C.I SDR 26 ) 10 STORM SEWERS, 10', TYPE 1 (R. C. P. I CL V ) 11 :STORM SEWERS, SPECIAL,117 (D. €. P.1 CL 50 ) 12 CATCHBASINS, TYPE A, 4' DIAMETER, TYPE 1 FRAME, OPEN LID 13 MANHOLE, TYPE A, 4' DIAMETER, TYPE 1 FRAME, OPEN LID 14 MANHOLE, TYPE A, 5' DIAMETER, TYPE 1 FRAME, CLOSED LID 15 INLET, TYPE A, TYPE 1 FRAME, OPEN LID 16 REMOVING CATCH BASINS 17 COMBINATION CONCRETE CURB AND GUTTER, TYPE B 6.12 18 PAVEMENT REMOVAL 19 DRIVEWAY PAVEMENT REMOVAL '0 CURB REMOVAL 21 SIDEWALK REMOVAL 22 PORTLAND CEMENT CONCRETE DRIVEWAY PAVEMENT -F 23 PORTLAND CEMENT CONCRETE SIDEWALK - 5" 24 PROTECTIVE SEALER 25 CRUSHED STONE, CA -14 26 FURNISHING AND PLACING TOPSOIL, 3" 27 SODDING, SALT TOLERANT 28 CLASS B PATCHES, SPECIAL 9" (HES ) 29 DETECTABLE WARNINGS 30 HOT - MIX ASPHALT SURFACE REMOVAL UNIT QUANTITY CU. YD, 52 CU. YD. 79 CU. YD, 10 TON 38 SO. YD. i 15 TON 10 SQ. YD, i 215 FOOT 36 FOOT 10 FOOT 121 FOOT 22 EACH 1 EACH 1 EACH 1 EACH 1 EACH 1 FOOT 85 SQ. YD. 45 SQ. YD, 20 FOOT 85 SQ, FT, 80 SO, YD. 20 SQ. FT. 70 SO, YD, 235 TON 10 SQ. YD. 30 SQ. YD. 30 SQ. YD. 25 80. FT, 10 SO. YD, 85 TOTAL SCHEDULE OF PRICES 2011 ALLEY IMPROVEMENT PROGRAM( PROJECT NO.: PW A[-1 107 rTEVt 'No. 1 EARTH EXCAVATION 2 SUB -BASE GRANULAR MATERIAL, TYPE B ITEM 3 INCIDENTAL HOT -MIX ASPHALT SURFACING 4 PORTLAND CEMENT CONCRETE PAVEMENT, 8" 5 PORTLAND CEMENT CONCRETE PAVEMENT, 8" (HIGH EARLY STRENGTH) 6 MANHOLE TO BE RECONSTRUCTED 7 CATCHBASIN TO BE ADJUSTED 8 HOT - MIX ASPHALT SURrACE REMOVAL ( VARIABLE DEPTH) 9 PAVEMENT REMOVAL 10 DRIVEWAY PAVEMENT REMOVAL 11 PORTLAND CEMENT CONCRETE DRIVEWAY PAVEMENT - 6" 12 PORTLAND CEMENT CONCRETE DRIVEWAY PAVEMENT- 8" 13 PROTECTIVE SEALER 14 CRUSHED STONE, CA•14 c 15 FURNISHING AND PLACING TOPSOIL, 3" 16 SODDING, SALT TOLERANT 17 FRAMES AND LIDS, TYPE 1, OPEN LID 18 VALVE BOXES TO BE ADJUSTED TOTAL UNrr UNIT TOTAL QUANTUY PFJCE _- .. CU, YD. 43 CU. YD. 12 TON 8M SQ. YD. 870 SQ, YD. 250 1 e_® � EACH EACH $ SQ. YD. 40 SQ, YD. 820 FiIts a SQ, YD. 110 SO. YD. 60 ,�. SQ. YD. 30 SQ. YD. 910 t TON 5 ® �" c SQ. YD. 25 `7 — SO. YD. 25 I EACH 2 EACH 3 i TOTAL KNEngineerslFY 2011 PROJECTSV+IIcys12011 ALLEY ITEMS SUMMARY REVISED 5-16-11 ATTACHMENT B DISCLOSURE OF OWNERSMP INTERESTS City of Evanston Ordinance I5-0-78 requires all persons (APPLICANT) seeking to do business with the City to provide the following information with their proposal. Every question must be answered. If the question is not applicable, answer with "NA APPLICANTNAME: VI - �-04 C . APPLICANT ADDRESS: ��DO O r, TELEPHONE NUMBER: q (- I — <� FAX NUMBER: APPLICANT is (Check One) 1. Corporation4b-2. Partnership() 3. Sole Owner ( ) 4. Association() 5. Other( ) Please answer the following questions on a separate attached sheet if necessary. SECTION I - CORPORATION la. Names and addresses of all Officers and Directors of Corporation. CN4, lb. (Answer only if corporation has 33 or more shareholders.) Names and addresses of all those shareholders owning shares equal to or in excess of3% ofthe proportionate ownership interest and the percentage of shareholder interest. (Note: Corporations which submit S.E. C..form I OK may substitute that statement for the material required herein..) le. (Answer only if corporation has fewer than 33 shareholders.) Names and addresses of all shareholders and percentage ofinterest of each herein. (Note: Corporations which submit S.E.C. foray IOK may substitute that statement for the material requested herein.) LqYYM SECTION 2 - PARTNERSHIP/ASSOCIATION/JOINT VENTURE 2a. The name, address, and percentage of interest of each partner whose interests therein, whether Limited or general, is equal to or in excess of 3%. 2b. Associations: The name and address of all officers, directors, and other members with 3% or greater interest. SECTION 3 - TRUSTS 3a_ Trust number and institution.. 3b. Name and address of trustee or estate administrator. 3c. Trust or estate beneficiaries: Name, address, and percentage of interest in total entity. SECTION 4 - ALL APPLICANTS - ADDITIONAL DISCLOSURE 4a. Specify which, if any, interests disclosed in Section. l ,2, or 3 are being held by an agent or nominee, and give the name and address of principal. V�— IN - 4b. If any interest named in Section 1,2, or 3 is being held by a "holding" corporation or other "holding" entity not an individual, state the names and addresses of allparties holding more than a. 3% interest in that "holding' corporation or entity as required in l(a), 1(b), 1(c), 2(a), and 2(b). 4c. If "constructive control" of any interest named in Sections 1,2, 3, or 4 is held by another party, give name and address ofparty with constructive control. ("Constructive control" refers to control established throw voting trusts, proxies, or special terms of venture ofpartnership agreements.) I have not withheld disclosure of any interest known to me. Iuffoorrmaation provided is accurate and current. Date Signature of Person Prep g Statement re ,` Title ATTEST: Notary Pu lic (Seal) six NOTARY Kwjc. M COMMISSION pCplki�5 � SCHEDULE C..A.ffidavit of Joint Venture (MBE/WBE/EBE) This form need not be submitted if all joint venturers are MBEs, WBEs and/or EBEs. In such a case, a written joint venture agreement between the MBE, WBE and EBE partners must be submitted. In all proposed joint ventures, each MBE or WBE partner must submit a copy of their current Certification Letter. EBE status will be verified by the City of Evanston.. All information requested by this Schedule must be answered in the spaces provided. Do not refer to your joint venture agreement except to expand on answers provided on this form. If additional space is required additional sheets may be attached. Please note: the City of Evanston references 49 CFR Part 26 to evaluate compliance with the provisions of Schedule C: Affidavit of Joint Venture (MBUNBE/EBE). 1. Name of joint venture: Address of joint venture: Phone number of joint venture: 11. Identify each MBE/WBE/EBE joint venture partner(s) Name of Firm: Address: Phone: Contact person for matters concerning MBE/WBE compliance: fill. Identify each non-YMEMBE/EBE joint venture partner(s) Name of Firm: Address: Phone: Contact person for matters concerning MBE/WBE compliance: Describe the role(s) of the MBE. WBE and/or EBE partner(s) in the joint venture IV. Attach a copy of the joint venture (JV) agreement. The JV agreement shall comply with 49 CFR Part 26 Section 26.55, Provision (b). In order to demonstrate the MBE, WBE or BBE joint venture partner's share in the ownership, control, and management responsibilities, and the partner's risks and profits of the joint venture, the proposed joint venture agreement must include specific details related to: (1) the contributions of capital and equipment; (2) work items to be performed by the MBE/WBE/F-BE's own forces; (3) work items to be performed under the supervision of the MBE/WBE/EBE joint venture partner; and (4) the commitment of management, supervisory and operative personnel employed by the MBE/WBE/EBE to be dedicated to the performance of the project. V. Ownership of the Joint Venture What are the percentage(s) of MBE/WBE/EBE ownership of the joint venture? MBE/WBE/EBE ownership percentage(s) Non-MBE/WBE/EBE ownership percentage(s) MIWIEBE Specification 12--0$-10 A. Specify MBEMBE/EBE percentages for each of the following (provide narrative descriptions and other detail as applicable): 1. Profit and loss sharing: 2. Capital contributions: a. Dollar amounts of initial contribution: b. Dollar amounts of anticipated on -going contributions: 3. Contributions of equipment (Specify types, quality and quantities of equipment to be provided by each joint venture partner: 4. Other applicable ownership interests, including ownership options or other agreements which restrict or limit ownership and/or control: 5. Provide copies of all written agreements between joint venture partners concerning this project. 6. Identify each current City of Evanston contract, and each contract completed during the past two years by a joint venture of two or more firms participating in this joint venture. VI. Control of and Participation in the Joint Venture Identify by name and firm those individuals who are, or will be responsible for, and have the authority to engage in the following management functions and policy decisions. Indicate any limitations to their authority such as dollar limits and co -signatory requirements: A. Joint venture check signing: MMES1w Specification 12-08-10 B. Authority to enter contracts on behalf of the joint venture: AA. C_ Signing, co-signing and/or collateralizing loans: Acquisition of lines of credit: D. Acquisition and indemnification of payment and performance bonds: E. Negotiating and signing: labor agreements: F. Management of contract performance. (Identify by name and firm only): 1. Supervision of Meld operations: 2. Major purchases: 3. Estimating: 4. Engineering: M/W/EBE Specification 12-09-10 rM VII. Financial Controls of Joint Venture A. Which firm and/or individual will be responsible for keeping the books of account? B. Identify the "managing partner," if any, and describe the means and measure of their compensation: C. What authority does each joint venture partner have to commit or obligate the other to insurance and bonding companies, financing institutions, suppliers, subcontractors, and/or other parties participating in the performance of this contract or the work of this project? VIII. State the approximate number of operative personnel (by trade) needed to perform the joint venture partner's work under this contract. Indicate whether they will be employees of the non-MBE/WBE/EBE firm, the MBE/WBE/EBE firm, or the joint venture Trade 1n-MBE/WBE/EBE Firm VIBE/WBE/EBE oint Venture (number) (number) (number) If any personnel proposed for this project will be employees of the joint venture: A. Are any proposed joint venture employees currently employed by either partner? Currently employed by non-MBE/WBE/EBE (number) err>ployed by MBE/WBE/EBE B. Identify by name and firni the individual who will be responsible for hiring joint venture employees: M/W/EBE Specification 12-09-10 K6 C, Which partner will be responsible for the preparation of joint venture payrolls: 1;X. Please state any material facts or additional information pertinent to the control and structure of this joint venture The undersigned affirm that the foregoing statements are true and correct and include all material information necessary to identify and explain the terms and operations of named joint venture and the intended participation of each partner in the undertaking. Further, the undersigned covenants and agrees to provide to the City of Evanston current, complete and accurate information regarding actual joint venture work and the payment therefor, and any proposed changes in any provision of the joint venture agreement, and to permit the audit and examination of the books, records and files of the joint venture, or those of each partner pertaining to the joint venture by authorized representatives of the City of Evanston.. MMeBBSPmiticalion 12-08-10 Any material misrepresentation will be grounds for terminating any contract that may be awarded and for initiating action under federal and state laws regarding false statements. Note: If after filing this Schedule C and before the completion of the joint venture's work on the project, there is any change in the information submitted, the joint venture must submit a revised version of this document to the City of Evanston either directly, or through the prune contractor if the joint venture is a subcontractor. Name of MBE/WBE/EBE Partner Firm Signature of Affiant Name and Title of Affiant Date On this day of Name of non-MBE(WBE/EBE Partner Firm Signature of Affiant Name and Title of Affiant Date , 20_ , the above signed officers (names ofafants) personally appeared and known to me, are the persons described in the foregoing Affidavit, who acknowledged that they executed the same in the capacity herein above stated and for the purpose herein above contained. IN WITNESS W-BEREOF, I hereunto set my hand and seal. signozore of S3olary Public (SEAL) Commission Expires: MIWIEBESpecification 12-08-10 Schedule of Additional M/W/EBE Subcontractors Project Description: 2o 11 o iNC1 ���i ov Specification Number: A-)- A T do hereby certify that: �1 ) ntends to participate as a Subcontractor on the (Name of "IEBB Fimt) project known as 11 7? l3! to (TYork) This firm is a: (Check Only One) Minority Business Enterprise (MBE), a firm that is at least 51%, managed and controlled by a Minority. Worxmrr's Business Enterprise (WBE), a firm that is at least 51%, managed and controlled by a Woman. Evanston Business Enterprise (EBE), a firm located in Evanston for a minimum one year and which performs a "commercially useful function:' � --Vne 4 , )Sq to)CA- Address of N W/EBE 'Fe,mund- (,-) Contact Person Phone No. $ C � U30. Dollar Arrfount of Participation 5, t3 5 % Percent Amount of Participation [use additional streets as necessary and attach to affidavit M/W/E 3F- Specification 12-08-10 Letter of Intent from M/W/ERE to Perform as a Subcontractor, Supplier, and/or Consultant and Affirmation of MM/EBE Status Project Description - Specification Number: From (Name of iv1 RB iimn To. an City 0 ,vanston: (Name offiid r roposerlPrime Contractor) r int nds to participate as a Subcontractor on the fF' (Name PfMIW/+EjBE arm) j project known as 11 Q( Pr gic ct Descri ( J �) T his firm is a: (Check Only One) Minority Business Enterprise (MBE), a firm that is at least 51 %, managed and controlled by a Minority, Women's Business Enterprise (WBE), a firm that is at least 51%, managed and controlled by a Woman. Evanston Business Enterprise (EBE), a firm located in Evanston for a minimum one year and which performs a "commercially useful function." Conies of all NTBE or WBE certifications have been attached. The undersigned is prepared to provide the following described services or supply the following described goods in connection with the above named project/contract: � The above described performance is offered for the following price and described terms of payment: 00 The undersigned will enter into a formal written agreement for the above work with you as a prime contractor, conditioned upon your execution of a written contract with the City of Evanston, and will do so within (3) three working days of receipt of a signed contract from the City of Evanston. Signed: (% _. Date: b (Signatur O e sx t, authorized agent of M W/EBE) arc Name/T'itl + � - Phone No. MIMEB> Speeificalion 72-08-10 Affidavit of M/W/EBE Goal Implementation Plan Project Description - Specification Number: Z hereby declare and affirm thqA l am the duly authorized representative of (Name of BidderRro�rser) � and that 1 have authority to execute this affidavit on behalf of this firm, 1 have personally reviewed the material and facts set forth herein describing our proposed plan to achieve the M/WIEBE goals of this contract. Copies of all MBE or WBE certifications have been attached. Neither this firm nor its partners, directors and/or officers have a controlling interest, a conflict of interest, or any authority to control the activities of the scheduled M/W/EBE furn(s). 1 do hereby certify that: % f �� � 4 �ds participate as a Subcontractor on the (Name of /EBE Firm) project known as \ ,k ), \� oegD 5,U (Type of Work) Address ofM/W/EBE Conta�ctj Person Phone No. Dollar ArPu ofParticipation % Percent Amount of Participation Further, this firm is a: (Check Only One) Minority Business Enterprise (MBE), a firm that is at least 51 %, managed and controlled by a Minority. Women's Business Enterprise (WBE), a fun that is at least 51%, managed and controlled by a Woman. Evanston Business Enterprise (EBE), a firm located in Evanston for a minimum one year and which performs a "commercially useful function." [If more than one Subcontractor is indicated, attach completed schedule for additional Subcontractors, -which is attached to this affidavit] MIWEBE Specification 12-08-10 i 06/20/2005 18:29 2177991574 SMALL BUS ENT WE G4 CY •,i w;�U:_ �•k %� it ,. � •-� r ,� �'q•'.ate•: r,_ .. ••-3i r"','i,•!:i r .'� ;'�s:?lr: :r�,...1 wJlr+,rl�a .. .. .. yam. �` '.+. �y'}.� y� t..,, :I�'� �, : •y���r.• J'' •: �;•• � • •wJ. •e"• - . . �J ,J.' " :1�. .Y�pr •ti L-�.`. � ; ; ,; jY '�t'sr. ,r;�,;• T . w�"''�•n ow r -'_`- t;4:. ;� ''�•Si t, •' !' '� { :'r i:',r�l;t •: � �y..t y"�+,: ; ' •'' , •,, � fs a',;•4 . {:Lt•:ia. '"�P.:�- 'i..y ' ' i� a f7,1!'r's•'d ,4.a J �.:t r. , : ti �_:r, �.�s�%^ �} ..,, ��. T r Y•hft (. r1ge:�r'':' '• Lf'S �r :'� �,' •,�.•^.1��r t. .,�,•., , �L..•I9Y1o�.-.,. r^r �.�1. ..'^,•. � _ ,� ;: ./k'•i;i •:"ter.•!• :.1r�..• ;+{�.:< _ „f`' ••..' 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' w. � • •,IFS. `�!r' . s 1•Yi - - ••Imp4Y1' i{;. ,sir , ; �:.1�.i:N�".,-'.�,,�}.yy -''- -'•• 'I, kf"N'�i SSi; .^7�,`_3: -s�4':��"a".'t` i,,. �:J.'•:.fi.. i,.,•�I,, '7ti :'�', , •J -k; '.r rl: .�' 4+tlI. !'''•i .'\... r'„ `. fr.�•- ` :�1.: - )}Sn� _ r r Mt,. All •' t..�, k�}.... 'try%�' �4i( �r,•+ ; � ''• . ' «,l 1. rY ,Cf�1i� ., 4. .!." ,'r 'S `4 ,. ��1 3r~I��•r:I': f'{��•.:L .. .., f��'Y�.�. -.1. .. ..1. _ •,4 .� rlr .. •. .. ' � ,i� '•� .. . :,t�i, " '? ' � L'{.�,r sty.{'1 . • '.{!. !, 1 �., _ �...� :.r•, � r A ffid.,wit of 1iTAtifCBE, Goal implement-Ati(yn 1:11zn j1'i,erf i�F':,:}'i;' S;'. ?,':.. �•! EFr'.,b_',`�'a"r_ _'2 __,.. .37'1'[ a=,^-�.. 7 ,•} �,.l..,i'. ',.$ '^'� ti�C 4n # hereby deci:rrc and wffili ) that 1 ain the duly : offi uirc•ll rcp se}ri:)tiv:' ul' (Na= of Biddrr/Prnfu�scr) -•µ arid that i har7t authoriiy to exit'r:tc this uflid;iv I on br;blf of thits fum. 1 1im-c• personaY reviE ved the material and facts set forth herein descTibing oui ta)oposcd plan to achieve the hiNIfFBF, go,,ih; of (itis ccinirucl, Copies of all AIBE or t393E cGrtifscataans lmvc been 211lmd. Neither this fiani um its 1;a rtitcic, dircowr and/ar offic-ers har'c a coatrollin infuest, a conflict elf interc!'t, ur t}tty ar)t)rotity to c'lit LTIC}1 $be aciiviti-, s of thr su cdoled hSrWIEDE firm(;;). i clo 1)MbY certify tlixt: {Name of WW/T'BFirm) f�rirjeF:t };,it�>+wr :;� � ,�VE�; : '-,� t^� -�.-t_ t. � ..`•,c i��� � .., .. 0'51)c of Wojlr ) i , tcA-�b t, Contact Person }'hc3rc Ain. ^ Dallar Arnolb;nt u pa�',ri)�aticn Pcicem Amount of Parlicaf,ation Fwth.r, Oks iron is a: (Chf.ck Orrly ow:) o Minnrily Busincss Emcrpiisc (iViF U), a firm Toni is ;:t !c: rst `) Mc,; m,!.-,aL!cd ;mJ coi-it-mlima by 2 lAino;;ty �. V,'nrnl�n's Estasiness F)ris:rprii;l• (1h'i�1;j, :, tstr}� t1,,.t i�` al 1:<;i; t '.I , i,, ni�F).+s;t•u :?nJ r.cmi;u}ic•.ii 1,}' .s !�'otnan. l,V21)slou l:trirr#1r iFt: i i'.i�t'.), F ii:rlt l�„ .:is li is t:.1+:.rJ''tt�li 3,61 R, n1jillim um.- WIC S'L-2r -md "tc+rru})crci:,Lv lrs't=foal fi;r)ctiun.' lt( Ilmre for :ttir#;t;rarr,_# is ti, a''r}nd tt; ibis 11`5 .wit) F Oter of Jvfcnt from ri3AV/J f3J' It, Perform :}a t{ Subconttactt't', tiu33Jl1 O. lilAfor Constthnt and Affirmation (it �f?CL.kftCi3f3f}7i )v1i317)3L:i: 3 -' +;.. From- Q GZ C.1Qt'q c r^r.--Tc- 04alnv of IWI14E•k;E, Firm �g () ,aAfi derillr€ posci Mi irm, CoutracwT I C)-Z !4j cp,_O�-- 4 _ ��r intends In tt.tkticipflea a �:ub,,twlr+win� Maine of MCt7��fi;w 3�iwl �J tl'UitiI 1'.13u;.€,ar. . V,v �.4J'ihjcc.t f)cscli�tic3'n) . € ilis firm is ;_: (cherl, tlkl)y Onc) _ _ _"... Mirl'rrit� llsik€css Pllterprise (?JilSi?), a `im) thal 1% t lcast `'l" :. 1t1a ;a ;c c3 : nd controflect by a'Akiwify, Women's Bu3iness Entcrmise (« BE), a find that is ;:t )Gust I m.,ngrcl and coutrc,l)cd by a Womi'll. f:ti'ansttrn Buss"n ss Lnicrjllisc (EB ), a fin-il locate") in I-varr.;tnn fbi t min€mum rmt; vuzi and which f!erfarnls 3 „,.o=Mdally usr.f"u) furtc:tiesn." i:c� iie-s -nf off Nftk: c5r LLN"Ly: ctcrtific:ativals il:sa'e bet-11 allac))1v1. ll�e, Llldu41 tv.lwd is jacp %i,(:d to provide (fie fol)tm,ljEv, lollIS vi i , [jovt ;!lbvd Lonely :n c muiec�tian with the A)ovc rl med p*oJect/contrzia .l �k'.' 0110t e c)t:sc:rlbccl is ofic;vd I'm ilw folkswn,t! )trice alld a mis- of 15 'ynletkE: 1'i" ilti£i<i lPnct) 1' 3.i t:3itE:; 1]IaU:- fL,;rml \'::lilwl f!li I)7 df.. t't' ,�!oj; with you i:r :! tlitltl4' L't7sktTu$tlli, i,/7:1C31i;(171�!i il�.lf'fl 11,Ul i:':t;C,t1:1G71 Cif ea tl'lltil''73 E:illi?;aC'i >']tik lilt I'ft'.' {� )'�';+t;Gi!''-2'1 i:]?t• %vill Ui+ ct+ 1,') 01--c t+,ofl il,,!i- dz!v! of rerx-, i of conti3t:: f3'om lht=. oil Y-Na-nFlw1 1�K: {'i f•f}11IC ;3! /i..]c,itics#;:;1 )33i1�'i ;j}j� :1�f)t•ilflf3-:i �`flst•i ' , 3 �� b,i f � R,,S `r..� ,�,., 4 F •. .. .,.. 4 i �,::'? �^.^. i L � g h'7"a..%..T :. ,� ��t`';; S � `wf 6.«„ 1 l ki llC s'c}7v izC—P qqjn .. 1111C'i7!��' f�3 F7Sili1['1]�i.fl" .:M ,. ;T(l;.t)ililii:;il:?i on tb,: Ct.,.1m of MAVIFIBE. PI n) projecl 3 is �: {+'l;.:r1, t %lTk 011C. I Yi ii7i)i Si •y� 1 �)iS 1f 1('SF: } 77f�1})1 i?l }�b�]il _7. :� E11 1:i li;i.f 1` ;'1 i4:;. � �U,,. !: ieli l.f i�4 f1 .111ti �, �h3�l iii 111:'tr 1.7;' �1(S?if,Sit1 Won-ic.11'C Busilie .q ):17f['q'fil'isi' n lI1:fF 1t ;TILL conlio]lee, by n V+'ctmall. j�u:,)lIcss 1"1311[:1P71st: (03h, 1i7!!-, it),-.il['i} in 1'i;i111;'.77Li11; +i`•'![' l't*: ,_.i� '!C01111 Ii:TC),dly' LISO'W fWlt-tltrll Address of 1A N'1}iBE 1?{)}Ial ?mount of 'a:lici}-lafion Vercer,i .Amoun1 (if Part;6po#fim S)fCi'E!::..; 1)Vcl f,S:IF-V S31111 ;1112v 1ft :1111d"!vli It Or i of a nq know letlf 4 trAi'I ajon and l,r:AL the fsc.nc) rc°lYre,stt_ Lions contained ill this Affidsvif znv c,tf;dC)leG° tiC)7pjir,)tV ve furl{. a"if no tints i i ) firm i,yve f'+: r rrfklttiuf. •.. 'P •vL�.•tir r. ty3 Sl3 .:� li• S�, ij��i;. i!'1 .� �oS �t.. 3 .• � ., •r � ...,'. l ela Solcarrrls' elect:uc end Wirm unclear penalfies r,f perjury thzt thrf cunfents of (lie foregoing docunrcnf art {rise "d Cum, and {bat f on-, 21111Yorized on b ch:df of €lair, It'vtle)e:r;}'rrtlact•c•t ii.',sntr W=ctc,r, to mnkc this Affidavit. �f!�ffiant)^ State c,f: c rilS clawy full no Phis instrltnient was arknomdedged before mv nut tits ct v c,t liyL�... by ati y'Tt_cl�iaY1€ {<,: nthct atttltc�rireci cuff icez) <tf (Curti N;Inw) Natetts _, _ . _.. _. .'... �i! ,_ z i �' ✓ r._. ...... _._. _ �.'"� 1 i^i} kiC �7�7r 4F 1113H{it$ f lti�titl"1' l'tY)a1rC St�trxtr�rr� ,J'j ;'(ll,e4+tS$�3tr' �Xr'�3��'�`�,<t��t} t Urr2i7l1S51Q71):rjr3Y@�: ?.�.� I l ! c To the best of my knowledge, information and belief, the facts and .representations contained in this Affidavit and attached schedule(s) are true, and no material facts have been omitted. The Bidder/Proposer/Contractor designates the following person as its M/W/BBE Liaison contact: OODMAName: Phone: I do solemnly declare and affirm under penalties of perjury that the contents of the foregoing document are true and correct, and that I am authorized on behalf of the Bidder/.Proposer/Contractor, to make this Affidavit. Signed: (Aiffii t) State of: County (City) of Oa7�4- Date: U. This ins3rurnent was acknowledged before rite on this 4 day of �� ►. �.,I mil . � . - (or other au orized officer) of trrn e (Notary Signature) Commission Expires: 5 - d �-2, M Notary Seal w.sdv, OFFIaVAL SEAL WCOLE A ENGEUONG NOTARY PIUBUC, STATE OF I LINOIS OOMMiSS ON EXPIRES 05-15.2012 MMEBE Specification 12-H-10 To the best of my knowledge, information and belief, the facts and representations contained in this Affidavit and attached schedule(s) are true, and no material facts have been omitted. The Bidder/Proposer/Contractor designates the following person as its M/W/EBE Liaison contact: Name: Phone: T do solemnly declare and affirm under penalties of perjury that the contents of the foregoing document are true and correct, and that f am authorized on behalf of the Bidder/Proposer/Contractor, to make this Affidavit. Signed: (Aff ant) State of: County (City) of: Date: This instrament was acknowledged before ine on this day of , by as President (or other authorized officer) of (Firm Name) Notary Seal (Notary Public Signature) Commission Expizes: M/W/EBE Specification 12-09-10 IV IW/EBE PARTICIPATION WAIVER REQUEST I arr►i © �1 i��l , are have authari to (Title of Affiant) (N of Fir, M omilv, N ) execute this certification on behalf of the firm.qm�t� o Name of Affiant) hereby certify that this firm seeks to waive all or part of this MAN/EBE partc€pation goal for the following reason(s): ( CHECK ALL THAT APPLY. SPECIFIC SUPPORTING DOCUMENTATION MUST BE ATTACHED.) 1. No MIWIEBEs responded to our invitation to bid. 2. An insufficient number of firms responded to our invtation to bid. 3. No subcontracting opportunities exist. 4. MNVIEBE participation is impracticable. Please provide a written explanation of why MNVlEBE participation is impracticable. Therefore, we request to waive �of the 25% uti€ization goal for a revised goa€ ofla4� Signature:- "Date:g�etz, e of �7 ffiant} 7��� Corporate Sea! (where approp-Oate) 4 This instrument was acknowledged before me on this ` da of 01 t `�s P esident (or other at ithorized officer) i 4, Notary Seal A(NogtaryublicSignatu,rel (Firm Name) Commission Expires:" +�nrsvva° No7ARY I+USM, STALE OF'Uj �'y fiOMMj$stoN a(MRES b5 15 2012 M/W/EBC Specification 12-08-10 (05/09) SUGGESTED DISADVANTAGED BUSINESS ADVERTISEMENT FOR CONSTRUCTION CONTRACTORS* NOTICE TO DISADVANTAGED BUSINESSES, �?cd041,e� /�0a 9) &A17- 64 V� � 7 (Name of Company) (Address of Company) (Telephone) seeking disadvantaged businesses for the (Name of Loan Recipient) Project for subcontracting opportunities in the following areas:����`����� All disadvantaged businesses should contact, in writing, (certified letter, return receipt reauested), I � � to discuss the (Company Contact Person) subconttr-a-cuing opportunities. All negotiations must be completed prior to the bid opening date /U� "`S' �' / � 2✓, �Wfl 477. (Date of Bid Opening) The advertisement must clearly state the method of evaluating the proposals or quotations, and the relative importance attached to each criterion. Bidders must uniformly and objectively evaluate the proposals submitted by disadvantaged businesses in response to the advertisement based upon the evaluation criteria stated in the advertisement. The evaluation criteria must not be restrictive or exclusionary. Proof Agency: Customer: Address: City: State: Phone no: Account ID: Purchase order no: Payment type: Newspaper Classified A Camp Concrete 1900 WRIGHT BLVD SCHAUMBURG IL 601934587 (847)891-6000 92164 (f,hicago arobune Jun. 02, 2011 Order ID: 1548770 Caller name: BOB BIALEK Fax no: 8478916100 Sales rep: Sadc DeRamuS Title Class.name Package Begin Date End .Date Chicago Tribune Legal Notices - Govemment/.Fducatio MD_Lega1_Notice 06-04-2011 06.04-2011 NOTICE TO DISADVANTAGED BUSINESSES A. Lamp Concrete Contractors Inc., 1900 Wright Blvd. Schaumburg IL. 60193, 847-891- 6000 is seeking disadvantaged businesses for City of Evanston the 2011 Paving of vari- ous Al eys. Project for subcontracting opportunities in the following areas: TREE REMOVAL., LAND- SCAPING, BRICK PAVING, STORM SEWERS, ASPHALT PAINING, CONCRETE WORK. All disadvantaged businesses should con- tact, in writing, (certified letter, return re- ceipt requesked),Bob Bialek, to discuss the subcontracting opportunities. All negotia- tions must be completed prior to the bid opening date Tuesday, June 21, 2011 at 2:00 P.M. Order III: 1548770 *; Agency Commission not included Size Color Ix18 No Gross price: Discounts: Net price*: Prepaid amount: Amount due: Price $ 198.06 $ 198.00 $ 198.00 $ 0.00 $ 198.00 $0,00 $ 198.00 CERTIFICATE OF COMPLIANCE WITH PREVAILING WAGE RATE ACT The undersigned, upon being first duly sworn, hereby certifies to the City of Evanston, Cook, County, Illinois, that all work under this contract shall comply with the Prevailing Wage Rate Act of the State of Illinois, Illinois Compiled Statutes, 1987, Chapter 820, par. 130/31, et. sec{, and as amended by Public Acts 86-799 and 86-693 and our current city resolution, with rates to be paid in effect at time work is performed. Contractors shall submit monthly certified payroll records to the city. By - By: State of �\ t }, ss County of ) Subscribed and sworro to before me this day of Notary Public a ' -tzs Ae�C . IRMS . I CONFLICT OF INTEREST hereby certifie*tha qhasnd(_ubcteY2an investigation into whether an actual or potential conflict of interest exists between the bidder, -its owners and employees and any official or employee of the City of Evanston. Bidder further certifies that it has disclosed any such actual or potential conflict of interest and acknowledges if bidder/proposer has not disclosed any actual or potential conflict of interest, the City of Evanston may disqualify the bid/proposal. (� ieele (Name of Bidder/proposer i'f'the Bidderlpropo a is an IndiAduai) (Name of Partner if the Bidderfproposer is a Partnership) (Na e f Offic'er if the Bidder/proposer is a Corpora n) �yq / The above statements must b cribed an worn to before a notary public. Subscribed and Sworn to this 10 day of " C 2011 - Failure to complete and return this form may be considered sufficient reason for rejection of the bid/proposal. ATTACHMENT F Irv, Contact Name: Aaa,ess:1QDD I.l�fiqh� City,State, Zip: jj Telephone/FAX: # `7- �q I - LoOT) gq(- l d JYYV�Pp—Qc9,�A �,� QMUPjil. i r� l Comments: AFFIDAVIT OF COMPLIANCE PROJECT NUMBER. PW-AP 1105 RETURN WITH BID As of Illinois Department of Transportation Memorandum dated November 26, 1996 from Robert H. Hilton, the following individuals and companies were suspended by the Federal Highway Administration on November 21, 1996: Mr_ Joseph Palumbo Mr. Sebastian Palumbo Mr. Gerald McGreevy Orange Crush Recycle L.P. Palumbo Brothers, Incorporated Mr. meter A. Palumbo Mr. Daniel Ferreniani Mr. Kelson Abdishi Monarch Asphalt Company Under the terms of this suspension, these individuals and companies are prohibited from participating in primary or lower tier transactions as defined by federal rules, and they cannot be awarded contracts, which require the approval of the Illinois Department of Transportation. They also cannot enter irito subcontracts on or be employed by firms awarded such contracts. On Friday, March 13, 1998 the FHA suspension has been modified to allow Orange Crush Recycle L.P. to supply construction materials to contractors and subcontractors, and authorizes Palumbo Brothers, Inc. to lease equipment to contractors and subcontractors in the state of Illinois. The suspended parties may still not participate in any other manner on highway projects and will not be pre -qualified with the .Illinois Department of Transportation. Therefore, the suspended parties will not be approved for this project as contractors or subcontractors, engaged as consultants, or be employed by firms awarded such contracts. Corporation NameNaAip CfY)ftk�&� Signed By SPECIAL PROVISIONS AFFIDAVIT OF COMPLIANCE PROJECT NUMBER. PW AP-1105 RETURN WITH BID The Contractor's attention is called to the requirement in section 9-5-23(C) of the City of Evanston Code, which regulates the hours permitted for the construction activities. This section has been revised for this project. Contractor will be allowed to perform any construction activities between the hours of 7:00 AM to 4:00 PM, Monday through Friday. Contractor must get written permission at least twenty-four hours in advance from the City Engineer and/or Senior Engineer for any Saturday work. 2. The Contractor must follow MOT recommended )Holidays in SSRBC, January 2007. In addition, the Contractor will be required to discuss their operations and get verbal and / or written permission at least twenty-four (24) hours in advance in order to work on the following dates: Friday, April 22, 2011 Tuesday, April 26, 2011 Thursday, September 29, 2011 Saturday, October 8, 2011 Good Friday Passover Rosh Hashanah Yom Kippur Corporation Nam6v (�n eotk &4WC4 Signed By: SPECIAL PROVISIONS City of Evanston RETURN WITH BID AFFIDAVIT OF COMPLIANCE CLOSED CIRCUIT TELEVISION INSPECTION & ALLEY CONCRETE PAVING PROJECT NUMBER: PW--AP-1105 I. General This work shall consist of Closed Circuit Television Inspection of all mainline sewers installed. Following completion of sewer and water main installation, infiltration/exfiltration testing, backfill compaction testing and deflection testing, the Contractor shall conduct an internal television inspection of all new mainline sewers 48 inch in diameter or smaller. IL Materials/Construction The television camera used shall be in high -resolution color, shall be equipped with a lighted revolving head capable of viewing up service connections, and shall be equipped with a footage counter which records on the videotape. For televising pipes 54-inches and smaller, the camera shall be stopped at each lateral connection and the camera head rotated to give a full view of the interior of the lateral. Video tapes in VHS format or discs in DVD format made from the internal inspections shall be given to the Owner. The Contractor shall furnish the CCTV tape/disc within five (S) working days after the completion of the sewer work in each alley. After the acceptance of the sewer work the Contractor shall pave the alley within a week. The Contractor is required to protect the freshly poured concrete from any kind of graffiti. Should the Contractor failed to protect the concrete from graffiti, the City has the right to require the Contractor to repair or replace the alley concrete at the Contractor's expense. III. Basis of Payment The cost of the Closed Circuit Television inspection for the Relief Sewer, Storm Sewer, Sanitary Sewer and Combined Sewer and all related activities/materials to complete the work will be paid as lump sum item. Signature & Date City of Evanston SPECIAL PROVISIONS RETURN WITH BID AFFIDAVIT OF COMPLIANCE FOR DISPOSAL OF EXCAVATED MATERIAL PROJECT: PW-AP-1 t 05 DESCRIPITION: This work shall consist of meeting IEPA requirements for the disposal of excavated material including, but not limited to clean construction or demolition debris (CCDD), uncontaminated soil, and/or contaminated soil. CONSTRUCTION REQUIREMENTS: The contractor will be responsible to provide CCDD and soil fill site operators with all information and fees as required by the IEPA and fill site operators. The City will not provide certification as an owner or operator of the site of origin presuming that excavated soil is uncontaminated. This will require the Contractor to provide fill site operators with IEPA form LPC-663 "Uncontaminated Soil Certification by Licensed Professional Engineer". It will be the Contractors sole responsibility to dispose all excavated material generated as a part: of this contact. BASIS OF PAYMENT: This work will not be measured or paid for separately, but shall be considered as included in the contract unit price for the various items generating excavated material. have read and understood the above statement, and will comply wi this special provision for this project. Accepted • Company Name/Signature SPECIAL PROVISIONS RETURN WITH BID 2011 PAVING OF VARIOUS ALLEYS PIN -AP-1105 AFFIDAVIT OF COMPLIANCE FOR CONSTRUCTION INSPECTION DESCRIPITION: This work shall consist of the City providing engineering services for the inspection of all construction operations. CONSTRUCTION REQUIREMENTS: The City shall provide CONSTRUCTION INSPECTION for this contract Monday through. Friday between the hours of lam to 4pm, herein defined as `normal working hours', expect on legal holidays, as defined by Article 107.09 of the latest edition of the SSRBC, Se turdays, and on Sundays. If the Contractor elects to conduct any construction activities outside of the normal working hours; the City shall be compensated for providing CONSTRUCTION INSPECTION at a rate of $100.00 per hour. The City will invoice the Contractor at the end of each month for CONSTRUCTION INSPECTION provided outside the normal working hours. Failure to pay the invoice may result in the suspension of impending partial or final payments. METHOD OF MEASUREMENT: The unit of measure is in hours the Contractor spends working outside `normal working hours' rounded to the next greatest half-hour increment. BASIS OF PAYMENT: This work will not be paid for separately, but shall be considered as included in the contract unit price for the various contract items. I0-no *A& have read and understood the above statena rat, d will comply with this special provision for the above referenced project. Accepted by: X af_5--` Compare Name/Signature City of Evanston RETURN WITH BID AFFIDAVIT OF COMPLIANCE FOR GENERAL CONDITIONS PROJECT NUMBER. PW-AP-1105 ADD ARTICLE 4.13 CONTRACT PERIOD "The Contract will be awarded after the City Council approval subject to the necessary documentation. The Notice to Proceed will be issued by the City in coordination with other City projects. After the Notice to Proceed letter is issued by the City, the Contractor must attend the Pre -construction Meeting and start the project within two weeks (10 Business Days)." The Contractor must fully complete the work within. 30 working days as specified in the contract. Should the Contractor fail to complete the work within working days, the Contractor shall be liable to the City of Evanston double the amount_ specified in Section 108 of the Standard Specifications for Road and Bridge Construction for each day of over -run in. the contract time or such extended time as may have been allowed. have read and will comply ith this Special Provisions for the above referenced project. Date: a� r Signed By: SPECIAL PROVISIONS RETURN WITH BID AFFIDAVIT OF COMPLIANCE FOR GENERAL CONDITIONS CONTRACT FOR: 2011 PAVING OF VARIOUS ALLEYS PROJECT NUMBER: PW-AP-1105 DETECTABLE WARNINGS DETECTABLE WARNINGS shall be installed at curb ramps as specified by Section 424 of the Standard Specifications and at locations as shown on the plans or as directed by the Engineer. The product used for installing detectable warnings shall be the following: (a) Prefabricated Cast -In -Place Detectable Warning Panels (2 minimum per ramp) (b) Color —Red (c) Anchor System — Removable Concrete Anchors (5 minimum per panel) Manufactured by one of the following: (a) Access Products, Inc. (888-679-4022) / Supplier (630-689-7574) (b) Armorcast Products Company (818-982-3600) (c) Detectable Warning Systems, Inc. (866-999-7452) (d) Or approved equal Submittals as required by Standard Specifications: (a) Manufacturer's certification stating the product is fully compliant with the ADAAG. (b) Manufacturer's five year warranty (c) Manufacturer's specification stating the required materials, equipment, and installation procedures. Additional installation requirements: Panels must be cut in a neat and workman like manner per manufacturers requirements to match the entire curb ramp width with a minimum of 5 pins per panel cast into concrete ramp. The panel size and method, as shown on the Curb Ramps detail, used for installing detectable warnings shall be approved by the Engineer prior to installation. Basis of Payment: Detectable warnings will be paid for at the contract unit price per square foot for DETECTABLE WARNINGS. I of have read and understood e ve statement, an will comp with this special provision for the above referenced project. Accepted: Date: Signature: City of Evanston SPECIAL PROVISIONS RETURN WITH BID AFFIDAVIT OF COMPLIANCE PROJECT NUMBER: PW-AP-1105 WEEKL Y PROGRESS MEETING The Contractor's Project Superintendent must attend the required Weekly construction progress meeting. The Weekly meeting schedule and location will be finalized at the Pre construction meeting for the project. 1Q�� of Mk have read and will comply with is Special Provisions for t e above referenced project. Date: b "1P1 Signed By: do"lele_ City of Evanston SPECIAL PROVISIONS RETURN WITH BID AFFIDAVIT OF COMPLIANCE FOR GENERAL CONDITIONS CONTRACT FOR: 2011 PAVING OF VARIOUS ALLEYS PROJECT NUMBER: PW-AP-1105 IF THE JULIE SYSTEM LOCATES A CITY OF EVANSTON FIBER OPTIC COMMUNICATION UTILITY, THE CONTRACTOR/PERMIT HOLDER SHALL BE REQUIRED TO VISUALLY EXPOSE FIBER OPTIC LINES BY HAND DIGGING WITHIN THREE (3) FEET OF EITHER SIDE OF JULIE LOCATE ON ALL CONSTRUCTION PROJECTS AND PERMIT WORK. P _00CM 1 l 0 V have read and understood the above statement, and will comply with this special provision for the above referenced project. ACCEPTED: Date: b -ZI-1 Signature_ CITY OF E'VANSTON CHANGE ORDER Number: Date: Original Agreement Date: Project: Bid No. (if applicable): Owner: City of Evanston, Illinois Contractor: NNW tl i tl i E M w w w■■ E E E tl M Ff w M K E r E E r e a K M i E w w r K i E w■ tl r W w w w tl r E i r tl E i w i M M K w w tl K tl r i E w r tl w i E M M w x Change to Contract Price: The following change is hereby made to the contract between the parties: Price of new work Original Contract Price = Revised Contract Price = i E 1 i a w tl M w w w r a E e tl! tl g w w K w tl r E E■ tl r W E w r w W tl E w 1■ tl r M M E w K w tl E w tl a a tl tl E ■f M w w w w K tl W E E tl r tl p r M M W K E Change to Contract Time: Not Applicable i M e w w w K f f E E tl K tl IC E w P f E w M a M M E w w w w r M E E w i tl a r M !w w tl K E a w* K a p p E M' w w 1[ of if E f E K w E tl tl r tl M 1f r e w i r w M f Recommended by Date Approved by (Owner) Accepted by (Contractor) Date .Date