HomeMy WebLinkAboutClark Street Brick Replacement and Emerson-Green Bay Intersection Improvement ProjectCITY OF EVANSTON
BID FORM
SECTION 20300
CLARK STREET SIDEWALK REPLACEMENT AND
GREEN BAY ROAD-EMERSON STREET
INTERSECTION IMPROVEMENT
PW-SR-1108/PW-SP-1109
Bid Number: 1240
1.01 BID TO:
THE CITY OF EVANSTON
2100 Ridge Avenue — Room 4200
Evanston, Illinois 60201
hereafter called "OWNER".
1.02 BID FROM:
Name: .Irp"f-bek -r `,l!W1 MMCAC
(Hereinafter call "BIDDER')
Address: 9-Wo Cf�y,p)Pk 6L7ka-,. IL bwln
TelenhoneNumber:
Fax Number:
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 ofthe 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. Dated
Addendum 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 Owner to reject any or all bids, to waive an informality in
connection therewith and to award a Contract for any part of the work or the Project as a whole.
C. The undersigned declares that the person(s) signing this bid is/are fally authorized to sign oubehalf oflhD
named firm and to fully bind the named firm to all the conditions and provisions thereof.
D. It is agreed that no person(s) 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 thebid is legal and fair, submitted in good faith, without collusion or fiand.
E. It is agreed that the undersigned has complied and/or will comply with all requirements concerning
licensing andwith all otherlocal, state andnational laws, and that no legalrequirementhas been orwiill be
violated in making or accepting this bid, in awarding the Contractto him, and/or in the prosecution ofthe
Work required thereunder.
F. To be considered abonafide offer, this bid oustbecompletedinfullandaccompaniedbyabiddepositor
a bid bond when required by Contract Documents or Addenda.
1.05 ALTERNATES
A. When altemate bids aiciequiredby Contract Documents or Addenda thereto, theraidersignedplOpMeS to
perform alternates for herein stated additions to or deductions from the stated Based Bid. Additions and
deductions include all modifications of Work or additional Work that the undersigned maybe required to
perform by reason of the acceptance of alternates.
1.07 AGREEMENT
A By submitting this Bid, the undersigned agrees:
I. To hold this Bid open for sixty (60) days from submittal date.
2. To enter 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.
Log SCHEDULE
A_ See General Conditions for required schedule of completion dates.
1.09 PROPOSED PRICES
A. The Bidder hereby proposes to famish all labor, materials, equipment, transportation, and facilities
necessary to complete, in a workmimlike manner and in accordance with the contract documents, the
contract of work -bid upon herein for compensation in accordance with the follow``in��g prices:
1. BASE BID AMOUNT: 7 /�
(SEE BID SCHEDULE FOR UNIT PRICE BIDS)
1.10 UNIT PRICING UST
The undersigned submits the attachedUNfl' PRICING LIST (Attachment A) to be performed as shown on the
Plans and described in the Specifications, and agrees that items ofworknot specifically mentioned inthe Schedule
which are necessary and required to complete the work intended shall be done incidental to and as part ofthe 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 ofvalues, 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 -limited 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.
wu eW�l "'6' .3d tiY"SG: 'ter ry hraea
I Item • es rautio :°.:• : ;•d ra :;
.:'; ` aa.t %...
. _=•
Y3' `t.: ''
is Y! .
ufi ;x
Ix �:.ofitCo`s,:i,.:.
tTl
SEE ATTACHMENT
I
I
"A"
I
I
I
1.11 BID SECURITY
Accompanying this bid is a bank draft, bid bond, Cashier's check or Certified check as surety in the amount ofnot
less than five percent (5°/n) of the Total Bid payable to the City of Evanston.
The amount of the check or draft is: $ btl) ,g AN
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 orbidder's bond substituted in lieuthereof, shallbecome the property
of the City and shall be considered as payment of damages due to delay and other causes suffered by the City
because of the failure to execute said contract and contractbond, otherwise said check or draft shall be returredto
the undersigned.
1' :11 • � • 1 1 :1 a '
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 checkor draft is placed on anotherbid, state below where itmaybe found, as follows: The check or draft will
be found in the bid for. ##
(Name of Projed) (Proj-tNomber)
1.12 PERFORMANCENAYMENT• 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 (A -TA form A312), or the
Associated General Contractors of America or acceptable to the Owner written with
14ft1q RK11M,
in the amount bf 100% of the Contract Sum (Total Base Bid 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
Theundersigned Bidder tmderstands and agrees to the provision stated under "LIQUIDATED DAMAGES" inthe
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 SUB STI UTION SHEET
Thefollowing is a schedule of substitute materials I propose to furnish on this job, withthe difference inpricebeing
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
1.15 DISCLOSURE OF OWNERSHIP INTERESTS (SEE ATTACHMENT 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 cement and said
undersigned has not entered into any agreement with any other bidder or prospective bidder orwith any
other person, firs 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 actor omission in restraint of free competition amongbidders 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 Interests foam attached hereto as Attachment B.
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:
17 tlt
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: p�SlOPlf�
A�fl"V4-11
Nameabove(typed orprinted): CW,45 Cam{' b(-AeI
(If other than the president, attach a certified copy of that section of Corporate by-laws or other
authorization by the Corporation which permits the person to execute the offer for the Corporation.)
(Corporate Seal)
Attest ISecreta
Secretary
SUESCRILAND SWORNto before me this dayof 20 ��II "O ICIAL SEAL"
otary Public RITA RUBIN
Commission E ices: 10-a-l`� NOTARY PUBLIC, STATE OF ILLINOIS
xP MY COMMISSION EXPIRES 10/22/2014
1.17 REFERENCES
A. Provide three (3) references for which your firm has completed workof a similar scope in the past
two years in the State of Illinois.
1_ Name: Clr bK
Address: 41A\ D(IVC- -1, 17 r,�
Contact Person: tl1_tt�cl
Phone:
Contract Value: o ' qe
Contract Datest C90
2. Name: �1(( stict v_ C�t�JiB
Address: ip1 Ot+yfAtl/NP a St&Ar1M""I— Ot�i(P
Contact Person: tam litlQJikf >
Phone: H7-$95-41Co
Contract Value:
Contract Dates: JDlh
3. Name: JI L! ALI,, o%' j 1>LSlil'aa1P.FtL_
Phone: 14911
Contract Value:
Contract Dates: qW4. Mff)
CERTIFICATION OF REDDER
REGARDING
EQUAL EMPLOYMENT OPPORTUNITY
(Only if Contract Exceeds $10,000)
INSTRUCTIONS
This certification is required pursuant to Executive Order 11216 (30 F.R. 12319-25). The implementing rules and
regulations provide that anybidder orprospective contractor, or any of theirproposed subcontractors, shall state as an initial
part of the bid ornegotiations of the contractwhetheritbas participated in anyprevious contractor subcontract subject to the
equal opportunity clause; and, if so, whether it has fled 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 shall be required to submit a compliance report within seven calendar days after bid opening. No contract shall be
awarded unless such report is submitted.
CERTIFICATION OF BIDDER
Name and Address of Bidder (Include ZIP Code)
/A11.10 em%2k{ i°#-Jl(
1. Bidder his participated in z previous contract or subcontract subject to the Equal Opportunity Clause.
✓ Yes No
2, Bidder has filed all coropliimce reports due under applicable instructions_
✓ Yes No
3. Have you everbeen or are youbeing considered for sanction due to violation of Executive Order 11246, as amended?
Yes VK
Name: CIMJ5 th(1.rFkDtA6e_ _
Title:
Signature: -
Date:
Clark Street Sidewalk Replacement
PW-SR-1108
SCHEDULE OF PRICES
ITEM
NO.
ITEM
UNIT
QUANTITY
UNIT PRICE I
TOTAL PRICE
1
TEMPORARY FENCE
FOOT
725
15, fD f
AV 9.
2
EARTH EXCAVATION
CU YD
215
qO, C6 I
866 , M
3
REMOVAL AND DISPOSAL OF UNSUITABLE MATERIAL
CU YD
20
9b. bb
14th6)
4
MULCH
CU YD
5
,Q bb. M
((yll) -m
5
TOPSOIL FURNISH AND PLACE, 3"
CU YD
135
5,t�jj
h1%
6
SODDING, SALT TOLERANT
SO YD
135
7
SUB -BASE GRANULAR MATERIAL, TYPE B
TON
235
/f�-
A�%l{ IN , I
8
SUB -BASE GRANULAR MATERIAL, TYPE B
CU YD
20
f 3 r/• Lb
I� bb
9
AGGREGATE FOR TEMPORARY ACCESS
TON
30
f f k>_ba f
�{�j�•
L. h
10
HOT -MIX ASPHALT SURFACE COURSE, MIX "C", N50
TON
20
f �ra, pn
11
HOT -MIX ASPHALT SURFACE REMOVAL, 2"
SO YD
155
' /(), &)
12
INCIDENTAL HOT -MIX ASPHALT SURFACING
TON
35
I "q_ pD, &)
13
PCC BASE COURSE 9"
SO YD
70
AA5. M
14
PCC SIDEWALK 5 INCH
SQFT
10,150
15
PCC DRIVEWAY PAVEMENT, 8 INCH
SO YD
40
16
DETECTABLE WARNINGS
' SOFT
116
17
PAVEMENT REMOVAL
SO YD
9D
[Azgq),
18
CURB REMOVAL
FOOT
50
19
COMBINATION CURB AND GUTTER REMOVAL
FOOT
1,150
20
SIDEWALK REMOVAL
SO FT
25
[, no
21
CLASS B PATCHES, SPECIAL, 10" (HES)
f SO YD
10
x[j, M
22
DOMESTIC WATER SERVICE BOXES TO BE ADJUSTED
EACH
3
tm, (�
,
23
MANHOLE TO BE ADJUSTED
EACH
1
9 , 0 f
24
CATCH BASINS TO BE ADJUSTED
EACH
2
M,^ 4) (
/-,_ ,
25
INLETS TO BE ADJUSTED
EACH
2/�(),�
26
VALVE VAULTS TO BE ADJUSTED
EACH
1
27
VALVE BOXES TO BE ADJUSTED
EACH
2
175. 1:16 I
6"
28
CONCRETE CURB, TYPE B (AEP-MODIFIED)
FOOT
50
29
COMB, CONC. CURB AND GUTTER, TYPE B-6.12 (AEP-MODIFIED)
FOOT
1,150
,a %�, (;(�
a bba , b'-)
30
DRILL AND GROUT #5 TIE BARS
EACH
275
pj}
C441T),
31
THERMOPLASTIC PAVEMENT MARKING - LETTERS AND SYMBOLS
SO FT
60
�7711++j����
32
THERMOPLASTIC PAVEMENT MARKING - LINE 4"
FOOT
725
33
THERMOPLASTIC PAVEMENT MARKING - LINE 6"
FOOT
215
34
THERMOPLASTIC PAVEMENT MARKING - LINE 24"
FOOT
95
/%j,�(p
holj -12-b
35
PARKING METER POST REMOVAL AND REPLACEMENT
EACH
15
36
REMOVING AND RESETTING STREET SIGNS
EACH
5
�06
37
38
STREET SWEEPING
TREE FRAME AND GRATE
EACH
EACH
6
10
no
IM 5D +
ley(„ R
39
TREE FRAME AND GRATE REMOVAL OR SALVAGE
EACH
10
40
BRICK PAVER REMOVAL AND DISPOSAL
' SO FT
10,000
/, 50
/lltf" - 6-)
41
BRICK PAVER REMOVAL AND SALVAGE
f SO FT
1,435
4,5()
M>
42
BRICK PAVER REMOVAL AND REPLACEMENT
I SO FT
250
1/ , 150
T
43
BRICK PAVER SIDEWALK ON RIGID BASE
f SOFT
1,435
141, to
''
�"966,
44
MATERIAL TESTING AND INSPECTION
+ L SUM f
1
$12,000.00
$12,006,00
45
CONSTRUCTION LAYOUT AND STAKING
+ L SUM I
1
CVrf115, (b
46
TRAFFIC CONTROL AND PROTECTION
( L SUM I
1
/��/�, /'y)+
/�! , M
47
PEDESTRAIN TRAFFIC CONTROL AND PROTECTION
f LSUM
1
48
CHANGEABLE MESSAGE SIGN
ICALMOI
2
49
BICYCLE RACKS
I EACH
50
HANDHOLE TO BE ADJUSTED
f EACH
51
DETECTOR LOOP REPLACEMENT
+ FOOT f
375
yU
Clark Street Sidewalk Replacement Total Cost (to be carred forward to next page)==>L2%gh- .
Green Bay Road and Emerson Street Intersection Improvement
PW-SP-1109
SCHEDULE OF PRICES
ITEM
NO.
ITEM
UNIT
QUANTITY
UNIT PRICE
111
TOTAL PRICE
1
PREFORMED PLASTIC PAVEMENT MARKING LINE -4"
I FOOT
220
AQ
2
PREFORMED PLASTIC PAVEMENT MARKING LINE - 6"
I FOOT
120
h , `�S
90 bb
3
PREFORMED PLASTIC PAVEMENT MARKING LINE -12"
I FOOT
120
/ j , 9()
/s 8, ea
4
PREFORMED PLASTIC PAVEMENT MARKING LINE - 24"
( FOOT
55
I- 5, so
1'119.66
5
THERMOPLASTIC PAVEMENT MARKING - LINE 4"
( FOOT
150
4.48
a
6
7
THERMOPLASTIC PAVEMENT MARKING - LINE 6"
THERMOPLASTIC PAVEMENT MARKING - LINE 12"
FOOT
FOOT
115
120
8
THERMOPLASTIC PAVEMENT MARKING - LINE 24"
( FOOT
40
9
TRENCH BACKFILL
I CU YD
5
'" A. 16
,-.?F71. bb
10
GRANULAR BACKFILL
TON
3
r j. pp
/;, t�
11
TOPSOIL FURNISH AND PLACE, 3"
SO YD
160
6.00
SOF),e>')
12
SODDING, SALT TOLERANT
SO YD
160
f F-
).bb
ca24n6, Dd
13
SUB -BASE GRANULAR MATERIAL, TYPE B
, CU YD
10
?? M
,396, Oa
14
AGGREGATE FOR TEMPORARY ACCESS
( TON
10
66
/415 , M
15
AGGREGATE BASE COURSE, TYPE B, 4"
( SO YD
70
16
INCIDENTAL HOT -MIX ASPHALT SURFACING
_
I TON
5
C,M, DO
17
PCC SIDEWALK 5 INCH
SO FT
1,780
18
PAVEMENT REMOVAL
, SO YD
90
19
CURB REMOVAL
( FOOT
650
20
COMBINATION CURB AND GUTTER REMOVAL
FOOT
15",
21
SIDEWALK REMOVAL
SO FT
1,850
22
CLASS B PATCHES, SPECIAL, 10" (HES)
J SO YD
120
87j, (�
`�/j(, }, ob
23
STORM SEWERS, 10", SPECIAL (D.I.R, CL. 50)
FOOT
10
(1), p()
// (0, M
24
INLET, TYPE A, TYPE 1 FRAME, OPEN LID, 36" DEPTH
! EACH
i
15M-pd
/=. Lb
25
CATCH BASINS TO BE RECONSTRUCTED
J EACH
1
I jjy�,pD
/lye .6b
26
VALVE VAULTS TO BE ADJUSTED
I EACH
1
3
3�, pp
27
FRAMES AND LIDS, TYPE I, CLOSED LID
J EACH
1
, )7.4,a)
0196:Qn
28
CONCRETE CURB, TYPE B (AEP-MODIFIED)
( FOOT I
390
r4_15, f Y)
Cl?,6b, Q)'
29
COMB. CONC. CURB AND GUTTER, TYPE B-6.12 (AEP-MODIF(ED)
( FOOT I
275
�� , (`(�
C?y/�,jj, t6
30
DETECTABLE WARNINGS
( SOFT (
70
3�,(�
31
PAVEMENT MARKING REMOVAL
J SO FT I
200
d' ,,
32
GALVANIZED STEEL CONDUIT IN TRENCH - 2"
J FOOT +
25
33
TRENCH BACKFILL FOR ELECTRICAL WORK
FOOT I
40
34
ELECTRIC CABLE IN CONDUIT SIGNAL #14 3/C
P FOOT (
275
35
ELECTRIC CABLE IN CONDUIT SIGNAL #14 5/C
FOOT I
160
pQ
36
REMOVE ELECTRIC CABLE FROM CONDUIT
FOOT
280
0 -AD
146>, jIZ
37
CONCRETE FOUNDATION, TYPE
J EACH
2
hVI. M
I
38
RELOCATE EXISTING TRAFFIC SIGNAL POST
J EACH (
2
1%,6
IaQ,tb
39
RELOCATE EXISTING SIGNAL HEAD
EACH I
1
, 06
f,
40
RELOCATE EXISTING PEDESTRIAN SIGNAL HEAD
EACH I
2
'� L`
t jb
fi)b
41
REMOVE EXISTING CONCRETE FOUNDATION
' EACH (
2
, 06
��R�q;
42
STREET SWEEPING
J EACH J
2
�ffj xb
, y-+!b
43
MATERIAL TESTING AND INSPECTION
I L SUM I
1
$6,000.00
$6,000.00
44
CONSTRUCTION LAYOUT AND STAKING
I L SUM (
1
IIPa}
45
TRAFFIC CONTROL AND PROTECTION
I LSUM I
1
/7/fz,QO
/ tb
46
CHANGEABLE MESSAGE SIGN
ICALMOI
6
,06
Green Bay Road - Emerson Intersection Improvement
Total Cost =_>
81 Mff,
Clark Street Sidewalk Replacement Total Cost (carried forward
from previous page)
Bidder's Proposal for making Entire Improvements (Clark St plus Green
Bay- Emerson)
City of Evanston Ordinance 15-0-79 requires all persons (APPLICANT) seeldngto do business withthe
City to provide the following information with their proposal. Every question must be answered. If the
question is not applicable, answer with "NA'.
APPLICANT NAME:
APPLICANT ADDRESS:
TELEPIIONENUMBER: 1>-2lo
FAX NUMBER: W7 imi, -1)J-1W9
APPLICANT is (Check One) 1. Corporation V 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.
_ChD!) SG�
14AAc4o-U2F,4
lb. (Answer only if corporation has 33 or more shareholders.) Names and addresses of all those
shareholders owning shares equalto or in excess of3%oftheproportionate ownership interest and
the percentage. of shareholder interest. (Note: Corporations which submit S.E.C. form IOK may
substitute that statement for the material required herein.)
n IA-
lc- (Answer only if corporation has fewer than 33 shareholders.) Names and addresses of all
shareholders and percentage of interest of each herein. (Note: Corporations which submit S.E.C.
form 10Kmay substitute that statement for the material requested herein.)
f
SECTION 2 - PARTNERSHIP/ASSOCIATIONJOINT VENTURE
23. 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%.
n iA
2b. Associations: The name and address of all officers, directors, and other members with 3% or
greater interest.
AIA
SECTION 3 - TRUSTS
3a. Trust number and institution,
n/A
3b. Name and address of trustee or estate administrator.
!� ik
3 c. Trust or estate beneficiaries: Name, address, and percentage of interest in total entity.
A�k
SECTION 4 - ALL APPLICANTS - ADDITIONAL DISCLOSURE
4a. Specify which, if any, interests disclosed in Section 1,2, or 3 are being held by an agent or
nominee, and give the name and address of principal.
4b. If any interest named in Section 1,2, or 3 is being held by a "holding" corporation or other
"holding" entitynot an individual, state the names and addresses of allparties holding more than a
3% interest in that "holding" corporation or entity as required in 1(a), l(b), 1(c), 2(a), and 2(b).
4c. If"constructive control" o£anyinterestnamedin Sections 1,2, 3, or 4 is heldby, anctherparty, give
name and address of party with constructive control. ("Constructive control" refers to control
established through voting trusts, proxies, or special terms ofventure ofparinership agreements)
AAA
I have not withheld disclosure of any interest known tome. InfibimPuanprovi ed is accurate and current
0-19-11
Date
Signature of Person Preparing Statement
P&5[Br,(
Title
ATTEST:
ko4P44blich
(Seal) OFFICIAL SEAL"
NOTARY PUBLIC, S AB OF ILLIN0IS
MY COMMISSION EXPIRES To/2212074
SCHEDULE C: Affidavit of Joint Venture (16 BEIW E/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 VIBE 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 (MBE/WBE/EBE).
Name of joint venture:
Address of joint venture:
Phone mirober of joint venture:
H. Identify each bOE/WBE/EBE+, joint venture partner(s)
Name of Firm:
Address:
Phone:
Contact person for matters concerning MBE/WBE compliance:
Ill. Identify each non -MBE/ v'r uEIEDE joint venture partner('")
Name of Firm:
Address:
Phone:
Contact person for matters concerning MBE/`VBE 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 EBE 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/EBE'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)
M!W/EBE Specifxation 12-OR-70 n
A. Specify MBEMBE/EI�E percentages for each of the following (pro«de narrative descriptions and otl-kpr
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. C3uher applicable ownership interests, including ownership options or ether agreements
which restrict or Iirnit 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:
NOW/BBE Specification 12-08-10
B. Authority to enter contracts on behalf of the joint venture:
a
e
C. Signing, co-signing audlor collateralizing loans:
Acquisition of lines of credit:
D. Acquisition and indemnification of payn.ent and performance bonds:
E. Negot.atmg and signing labor agreements:
F. Management of contract performance. (Identify by name and firm only):
1. Supervision of field operations:
2. Major purchases:
3. Estimating:
4. Engineering:
` M/WIEBr Specification 12-08-10
' ` e
0
0
u
ra
VIi. Financial Controls of Joint Venture
y i <'
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?
VIH, 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/ BE/EBE firm, the Ii BEMIBE/EBE firm, or the joint
venture
Trade an-MBE/WBE/EBE Firm VIBE/WBE/EBE oint Venture
(number) (number) (number)
If aU 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 bynon-MBE/WBE/EBE (number) employed by !NI E/WBE/EBE
B. Identify by name'and firm the individual who will be responsible for hiring joint venture
employees:
a
POMEBE Specifrcation 1 Z-08-10
C. Which partner will be responsible for the preparation of joint venture payrolls:
a
IX. Please state any material facts or additional information pertinent to the control and
structure of this joint venture
The undersigned affr rn that the foregoing statements are true and correct and include all
material information necessary to identify and explain the terns 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.
M/W/EBE Specification 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 prime contractor if the joint
venture is a subcontractor.
Name of MBE/WBEMBE Partner Firm
Signature of Affant
Naare and Title of A ffiant
Date
On this _ day of
Frame ofnon-MBE/WBE/EBE Partner Firm
Signature of Affant '
Name and Title of Affant
Date
, 20 , the above signed officers
(names of afnants)
personally appeared and known to are the persons described i a 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 WHEREOF, I hereunto set my hand and seal.
Signamrc of N.t ryNbbc
Commission Expires:
a
(SEAT,)
c
A
° M!W/EBE SpeciFicatiort l2-08-10
w ,
07/16/11 01:29AM OZINGA 8476666313 p.05
Schedule of Additional M/W/1 BE Subcontractors
Project Description- e- r kAtfstAM /rfra xffl74b51
Specification Number: 5 - SP-I61
I do hereby c`et�tify tha
pt:
�/
,- /NG# �.••t AAy //k X _,.,, intends to participate as a Subcontractor on the
(Name of mmiEBE Firm)
Pxoi�
ctknownae Atsr. D K.(�a�/!'i k/ ���"
a
(Tyt><of Work)
This firm is a: (Check Only One)
Minority Business Enterprise (NME), a firm that is at least 51%, managed and controlled
Minority.
Women,s Busincas Enterprise (WEE), a firm that is at least 5 i%, managed and
/coptrollcd by a Woman.
_V Evanston Business Enterprise (EMI), a firm located in Evanston for a tninimum one year
which performs n "commercially useful function."
Address of M/W/EBE
Contact Person
2-
Phone No.
S 1
391,
Dollar Amount of Participation
/b Rio
Percent Amount of Participation
[use additional sheets as necessary and attach to affidavit
MMEBE Spmificafim I2.45-10
bya
and
07/16/11 01:29AM OZINGA 8478666313
p.03
Letter of Intent from M/W/EIIE to )Perform as a Subcontractor, Supplier, and/or Consultant And Affirmation of
MIW/EBE Status
projent Description:
Specification Number:
"�_-�.�_5B• 14a4 j_Pld�•5P-flog
From Q2I�tS,t7PAQu /%%r _ I
(Name of M/W/%E Firm)
To: �1LiI1)S27Inp `Y r ., Q LY1i'.�:,..-,._ and the City of rvaustow
� (Narne of Bidder/Proposer/prlrnc Contractor)
, . 4al
-O /IJ K jeatl AY, intends to participate as a Subcontractor no the
(Name of/+M11O1EHI(i'pinn()?
prujectimawnasl.</3B�f�JT-�/�F�X� Gk'Fi'!t/!.�iy,Pv �'I/Nf.�&+r/�MI-¢'4S;wc7/o't'�
(projent Description)
This fum is a: (Check Only One)
Minority 11whi m Enterprise (MBC), a firm that is at least 510K, managed and controlled by a Minority.
Women's Business Ent'ctprise (WBE), a firm that is at least 5 t %, fnanagcd and controlled by a Woman.
-,,,• zivanston Business Enterpriso (EBE), a fuze located in Evanston for a minimum one year and which performs a
"comrttarciailyuseful functiaa."
govies of all MBF or WOE certil jgsys bava boon attached,
Tba undersigned is prepared to provide the fbllowing described services or supply the following described goods in
connection with the above named lrxoject/crmtmcu
Pmulfxf_
the above described perfonuanco is offored fnr the following price and described terms of payment:
The uodarsigoed will enter into a formal writion agreement for the above work with you as a priuu: contractor.,
conditioned up(m your execution of a written contract with the City of Evanson, and will do so within (3) three working
(Says of xaccciipptt ooff/aa glgnell� from the City of Evanston.
S'igned:(,c/�Gr � irate:
(Signature of Owner, president, authorir :d agent of M/W/BBE)
Namdi'itic
Phone No.
MME8e $pedficntion U4)R-10
07/16/11 01:29AM OZINGA 8478666313 p.04
.Affidavit ofMMIEBA', Goal Implementation Plan
Project Description:
Specification Number:
I bemby declare and aH`uat that I am the duly authorized representative of:
(Nam of13 d os )
and that I have authority to execute this affidavit on bcbslfof this fmn. I have personally reviewed The mateXial and faetu
net forth hemin describing our proposed plan to achieve the NMEBE goals of this contract. Copies of all MiIE or
WRF certifications have been attached. Noitbtr this firm auk its partners, directors anNor opfcors have a controlling
interest, a conflict of interest, or any authority to control the activities of the scheduled M/W/EBR firrn(s),
I duo hereby certify that:
/ J 21A10 L t0111 ,�/ K intends to participate as a Subcontractor on the
(Name of IEB)'E
project known agIeNr'Z .,,vl%t 4x (1tc W 05. 'IIfv t°�!�► s
(Type of Work)
2�25'� fJ�rzk.J
Address of Tr
2ontact person
rt_}_,..a__�.................
Pho2nee No.
�O
$ 19/0 69!
Dollar Amount of Participation
Percent Amount of participation
Prather, this firm is a: (Cbmk only One)
Minarity Business Entetptise (MBE), a firm that is at least SI %, mAnagod and controlled by a Minority.
Womm's Business rutetptise (WISP.), a firm that is at least S 1 %, managed and controW by a Woman.
TV Rvamton Business Enterprise (BBB), a fnm located in Evanston for a minimum out year and which performs a
"commercially useful fimedon."
(If more than one Subcontractor is indicated, attach completed schedule for additional Subcontractors, which is
attached to this affidavil)
M/Woeurstmilcation 12-0 .10
67/16/11 01:29AM OZINGA 8476666313
Ili
To the best of my knowledge, information and belle& the forts Rod represontations contained in ibis Affidavit and
aftached 3chodule(s) are true, and no material facts have; been omlttcd.
The Aidder/Proposer/Contractor designates the following person as its mm/Ellin Liaisoe contact:
Phone•3t2-,73.Y -6914 7-
i do solauaoly declare and affirm under penalties of perjury that the contents of the foregoing document are true
and correet, and that I aln authorized on behalf of the iiidder/Proposor/Contractor, to make this Affidavit.
Signed: AL _
(Aff-iam)
State Of. (fjnt�l
county (city) (City) of: dork
Date: ,..,. /.-L / f
This instrnuleaf was ark owledgodb�1effo/ore. mr, on this -„lqeL day of
Jai
(or other authorized offecar) of 4" 1 L1�C01 y
(Firm Name) Notary Seal
�Na�. nature ^`...
arY g ) � L SEl1L„
y CO3YF R� ARUBIN
PUOtIC, STATE OF ILLINOIS C_omrnission Expixm AL�.� N MY COMMISSION EXPIRES 1O/22/2014
MNJIM Specification IS-oSdo
07/15/2011 18:33 18474620929 MARKING SPECIALISTS
Schedule of Additional MMIMBE Subcontractors
Project Aeacription: S! �[e v3iltc.� , 4a "r- t~50vl 147U XCTXh,,,
Specification Number. - : -1! -SP lit3j
l do hereby certify that:
ft t ezr �i� q S�/5 intends to participate as a Subcontractor on the
�TJarcc of MfW&AE l:irin)
prolmt known as
(Type of Work)
This firm is a: (check Only One)
Minority Business Enterprise (MBE), a firm that is at least 51%, managed and controlled
Minority.
Women's Business Enterprise (WEE), a firm that is at least 51%, managed and
controlled by a Woman.
Evaustoo Eusimess Euterprise QEBE), a firm located in $vanston for a minimum one year
wbieh performs a "commercially useful function."
Ste' Ut-'
Address of M/W/EBE
contact 1'
Phone No.
Dollar Amormt of Participation
3 s
Percent Amount ofkarticipatiou
luac additional sheets as necessary and attach to affidavit
M/W/Fse Specification 12A8-10
by a
and
07/15/2011 18:33 18474620929 MARKING SPECIALISTS PAGE 03/04
Letter of intent from bf/W/EBE to Perform as a Subcontractor, Supplier, and/or Consultant and Affirmation of
AVW/EBE Status
ProjectDescriptioa: It/ -9� S.';`�V 1 �,@C)BAD[P_44-£A7fA-Ems'?!/!7"7►4'`*77...
specification Number: "�AI!?-5/?-lla�.�Q(.�•5P-11D`j /
From }YA1^A�—`c��i� lIC cvc4)
'(Name ofYvatW/E I''i=4r
To: !N!#+oryp)pQ_q- //gQ, ( and the City of Evausmn:
(,flame of 8iddor/ProposerlPriaoe Contractor)
r`.,� ids to participate as a Subcontractor on the
-lyclade of WW//EBS Firm)
project known as 1 a'r��'"*?•-'t'��'`"'t n c . n. (S tCt--��M._ 1Lr��,.,,,.(/��
. (ProjectDezc4tiou) - ,,,,,,..,_p„Lc��„r�, •n �`�.�t,.•e.} rz��K�� +~� "'.�
This firm is w (Cheek, Only One)
X Minority B1r9ir' cPx Enterprise (ME), a firm that is at least 51'/y managed and contrU)lcd by a Minority.
Womm's %usiness Enterprise (WBF.), a firm that is at least 510/6, managed and ceutrolled by a Woman,
Evanston Business F..nterprisc (E)RE), a firm located in Evanston for a miniruum ooc year and which per£oons a
"commercially uscfu) £unction.^
Copies of all MHE or NVBE certifications have been attached,
The undersigned is prepared to provide the following described services or supply the following described goods in
connection wish the above named project/contract:
tit Vevv ey-ct"-.�>.r� n k ►
The above descobed performance is offered for the following price and desoribcd terns of payment
The undersigned will enter into a formal written, agreement forlhe above work with you as a prinae contractor,
conditioned upon your execution of a written contract witb the City of Evanston, end will do so within (3) throe wod*
days of'reonyt of a signed contract from the City of Evanston,
Signed: "�4 Date;
(Signature of Owner, President, authorized agent of X VJ/$$E)
!�-v�Pu'j- �, ��fi'G•'.c� r �X.-N.G�J 7-l�/' pL l%.- Y'
xamerfiue
Phone No,
Mir"/EAE Specification 72-0B�tD
Affidavit of AM/ERE Goal Implementation Plan
ProjectDescriptiom aAde�/aSALIL V-6POl,pyq..�( Specification Number: /
I hereby declare and affirm that I am the duly authorized representative of
(Name of Bidder/Proposer)
and that I have authority to execute this affidavit on behalf of this firm. I have personally reviewed the material and facts
set forth herein describing our proposed plan to achieve the NM/EBE 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 Srxn(s).
I do hereby certify that:
d(✓iGLSJ Q� • intends to participate as a Subcontractor on the
(Name ofM/W/EBE Firm) gL
project known as �.c4.. v �U L yQ•�� .PJ IQQ� q' �Qi�l.. r �.j` )t _
(Type of Work)
11 �J
Address of
c "" P�
tact erson
Phone No.
$ 11TD'�G� . In
Dollar Amount of Participation
Percent Amount of Participation
Furthe/r, this firm is a: (Check Only One)
y Minority Business Enterprise (MBE), a firm that is at least 51 %, managed and controlled by a Minority.
Womm'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 fimction."
(If more than one Subcontractor is indicated, attach completed schedule for additional Subcontractors, which is
attached to this affidavit]
MMEBESpecification 12-08-10
To the best of my Imowledge, 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 N W/EBE Liaison contact:
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: (Affia6 / Date:
State of: 7t.1.lv,� )
County (City) of (?CEV—
This instrument was acknowledged before me on this 10fYA-_ day of
�fvJAxoil by t�tclj J j f(� , as President
(or oth,Ulmrized officer) of �i9 1A�i(� 9l^ lSOf�
(Firm Name) Notary Seal
�. ow 1,
(Notary Public Signature)
Commission Expires:
tm -1�
OFFICIAL SEAL"
RITA R21M
NRYARY PUBLIC, STATE OF ILLINMI
MY Fh^P1dM1$$!t)N EXPIRES t 0/22j2014
M/W(EBE Specification tb08-10
07/19/2011 08:28 18474620929 MARKING SPECIALISTS PAGE 01/02
CITY Ot: CHICAGO
OFFICE OF COMPLIANCE
August24,2010
Alfredo Zavala
Marking Specialist Corporation.
555 Sundown
South Elgin, IL 60177
Annual No Change Affidavit Due: December 1, 2011
Dear: Alfredo Zavala
Congratulationson your continued el igibilityfor certification as a Minority Business ;E nterprise (MME) by
the City of Chicago. This certification is valid until December 1, 2012.
As you know, your firm must also be re -validated annually. We extcadedtbe deadline for submitting the No-
ChangeAffidavit to September I "so that we mightreviewtheprogram for waysto streamlinetheproeess. As
a result, while you will still be required to submitan annual No -Change Affidavit we will no longer require
firms to submit financial records with the Affidavit. and we will allow the Affidavit to be submitted on-line.
This should improve the process for businesses and make it easier to comply with annual validation
requirements. however, as nart of our nroeram imurovements.we will also increase auditing activities and
You may at any time be reauired to submit financial records and other documents needed to suction your
continued elieibilitv.
This new process will begin in 2011. As such, your fiirm's next No Change Affidavit is due by December 1,
2011. Please remember, you have an affirmative duty to file your NeChange Affidavit 60 days prior to the
date of expiration. Thomfore, you must file your No -Change Affidavit by October 2, 2011.
It is important to note that you also have an ongoing affirmative duty to notify the City of Chicago of any
changes in ownership or control of your firm, or any otherfactaffectingyourfirm's eligibility for certification
within 10 days of 'such dliangb. These changes May include but are not"Itlttlredtu a change df address, change
of business structure, change in ownership or ownership structure, change of business operations, and/or gross
receipts that exceed theprogram threshold.
Please note — you shall be deemed to have had your certification lapse and will be ineligibleto participate as a
MBE if you fail to
• file your No Change. Afftdavitwithin the required ttrrte period;
• provide financial or other records requested pursuant to an auditwithin the required timeperiod: or
notify the City of any changes affecting your firm's certifaation within 10 days of such change.
Further, ifyou or yourfirm lsfound to be involved in certification, bidding and/or contractualfraud or abuse.
the City will pursue decertifrcatton and debarment find in addition to any other penalty imposed by taw, any
person who knowingly obtains, or knowingly assists another in obtaining, a contract with the city byjalsely
07/19/2011 08:28 18474620929 MARKING SPECIALISTS PAGE 02/02
representingthat the individual or entity, or the individual or entity assisted, is aminority-owned business or a
woman -owned business, is guilty of a misdemeanor,. punishable by incarceration in the counlyjad for aperiod
not to exceed six months or a fine of not less than $5, 000.00 and not more than $10, 000; or both.
Marking SpecialistCorporation is listed in the City's Directory of Minority Business Enterprises and Women
Business Enterprises in the specialty area(s) of:
63064 Paint, Spray (Aerosol)
63066 Raints, Traffic
76543 Pavement Marking Removal Equipment and Accessories
96861 Pavement Marking Services (including Removal of Markings)
Your firms participation on City contracts will he credited only toward MBE goals in your area(s) of
specialty. While your participation on City contracts is not limited to your specialty,credittoward MBE goals
will be given only for work done in a specialty category.
Thank you for your continued participationin the City's Supplier Diversity Program.
Sincerely,
Mary Elliott
Acting Managing Deputy
M/W/EBE PARTICIPATION WAIVER REQUEST
I am J9&5,bsl Of and have authority to
. Mile of Affiant) (Name of Firm)
execute this certification on behalf of the firm. do
(Name of Af lant)
hereby certify that this firm seeks to waive all or part of this M/W/EBE partcipation goal
for the following reason(s): ( CHECK ALL THAT APPLY. SPECIFIC SUPPORTING DOCUMENTATION
MUST BE ATTACHED.)
f . No M/W/EBEs responded to our invitation to bid.
2. An insufficient number of firms responded to our invtation to bid.
3. No subcontracting opportunities exist. _
4. M/W/EBE participation is impracticable.
Please provide a written explanation of why MANIEBE participation is impracticable. y
Therefore, we request to waive -1�of the 25% utilization goal for a revised goal of
Signature: / fdt (lam/�LZt7L/� ?� _ Date:
(Signature of Affiant)
Corporate Seal (where appropriate)
This instrument was acknowledged before me on this N r day of
u (Ao1( by ,A,.r.(�l.-Ti1�l Y!/i as President
(o thdC, thodzed officer) of f Irwf.�C� Y �l� Notary Seal
''/�ryn�1yy �,n�t (Firm Name)
_ L�041j I(y�'' ) „RFFIC1AL SEAL"
(Notary Public Signature) NoiARy R)TA RtJg)N
PUBLIC, STATE OF !lLiN915
Commission ExTres:
p Ju, _ 1,� MY Ct1M641SSION EXPIRES tUr22K;:
- -
M/W/EBE Specification 12,-08-10
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. 130131, et. seq, 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.
Name of Contractor
<�_'fls2D�ee�.4-�zEH�i�fQ�C�IG' .
By: AWN44
By:
State of 441W-) ), ss
County of O-EcI ._ )
Subscribed and sworn to
befor me this 1919' day
of eQti o2-0II
Not blic�
OF 81TIALARU SEAL" '
RITA RUBIN
NOTARY PUBLIC, STATE OF RLINOIS
MY COMMISSION EXPIRES 10/22t2014
CONFLICTOFINTEREST
°ll?M48a 9- 5##{�1� hereby
certifies that it has conducted an 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.
(Name f Bidder/pr`oposer if the 8iddedproposer is an Individual)
(Name of Partner if the Bidder/proposer is a Partnership)
(Name of Officer if the Bidder/proposer is a Corporation)
The above statements must be ubscribed ano sworn to before a notary public.
Subscribed and Sworn to this day of 2011
"OFFICIAL SEAL"
RITA RUBIN
LOTARY PUBLIC, STATE OF ILLINOIS
COMMISSION EXPIRES 10/22/2014
MGM —/PM
�• s
Failure to complete and return this form may be considered sufficient reason for
rejection of the bid/proposal.
ADDITIONAL INFORMATION SHEET
Bid/Prospal Name
Bid/Bid Number#
Company Name: A�kq -q—
Contact Name: e&L6
Address: 9,W, PMfP_AC_PAW,
City,State, Zip: IL 0'_,7&,
Teiephone/FAX: #_Sqr� 9_51-b6o
E-mail: am
Comments:
AFFIDAVIT OF COMPLIANCE
PROJECT NUMBER: PW-SR-1108/PW-SP-1109
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. Peter A. Palumbo
Mr. Sebastian Palumbo
Mr. Daniel Ferreniani
Mr. Gerald McGreevy
Mr. Kelson Abdisbi
Orange Crush Recycle L.P.
Monarch Asphalt Company
Palumbo Brothers, Incorporated
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 into
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 Name di,
Signed By
SPECIAL PROVISIONS
AFFIDAVIT OF COMPLIANCE
PROJECT NUMBER: PW-SR-1108/PW-SP-1109
RETURN WITH BID I
1. 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 IDOT 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 4-r�?W�
Signed By: ewliff�
SPECIAL PROVISIONS
RETURN WITH BID
CLARK STREET SIDEWALK REPLACEMENT AND
GREEN BAY ROAD-EMERSON STREET INTERSECTION
IMPROVEMENT
PW-SR-1 108/PW-SP-1109
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, Saturdays, 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.
I �� 1, hR.lfQF 5,J)4 have read and
understood the above statement, and will comply with this special provision for the above
referenced project.
Accepted by:
Company Name/Signature /
City of Evanston
SPECIAL PROVISIONS
RETURN WITH BID
AFFIDAVIT OF COMPLIANCE
FOR
DISPOSAL OF EXCAVATED MATERIAL,
PROJECT: PW-SR-1108/PW-SP-1109
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.
I N{pih ,hP.6ftP� Mg. have read and understood the above
statement, and will comply with this special provision for this project.
Accepted by:
l
Company Name/Signature
SPECIAL PROVISIONS
RETURN WITH BID
AFFIDAVIT OF COMPLIANCE FOR GENERAL CONDITIONS
CONTRACT FOR: CLARK STREET SIDEWALK REPLACEMENT AND GREEN BAY ROAD-
EMERSON STREET INTERSECTION IMPROVEMENT
PROJECT NUMBER: PW-SR-1108/PW-SP-11009
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 (City of Evanston)
(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 Clf�l�CSesNA1 of---r��_ �r5r��� C� .
have read and understood the above statement, and will comply with this special provision for the
above referenced project.
Accepted:
Date: Q-/Q-//
Signature:
SPECIAL PROVISIONS
RETURN WITH BID
AFFIDAVIT OF COMPLIANCE FOR GENERAL CONDITIONS
PROJECT NUMBER. PW-SR- 9 908/PW-SP-1109
STREET SWEEPING
When requested by the resident engineer the contractor shall provide street sweeping or a water tanker
truck within 4 hours of being requested and by 3 P.M. each day requested for the street locations he has
previously worked and/or the locations as directed by the resident engineer. This work will be paid for
at the contract unit price for each street sweeping, which price shall include all labor, material &
equipments necessary to complete the work. If the contractor fails to meet these requirements a penalty
of $ 500.00 per occurrence shall be applied.
.ADD TO ARTICLE SECTION 606
All curb and gutter removed shall be formed within 2 working days of removal. New curb and gutter
shall be poured within 1 working day of being formed. The forms shall be removed within 1 working
day after the concrete pour and the restoration behind the new curb shall be done with 24 hours after
removal of the forms. All low areas shall be filled in to match the surrounding grades within 72 hours of
the curb being poured.
All the work will be paid for at the contract unit price per foot for concrete curb or combination curb &
gutter of the type specified which price shall include all materials, excavation, disposal, backfill and
furnishing. Installing all joints as required and confirm to Section 606 of the Standard Specifications for
Road and Bridge Construction.
I have read and understood
the above statement, and will comply with this special provision for the above referenced project.
Accepted by:
Name/Signatufe
City of Evanston
SPECIAL PROVISIONS
RETURN WITH BID
AFFIDAVIT OF COMPLIANCE
FOR
GENERAL CONDITIONS
PROJECT NUMBER: PW-SR-11081PW-SP-' l09
ADD ARTICLE 4.B 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.
t U4_ of _,�91Y/Q.9 r�ibPlYs/ly1L
have read and will comply with this Special Provisions for the above referenced project.
Date:
Signed By: 16&7/Jkellt/
City of Evanston
SPECIAL PROVISIONS
RETURN WITH BID
AFFIDAVIT OF COMPLIANCE
PROJECT NUMBER; PW-SR- 1108/PW-SP-1109
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.
I �flPJ4i tXli2F�lrf of rU,"_w9'r�/
have read and will comply with this Special Provisions for the above referenced project.
Date: 9- 1
Signed By: A41v��
City of Evanston
SPECIAL PROVISIONS
RETURN WITH BID
AFFIDAVIT OF COMPLIANCE FOR GENERAL CONDITIONS
CONTRACT FOR. CLARK STREET SIDEWALK REPLACEMENT AND
GREEN BAY ROAD- EMERSON STREET IMPROVEMENT
PROJECT NUMBER: PW-SR- 1908/PW-SP-1109
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, THIS WORK WILL NOT BE
PAID FOR SEPARATELY. THE COST OF THIS WORK SHALL BE INCLUDED IN THE
UNIT PRICES BID FOR VARIOUS PAY ITEMS.
I (&,,) 6eA— of 'iV-00M0o-- 4' "I?JweLne"e-
have read and understood the above statement, and will comply with this special provision for the
above referenced project.
ACCEPTED:
Date: 9-8-If
Signature:
N
CITY OF EVANSTON
Number:
Date:
Original Agreement Date:
Project:
Bid No. (if applicable):
Owner: City of Evanston, Illinois
Contractor:
MMMiMYMM... %..O.............. K............... A......................... ppMfOY 0.
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 =
YYMMMY.....W... W..YYY.......A.. ............................... YYYMYgYYYY Y X...MI
Change to Contract Time:
Not Applicable
YYYMM}.x...... M....................... k................ 4.................. YMMM.
Recommended by Date
Approved by (Owner) Date
Accepted by (Contractor) Date
Local Agency
Illinois Depaft!pent Proposal Bid Bond
of Transpoftation
Route
County Cook
RETURN WITH BID Local Agency City of Evanston
Section PW-SR-1 108/PW-SP-1 109
PAPER BID BOND — -- - —
WE
as PRINCIPAL,
and
as SURETY,
are held jointly, severally and firmly bound unto the above Local Agency (hereafter referred to as "LA") in the penal sum of 5% of the total bid price, or for
the amount specified in the proposal documents in effect on the date of invitation for bids whichever is the lesser sum. We bind ourselves, our heirs,
executors, administrators, successors, and assigns, jointly pay to the LA this sum under the conditions of this instrument
WHEREAS THE CONDITION OF THE FOREGOING OBLIGATION IS SUCH that, the said PRINCIPAL is submitting a written proposal to the LA
acting through its awarding authority for the construction of the work designated as the above section.
THEREFORE if the proposal is accepted and a contract awarded to the PRINCIPAL by the LA for the above designated section and the PRINCIPAL
shall within fifteen (15) days after award enter into a formal contract, furnish surety guaranteeing the faithful performance of the work, and furnish
evidence of the required insurance coverage, all as provided in the "Standard Specifications for Road and Bridge Construction" and applicable
Supplemental Specifications, then this obligation shall become void; otherwise it shall remain in full force and effect.
IN THE EVENT the LA determines the PRINCIPAL has failed to enter into a formal contract in compliance with any requirements set forth in the
preceding paragraph, then the LA acting through its awarding authority shall immediately be entitled to recover the full penal sum set out above, together
With all court costs, all attorney fees, and any other expense of recovery.
IN TESTIMONY WHEREOF, the said PRINCIPAL and the said SURETY have caused this instrument to be signed by their
respective officers this
day of
Principal
(Company Name) (Company Name)
By:
(Signature and Title) (Signature and Title)
(If PRINCIPLE Is a joint venture of two or more contractors, the company names, and authorized signatures of each contractor must be affixed.)
Surety
By:
(Name of Surety) (Signature of Attorney -in -Fact)
STATE OF ILLINOIS,
COUNTY OF
I.
do hereby certify that
, a Notary Public in and for said county,
( Insert names of individuals signing on behalf of PRINCIPAL & SURETY)
who are each personally known to me to be the same persons whose names are subscribed to the foregoing instrument on behalf of PRINCIPAL and
SURETY, appeared before me this day in person and acknowledged respectively, that they signed and delivered said instruments as their free and
voluntary act for the uses and purposes therein set forth.
Given under my hand and notarial seal this day of
My commission expires
ELECTRONIC BID BOND
(Notary Public)
❑ Electronic bid bond is allowed (box must be checked by LA if electronic bid bond is allowed)
The Principal may submit an electronic bid bond, in lieu of completing the above section of the Proposal Bid Bond Form. By providing
an electronic bid bond ID code and signing below, the Principal is ensuring the identified electronic bid bond has been executed and
the Principal and Surety are firmly bound unto the LA under the Conditions of the bid bond as shown above. (If PRINCIPAL is a joint
venture of two or more contractors, an electronic bid bond ID code, company/Bidder name title and date must be affixed for each
contractor in the venture.)
I I) I I I I I I
Electronic Bid Bond to Code
(Company/Bidder Name)
(Signature and Title)
Date
Page 1 of 1
Printed on 6/9/2011 11:17:45 AM
BLR 12230 (Rev. 7/05
Illinois Department. -
of Transportation
Bureau of Construction
2300 South Dirksen Parkway/Room 322
Springfield, Illinois 62764
Part I. Work Under Contract
Affidavit of Availability
For the Lefting of
Instructions: Complete this form by either typing or using black ink "Authorization to Bid" will not be issued
unless both sides of this form are completed in detail. Use additional forms as needed to list all work.
List below all work you have under contract as either a prime contractor or a subcontractor. It is required to include all pending low bids not yet awarded
or rejected. in a joint venture, list only that portion of the work which is the responsibility of your company. The uncompleted dollar value is to be based upon
the most recent engineer's or owners estimate, and must include work subcontracted to others, if no work is contracted, show NONE
1 2 3 4 Awards Pending l
County and Section Number
Contract With
Estimated Completion Date
Total Contract Price
! Uncompleted Dollar Value if Firm is
the Prime Contractor
Uncompleted Dollar Value if Firm is
the Subcontractor
iML A4400-5i'
5o/1Co
Al:,3Zoil
15B6'{a'.5b
t�txM(yf-CQ.u.`kl- VIU.Aey� &-r
__��.EE.... Wit-thl�'.
5ra/Ytm�-mil �r¢rpt(�,Zvl1
&4&:�. eo
99-5993'=
9g3?93`°
Part It. Awards Pending and Uncompleted Work to be done with your own forces.
EllAAS'ttJl
FILL Zoll
l8502.5�'=
Total Value of All Work
List below the uncompleted dollar value of work for each contract and awards pending to be completed with your own forces. All work
subcontracted to others will be listed on the reverse of this form. In a joint venture, list only that portion of the work to be done by your
company. If no work is contracted, show NONE.
( Earthwork
Portend Cement Concrete Paving
HMA Plant Mix
HMA Paving
' Clean & Seal Cracks/Joints
Aggregate Bases & Surfaces
Highway, R.R. and Waterway Structures
i
Irefnage
Electrical
Cover and Seal Coats
Concrete Construction
Landscaping
Fencing
Guardrail
Painting
Signing
Cold Milling, Planning & Rotomilling
Demolition
Pavement Markings (Paint)
gtherConstructlon (List)
/5.96'f8.5D 3roN'D IIY3�33m l$5<5t�
Accumulated
Totals
9`IRDy�- �II
1Y/t5'D?8=" 1
bi f7l '515
Accumulated
Totals
.Totals -- - _ y/59649.1z &436.to /75M•oD i'05t5b.u-i '/INh'-i' •
Disclosure of this information is REQUIRED .o accomplish the statutory purpose as outlined in the "Illinois Procurement Code." Paiiure to com Sly will fesult in
non -issuance of an "Authorization To Bid." This form has been approved by the State Forms Management Center,
Printed 12/2/2009 Page 1 of 2 BC 57 (Rev. 08/20/08
Part Ill. Work Subcontracted to Others.
For each contract described in Part I, list all the work you have subcontracted to others.
1
Subcontractor
II Type of Work
! Subcontract Price
Amount
Uncompleted
Subcontractor
Type of Work
Subcontract Price
Amount
Uncompleted
Subcontractor
Type of Work
Subcontract Price
Amount
Uncompleted
rSubcontractor
Type of Work
Subcontract Price
Amount
Uncompleted
Subcontractor
Type of Work
Subcontract Price
r
Amount
Uncompleted
Total Uncompleted
2 3
4 Awards Pending
1, being duly sworn, do hereby declare that this affidavit is a true and correct statement relating to ALL uncompleted contracts of the
undersigned for Federal, State, County, City and private work, including ALL subcontract work, ALL pending low bids not yet awarded
or rejected and ALL estimated completion dates.
Subscribed and sworn to tlefore me
r this F day of �p
0k,
1 Notary Public ��1
My commission expires /O-Ors'= W
"OFFpSEAL"
TARUBN
FARY PUBLIC, STATE OF ILLINOIS
^MANAMRInN Fxa'?cQ l^ '014
jb �__ Type or Print NameOfficer or ctor
Signed
Company -, ��/��� W p- r*-,r*- WAC
Address '/life (z/71QM PAU-
�4� it. (Otb?(o
"OFFCH�
RTARUBIN
NOTARY PUBLIC, STATE OF 4.UNOIS
Prinked 72/2/200 My CODAbfISSION EXPIRES 1r12202Nl
Page 2 of 2
BC 57 (Rev. 08/20/01
Client#:69888 SCHRINC
ACORD. CERTIFICATE OF LIABILITY INSURANCE DATEIYYYY
08l17/207/2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. if SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
I NAMEACT Melinda Romanowski
HarneyTeam
PHONE 312 595-6289 NublAJC
I PHONE
E Extl:
312 595-6837
Mesirow Insurance Services
I mrmmanowski@mesirowfinancial.com
ADDRESS:
353 N. Clark Street
INSURER(S) AFFORDING COVERAGE
NAICA
Chicago, IL 60654
INSURER A: National Fire Ins Co. of Hartfo
20478
INSURED
( INSURERS: Continental Casualty
20443
Schroeder & Schroeder, Inc.
INSURER C:Valley Forge Insurance
20508
7306 Central Park
INSURER 0: Great American Insurance Compan
Skokle, IL 60076
I INSURERE:
I INSURER F:
COVERAGES CERTIFICATE
NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE
POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,
TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT
TO WHICH THIS
':ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE
INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
XCLUSIONS AND CONDITIONS OF SUCH POLICIES.
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL'SUBR
LTR TYPE OF INSURANCE INSR MD
POLICY EFF POLICY EXP
POLICY NUMBER (MWDOIYYYY) IMM/DDNYYYI
LIMITS
A GENERAL LIABILITY
GL4026148583 08/19/2011 08/19/201
EDAgCCHp�OECCpURRENCE
$1.000,000
X
COMMERCIAL GENERAL LIABILITY
(PREMISES /Ea ocarmncof
$100,000
CLAIMS -MADE aOCCUR
(NEDEXP(Any one person)
$15,000
X
BI/PD Ded:1,000
(PERSONAL&ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
G�E 1 AGGREGATE LIMIT APPLIES PER:
(PRODUCTS - COMP/OP AGG
s2,000,000
( POLICY
( AI JFCT I LOC
$
C AUTOMOBILE LIABILITY
BUA4026148616 08/19/2011 08H 91201
IEd abb,d.rtSiNGLE LIMIT
S1,000,000
X
ANY AUTO
BODILY INJURY (Per person)
$
ALL OWNED
�
X
jSCHEDULED
BODILY INJURY (Per accident)
$
X
AUTOS
I
AUTOS
NOON -OWNED
PROPERTY DAMAGE
$
HIREDAUTOS
Inc,AUTOS accident)
B X
UMBRELLA LIAR
I OCCUR
CUP4026148597 .J8/19/2011 08/19/201
EACH OCCURRENCE
$5,000,000
EXCESS LIAR
- --
CLAIMS -MADE
AGGREGATE
$5.000.000
DED I XIRETENTION$10000
$
WORKERS COMPENSATION
WC4026148602 )8/19l2011 08/19/201
WC STATU- OTH-
X TpRVIIMTS Fro
AND EMPLOYERS' LIABILITY
PROPRIETORIPARTNER/EXECUTIVEY/N
E.L. EACH ACCIDENT
$1.000.000
OFFICERJMEMBER E%GLUDED4
N NIA
EL, DISEASE EA EMPLOYEE
$1,000,000
(Mandatory In NH)
-
I( (yes.dCRIPTION OF OPERATIONS below escnbe under
DES '
E.L. DISEASE - POLICY LIMIT
$1,000,000
D Scheduled
MAC879920002 D8/19/2011 08/191201
Per List on File
Equipment
with Company
DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
Clark Street Sidewalk Replacement PW-SR-1108 Green Bay Rd -Emerson Street Intersection Improvement PW-SP-1109
City of Evanston is included as an additional insured regarding general liability as required by written
contract for work performed by the named insured with respect to the referenced project.
CERTIFICATE HOLDER CANCELLATION
City of Evanston THEULD EXANY
PIRATTIIONHDATTEVTHEREOF,,ENOTTICEIES WIILLLCELLED BECDELIVERED NE
Attn: Risk Management Director ACCORDANCE WITH THE POLICY PROVISIONS.
2100 Ridge Avenue
Evanston, IL 60201-0000 AUTHORIZED REPRESENTATIVE
t1
@ 1988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S1001638/M1001596 MLR
1. THIS AGREEMENT, made and concluded the
between the Citv
actinq by and throuqh its Citv Council
Schroeder and Schroeder Inc.
known as the party of the second part.
day of
of Evanston
Contract
Month and Year
known as the party of the first part, and
his/their executors, administrators, successors or assigns,
2. Witnesseth: That for and in consideration of the payments and agreements mentioned in the Proposal hereto attached,
to be made and performed by the party of the first part, and according to the terms expressed in the Bond referring to these
presents, the party of the second part agrees with said party of the first part at his/their own proper cost and expense to do all
the work, furnish all materials and all labor necessary to complete the work in accordance with the plans and specifications
hereinafter described, and in full compliance with all of the terms of this agreement and the requirements of the Engineer under
it.
3. And it is also understood and agreed that the Notice to Contractors, Special Provisions, Proposal and Contract Bond
:reto attached, and the Plans for Section PW-SR-1 108/PW-SP-1 109
in the Citv of Evanston
approved by the Department of Transportation of the
State of Illinois , are essential documents of this contract and are a part hereof.
Date
4. IN WITNESS WHEREOF, The said parties have executed these presents on the date above mentioned.
A The ACif/v of Evanston
Clerk By City �
_
v / ytierjyoffhe5�3arY CJ
(Seal) City Manager
Of a Corporation)
Attest: �
f p
pecretary
Approved as to form:
a .
W. Grant Farrar
Corporation Counsel
Corporatmp;
9-'1P- 'rPi)b0FeL�.
By fParty of the Second Part
(If a Co -Partnership)
Partners doing Business under the firm name of
Party of the Second Part
(if an individual)
Party of the Second Part
Page 1 of 1 BLR 12320 (Rev. 7105)
Printed on 5/8/2006 9:21:53 AM
Bond# 285036026
5 originals issued
We, Schroeder & Schroeder, Inc.
Contract Bond
Route
County Cook
Local Agency City of Evanston
Section PW-SR-1108
PW-SP-1109
a/an) ❑ Individual ❑ Co -partnership ❑x Corporation organized under the laws of the State of Illinois
as PRINCIPAL, and Liberty Mutual Insurance Company
as SURETY,
held and firmly bound unto the above Local Agency (hereafter referred to as "LA') in the penal sum of
Three Hundred Fifty Two Thousand Two Hundred Fourty Four and 001100
Dollars ( $352,244.00 ), lawful money of the
United States, well and truly to be paid unto said LA, for the payment of which we bind ourselves, our heirs, executors,
administrators, successors, jointly to pay to the LA this sum under the conditions of this instrument.
WHEREAS THE CONDITION OF THE FOREGOING OBLIGATION IS SUCH that, the said Principal has entered into a
written contract with the LA acting through its awarding authority for the construction of work on the above section, which
contract is hereby referred to and made a part hereof, as if written herein at length,,and whereby the said Principal has
promised and agreed to perform said work in accordance with the terms of said contract, and has promised to pay all sums of
money due for any labor, materials, apparatus, fixtures or machinery furnished to such Principal for the purpose of performing
such work and has further agreed to pay all direct and indirect damages to any person, firm, company or corporation suffered
or sustained on account of the performance of such work during the time thereof and until such work is completed and
accepted; and has further agreed that this bond shall inure to the benefit of any person, firm, company or corporation to whom
any money may be due from the Principal, subcontractor or otherwise for any such labor, materials, apparatus, fixtures or
VAchinery so furnished and that suit may be maintained on such bond by any such person, firm, company or corporation for
recovery of any such money.
NOW THEREFORE, if the said Principal shall well and truly perform said work in accordance with the terms of said contract,
and shall pay all sums of money due or to become due for any labor, materials, apparatus, fixtures or machinery furnished to
him for the purpose of constructing such work, and shall commence and complete the work within the time prescribed in said
contract, and shall pay and discharge all damages, direct and indirect, that may be suffered or sustained on account of such
work during the time of the performance thereof and until the said work shall have been accepted, and shall hold the LA and
its awarding authority harmless on account of any such damages and shall in all respects fully and faithfully comply with all
the provisions, conditions and requirements of said contract, then this obligation to be void; otherwise to remain in full force
and effect.
Page 1 of 2 IL 494-0372 SLR 12321 (Rev. 7/05)
Printed on 8/10/2011 9:56:22 AM
IN TESTIMONY WHEREOF, the said PRINCIPAL and the said SURETY have caused this instrument to be
signed by their respective officers this lsth day of August A.D. 2011
PRINCIPAL
Schroeder & Schroeder, Inc. ���///
%a I // (Company Name)
BY: /' � /� �� By
(Signature &`('IUe) Chris Schroeder, President (Signature & Title)
Attest: Attest:
(Signature & Title) (Signature & Title)
(if PRINCIPAL is a Joint venture of two or more contractors, the company names and authorized signature of each contractor must be
affixed.)
STATE OF ILLINOIS,
COUNTY OF I'la
1, &' th
0
a Notary Public in and for said county, do hereby certify that
(Insert names of individuals signing on behalf or PRINCIPAL)
who are each personally known to me to be the same persons whose names are subscribed to the foregoing instrument on behalf
of PRINCIPAL, appeared before me this day in person and acknowledged respectively, that they signed anc(yfg fi7TAR
8 E A L
Instrument as their free and voluntary ad for the us�nd purposes therei t forth IN
Given under m hand and notarial seal this dayo AA„��yqr��� 'E OF ILLINOIS
RES 10122/2014
My commission expires JDrz. /L� SEAL
Ndtary Public ( )
Liberty Mutual Insurance Company
(Name of Surety)
STATE OF ILLINOIS.
COUNTY OF cook
Jessica Diaz
40 Josefina Cervantes
SURETY /� A�
By:
(Signature ofAttarnay-in-Fact)
J sefin ervantes, Attorney -in -Fact
(SEAL)
a Notary Public In and for said county, do hereby certify that
(Insert names of individuals signing on behalf or SURETY)
who are each personally known to me to be the same persons whose names are subscribed to the foregoing instrument on behalf
of SURETY, appeared before me this day in person and acknowledged respectively, that they s ed and•-defiV In
instrument as their free and voluntary act for the uses and purposes therein set forth. OFFICIAL V AL
Given under my hand and notarial seal this lath day of August A.D. 20}(LSSICA D,..
c, NOTARY PUUBL�STATE OF ILLINOIS
My commission expires 7/10/2013 J�� rm X)MY COMMISSION EXPIRES:07/10113
/i-="'" Notary Public
Approved this Sth day of August , A.D. 2011_
Attest:
% City
Clerk
Page 2 of 2
Printed on 5/8/2006 9:23:33 AM
City Council
4I(ardKW".,ng
Authority)
)o�rvss
Appro V*f":
IL 494-0372 4 J BLR'12321 (Rev. 7/05)
W` , W.
Grant Farrar
Corporation Counsel
THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND.
This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to
the extent herein stated.
LIBERTY MUTUAL INSURANCE COMPANY
BOSTON, MASSACHUSETTS
POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS: That Liberty Mutual Insurance Company (the "Company"), a Massachusetts stock insurance
company, pursuant to and by authority of the By-law and Authorization hereinafter set forth, does hereby name, constitute and appoint
JACQUELYN M. NORSTROM, DOROTHY J. BALLIS, JUDITH A. MCGOOGAN, JOHN R HARNEY,
JOSEFINA CERVANTES, ALL OF THE CITY OF CHICAGO, STATE OF ILLINOIS.........................................................
......................................................... ................. :.................................................... ................................................................
, each individually if there be more than one named, its true and lawful attorney -in -fact to make, execute, seal, acknowledge and deliver, for and on its
behalf as surety and as its act and deed, any and all onkdertta kings, _bon*d , recognizances and other surettyy obliggations in the penal sum not exceeding
TWENTY MILLION AND 00/100 nOLLARS (F 20,000, 00.00 I each, and the
execution of such undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents, shall be as binding upon the
Company as if they had been duly signed by the president and attested by the secretary of the Company in their own proper persons.
That this power is made and executed pursuant to and by authority of the following By-law and Authorization:,
ARTICLE XIII - Execution of Contracts: Section 5. Surety Bonds and Undertakings.
Any officer of the Company authorized for that purpose in writing by the chairman or the president, and subject to such limitations as the
chairman or the president may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make,
execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such
attorneys -in -fact, subject to the limitations set forth in their respective powers of attorney, shall have full power to bind the Company by their
signature and execution of any such instruments and to attach thereto the seal of the Company. When so executed such Instruments shall be
N as binding as if signed by the president and attested by the secretary.
Cy By the following instrument the chairman or the president has authorized the officer or other official named therein to appoint attorneys -in -fact:
N
c Pursuant to Article XIII, Section 5 of the By -Laws, Garnet W. Elliott, Assistant Secretary of Liberty Mutual Insurance Company, is hereby
.: authorized to appoint such attorneys -in -fact as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and
deliver as surety any and all undertakings, bonds, recognizances and other surety obligations.
iIm
w3 That the By-law and the Authorization set forth above are true copies thereof and are now in full force and effect.
O
IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Company and the corporate seal of
Liberty Mutual Insurance Company has been affixed thereto in Plymouth Meeting, Pennsylvania this 28th day of April ,
N 3 2010
C L LIBERTY MUTUAL INSURANCE COMPANY
O
e to Garnet W. Elliott, Assistant Secretary
ej.`, COMMONWEALTH OF PENNSYLVANIA ss `"-='•
R COUNTY OF MONTGOMERY
Ci
On this 28th day of April 2010 , before me, a Notary Public, personally came Garnet W. Elliott. to me known, and acknowledged
,hat he is an Assistant Secretary of Liberty Mutual Insurance Company; that he knows the seal of said corporation; and that he executed the above
.d. Power of Attorney and affixed the corporate seal of Liberty Mutual Insurance Company thereto with the authority and at the direction of said corporation.
02
IN TESTIMONY WH zFES 1 jzave k�,Peunto subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year
° = first above written. � 4e Ft,r3,,w ;Y . coMMgryw_gyXH orP17NNsn_ AAA
i {�4 y4f
a. F ' msn Paefere, NotMY P,NI.c .
Z V @ 4, r'" Plymoyth nw•tnontro�meq'Co,mo B\/
55 'gyp,, w yN nnc��»,•ex��"exp„��ue,�nza.zma Ter sa Pastella, Notary Public
`U,'��-y �' hfemeer. r'en�:w+aneazweni�a, or Ho�anev
— CERTIFICATE
I, the undersigned, AssistanrSec etary of Liberty Mutual Insurance Company, do hereby certify that the original power of attorney of which the foregoing J
is a full, true and correct copy, is In full force and effect on the date of This certificate; and I do further certify that the officer or official who executed the
said power of attorney is an Assistant Secretary specially authorized by the chairman or the president to appoint aftorneys-in-fact as provided in Article
XIII, Section 5 of the By-laws of Liberty Mutual Insurance Company.
This certificate and the above power of attorney may be signed by facsimile or mechanically reproduced signatures under and by authority of the
following vote of the board of directors of Liberty Mutual Insurance Company at a meeting duly called and held on the 12th day of March, 1980.
VOTED that the facsimile or mechanically reproduced signature of any assistant secretary of the company, wherever appearing upon a
certified copy of any power of attorney issued by the company in connection with surety bonds, shall be valid and binding upon the company
with the same force and effect as though manually affixed.
IN T TIMONY VqHEREO
F, reunto subscribed my name and affixed the corporate seal of the said company,
this _� day of
By
David' M. Carey, Asiit Secretary