HomeMy Public PortalAbout030-2016 - Sanitary - County Tire & Service - TiresAGREEMENT ORIGINAL
THIS AGREEMENT made and entered into this � day of r-i , 2016, and referred
to as Contract No. 30-2016 by and between the City of Richmond, Indiana, a municipal corporation
acting by and through its Board of Sanitary Commissioners (referred to as the "City"), and County
Tire and Service, Inc., 605 South Center Street, Cambridge City, IN 47327 (hereinafter referred to
as the "Contractor").
SECTION I. STATEMENT AND SUBJECT OF WORK
City hereby retains Contractor for supplying and delivery of tires for use by the Sanitary District
for a period ending December 31, 2016.
A Request for Quotes has been made available for inspection by Contractor, is on file in the office
of the Department of Sanitation for the City of Richmond, consisting of four (4) typewritten pages,
which is attached hereto and incorporated by reference herein as Exhibit "A".
The response of Contractor to said Request for Quotes is attached hereto and incorporated by
reference herein as Exhibit `B", consisting of four (4) typewritten pages.
Should any provisions, terms, or conditions contained in any of the documents attached hereto and
incorporated by reference herein as Exhibits, conflict with any of the provisions, terms, or
conditions of this Agreement, this Agreement shall be controlling.
The Contractor shall furnish all labor, material, equipment, and services necessary for the proper
completion of all work specified. Contractor shall submit statements or bills monthly.
No performance of services shall commence until the following has been met:
1. The City is in receipt of any required certificates of insurance and/or warranties;
2. The City is in receipt of any required affidavit(s) signed by Contractor in accordance with
I.C. § 22-5-1.7-11(a)(2); and
3. A purchase order has been issued by the Purchasing Department.
SECTION II. STATUS OF CONTRACTOR
Contractor shall be deemed to be an independent contractor and is not an employee or agent of the
City of Richmond. The Contractor shall provide, at its own expense, competent supervision of the
work.
SECTION III. COMPENSATION
City shall pay Contractor at the rates indicated in Exhibit `B" in an amount not to exceed Eighty-
two Thousand Dollars and 00/100 ($82,000.00).
SECTION IV. TERM OF AGREEMENT
This Agreement shall become effective when signed by all of the parties hereto and shall continue
in effect until in effect to an including December 31, 2016 unless the parties extend this Agreement
by a written and signed Addendum.
Contract No. 30-2016
1 1 Page
Notwithstanding the term of this Agreement, City may terminate this Agreement in whole or in
part, for cause, at any time by giving at least thirty (30) days written notice specifying the effective
date and the reasons for termination which shall include but not be limited to the following:
a. failure, for any reason of the Contractor to fulfill in a timely manner
its obligations under this Agreement;
b. submission of a report, other work product, or advice, whether oral or written, by the
Contractor to the City that is incorrect, incomplete, or does not meet reasonable
professional standards in any material respect;
c. ineffective or improper use of funds provided under this Agreement;
d. suspension or termination of the grant funding to the City under which this Agreement
is made; or
e. unavailability of sufficient funds to make payment on this Agreement.
This Agreement may also be terminated by either the City or the Contractor, in whole or in part,
by mutual Agreement setting forth the reasons for such termination, the effective date, and in the
case of partial termination, the portion to be terminated.
This Agreement may also be terminated by either the City or the Contractor, without cause, by
giving at least thirty (30) days written notice to the other party.
In the event of termination of this Agreement, the City shall be required to make payment for all
work performed prior to the date this Agreement is terminated, but shall be relieved of any other
responsibility herein.
SECTION V. INDEMNIFICATION AND INSURANCE
Contractor agrees to obtain insurance and to indemnify the City for any damage or injury to person
or property or any other claims which may arise from the Contractor's conduct or performance of
this Agreement, either intentionally or negligently; provided, however, that nothing contained in
this Agreement shall be construed as rendering the Contractor liable for acts of the City, its officers,
agents, or employees. Contractor shall as a prerequisite to this Agreement, purchase and thereafter
maintain such insurance as will protect it from the claims set forth below which may arise out of
or result from the Contractor's operations under this Agreement, whether such operations by the
Contractor or by any sub -contractors or by anyone directly or indirectly employed by any of them,
or by anyone for whose acts the Contractor may be held responsible.
Coverage Limits
A. Worker's Compensation & Statutory
Disability Requirements
B. Employer's Liability $100,000
C. Comprehensive General Liability
2 1 Page
Section 1. Bodily Injury
Section 2. Property Damage
D. Comprehensive Auto Liability
Section 1. Bodily Injury
Section 2. Property Damage
E. Comprehensive Umbrella Liability
$1,000,000 each occurrence
$2,000,000 aggregate
$1,000,000 each occurrence
$1,000,000 each person
$1,000,000 each occurrence
$1,000,000 each occurrence
$1,000,000 each occurrence
$1,000,000 aggregate
F. Malpractice/Errors & Omissions Insurance $1,000,000 each occurrence
$2,000,000 aggregate
SECTION VI. COMPLIANCE WITH WORKER'S COMPENSATION LAW
Contractor shall comply with all provisions of the Indiana Worker's Compensation law, and shall,
before commencing work under this Agreement, provide the City a certificate of insurance, or a
certificate from the industrial board showing that the Contractor has complied with Indiana Code
Sections 22-3-2-5, 22-3-5-1 and 22-3-5-2. If Contractor is an out of state employer and therefore
subject to another state's worker's compensation law, Contractor may choose to comply with all
provisions of its home state's worker's compensation law and provide the City proof of such
compliance in lieu of complying with the provisions of the Indiana Worker's Compensation Law.
SECTION VII. COMPLIANCE WITH INDIANA E-VERIFY PROGRAM
REQUIREMENTS
Pursuant to Indiana Code 22-5-1.7, Contractor is required to enroll in and verify the work
eligibility status of all newly hired employees of the contractor through the Indiana E-Verify
program. Contractor is not required to verify the work eligibility status of all newly hired
employees of the contractor through the Indiana E-Verify program if the Indiana E-Verify
program no longer exists. Prior to the performance of this Agreement, Contractor shall provide
to the City its signed Affidavit affirming that Contractor does not knowingly employ an
unauthorized alien in accordance with IC 22-5-1.7-11 (a) (2). In the event Contractor violates
IC 22-5-1.7 the Contractor shall be required to remedy the violation not later than thirty (30)
days after the City notifies the Contractor of the violation. If Contractor fails to remedy the
violation within the thirty (30) day period provided above, the City shall consider the
Contractor to be in breach of this Agreement and this Agreement will be terminated. If the
City determines that terminating this Agreement would be detrimental to the public interest or
public property, the City may allow this Agreement to remain in effect until the City procures
a new contractor. If this Agreement is terminated under this section, then pursuant to IC 22-5-
1.7-13 (c) the Contractor will remain liable to the City for actual damages.
SECTION VIII. IRAN INVESTMENT ACTIVITIES
Pursuant to Indiana Code (IC) 5-22-16.5, Contractor certifies that Contractor is not
engaged in investment activities in Iran. In the event Board determines during the course
of this Agreement that this certification is no longer valid, Board shall notify Contractor in
Page
writing of said determination and shall give contractor ninety (90) days within which to
respond to the written notice. In the event Contractor fails to demonstrate to the Board that
the Contractor has ceased investment activities in Iran within ninety (90) days after the
written notice is given to the Contractor, the Board may proceed with any remedies it may
have pursuant to IC 5-22-16.5. In the event the Board determines during the course of this
Agreement that this certification is no longer valid and said determination is not refuted by
Contractor in the manner set forth in IC 5-22-16.5, the Board reserves the right to consider
the Contractor to be in breach of this Agreement and terminate the agreement upon the
expiration of the ninety (90) day period set forth above.
SECTION IX. PROHIBITION AGAINST DISCRIMINATION
A. Pursuant to Indiana Code 22-9-1-10, Contractor, any sub -contractor, or any person acting
on behalf of Contractor or any sub -contractor shall not discriminate against any employee
or applicant for employment to be employed in the performance of this Agreement, with
respect to hire, tenure, terms, conditions or privileges of employment or any matter directly
or indirectly related to employment, because of race, religion, color, sex, disability,
national origin, or ancestry.
B. Pursuant to Indiana Code 5-16-6-1, the Contractor agrees:
That in the hiring of employees for the performance of work under this Agreement
of any subcontract hereunder, Contractor, any subcontractor, or any person acting
on behalf of Contractor or any sub -contractor, shall not discriminate by reason of
race, religion, color, sex, national origin or ancestry against any citizen of the State
of Indiana who is qualified and available to perform the work to which the
employment relates;
2. That Contractor, any sub -contractor, or any person action on behalf of Contractor
or any sub -contractor shall in no manner discriminate against or intimidate any
employee hired for the performance of work under this Agreement on account of
race, religion, color, sex, national origin or ancestry;
That there may be deducted from the amount payable to Contractor by the City
under this Agreement, a penalty of five dollars ($5.00) for each person for each
calendar day during which such person was discriminated against or intimidated
in violation of the provisions of the Agreement; and
That this Agreement may be canceled or terminated by the City and all money due
or to become due hereunder may be forfeited, for a second or any subsequent
violation of the terms or conditions of this section of the Agreement.
C. Violation of the terms or conditions of this Agreement relating to discrimination or
intimidation shall be considered a material breach of this Agreement.
SECTION X. RELEASE OF LIABILITY
Contractor hereby agrees to release and hold harmless the City and all officers, employees, or
agents of the same from all liability which may arise in the course of Contractor's performance of
its obligations pursuant to this Agreement.
Page
SECTION XI. MISCELLANEOUS
This Agreement is personal to the parties hereto and neither party may assign or delegate any of its
rights or obligations hereunder without the prior written consent of the other party. Any such
delegation or assignment, without the prior written consent of the other party, shall be null and
void. This Agreement shall be controlled by and interpreted according to Indiana law and shall be
binding upon the parties, their successors and assigns. This document constitutes the entire
Agreement between the parties, although it may be altered or amended in whole or in part at any
time by filing with the Agreement a written instrument setting forth such changes signed by both
parties. By executing this Agreement the parties agree that this document supersedes any previous
discussion, negotiation, or conversation relating to the subject matter contained herein.
This Agreement may be simultaneously executed in several counterparts, each of which shall be an
original and all of which shall constitute but one and the same instrument.
The parties hereto submit to jurisdiction of the courts of Wayne County, Indiana, and any suit
arising out of this Contract must be filed in said courts. The parties specifically agree that no
arbitration or mediation shall be required prior to the commencement of legal proceedings in said
Courts. By executing this Agreement, Contractor is estopped from bringing suit or any other action
in any alternative forum, venue, or in front of any other tribunal, court, or administrative body other
than the Circuit or Superior Courts of Wayne County, Indiana, regardless of any right Contractor
may have to bring such suit in front of other tribunals or in other venues.
Any person executing this Contract in a representative capacity hereby warrants that he/she has
been duly authorized by his or her principal to execute this Contract.
In the event of any breach of this Agreement by Contractor, and in addition to any other damages
or remedies, Contractor shall be liable for all costs incurred by City in its efforts to enforce this
Agreement, including but not limited to, City's reasonable attorney's fees.
In the event that an ambiguity, question of intent, or a need for interpretation of this Agreement
arises, this Agreement shall be construed as if drafted jointly by the parties, and no presumption or
burden of proof shall arise favoring or disfavoring any party by virtue of the authorship of any of
the provisions of this Agreement.
5 1 Page
IN WITNESS WHEREOF, the parties have executed this Agreement at Richmond, Indiana, as of
the day and year first written above, although signatures may be affixed on different dates.
"CITY"
The City of Richmond, Indiana, by and through
its Board of Sanitary Commissioners
fludiktT, President
LA
Stiens, Member
Dated:
F_\».Z�I�I lI
Dave Sujwk, Mayo
��.zj.1
Dated:
"CONTRACTOR"
County Tire and Service, Inc.
Bydire
(Printe G i�. r /�-i �k 5j-e
Title: A,- ,rti
Dated:
3
RICHMOND SANITARY DISTRICT
2016 & 2017 REQUEST FOR QUOTE
With Option to renew year two (2) 2017
RICHMOND SANITARY DISTRICT
TIRE QUOTE SPECIFICATIONS
PLEASE QUOTE COST OF BALANCING INSTALLATION OF LIGHT TRUCK
TIRES SEPERATELY AND FRONT END ALIGNMENT
Front and Rear Tires for International Impac Trash Trucks (approx. 20 tires)
Size: 11-R-22.5G622 RSD
Brand Preferred: Goodyear (Acceptable other Brands: Firestone or Yokohama)
QUOTED PRICE PER TIRE:
• 2016 PRICE PER TIRE $ 3 10 ' > Brand:
• 2017 PRICE PER TIRE: $ Brand:
e n r < "Yq
Front and Rear Tires for International Impac Trash Trucks (approx. 20 tires)
Size: 11-R-22.5 G661 HSA
Brand Preferred: Goodyear (Acceptable other Brands: Firestone or Yokohama)
QUOTED PRICE PER TIRE:
• 2016 PRICE PER TIRE $ 3 0 f ' �3 1 Brand: i;:� *
• 2017 PRICE PER TIRE: $
Brand:
Front and Rear Tires for McNeil's Trash Trucks (approx. 20 tires)
Size: 11-R-22.5 G177
Brand Preferred: Goodyear (Acceptable other Brands: Firestone or Yokohama)
QUOTED PRICE PER TIRE:
• 2016 PRICE PER TIRE
$ 3 77 7 41
Brand:
C j
• 2017 PRICE PER TIRE:
$
Brand:
1
Front and Rear Floatation Tires for EVO Local Trash Trucks (approx. 20 tires)
Size: 425/65R22.5 G296 MSA
Brand Preferred: Goodyear (Acceptable other Brands: Firestone or Yokohama)
QUOTED PRICE PER TIRE:
• 2016 PRICE PER TIRE $ Q Brand:.
• 2017 PRICE PER TIRE: $ Brand:
Front and Rear Tires for International Impac Trash Trucks (approx. 20 tires)
Size: 315/80R22.5 G661 HSA
Brand Preferred: Goodyear (Acceptable other Brands: Firestone or Yokohama)
QUOTED PRICE PER TIRE:
• 2016 PRICE PER TIRE Brand: r eS 4 N X
• 2017 PRICE PER TIRE: $ Brand:
Front and Rear Tires for Light Duty Pickup Trucks (approx. 20 tires)
Size: P235/80R17SL 105S WRANGLER Ply Rating: 4 Ply
Brand Preferred: Goodyear (Acceptable other Brands: Firestone or Yokohama)
QUOTED PRICE PER TIRE:
• 2016 PRICE PER TIRE $ ' �. Brand:
• 2017 PRICE PER TIRE: $ Brand:
Front and Rear Tires for Light Duty Pickup Trucks (approx. 20 tires)
Size: P245/75R17SL 105S WRANGLER Ply Rating: 4 Ply
Brand Preferred: Goodyear (Acceptable other Brands: Firestone or Yokohama)
QUOTED PRICE PER TIRE:
• 2016 PRICE PER TIRE $ 114,73 Brand: K• �- t
• 2017 PRICE PER TIRE: $
Brand:
0j,
Front and Rear Tires for Pickup Trucks and SUV's (approx. 16 tires)
Size: LT225/75RI6 E WRANGLER SR -A BSL
Brand Preferred: Goodyear (Acceptable other Brands: Firestone or Yokohama)
QUOTED PRICE PER TIRE:
• 2016 PRICE PER TIRE $ 1 P,53 Brand: .4<3 `�� Al x
• 2017 PRICE PER TIRE: $
Brand:
Front and Rear Tires for Pickup Trucks and SUV's (approx. 16 tires)
Size: LT235/75R16 WRL SLTARMER E BSL TL
Brand Preferred: Goodyear (Acceptable other Brands: Firestone or Yokohama)
QUOTED PRICE PER TIRE:
• 2016 PRICE PER TIRE $ 6 S , g Brand: 7 r_ e 7 7", ,✓ a
• 2017 PRICE PER TIRE: $
Brand:
Front and Rear Tires for Pickup Trucks and SUV's (approx. 16 tires)
Size: LT245/70R19.5 WRANGLER SR -A BSL
Brand Preferred: Goodyear (Acceptable other Brands: Firestone or Yokohama)
QUOTED PRICE PER TIRE:
• 2016 PRICE PER TIRE $ Brand:
• 2017 PRICE PER TIRE: $ Brand:
Front and Rear Tires for Pickup Trucks and SUV's (approx. 25 trucks for LT tires)
Size: LT245/75R16 WRANGLER SR -A BSL Ply Rating: 10 Ply
Brand Preferred: Goodyear (Acceptable other Brands: Firestone or Yokohama)
QUOTED PRICE PER TIRE:
• 2016 PRICE PER TIRE $ %/ (? . 1 Brand:
• 2017 PRICE PER TIRE: $
Brand:
9
COST OF MOUNTING AND BALANCING OF LIGHT TRUCK TIRES
QUOTED COST PER TIRE:
• 2016 PRICE PER TIRE $ l J
• 2017 PRICE PER TIRE: $ % 0 ' y o
FRONT END ALIGNMENT COST
Vehicle -
• 2016
$ 60 c
0 2017
$
Light Truck
-
�6•fl J
• 2016
$
• 2017
$
Large Truck
-
• 2016
t J
$
• 2017
$
Please include the following with quote:
Vendor Name: Q un Tre (ye M i ee ,
Date: Fe b 13, d,0 Lb
Quote Valid Till:
Include Warrantees
E-Verify: YES V NO
Indiana Local Preference YES ✓ NO
Iran Investment Activities YES NO
0
ARTICLE F
INSTRUCTIONS TO BIDDERS
INDEMNIFICATION, INSURANCE, AND PROTECTION OF LIVES -AND PROPERTY
F.1 INDEMNIFICATION
F. 1,1 The contractor shall indemnify and hold harmless the City of Richmond and its officers and
employees from and against all claims, damages, losses, expenses, including but not limited to
attorney's fees, arising out of or resulting from the performance of the contract, provided that
any such claim, damage, loss or expense (a) is attributable to bodily injury, sickness, disease or
death, or to injury to or destruction of tangible property (other than goods, materials and
equipment-flirnished under this contract) including the loss of use resulting there from, and (b)
is caused in' whole or in part by, any negligent act or omission of the contractor, any
-subcontractor, or anyone directly employed by any of them or anyone for whole acts any of
them maybe liable, regardless of whether or not it is caused in part by a party indemnified
hereunder.
F. 1.2 In any and all claims against the City or -any of * officers or employees by any employee of the
contractor, any subcontractor, anyone directly or indirectly -employed by any of them or anyone
for whose acts any of them maybe liable, the indemnification obligation under this paragraph
G. 1 shall not be limited in any way by any limitation of the amount or type of damages,
compensation or benefits payable by or for the coniractor or any sub -contractor under worker's
or workmen's compensation acts, disability benefit acts or other employee benefit acts.
F.2 WORKER'S COMPENSATIONII�,TSURANCE
F. 2.1 For contracts involving performance of work pursuant to the provisions of Indiana Code IC 22-
3-2-14 (a) bidders are required to furnish a certificate, from the Indiana Worker's Board
showing that such bidder has complied with IC 22-3-2-5, 22-3-5-1 and IC 22-3-5-2.
F.3 INSURANCE.
F. 3.1 The Contractor shall, as prerequisite to this Agreement, purchase and thereafter maintain such
insurance as will protect him from the claims set forth below which may arise out of or result
from the Contractor's operations under this Agreement, whether such operations by the
Contractor or by any Sub -contractors or by anyone who directly or indirectly employed by any
of them, or by anyone for whose acts any of them may be liable.
Coverage Limits .
A: Worker's Compensation & Statutory
Disability Requirements
B. Employer's Liability
C. Coinprehensive'General Liability
Section I. Bodily Injury
Section 2. Property Damage
$100,000
$1,000,000 each occurrence
$2,000,000 aggregate
, . $1,000,000 each occurrence
F.3.1
(con't)
D. Comprehensive Auto Liability
Section 1. Bodily Injury .
Section 2:' - Property Dam- age
1 . Comprehensive Umbrella Liability
F. Malpractice/Errors & Omissions
Insurance
$1,000,000. each person
$1,000,000 each occurrence
$1,000,000 each occurrence
$1,000,000 each occurrence
$2,000,000 each aggregate
.$1,000,000 per claim
$2,000,000 each aggregate
E-Verify Requirements:
Definitions:
E-Verify Program — A electronic verification of work authorization program of the Illegal
Immigration Reform and Immigration Responsibility Act of 1996 (P.L. 104-208), Division C, Title
IV,s.403 (a), as amended, operated by the United States Department of Homeland Security or
successor work authorization program designated by the United States Depart of Homeland Security
or other federal agency authorized to verify the work authorization status of newly hired employees
under the Immigration Reform and control Act of 1986 (P.L. 99-603).
No performance of services shall commence until the following has been met:
1. The City is in receipt of any required certificates of insurance;
2. The City is in receipt of any required affidavit signed by Contractor in accordance with
Indiana Code 22-5-1.7-11 (a) (2); and
3. A purchase order has been issued by the Purchasing Department.
■ � � � � � � � i � � f � � � � 1 � � � � � � � � 1 � � 1 � � ■ f � � � I f � � � � � � 1 � � ■ � � t t � 1 � � � � � 1 � ■ � ■ � � 1 � � � 1 f � � � � � � � � � � � � ■
COMPLIANCE WITH INDIANA E-VERIFY PROGRAM .REQUIREMENTS
Pursuant to Indiana Code 22.5.1,7, Contractor is required to enroll in and verify the work eligibility
status of all newly hired employees of the contractor through the Indiana E-Verify program. Contractor
is not required to verify the work eligibility status of all newly hired employees of the contractor through
the Indiana E-Verify program if the Indiana E-Verify program no longer exists. Prior to the
performance of the Agreement, Contractor shall provide to the City its signed Affidavit affirming that
Contractor does not knowingly employ an unauthorized alien in accordance with IC 22-5-1.7 (a) (2). In
the event Contractor violates IC 22-5-1.7 the Contractor shall be required to remedy the violation no
later than thirty (30) days after the City notifies the Contractor of the violation. If the Contractor fails to
remedy the violation within the thirty (30) day period provided above, the City shall consider the
Contractor to be in breach of this Agreement and this Agreement will be terminated. If the City
determines that terminating this Agreement would be detrimental to the public interest or public
property, the City may allow this Agreement to remain in effect until the City procures a new contractor.
If this Agreement is terminated under this section, then pursuant to IC 22-5-1.7-13 (c) the Contractor
will remain liable to the City for actual damages.
Affidavit ofEnmploymant ERgibility Verification
The.• Contractor, : ,,,YI ff, under, the .penalties of 'perjury that
Contractor does. not ImOvAgly employ an unauthorized alien. If Contractor is self-employed and
does not employ any employees, Contractor verifies he or she is a' United States citizen or quali .fled
alien.
The Contractor has not knowingly employed or, contracted with, an unauthorized alien and shall not
retain. an employee or contract with • a person that the Contractor- subsequently learns is an
unauthorized alien. Pursaai,t to Indiana Code 22-5-1.7, Contractor has enrolled in and verified the
worts eligibility status of all newly hired employees of the contractor through the Indiana E-Verify ' •
Prole -
The Contractor has required Contractor's subcontractors to certify to the Contractor tbat the
subcontractor does not knowingly employ or contract with an unauthorized alien and that the
subcontractor has enrolled and is parfacipadug in the E-Verifyprogcam. The Contractor will maintain
this certification throughout the duration of the term of a contract wiffi a subcontractor.
I hereby verify under the penalty of perjury that the foregoing statement is true.
Dated this 'day of
(sipat�r
(printed name)
Indiana Local Preference Claim:
Affected County— Wayne County or an adjacent county.
Local Indiana Business— A business whose principal place of business is in an Affected County; a
business that pays a majority of its payroll (in dollar volume) to residents of Affected Counties; or a
business that employees residents of Affected Counties as a majority of its employees.
Local Preference Documentation
If the Bidder is claiming local preference as defined by Indiana Code 5-22-15-20.9, it shall include such
claim with its Bid. In addition the Bidder shall submit, as a Post -Bid submittal, all documentation
required by the Local Indiana Preference form.
If the Bidder is a Joint Venture and is claiming local preference pursuant to Indiana Code 5-22-15-20.9,
the Bidder shall submit all post bid documentation as required by the Post -Bid submittals. In
determining whether the Joint Venture qualifies as a Local Indiana Business, as defined by Indiana Code
5-22-15-20.9, the Owner will evaluate the Joint Venture by combining each business's total payroll,
payroll paid to residents of Affected Counties, total number of employees, and total number of
employees who are residents of Affected Counties. Further, each part of the Joint Venture shall submit
the location of it's principal place of business will be a consideration in whether the Joint Venture
qualifies as a local Indiana business. The Owner will determine whether the Joint Venture qualifies as a
Local Indiana business. The total overall Joint Venture must qualify as a Local Indiana Business to .
receive the local preference as defined in Indiana Code 5-22-15-20.9.
Subject to Indiana Code 5-22-15-20.9, award of the Contract will be made to the lowest, responsive and
responsible Bidder, where the Bid is reasonable and does not exceed the funds available for the project.
The Owner reserves the right to reject all Bids and may waive or allow a Bidder to correct errors,
omissions or other irregularities in Bid Documents that are found not to have afforded the Bidder a
substantial competitive advantage over other Bidders.
INDIANA LOCAL PREFERENCE CLAIM
(Only fill out this Part if claiming to be a Local Indiana Business)
Pursuant to Indiana Code 5-22-15-20.9, b re�Ujrjziee,Sric .
(NaJ6e of Business)
Claims a local Indiana business preference for the bid for Project �l4( a T chmo" UA4t -(a, &r)
Ky l � -riry $t_d in Wayne County, Indiana.
(Name of Project)
The Claim of applicability of the Local Indiana Business preference is based upon the following
(Check all that apply)
Q 1. The location of the Business's principal place of business is:
A) in Wayne County, or
B) in an adjacent county
LN 2. The majority of the business's payroll, for the previous twelve (12) months from the
/ date of this Bid, is to residents in Wayne or an adjacent county.
[5 3. The majority of the business's employee's, for the previous twelve (12) months from
the date of this Bid, are residents of Wayne or an adjacent county.
If business is deemed to be the apparent low bidder, business shall provide information pursuant to
Post -Bid submittal (Local Indiana Business Preference), to substantiate the claim of a local Indiana
business.
POST BID SUBMITTAL
Local Indiana Business Preference
Pursuant to the City of Richmond Bidding and Contract Requirements, this application for the local
Indiana business, pursuant to Indiana Code section 5-22-15-20.9, is hereby submitted for the Project
listed below by Bidder/Applicant (hereinafter Bidder). (Use additional sheets if necessary.)
Date Bid Submitted: Feb a3 . ko l to Project Number:
ProjectName: T.,e ZV
Bidder: 00m4y ire if ( ery►ee , one.
i
Contact Name: �Eaenj "u.S5e-1 f
Principal Place of Business: 50 5 S. C e n +e r
Phone Number: 147?- No
i"a.m bridge 0c4 37AI q73k7
Number of Months Address has been Principal Place of Business: 1. nto .
Number of all Employees for the twelve (12) months prior to the date of Bid submission: I
Number of Employees who were residents of Affected Counties for the twelve (12) months prior to
the date of Bide submission:
1. If the Bidder claims it is a local Indiana business because the Bidder's principal place of business
is in Wayne County or an adjacent county, give a statement explaining the reasons the business
considers the location named as the business's principal place of business:
T i s 15 our on Iq to e&.-h on - (( us+ness ac-W e 6 are eondac4ed ou--f o � Ais
2. In order to claim local preference pursuant to Indiana Code section 5-22-15-20.9, the Bidder
must supply below its total payroll and the amount of the business's payroll paid t residents of
Affected Counties for the previous twelve (12) months from the date of the Bid.
a. Total Amount of payroll paid to all employees of Bidder in the previous twelve (12)
months from the date of the Bid: $ 333 9 3 0.58
b. Total Amount ofpayroll paid to residents of affected counties for the previous twelve
(12) months from the date of the Bid: S 31 6 6 G 4.Oq
Bidder shall supply supporting payroll records sufficient for Owner to establish the above
representations. When supplying supporting records, Bidder shall redact all Social Security
Numbers
ff AN INVESTMENT ACTIVITIES
Pursuant to Indiana Code (IC) 5-22-16.5, Contractor certifies that Contractor is not engaged in
investment activities in Iran. In the event City determines during the course of this Agreement that
this certification is no longer valid, City shall notify Contractor in writing of said determination
and shall give contractor ninety (90) days within which to respond to the written notice. In the
event Contractor fails to demonstrate to the City that the Contractor has ceased investment
activities in Iran within ninety (90) days after the written notice is given to the Contractor, the City
may proceed with any remedies it may have pursuant to IC 5-22-16.5. In the event the City
determines during the course of this Agreement that this certification is no longer valid and said
determination is not refuted by Contractor in the manner set forth in IC 5-22-16.5, the City reserves
the right to consider the Contractor to be in breach of this Agreement and terminate the agreement
upon the expiration of the ninety (90) day period set forth above.
=015
IYWI)
ACORD,,, CERTIFICATE 4F LIABILITY INSURANCE
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 hoidens an ADDITIONAL INSURED, the policy(ies) must be endorsed, if SUBROGATION IS WANED, 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 CONTACT
NAME:
RMD/Patti Insurance & Financial Services PHONE 765.966.7531
AIC No E.FOAM, No 765. 93 S. 2476
36 South 9th Street E
ADDRESS:
P . 0. Box 1167 INSURER(S) AFFORDING COVERAGE NAIC 0
Richmond, IN 47375 INSURER A: Cincinnati Insurance Company 10677
INSURED County Tire and Service Inc INSURERS: Cincinnati Casualty Co. 28665
DBA: Emery's County Tire INSURERC:
505 South Center Street INSURERD:
Cambridge City, IN 47327 INSURERE:
rnVFRAr.Fs CERTIFICATE NUMBER- 2015 - 2016 Master 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
MIDDIYYYY)
(MMIDDI -Y-M,
LIMBS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
ENP 028 20 24
10/06/2015
10/06/2016
EACH OCCURRENCE
$ 1,000,000
PREMISES (Ea occurrence)
$ 100, 00
MED EXP (Any one person)
$ 5,00(
PERSONAL & ADV INJURY
$ 1,000,00C
GENERAL AGGREGATE
$ 2,000,00(
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X PEQ X LOC
PRODUCTS - COMP/OP AGG
$ 2,000,00(
$
A
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS X AUTOS
X HIRED AUTOS X NON -OWNED
AUTOS
ENP 028 20 24
10106/2015
10/06/2016
(Ea accident)
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
(Per accident)
$
A
X
UMBRELLA LAB
EXCESS LIAS
X
OCCUR
CLAIMS -MADE
ENP 028 20 24
10/06/2015
10/0612016
EACH OCCURRENCE
$ 1,000,000
AGGREGATE
$
DED I X I RETENTI 0
$
B
WORKERS COMPENSATION
AND EMPLOYERS'LIASILITY
ANY PROPRIErORIPARTNEREXECUTIVE YIN
OFFICERIMEMBER EXCLUDED? N❑
(Mandatory in NH)
It yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
EWC 032 31 32-0
05/08/2015
05/0812016
TORY LIMITS OER
E.LEACH ACCIDENT
$ 100,00
E_L. DISEASE - EA EMPLOYEE
$ 100, 00
E.L. DISEASE - POLICY LIMIT
$ 500,00
A
chedul ed Equipment
ENP 028 20 24
10/06/2015
10/0612016
2015 Skid Steer Loader
$30,000 Value
CAT0226BNCMWD07160
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
UtsK I Irit.A1 r r1VLWCK w-V
Richmond Sanitary District
2380 Liberty Ave.
Richmond, IN 47374
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Easley/MLG
reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD