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HomeMy Public PortalAbout197-2017 - Sanitary - Brackney - NW 13th Street Interceptor Basin Improvements - Part 3(arrrTtcttte of (��xttliftrttiinu SBSUSD BY lubiana 3BP}rMrhLtPltt Dr T1`alt8}1artm INDIANAPOLIS, IN April 28, 2017 TO BRACKNEYINC BROOKVILLE, IN who has•filed with the Departments Contractor's Statement of Experience and Financial Condition as required under Indiana Code 8 23-10, Is hereby qualified to bid at any Department of Transportation letting in Classes of Work and within the amount and other limitation of each classification as listed below, for such period as the uncompleted work on hand from all sources does not exceed the Aggregate amount. Classification references by name or symbol are in accordance with the definitions in the Contractor's Statement of Experience and Financial Condition. This certificate supersedes any certificate previously issued, but is subject to revision or revocation according to the law, if and when changes in the financial condition of the contracting firm or other facts justify such revision or revocation. Valid May 1, 2017 Thni April 30. 2018 .... ....:.:.......:....:...::............................... $67,096,000 AGGREGATE........ A(B) CONCRETE PAVEMENT. LIMnw .........I............................................_ ... .......... ...................................... $1.000,000 ...... .. $67,096,000 cm) .. ..... ...... ............ LIGHT GRADING ...... ................................... ... ............ ...................... :$67,096,000 E(E) SMALL STRUCTURES AND DRAINAGE ITEMS .»............................... ............. .............. .... .................. :•••• $67,096,000 E(F) SURFACE MASONRY AND MISc CONCRETE ........................ :............ ........................................... E(H) DEEP SEWER AND/OR EXCAVATION ..........................................::................................................. $67,096,000 Eq) PERMANENT SEEDING, SODDING, AND TOP SOIL ......... ...........................a ............. ........... $1,000,000 E(Q) CONCRETE PAVEMENT REPAIRS ....................... ......... ......... ......... ......... .I.......... $1,0001000 :................ $67,096,000 EMDEMOLITION ............................ ..................... ..................... .................. .............. LAJ &'r-_ J--- - PREQUALIFICATION ENGINEER COMMISSIONER State Form 20508 (R3 / M5) OHIO DEPARTMENT OF TRANSPORTATION s OF p 0 0 a • ���fiTRpa��� Certificate of Qualification This certifies that BRACKNEY INC has been registered by the Ohio Department of Transportation as a prequalified contractor. This certificate of qualification allows your company to submit bids on.State Highway Projects up to but not exceeding $77,626,500 lessthe contractual amount pending on all incomplete work including ODOT and non-ODOT work. Your certificate will expire on Monday, April, 30, 2018. This -Certificate limits the holder to the classifications of work listed below: 6 Incidental Grading 35Drainage (Culverts, Mise.) 9 38 Misc. Concrete Aggregate Bases 19 Structure Removal Director Department of Transportation' Effective Date: 5/1/2017 Issued Date: 3/31/2017 Deputy Director Certificate Number: 16852 Division of Construction' Management EXHIBIT'A' - F 0 . � � $ to; w « $ �2 ■ E � 7 ( Bc &-Page 39 a,9 it, 4D STATE OF INDIANA OFFICE OF THE SECRETARY OF STATE CERTIFICATE OF INCORPORATION OF BRACKNEY, INC. I, JOSEPH H. HOGSETT, Secretary of State of Indiana, hereby certify that Articles of Incorporation of the above corporation, have been presented to me at my office, accompanied by the fees prescribed by law; that I have found such Articles conform to law; all as prescribed by the provisions of the Indiana Business Corporation Law, as amended. NOW, THEREFORE, I hereby issue to such Corporation this Certificate of Incorporation, and further certify that its corporate existence will begin November 16, 1992. In witness Whereof, I have hereunto set my hand and affixed the seal of the State of Indiana; at the City of Indianapolis, this Sixteenth day of November , 1992 JU EPH H. HOGSETT, Se retary of State By Deputy EXHIBIT'A' - Page 40 of 154 f AFFIDAVIT REGARDING CONTRACTOR DOING BUSINESS WITH THE GOVERNMENT OF IRAN Pursuant to Indiana Code 5-22-16.5, the Contractor entering into a Contract with the Owner is required to certify they are not engaged in business with the Government of Iran, as defined in IC 5-22-16.5. The undersigned, on behalf of the Contractor, being first duly sworn, deposes and states that the Contractor is not disqualified because of the requirement of IC 2-22-16.5. (Contractor): By (Written S (Printed Name) 7-Eai v �R' A-- /u e (Title): Es/,D�iUr Important — Notary Signature and Seal Required in the Space Below STATE OF COUNTY OF Subscribed and sworn to before me this / day of �(ldyLlfibF_ !2 , 20 i7 . My commission expires: '-T'J (Signed) 2 V-. eA Res ing in J� %+Cl/I K /Z. County, State of A i t-'m c BUSINESS WITH IRAN AFFIDAVIT 00536-1 201200457 EXHIBIT'A' - Page 41 of 154 DRUG TESTING OF EMPLOYEES OF PUBLIC WORKS CONTRACTORS Pursuant to Indiana Code 4-13-18, the Contractor hereby certifies that the Employee Drug Testing Plan provided is in accordance with IC 4-13-18, or provides evidence of being subject to a collective bargaining agreement as required in IC 4-13-18. Written Signature: Printed Name: Title: STATE OF �EU/•y fJ�PA�iUe� SS: COUNTY OF FXP,00"A) Subscribed and sworn to before me this day of Nvv e mkz , 20/;7. �L -xi My commission, expires: (Signs Residing ink//'r� County Printed Name: State of //-1 di 0 Y16� - EXHIBIT W - Page 42 of 154 E-VERIFY AFFIDAVIT Pursuant to Indiana Code 22-5-1.7-11, the Contractor entering into a Contract with the Owner is required to enroll in and verify the work eligibility status of all its newly hired employees through the E-Verify program. The Contractor is not required to verify the work eligibility status of all its newly hired employees through the E-Verify program if the E-Verify program no longer exists. The undersigned, on behalf of the Contractor, being first duly sworn, deposes and states that the Contractor does not knowingly employ an unauthorized alien. The undersigned further affirms that, prior to entering into its contract with the Owner, the undersigned Contractor will enroll in and agrees to verify the work eligibility status of all its newly hired employees through the E-Verify program. (Contractor):�aN c By (Written -Signature): (Printed Name): C 9,,u e y (Title): Important— Notary Signature and Seal Required in the Space Below STATE OF - ,u Of /1 N A COUNTY OF P A/u u 1,` N Subscribed and sworn to before me this / day of 20.17 My commission expires: (Signedji / Residing in ,� a/I K /,A County, State of Indi o n c --, E-VERIFY AFFIDAVIT 00535-1 201200457 EXHIBIT 'A' - Page 43 of 154 EPA I{orin 5 i06-49 Att•achnient Number 9 CI'RTIItICATION RRGARDING DEBARMENT, SUSPl;ria ION AND OTHERAESPONSIBILM MATTEI;`.S The prospective participant certifies to the best of its lotowledge and belief that it and its principals: (a) Are; not presently debarred, suspended, proposed for debarment, declarcd ineligibh:, or voluntarily ncluded froin covered transactions by any Federal department or agency; ('b) Ha've not within a three year period preceding this proposal been convicted of or had a civil judginent rendered against their for Commission of fraud or a criminal offense itt connectioia with obtaining, attempting to obtain, or performing a public (federal. 5tate,.orlooal) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of'enibezzlemotti, lhell, forgery, bribery, falsifloation or ilcstxxtction of records, making. False statements, or receiving stolen property; (c) Are not pre-setatly indicted for or uther►��ise criminally or civilly charged by a government entity (i ederttt, State, or U—cal) with commission of any of the offenses cnunterawd in paragraph (1)(b) of this certification, and (d) Have not Ivithin a. tbro-e-year period preceding this application1proposal had oiic or more public transactions (1700.ral, State, orrlocal) terminated for cause or default. I understand that a false statutuent on (his rerdfication -may be grounds for rojection of this proposal or terminati6n of the award. In. additio,), under l8 USC Sec.. t 0of, a false stwentcnt nmay restclt in a -tine of up to S 10,000 or iinprisunment for up to S years, or both. _. l atn unable to certify to the above statements. My explanation is attached. 00 13 02 - Sit}:p3 n purr.? f umont tbtuttu+m, tot t7i: jlCl`i c?c 04*17•t:• . �?FNI 007302 2 i EXHIBIT'A' - Page 44 of 154 Attachment I Required Contract Provisions Related to American Iron and Steel A provision substantially like the below will be included in each procurement contract when such contract involves theprocurement of iron and steel to be used in the Project. Tlie SRF Applicant shall remain responsible for compliance with applicable law (including American Iron and Steel). Such SRFApplicant has been encouraged to consult with its advisors and counsel regarding suck matters and, in any event, understands that the use of the following does not relieve the SRF Applicant front its obligation to comply with applicable law (including American Iron and Steel) and related provisions of any financial assistance agreement entered into with the Indiana Finance Authority, nor will the State Revolving Fund Loan Programs, the Indiana Finance Authority or the State of Indiana be responsible for or limited by any SRFApplicant's 11se of file following provision. The Contractor hereby acknowledges to and for the benefit of the ("Owner") and the Indiana Finance Authority (the "Authority") that it understands the work, goods and services under this Agreement are being funded with monies made available by the State Revolving Fund Loan Program and such appropriation contains provisions commonly known as "American Iron and Steel" (and as such is supplemented from time to time by federal rules and guidance) that requires all of the iron and steel products used in the project be produced in the United States ("American Iron and Steel Requirements") including iron and steel products provided by the Contactor pursuant to this Agreement. The Contractor hereby represents and warrants to and for the benefit of the Owner and the Authority, and agrees, that (a) the Contractor has reviewed and understands the American Iron and Steel Requirements, (b) all of the iron and steel products used in the project as provided by the Contractor under this Agreement will be and/or have been produced in the United States in a manner that complies with the American Iron and Steel Requirements and (c) the Contractor will provide any further certification or assurance of compliance .with this paragraph as may be requested by the Owner or the Authority. Notwithstanding any other provision of this Agreement, any failure to comply with this paragraph by the Contractor shall permit the Owner and the Authority to recover as damages against the Contractor (and the Contractor shall indemnify and hold the Owner and the Authority harmless against) any loss, expense or cost (including without limitation attorney's fees) incurred by the Owner or the Authority resulting from any such failure (including without limitation any impairment or loss of funding, whether in whole or in part, from the Authority or any damages owed to the Authority by the Owner). While the Contractor has no direct contractual privity with the Authority, as a lender to the Owner for the funding of its project, the Owner and the Contractor agree that the Authority is a third -party beneficiary and neither this paragraph (nor any other provision of this Agreement necessary to give this paragraph force or effect) shall be amended or waived without the prior written consent of the Authority. EXHIBIT'A' midge 45 of 154 i Attachment J Required Certification from Contractor Related to American Iron and Steel A certification substantially like the below will be obtained in advance of entering each procurement contract when such contract involves the procurement of iron and steel products to be used in the Project. The SRF Applicant shall remain: responsible for compliance with applicable Imp (including American Iron and Steel). Such SRFApplicant has been encouraged to consult with its advisors and counsel regarding such matters and, in any event, understands that the use of the following does not relieve the SRF Applicant from its obligation to comply with applicable late (including America: Iron and Steel) and related provisions of any financial assistance agreement entered into with the Indiana Finance Authority, nor ivill the State Revolving Fund Loan Programs, the Indiana Finance Authority or the State of Indiana be responsible for or limited by any SRFApplicant's use of the following certification. CERTIFICATION I (�`oJ!N 12F1C1'ZNcci , Of BQ eY'- le (Name and Title of Certifyi g Officer) (Successful Bidder) hereby certify and agree on behalf of the Successful Bidder as its duly authorized representative (and under penalties of perjury) that the Successful Bidder understands and agrees a material term and consideration applicable to the award and entry into a contract with the Successful Bidder by the related to its , )aggw, 'r 4-4 3ie5-Cr" (SRF Applicant) (Project Name) involves the procurement and provision of work, goods and services under a procurement contract to be entered into with the SRF Applicant is the Successful Bidder's compliance with the provisions of H.R. 3547, "Consolidated Appropriations Act, 2014" commonly known as "American Iron and Steel" provisions as contained therein requiring that all of the iron and steel products used in the Project be produced in the United States ("American Iron and Steel Requirements"). The Successful Bidder hereby represents and warrants to and for the benefit of the SRF Applicant and the Indiana Finance Authority, as a lender to the SRF Applicant for the funding of its Project, and agrees, that (a) the Successful Bidder has reviewed and understands the American Iron and Steel Requirements, (b) all of the iron and steel products used in the Project as provided by the Successful Bidder under its agreement related to the Project will be produced in the United States in a manner that complies with the American Iron and Steel Requirements and (c) the procurement contract will include a provision substantially like Attachment I. I SWEAR OR AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE ABOVE STATEMENTS ARE TRUE T THE BEST OF MY KNOWLEDGE. (Signature) (Date) 24 EXHIBIT'A' - Page 46 of 154 STATE OF �L.vDiAi0 d) ) SS: COUNTY OF { Before me, a Notary Public in and for said County and State, personally appeared 1K eju 2:2+zAeKNry , the of who, being first duly sworn, acknowledged the execution of the above and foregoininstrument for and on behalf of said entity. Dated this / day of A Ie-1u'1�!e , 20 ,17. My commission expires: -rino, Notary Public $. t3• 20as (Printed) County of Residence: 25 EXHIBIT'A' - Page 47 of 154 Subcontract List Work Description Midwest Mole, Inc.' Boring 2460 N. Graham Ave. Indianapolis, IN 46218 Kelley Dewatering & Construction Co. Dewatering 5175 Clay Ave. SW Wyoming, MI 49548 Sub -surface of Indiana, Inc. Directional Bore 7225 W700S Morgantown, IN 46160 ABC, Asphalt, Block Concrete, Inc. Sawing 5230 Commerce Circle Drive Indianapolis, IN 46237 Ludwig Contracting, Inc. Electrical P.O. Box 128 Cedar Grove, IN 47016 ITT Water & Wastewater Indiana, LLC Dewatering 7615 West New York Street Indianapolis, IN 46214 - Gillespie Surveying Construction Engineering 7110 Holland Rd. Brookville. IN 47012 Turn -key Tunneling, Inc. Boring 1247 Stimmel Rd. Columbus, OH 43223 . ,EXHIBIT 'A' - Page 48 of 154' EXHIBIT'A' - Page 49 of 154 s BID FORM CITY OF RICHMOND, INDIANA NORTHWEST 13TH STREET INTERCEPTOR BASIN IMPROVEMENTS, PHASE I TABLE OF CONTENTS Article1—Bid Recipient.............................................................................................................................P-8 Article2 — Bidder's Acknowledgements.................................................................................................... P-8 Article3 — Bidder's Representations.......................................................................................................... P-8 Article4 — Bidder's Certification................................................................................................................ P-9 Article5 — Basis of Bid..............................................................................................................................P-10 Article6 —Time of Completion................................................................................................................ P-10 Article7 — Attachments to this Bid.......................................................................................................... 1340 P-11 Article8 — Defined Terms......................................................................................................................... Article9 — Bid Submittal...........................................................................................................................P-12 This document is a MODIFIED version of EJCDC® C-410, Bid Form for Construction Contracts. Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers , or is based in part on excerpts from EJCDC documents. Those portions of the text that originated in publistguXi lOTdBcurRdi9grb(i ;UhtfOect to the copyright. P-T ARTICLE 1— BID RECIPIENT 1.01 This Bid is submitted to: City of Richmond Sanitary District 2380 Liberty Avenue Richmond, Indiana 47374 1.02 The undersigned Bidder proposes and agrees, if this Bid is accepted, to enter into an Agreement with Owner in the form included in the Bidding Documents to perform all Work as specified or indicated in the Bidding Documents for the prices and within the times indicated in this Bid and in accordance with the other terms and conditions of the Bidding Documents. ARTICLE 2 — BIDDER'S ACKNOWLEDGEMENTS 2.01 Bidder accepts all of the terms and conditions of the Instructions to Bidders, including without limitation those dealing with the disposition of Bid security. This Bid will remain subject to acceptance for the number of days after the Bid opening as specified in the Advertisement for Bids, or for such longer period of time that Bidder may agree to in writing upon request of Owner. ARTICLE 3 — BIDDER'S REPRESENTATIONS 3.01 In submitting this Bid, Bidder represents that: A. Bidder has examined and carefully studied the Bidding Documents, and any data and reference items identified in the Bidding Documents, and hereby acknowledges receipt of the following Addenda: Addendum No. Addendum. Date -�- ID /y— 2?D/ 2 Yo B. Bidder has visited the Site, conducted a thorough, alert visual examination of the Site and adjacent areas, and become familiar with and satisfied itself as to the general, local, and Site conditions that may affect cost, progress, and performance of the Work. C. Bidder is familiar with and has satisfied itself as to all Laws and Regulations that may affect cost, progress, and performance of the Work. D. Bidder has carefully studied all: (1) reports of explorations and tests of subsurface conditions at or adjacent to the Site and all drawings of physical conditions relating to existing surface or subsurface structures at the Site that have been identified in the Supplementary Conditions, especially with respect to Technical Data in such reports and drawings, and (2) reports and drawings relating to Hazardous Environmental Conditions, if any, at or adjacent to the Site that have been identified in the Supplementary Conditions, especialiywith respect to Technical Data in such reports and drawings. E. Bidder has considered the information known to Bidder itself; information commonly known to contractors doing business in the locality of the Site; information and observations obtained from visits to the Site; the Bidding Documents; and any Site -related reports and This document is a MODIFIED version of EJCDC® C-410, Bid Form for Construction Contracts. Copyright Q 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers , or is based in part on excerpts from EJCOC documents. Those portions of the text that originated in published EJCDC V "li hWXisftPa@WaQJc?fdt`J copyright. P-8 drawings identified in the Bidding Documents, with respect to the effect of such information, observations, and documents on (1) the cost, progress, and performance of the Work; (2) the means, methods, techniques, sequences, and procedures of construction to be employed by Bidder; and (3) Bidder's safety precautions and programs. F. Bidder agrees, based on the information and observations referred to in the preceding paragraph, that no further examinations, investigations, explorations, tests, studies, or data are necessary for the determination of this Bid for performance of the Work at the price bid and within the times required, and in accordance with the other terms and conditions of the Bidding Documents. G. Bidder is aware of the general nature of work to be performed by Owner and others at the Site that relates to the Work as indicated in the Bidding Documents. H. Bidder has given Engineer written notice of all conflicts, errors, ambiguities, or discrepancies that Bidder has discovered in the Bidding Documents, and confirms that the written resolution thereof by Engineer is acceptable to Bidder. I. The Bidding Documents are generally sufficient to indicate and convey understanding of all terms and conditions for the performance and furnishing of the Work. J. The submission of this Bid constitutes an incontrovertible representation by Bidder that Bidder has complied with every requirement of this Article, and that without exception the Bid and all prices in the Bid are premised upon performing and furnishing the Work required by the Bidding Documents. ARTICLE 4 — BIDDER'S CERTIFICATION 4.01 Bidder certifies that: A. This Bid is genuine and not made in the interest of or on behalf of any undisclosed individual or entity and is not submitted in conformity with any collusive agreement or rules of any group, association, organization, or corporation; B. Bidder has not directly or indirectly induced or solicited any other Bidder to submit a false or sham Bid; C. Bidder has not solicited or induced any individual or entity to refrain from bidding; and D. Bidder has not engaged in corrupt, fraudulent, collusive, or coercive practices in competing for the Contract. For the purposes of this Paragraph4.01.D: 1. "corrupt practice" means the offering, giving, receiving, or soliciting of any thing of value likely to influence the action of a public official in the bidding process; 2. "fraudulent practice" means an intentional misrepresentation of facts made (a) to influence the bidding process to the detriment of Owner, (b) to establish bid prices at artificial non-competitive levels, or (c) to deprive Owner of the benefits of free and open competition; 3. "collusive practice" means a scheme or arrangement between two or more Bidders, with or without the knowledge of Owner, a purpose of which is to establish bid prices at artificial, non-competitive levels; and 4. "coercive practice" means harming or threatening to harm, directly or indirectly, persons or their property to influence their participation in the bidding process or affect the a execution of the Contract. This document is a MODIFIED version of EJCDC® c-410, Bid Form for Construction Contracts. Copyright ® 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers, or is based in part on excerpts from EJCDC documents. Those portions of the text that originated in published EiCUW6 i_ffihh%s- &v0ln5QbXct54the copyright. P-9 ARTICLE 5 — BASIS OF BID 5.01 Bidder will complete the Work in accordance with the Contract Documents for the following price(s): SEE ATTACHED BID SCHEDULE Bidder acknowledges that (1) each Bid Unit Price includes an amount considered by Bidder to be adequate to cover Contractor's overhead and profit for each separately identified item, and (2) estimated quantities are not guaranteed, and are solely for the purpose of comparison of Bids, and final payment for all unit price Bid items will be based on actual quantities, determined as provided in the Contract Documents. ARTICLE 6 —TIME OF COMPLETION 6.01 Bidder agrees that the Work will be substantially complete and will be completed and ready for final payment in accordance with Paragraph 15.06 of the General Conditions on or before the dates or within the number of calendar days indicated in the Agreement. 6.02 Bidder accepts the provisions of the Agreement as to liquidated damages. ARTICLE 7 —ATTACHMENTS TO THIS BID 7.01 The following documents are submitted with and made a condition of this Bid: A. Required Bid security; B. Evidence of authority to do business in the State of Indiana by registration with the Secretary of State; C. Indiana State Form No. 96, as amended, with Non Collusion Affidavit; D. List of Project References; E. Contractors Bid (EJCDC C-410) and Bid Schedule — Completely executed and signed; F. Acknowledgement of Addenda Received (EJCDC C-410); G. Contractors required to have a drug testing program in accordance with IC 4-13-18; H. Required Bidder Qualification Statement with supporting data (EJCDC C-451); I. Financial Statement for Bidders — Completely signed and executed; J. E-Verify Affidavit; K. Certificate of No Investment Activities in Iran; 7.02 The following documents are to be submitted within five (5) days after Bid Opening. Failure to submit these additional documents shall be reason to reject the bid as non -responsive: A. SRF Documents 1. Forms OEE-1 and OEE-2 2. Documents demonstrating compliance with six (6) affirmative steps 3. EPA Form 6100-3 DBE Subcontractor Performance Form 4. EPA Form 6100-4 Subcontractor Utilization Form S. Good Faith Efforts Worksheet 6. Bidders List Form (to be used by prime contractor for recording of sub -contractor bids) This document Is a MODIFIED version of EJCDC® C-410, Bid Form for Construction Contracts. Copyright 0.2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers, or is based In part on excerpts from EJCDC documents. Those portions of the text that originated in published EJCDCIa&d&WtA6n YQQ@&Vo1fAcopyright. P-10 I % 1 i 7. Attachment G - SRF Loan Program -Green Project Reserve (GPR) and Sustainability Incentive GPR Bid Breakdown Form 8. Attachment H - SRF Loan Program -Green Project Reserve (GPR) and Sustainability Incentive GPR Final Bid Summary 9. Attachment J - Required Contract Provisions Related to American Iron and Steel 10. List of Subcontractors or Suppliers B. Schedule of Values (If Applicable) ARTICLE 8 — DEFINED TERMS 8.01 The terms used in this Bid with initial capital letters have the meanings stated in the Instructions to Bidders, the General Conditions, and the Supplementary Conditions. This document is a MODIFIED version of EJCDC® C-410,Bid Form for Construction Contracts. Copyright ® 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers, or is based In part on excerpts from EJCDC documents. Those portions of the text that originated in published EJCt IWd#S-r&ft %fub*dfi the copyright. P-11 ARTICLE 9 — BID SUBMITTAL BIDDER: [Indicate correct name of bidding entity] ZRAC-kAJ EY ..—t�,�,c By: [Signature] [Printed name] 1S ):_!I !A) _ QkSP ACKA► e (If Bidder is a corporation, a limited liability company, a partnership, or a joint venture, attach evidence of authority to sign.) Attest: /� [Signature] � o l/��„fQ`�/, [Printed name] Title: Submittal Date: Address forgiving notices: J Telephone Number: ,'7Zv Fax Number: Contact Name and e-mail address: dApu.ys 9 )AT-cr( 0-V >AJC, 'o Bidder's License No.: (where applicable) NOTE TO USER: Use in those states or other jurisdictions where applicable or required. This document is a MODIFIED version of EICDC' C-410, Old Form for Construction Contracts. Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers, or is based in part on excerpts from EICDC documents. Those portions of the text that originated in publishedEICDc%I:QhTWenl'iaw&j§Ac4 4 @rje copyright. P-12 AFFIDAVIT FOR CORPORATION By virtue of the original Articles of Incorporation or some subsequent official action of the Stockholders or Board of The following officers and others are authorized to execute contracts binding the corporation: Directors, the following are the current officers of the corporation: Chairman of the Board MARK E. BRACKNEY 1.. MARK E .BRACKNEY President KEVIN BRACKNEY 2. NINA M. BRACKNEY Vice President CHRISTA-WILSON 3. DOUG BRUNS 4. KEVIN BRACKNEY 5: 6. 7. 8• Secretary CHRISTA WILSON Treasurer 9. 10. Capital paid to cash hen incorporated? TJANUARY1, 1993 in what INDIANtAe? If a foreign corporation; give date admitted to do business In Indiana (mm/dd/yy) Is the corporation in good standing with:the :Secretary of State of Indiana in the matter of annual reports? YES STATE OF INDIANA COUNTY OF FRANKLIN KEVIN "BRACKNEY , being duly sworn, deposes and says: That he is PRESIDENT of BRACKNEY, INC the corporation _ p submitting the foregoing statement of experience and financial position; that he has read the same and that the same is tru knowledge; that the statement is for the purpose of inducing the Indiana Department of Transportation to award the submitt any depository, vendor, or other agency therein named or with whom they have had business relations is. hereby authorize._ Department with any information necessary to verify the statement. Signature of•o Sworn before me this S� day of /1 _w_____ _ 2B�- —• efResident of FRANKLIN County, State of 1N _• _ Notary Public` 1 / My ommission expires (mm/dd/yy) �-X _ NOTE: The indiana`Depattment of Transportation will not accept any document That is notarized by a notary who is anoffer, stockholder of the corporation, or by any relative of the signatory. Page 22 EXHIBIT'A - Page 56 of 154 EXHIBIT W - Page 57 of 154 CITY OF RICHMOND, INDIANA NORTHWEST 13TH STREET INTERCEPTOR REPLACEMENT PROJECT DM n UMt Pd. N s Tom Pka In ams OYHENAUTHAIEOALLOWANCE 390pom S.SDT..0SO0OD ro-Q. OGICALMMTORWALLOWANCE 1 LSS 57,000.00 AO WnWE380ETWRSIGHAGEALLOWANCE 1 LS 37J4400 $ 7.600.00 01.01 MOBNZAT04 L OEMOSWATWN + IS Z Q Q o Os D 2,90000 02.01 TREEPRUNNG 1 LS Q 7,960 D 02-M TREE REMOVAL 1 L6an 019 02-03 REPLACEMENT TREESIN FLOODWAY T LS 0�0, 6)6 02.a CEM6NTTRl$S)NCEMt7.MYALLOWANCE / LS 710.0" t 140W.00 03a SANITARY 5TR BYPASSING- LNEC& CIPP(NEW SIPHON STRUCTURETO 0466) 1 LS GS��Q 6O Z U F% W-W SANITARY BYPASSING- UNEA(STR04M TO STR6423AND 0472) 1 LS W-W SANITARY BYPASSING- LNEA(STR H23 TO 67R 0451) 1 LS W-a awTARYBYPASSING• UNEB(STR#4li TOS7R 020E i LS Dpp C70 03-05 SANITAAYGYPAS&NG-CWP(STRS44170SIRf447) 1 LS yl e? .Ob 00.E 03W SANITARY BYPASSING-CIPP ISM 9424TO STR 0473& STR 01LO022TO STR 6160020) 1 LS QO rOC)�Q 04-01 TEMPORARY EROSION CONTROL + L.S 5-600, i2 G o0 47a 05-01 MNNfENANCEOFTRAFFIC 09.01 GRANULAR SAWILL FOR OPEN OUT 17 CA SEWER Z6 LF C ,j QO[.7 ::> ..02 GRANULAR SACXFILL FOR OPEN CUT IB'OIA SEWER /63 lF 0E.03 GRANULARSAGMLFOROP@1CUT24'OM.SEWER 092 LF /r Cr,J. 06-04 GRANULAR BACKFILLFOR OPEN CUTVDIA SEWER 1,362 LF 86-05 OIMNULARRACI(RUFOROPEN CUTWDM.SBM 4307 LF 00 / S� v1JJ or-> ..CS GRANULAR BACNFILL FOR OPEN tlR42'DIASIPHON SEWER 256 LF -� PLOWABLE BAcwLLINABARDONEDPIPELNEA BETWEEN EX-STR 11160 515 EX SIR 0160S00 162 CY dd ��D. 'v"d GS'0B ROWABLE BACITIL.INABANDONED PIPE LINE ABETWEFN EX SIR #ISO= L EX STR 0I609D1 70 CY O. OL> %Q7 0F% 05 W FLOWABLEWKP2LINAEANDONMPIPEUNEADETWEENTULSTR S P414YA L E & STR 0141-030 71 Cy r - O76, 00 06-10 pLOWAREaCKFLLNAlWIE �ODPFEUNEAMWEENFXBTR 1I41-0WSEXSTR0I63ANDREYONDTOPLU13 27 L Q 06.11 FLOWABLELWCWLLNASINDONEOPIPEUURBBETWEENFXSTR n0455 EX S7R 04814501 B r QQ O R O 07.01 38NCH00,GRAA SANITARYSEWER(00) LSW IF .3 tJO. Q 07.02 1&INCHWA GRANT SANITARY SEWER(PVCORCCFRPMPJ") 373 LF /�,o��4. 07•03 HOSAORAMWSANRARYSIWER(PVCORCCfRPM"F) 1.V6 IF Z Cf - 040 07-04 301NCH LXA GRAVOYSANITARY SEWER JPVCORCCFRP41 PARE) 5L579 LF J/ 07-05 3SNCH mA GRANT SANITARY SEWER (PVC OR CCFRPM FIRE) S,BTL LFP-A�,9g . OO 07-06 184NCHM& PRESSURE SANRMYSEWFR(PICOR CCFRPMPNQ 90 LF U 01-07 NGiGAPRESSURESNGFARYSEWFR(PVCORCCFFtPM.PPE) 182 LF b ^- A,"/ 05-01 GINCHSOVERSER14CELATERALS 2200 LPOn =9 O W-a 424NCH OD)ND35.44NCHDDVLSANITARYSEWRSIPHONOPENCUT 516 IF o 09.0d Doi- HODALM3&444HCHIOMk UWAWSEWRSIPHON7WA120NfAL LIJNG 338 LF r 7 /4 /� q 7/S 4a0 d0 10-N 12ANCHCIPPL"m 450 LF .i aSO, 0c;; 10.02 184NCHCIPPUNM A3% LF D-W 21-INCHC" NM 1.0® LF O� 2 0 10-a 241NCH GPPUNm '10 LF S 0d t 7 4Db 10-05 D-INCHaPPUNNG 29 LF p 10-W 3aNCHtlPP UNNO 117 IF - t0-07 ISHICHCIPPSIPHONUNING I'm LF 10•09 24.INCHCIPP3IPNON UNNG I,= LFq. D-09 PLA7ERALRENSTATEMEMT 10 EA Q 11-a BORE ANOJACK-3WNCH CIA, CASINO 1211 lF '. C) p 12-01 IS*ICHDPIPE BURSTING TO 2275&NCH HOPE PIPE 1.60 LF 12.02 PwEOURSTING3EWERSEIMCECONNECTIONS S EA 12-03 POINT REPAIR(UNDISTMOUTED) 5 EA 4.j Z,Q 12-a SAG OR HUMP REPAIR (UNDISTRIBUTED) 5 Q Q 0 - 12•CS UTILITY PONE EXCAVATION 2 EA 2d 13-01 PRE CIPPUNWCLEAMINGS CCTVISINCH D SIPHON 1 LF age b8 ot lb�7 AddvWd 11 2 EXHIBIT'A' - Page 59 of 154 CITY OF RICHMOND, INDIANA N0RTHWEST 13TH STREET INTERCEPTOR REPLACEMENT PROJECT UMI Pd. Taal PLke Dm0d 10. UM n m) -) Ov POST CIPP LINING CLEANING&CCN IOINCH IN SIPHON 1.320 LF r13- PRE CIPP LINING CLEANING B CCN MNCH ID SIPHON 1.3A LFdPOSTGPPLININGCLEAMN3&CCN241NCHID SIPHON 1.� L /O 13-05 POST BYPASSING CLEAING&CCN354-INCH ID SIPHON /.3% LF 13.06 PREOPFINCUTCLEANING ICCN EX STR11-1 TOFX STR41224111 4.560 LF !V RPESURSTINO CLEANING ICON 1.649 LFPOSTPIPEBURSTING CLEAW40&CCTV 1.66 LFPRE r13-PRE OPEN CUT CLEANING I CCTVEX SIR 97466T0 EX STRI. SD7 LFPRECIPPUNINGCLEMING& CCTV EX STRII60S90TO EX SIR 'IBM' 336 LF 13-11 POSTCLPP LWTNGCLFANWG& CCNEX STR t1S095DTOEX SIR/IISD@7 336 LF / 13-12 PRECI'PUNINOCLEPNIND&CCTVEXSTRNI=lITOEXSTRH03.9W A314 tF 13.13 POSTCU?LINING CLEARING&CCN EX STR 1122-011 M EX SIR Illa 0 3.314 LF I EA IJ •� 00 'J L� � �u 14-01 4&INCHWA SANITARY MANHOLE e.7 38 EA 00 al/.7 D 14-02 604NCH DIA SANRARY MANHOLE a C LE1 14-03 661NCH 01A NfTAR DROP SNY hANHOtE 11 EA ' 14-Ot 6OIRCH DIA DOGHOUSE SANITARY MANHOLE 2 EA L o d© 6 FA !g" 4NCH DIA SANITARY MANHOLE -INCH DIA DROP SANITARY MANHOLE 4 FABLANCH F14-08 DIA SANRARYMANHOLE 2PA84INGH DIA C00HOUSE SANITARY MANHOLE 14-09 INCH DIA SANITARY MANHOLE 1 EA t 14.10 SIPHON ACCESS STRUCTURE 3 FA 1� GO 14-11 STRUCTURE 447 1 EA T �U 14-12 SIRLICTURE 462 1 EA 14.13 STRUCTURE 463 I EA ,a p0 4 14.14 STRUCTURE 468 1 En ar 15.01 REINFORCED CONCRETE PIPESUPPORT STRUCTURES(6TR 416TO SYR 411) 1 lS 6U f C 15.02 REINFORCED.REMPPESUPPORTSTRLVMES(M412TOSM.4M i LS "' 1S•03 SIPHON SANITARY STRUCTURE 1 LS cv 17-01 12-INCH DIA PVC STORM SEWER 326 LF p 00 17-02 OINCHDIAbTORMMMLE 3 EA 4? � da O�Al. 16-01 ASKMTPAVEMENTROADREPLACEMENT 5,418 LF .41�O p J ' 18-02 STONEACCESS DRIVE 4,44i lF 0 15.03 1.SWCLI ASPHALT ROAD SURFACE MLUNG&OVERLAY 18.428 SY ul 47 18.04 CONCRETE dIIVE PAVEMFNTRFJPACEMENT 85 SY 16.05 PAVEMENTSTPIPINO 1 LS 18-01 FIRM. GfL10R1G ANDSEEgN0 1 LS 19.02 FKALGRADINGALNOSOODIN0 1 LS � 1 ��—.O TALSA BIDSnlgurm) ! •% CL> ?Cad4• TmALlZE!QnwaM). IMR PAa ReLR11 owed Um am 1 Do rdkzc6abg 164r Ih&W?4: h:'Wmbm*& LkAn dl cab n.0k 0waAfli —k 1 LS- G4 2 Olr4aelw7+e141&mMdtls.40m4 U. B. D.W 1cals4ssxaedwlhM—k 1 LS. a? q VO 3 Mrn.%41 LMS. Dodvdlemb aaa0caadp9hldlwuk. 1 LS. d0 EXHIBIT'A' - Page 60 of 154 Add.d— N..2 EXHIBIT'A' - Page 61 of 154 /D QUALIFICATIONS STATEMENT THE INFORMATION SUPPLIED IN THIS DOCUMENT IS CONFIDENTIAL TO THE EXTENT PERMITTED BY LAWS AND REGULATIONS 1. SUBMITTED BY: Official Name of Firm: Address: Z'D S '52 2. SUBMITTED TO:vg/z/J eFJ�y,viT9Re/ t osh//��s s/D.vEp--S 3. SUBMITTED FOR: �ioR`rl`w NsTla'i �.S7e.-GT 1,uT.Pc�,p on�� sly ��nlj7R, Owner: Project Name:i,�Yh� TYPE OF WORK,��G2 ,RDU��Jel�l 1 S 4. CONTRACTOR'S CONTACT INFORMATION Contact Person:e������'`' t, Title: Phone: l01f 7 Email: E1CDC' C-451, Qualifications Statement. Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved. P-15 - O 5. AFFILIATED COMPANIES: Name: Address: 6. TYPE OF ORGANIZATION: ❑ SOLE PROPRIETORSHIP Name of Owner: Doing Business As: Date of Organization: ❑ PARTNERSHIP Date of Organization: Type of Partnership: Name of General Partner(s): 91 CORPORATION State of Organization:. —I -A., 0/A,0A- Date of Organization: 1%// �?3 Executive Officers: -President: WeL3;N 2RAC143e4 - Vice President(s): C hRIsTA u) (Som -Treasurer: RISTa L.c),`�,s0/y - Secretary: EICDC' C-451, qualifications Statement. Copyright 0 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved. P-16 [� LIMITED LIABILITY COMPANY State of Organization: Date of Organization: Members: JOINT VENTURE Sate of Organization: Date of Organization: Form of Organization: Joint Venture Managing Partner - Name: - Address: Joint Venture Managing Partner - Name: - Address: Joint Venture Managing Partner - Name: - Address: E1CDCf C-4si, qualifications Statement. Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved. P_17 7. LICENSING Jurisdiction: Type of License: License Number: Jurisdiction: Type of License: License Number: 8. CERTIFICATIONS E i A1 GI�TGGk .T, /I,(LI,.>ays f �/l-1 Q C7 LYs�s C o.. �c rTN Scr / J C CJ &A s ifl725 y� R - 2D/7 -d34 dri//017 .c7 F 6F�ie�an�s `Lo... %i r VRAOrNG �oN•R•se7,¢ Disadvantage Business Enterprise: Minority Business Enterprise: Woman Owned Enterprise: Small Business Enterprise: Other ( ); 9. BONDING INFORMATION CERTIFIED BY: Bonding Company: 0441,' ,lJr,edH/�ic,2/�/��.�� Address: 2 % ;��/caw /�Y,I o IA� Bonding Agent: ? ! 6 liu d lzN 0jR 1 - 0'%1 AN!! Address: / Contact Name: Phone: f 7 - 76 9 - z1 Aggregate Bonding Capacity: 201W, //04) Available Bonding Capacity as of date of this submittal: / J/ m,/11oN ElCDC'C-451, Qualifications Statement. Copyright ® 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved. P-18 D� Iv 10. 11. FINANCIAL INFORMATION Financial Institution Address: Account Manager: Phone: did { INCLUDE AS AN ATTACHMENT AN AUDITED BALANCE SHEET FOR EACH OF THE LAST 3 YEARS CONSTRUCTION EXPERIENCE: Current Experience: List on Schedule A all uncompleted projects currently under contract (If Joint Venture list each participant's projects separately). Previous Experience: List on Schedule B all projects completed within the last 5 Years (If Joint Venture list each participant's projects separately). Has firm listed in Section 1 ever failed to complete a construction contract awarded to it? YES 1 NO If YES, attach as an Attachment details including Project Owner's contact information. Has any Corporate Officer, Partner, Joint Venture participant or Proprietor ever failed to complete a construction contract awarded to them in their name or when acting as a principal of another entity? [] YES M NO If YES, attach as an Attachment details including Project Owner's contact information. Are there any judgments, claims, disputes or litigation pending or outstanding involving the firm listed in Section 1 or any of `its officers (or any of its partners if a partnership or any of the individual entities if a joint venture)? AYES [J NO If YES, attach as an Attachment details including Project Owner's contact information. EJCDC* C-451, Qualifications Statement. Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved. P-19 12. SAFETY PROGRAM: Name of Contractor's Safety Officer: C RR IST4 W I L,6,08-) Include the following as attachments: Provide as an Attachment Contractor's (and Contractor's proposed Subcontractors and Suppliers furnishing or performing Work having a value in excess of 10 percent of the total amount of the Bid) OSHA No. 300- Log & Summary of Occupational Iniuries & Illnesses for the past 5 years.��-�—�C�m r n Provide as an Attachment Contractor's (and Contractor's proposed Subcontractors and Suppliers furnishing or performing Work having a value in excess of 10 percent of the total amount of the Bid) list of all OSHA Citations & Notifications of Penalty (monetary or other) received within the last 5 years (indicate disposition as applicable) - IF NONE SO STATE. Provide as an Attachment Contractor's (and Contractor's proposed Subcontractors and Suppliers furnishing or performing Work having a value in excess of 10 percent of the total amount of the Bid) list of all safety citations or violations under any state all received within the last 5 years (indicate disposition as applicable) - IF NONE SO STATE. Provide the following for the firm listed in Section V (and for each proposed Subcontractor furnishing or performing Work having a value in excess of 10 percent of the total amount of the Bid) the following (attach additional sheets as necessary): Workers' compensation Experience Modification Rate (EMR) for the last 5 years: YEAR an I � EMR YEAR Ad IEMR YEAR R61 EMR YEAR d61,? EMR YEAR _2_0 �j EMR / �Q Total Recordable Frequency Rate (TRFR) for the last 5 years: YEAR g Q' YEAR (2 l YEAR j / YEAR YEAR TRFR TRFR TRFR TRFR TRFR EJCDC* C-451, Qualifications Statement. Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved. P-20 13 Total number of man-hours worked for the last 5 Years: YEAR r r TOTAL NUMBER OF MAN-HOURS goJ�35� YEARS TOTAL NUMBER OF MAN-HOURS YEAR a d TOTAL NUMBER OF MAN-HOURS YEAR -A613 TOTAL NUMBER OF MAN-HOURS t.$L ""44 YEAR ) / TOTAL NUMBER OF MAN-HOURS 5�� Provide Contractor's (and Contractor's proposed Subcontractors and Suppliers furnishing or performing Work having a value in excess of 10 percent of the total amount of the Bid) Days Away From Work, Days of Restricted Work Activity or Job Transfer (DART) incidence rate for the particular industry or type of Work to be performed by Contractor and each of Contractor's proposed Subcontractors and Suppliers) for the last 5 years: YEAR A l( DART _ YEAR aQ/s' DARTYEAR a� y DARTYEAR DART%—� YEAR DART_'' 13. EQUIPMENT: MAJOR EQUIPMENT: List on Schedule C all pieces of major equipment available for use on Owner's Project. EJCDC C-451, Qualifications Statement. Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved. P-21 I HEREBY CERTIFY THAT THE INFORMATION SUBMITTED HEREWITH, INCLUDING ANY ATTACHMENTS, IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF. NAME OF ORGANIZATION: 3 RAiTk)0JCK N e BY: - TITLE: LR s�av T DATED: 114)0'em 6F. R NOTARY ATTEST: SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY OF Aue&,Ar_t , 201 d Z J NOTARY SIGNATURE NOTARY PRINTED NAME: C hal-MA 0!/sr��? NOTARY PUBLIC -STATE OF _L,14;ow,4 MY COMMISSION EXPIRES: REQUIRED ATTACHMENTS 1. Schedule A (Current Experience). 2. Schedule B (Previous Experience). 3. Schedule C (Major Equipment). 4. Audited balance sheet for each of the last 3 years for firm named in Section 1. S. Evidence of authority for individuals listed in Section 6 to bind organization to an agreement. 6. Resumes of officers and key individuals (including Safety Officer) of firm named in Section 1. 7. Required safety program submittals listed in Section 12. 8. Additional items as pertinent. EJCDC* C-01, Qualifications Statement. Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved. 64'...-IT �42!Pege 60 of 464 ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Maryland, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by MICHAEL BOND, Vice President, in pursuance of authority granted by Article V, Section 8, of the By -Laws of said Companies, which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute, and appoint Vicky L. DIELMAN, Kimberly A. NAGEL, Suzanne M. ROZEK, William G. HUMMER and Mario N. PROCACCINI, all of Toledo, Ohio, EACH its true and lawful agent and Attorney -in -Fact, to make, execute, seal and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds and undertakings, and the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMPANY at its office in New York, New York., the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills, Maryland., in their own proper persons. The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, of the By -Laws of said Companies, and is now in force. IN WITNESS WHEREOF, the said Vice -President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AIVIERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 22nd day of September, A.D. 2016. 4c-, "), Ax� ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND SAL a��v " �� •" �o*roW o All t Secretary Yice President Eric D. Barnes Michael Bond State of Maryland County of Baltimore On this 22nd day of September, A.D. 2016, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, MICHAEL BOND, Vice President, and ERIC D. BARNES, Secretary, of the Companies, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and acknowledged the execution of same, and being by me duly swom, deposeth and saith, that helshe is the said officer of the Company aforesaid, and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies„ and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporations. IN TESTIMONY WHEREOF, I have hereunto set my band and affixed my Official Seal the day and year fast above written. Constance A. Dunn, Notary Public My Commission Expires: July 9, 2019 POA-F 142-4340A EXHIBIT'A' - Page 70 of 154 EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V, Section 8, Attorneys -in -Fact. The Chief Executive Officer, the President, or any Executive Vice President or Vice President may, by written instrument under the attested corporate seal, appoint attomeys-in-fact with authority to execute bonds, policies, recognizances, stipulations, undertakings, or other like instruments on behalf of the Company, and may authorize any officer or any such attorney -in -fact to affix the corporate seal thereto; and may with or without cause modify of revoke any such appointment or authority at any time." CERTIFICATE I, the undersigned, Vice President of the ZURICH AMERICAN INSURANCE COMPANY, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that Article V, Section 8, of the By -Laws of the Companies is still in force. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the ZURICH AMERICAN INSURANCE COMPANY at a meeting duly called and held on the 15th day of December 1998. RESOLVED: "That the signature of the President or a Vice President and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of Attorney ...Any such Power or any certificate thereof bearing such facsimile signature and seal shall be valid and binding on the Company." This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at a meeting duly called and held on the Sth day of May, 1994, and the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 1 Oth day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice -President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed. IN TESTIMO Y WHEREOF, I have hereunto subscribed my name and affixed the corporate seals of the said Companies, this/.Sr day o1j�:�:e r- , 20L. a oc�o o411.1 t 86A6 u« t � tooe XW '7• At Gerald F. Haley, Vice President TO REPORT A CLAIM WITH REGARD TO A SURETY BOND, PLEASE SUBMIT ALL REQUIRED INFORMATION TO: Zurich American Insurance Co. Attn: Surety Claims 1299 Zurich Way Schaumburg, IL 60196-1056 EXHIBIT'A' - Page 71 of 154 �b E-VERIFY PROGRAM Pursuant to Indiana Code 22-5-1.7-11, the Contractor awarded the Bid is required to enroll in and verify the work eligibility status of all its newly hired employees through the E-Verify program. The Contractor who is awarded the Bid is not required to verify the work eligibility status of all its newly hired employees through the E-Verify program if the E-Verify program no longer exists. The individual person(s) executing this Proposal, being first duly sworn, depose(s) and state(s) that the Contractor does not knowingly employ an unauthorized alien. The undersigned further affirms that, prior to entering into an agreement for this Bid, the undersigned business entity will enroll in and agrees to verify the work eligibility status of all its newly hired employees through the E-Verify program. Written Signature: Printed Name: Title: Important — Notary Signature and Seal Required in the Space Below STATE OF =Z&AA4 A SS: COUNTY OF ARAR)A(Iw Subscribed and sworn to before me this -4 day of NoJerrrAO'e 1 201-Z. My commission expires: (Signed-lj# Residingin t'-1'17nRjf\, County Printed Name: State • EXHIBIT'A'p Page 72 of 154 CERTIFICATE OF NO INVESTMENT ACTIVITIES IN IRAN (IC 6-22-16.6-13) 1. Indiana Code. Reference is hereby made to Indiana Code 5-22-16.5 (the "Code"), specifically to Section 5-22-16.5-13 of the Code. Terms used herein, not otherwise defined herein, shall have the meanings ascribed to them in the Code. 2. Contract. Reference is hereby made to that certain Agreement between Owner and Contractor for Construction Contract (Stipulated Price), by and between ("Contractor") and City of Richmond a Governmental Body ("Owner") respecting that certain project known as Northwest 13th Street Interceptor Basin Improvements - Phase I (the "Project"). 3. Certification. Pursuant to Section 5-22-16.5-13(b) of the Code, Contractor hereby certifies to Owner that Contractor is not engaged in Investment Activities in Iran. 4. Contract File. Pursuant to Section 5-22-16.5-13(c) of the Code, this Certificate shall be placed in the Contract File for the Project. In Witness Whereof, Contractor has executed this Certificate as of o c��Ir�c',e( , 20 l 7 STATE OF 41U/J //RN ii- SS: COUNTY OF 9RA/lli4I./N Subscribed and sworn to before me this My commission expires:/ �y Residing in 1 l�(�7YI //,A_ County State of I L4 /a n , (Contractor) By: (Signature) Printed Named REur,u Title: 7— _2 day of M r- 'r .1 Printed - /. /. EXHIBIT'A'`3Page 73 of 154 DETAILS RELATIVE TO ASSETS 1 Cash: (a) On hand (petty cash)------------------------------------------------------ $ (b) Deposited In banks named below _-_ r________________ _________�________ __- 5,848,352 _ _ _ ._...:...............:.. Attach the corresponding reconciled bank statement as supporting documentation. NAME OF BANK TYPE OF ACCOUNT DEPOSITED IN THE NAME OF AMOUNT MAIN SOURCE BANK CHECKING BRACKNEY, INC.. $ 6,848,352 2Notes Receivable Due Within One Year _ $ RECEIVABLE FROM FOR WHAT DATE OF MATURITY HOW SECURED AMOUNT Have any of the above been discounted, sold or pledged? ❑ Yes ❑ No if so, state amount, to whom and forwhat reason: 3 Bill Deposits and Guarantees ------------------------------------- ____---_;--_ DEPOSITED WITH FOR WHAT WHEN RECOVERABLE AMOUNT What amount, if any, has been assigned, sold or pledged? ___________________------- $.._........._........._... Accounts Receivable From Completed Construction Contracts (exclusive of claims not approved) ____ 44,450 INDOT may request corresponding A/R Aging by invoice date as supporting documentation. RECEIVABLE FROM NATURE OF CONTRACT AMOUNT OF CONTRACT AMOUNT DUE VARIOUS TIME & MATERIAL JOBS $ 700 WHITESTOWN WASTEWATER $ 43,750. Have any of the above been discounted, soldorpiedged? ❑ Yes [Z No If so, state amount, to whom and forwhat reason: Page 10 of 28 EXHIBIT'A' - Page 74 of 154 DETAILS RELATIVE TO ASSETS (confinueM 5 Accounts Receivable from Incomplete Construction Contracts (as shown by engineer's or architects estimate): 1:425 772 (a) Amount retained to date, due upon completion of.contracts------------------------------- _....,._____.—......1.8 277 (b) Amount receivable after deducting amount retained ------------------- ------------------- - - -- -„ INDOT May request corresponding AIR Aging by invoice date as supporting documentation. DESIGNATION OF CONTRACT AND FOR WHOM PERFORMED AMOUNT OF CONTRACT AMOUNT BILLED AMOUNT RECEIVED RETAIN -AGE AMOUNTDUE EXCLUSIVE OF AMOUNT RETAINED WHEN DUE AMOUNT DALY ROAD SEWER REPLACEMENT $ 5,092,654 $ 4 613,817 $ 4,108,656 " $ 369,105 $136,056 TILDEN ROAD BROWNSBURG, INDIANA $ 5 355 916 $ 5,268,619 $ 4,379,299 " $ 526 862 $ 362,459 WILLIAMSDALE SANITARY SEWER $ 2,443,786 $ 2 443 786 $ 2,176,028 ` $ 267.758, RICHARD STREED WM IMPROVEMENTS MIAMISBURG. OH $ 4,333 765 $ 4 275 457 $ 4,118.663 $156 894 RIVERVIEW SAMTARY SWR 6 WM IMPROVEMENTS MIAMISBURG. OH $ 3 038,583 $ 3 232.740 S 2,974,121 $ 258 619 PENDLETON, IN PHASE 1 SEWER REHAB $1,494 807 $ 858 646 $174,094 $ 74 446 $ 610,106 ROARING RUN STORM SEWER REHABILITATION FRANKLIN, IN $300.261 $ 229 456 $ 217,983 $11473 TOWN OF EDINBURGH STORM SEWER EDINBURGH. IN $ 83d 126 $ 567 467 $ 77,682 $ 28 373 $ 461.412 BROOKVILLE WATER LINE $ 277 281 $ 277 281 $ 249,245 $ 28,036 "- AT COMPLETION BAD DEBT ALLOWANCE - 10 000 Have any of the above been discounted, sold orpledged? ❑ Yes © NO if so, state amount, to whom and for what reason: 6 Costs of Incomplete Contracts In Excess of Related Billings--------------------------- ------------------------------------------ $,,,,„„„...................... .... (Completed Contract Method) Amount receivable after deducting amount retained Costs and Estimated Earnings in Excess of Billings on incomplete Contracts ----------------------------- _..45rs22 (Percentage of Completion Method) 8 Equipment Rentals and Other Accounts Receivable :_ 6,058 RECEIVABLE FROM FOR WHAT WHEN DUE AMOUNT STOCKHOLDERS PERSONAL EXPENSE 2017 $ 5,126 MAIN SOURCE BANK INTEREST 6/18117 $ 932 What amount, if any, is due after one year? -------- ---=---==--------------------------------------- $.... __..... ._...._.... ......... „—:„.. ..._. Assigned, sold or pledged?---------------------------------------------------------------------- $ __........... __.. __...... Page 11 of 28 EXHIBIT'A' - Page 75 of 154 DETAILS RELATIVE TO. ASSETS (continued) Materials In Stock Not Included In Items 4 and 5: $ 1,200 Inventory Values: (a) For use on own construction contracts _----- (b) Non -construction or for sale to others i.e. direct sales _ --_ --___- ••---•....-••••-•••• Attach supporting detail reflecting item quantities and unit values. DESCRIPTION OF MATERIAL QUANTITY PRESENT VALUE FOR INCOMPLETE CONTRACTS OTHER MATERIALS CONCRETE PIPE FITTINGS AND PLASTIC PIPE $1,200 10 Stocks, Bonds, and Other Securities $ (a) Listed -Book Value (b) Present Market Value -------------------------------_-----:- _- -- _ _ No consideration as working capital will be given unless book value and market value, determined or verified by the accountant, is given. ISSUING COMPANY DESCRIPTION QUANTITY PRESENT MARKET VALUE BOOK VALUE UNIT AMOUNT UNIT AMOUNT If any are pledged or in escrow, state to whom and for what reason. Specify co-owner or beneficiary of non-negotiables. 11 Accrued Interest and Other Current Assets ---_----- $ 72,130 DESCRIPTION AMOUNT CERTIFICATE OF DEPOSIT $ 72,130 Page 12 of 28 EXHIBIT'A' - Page 76 of 154 IIIIII II II IIIII III EXHIBIT'A' - Page 77 of 154 DETAILS RELATIVE TO ASSETS (continued) 13 Other Plant and Equipment - Net Book Value $ 7.836- (Ltat office equipment, plant and operating equipment of gravel pits, quarries, commerclal concrete products, steel fabrlgation plants, aircraft, etc., as well as equipment of any non -construction business enterprise, including recreational and pleasure boats. Do not include such items in Schedule 12: DESCRIPTION YEAR ACQUIRED COST ACCUMULATED DEPRECIATION NET BOOK VALUE ENCUMBRANCE MISCELLANEOUS OFFICE EQUIPMENT, PER ATTACHED $ 83,062 $ 76,226 $ 7,836 $ 0 14 Real Estate and Net Book Value of Improvements (includingLeasehold Improvements) 32,290 LOCATION AND DESCRIPTION OF PROPERTY TITLE HELD IN WHOSE NAME NET BOOK VALUE AMOUNT ENCUMBRANCES POLE BUILDING AND OFFICE TRAILER CORPORATE $ 32.290 $ 0; 15 Cash Surrender Value of Life Insurance Policies (exclusive of loans) __ __,___ $ _ ........ _ CORPORATIONS - Policies carried on officers or supervisory employees of the corporation, payable to and under control of the corporation. PARTNERSHIPS - Polices carried on partners or supervisory employees payable to and under control of the partnership. INDIVIDUALS - Policies carded on the individual under his exdusive control and payable to any beneficiary; policies carried on supervisory employees, payable to and under exclusive control of the qualifying individual or his estate; policies carded on members of the Immediate family, payable to and under exclusive control of the qualifying individual or his estate. CARRIED ON BENEFICIARY WHO HAS CONTROL AS TO LOANS OR SURRENDER SURRENDER VALUE AMOUNT OF LOANS 16 Other Assets 35,000 -. - --- --- --- - --------------- ----- ---- -- --- - $ _ ......r...... _ .:...:_00 DESCRIPTION AMOUNT RESTRICTED CASH $ 35,000 Page 14 of 28 EXHIBIT'A' - Page 78 of 154 DETAILS RELATIVE TO LIABILITIES 17 and 22 F Notes Payable and Other Long -Term Liabilities CREDITOR PAYMENT TERMS / BEGIN DATE DATE OF MATURITY (mmldd/YY) (A) PRINCIPAL BALANCE (B) DUE WITHIN 12 MONTHS (C) = (A) - (B) BALANCE AFTER 12 MONTHS (D) DUE WITHIN 13-24 MONTHS (E) = (C) - (D) BALANCE AFTER 24 MONTHS SEE ATTACHED $ 518,404 $ 257,996 $ 260.408 $182,832 $ 77,576 TOTAL $ 518,404 $182, 332.1 $ 77,576 TOTAL FOR ITEM 17 (TOTAL COLUMN B) TOTAL FOR ITEM 22 (TOTAL COLUMN C) $ 257,996 $ 26OA08 18 Accounts Payable --------------------- ----------------- -----_----------_-=----------- $ _.... .. ._ 377,432 .._. _ PAYABLE TO FOR WHAT DATE PAYABLE AMOUNT SEE ATTACHED $ 377,432 Page 15 of 28 EXHIBIT'A' - Page 79 of 154 DETAILS RELATIVE TO LIABILITIES continued 9 Billings on Incomplete Contracts in Excess of Related Costs (a) Cost Portion (Completed Contract Method) (b) Unrecorded earned Income $ $ » .» ,ZO Billings on Incomplete Contracts in Excess of Costs and Estimated Earnings -------------------------- (Percentage of Completion Method) 2,190,842 21 Accrued Taxes and Other Liabilities Due Within One Year _ $. . ---1 , - DESCRIPTION DATE PAYABLE AMOUNT Deferred Income Taxes (Current Portion) DIVIDENDS PAYABLE $ 2,627 ACCRUED EXPENSES AND PAYROLL WITHHOLDINGS $ 305,294 22 Notes Payable and Other Long Term Liabilities ____�_�, ��_ _—�_-.-_ Refer to Schedule 17 and 22 on Page 14 23 Deferred Income Taxes (Non -current Portion) _.;._--- ------------------- w__— ------- —....-------- NET WORTH 24 Individual or Partnership Capital ---- _ __-__----- --------- - -------_---- $ ........................... ..... 25 - Capital Stock (a) -Common __ _- --__---------------- ._____ Preferred ----------------------------------------- $ . $ ......... 550,988 ..» ....... 26 Additional Paid -in Capital $ ' " » ""."' ......'`'"»..... 27 Retained Earnings •7,706,027 28 Other. ............. » 29 Other: .... ....... ._............... .......... .:..... CONTINGENT LIABILITIES 30 Total Contingent Liabilities: Attach supplementary schedule explaining the Item(s) listed below ----------------------- $ ••••• •-••=-=............. --..... _-•••••---. On notes receivable, discounted or sold _.:_--,--------------------------------------------------- On accounts receivable, pledged, assigned or sold - - - Asa bondsman ----- ------------ ....--------------- -------------- ------ --------------- --------------- As guarantor on contracts, notes or accounts of others _-_ ___--_"_-_—_____----- Onlawsuits pending but not reduced to judgment __________________________ ---------------------- Other (specify) .... I. .............. . ............... .............. _•-,,,•, , ..,........... _... ........ .....»». .....:.::. . ............... .... Page 16 of 28 EXHIBIT'A' - Page 80 of 154 CONTRACTOR'S STATEMENT OF EXPERIENCE WORK TYPE CLASSIFICATIONS Check each work type the applicant desires for prequalification. For each work type checked, indicate the years of experience and the total amount of work performed (1,000s) by the company's own forces. Do not include work performed by subcontractors. If other specialty work types are desired, add the corresponding information in the blank spaces provided. New applications should list work for the previous three years. Renewal applicants should list work for the previous year only. The experience and total amounts shown here should be developed in pages 19-20. NOTE: Information regarding specific work type requirements is available on hltn //wwW.in.ctov/indot/2740.htiii. YEARS OF EXPERIENCE MAJOR WORK TYPE CLASSIFICATIONS SELF PERFORMED WORK (1,000s) YEAR: 2016 YEAR: YEAR: 30 A (a) Concrete Pavement — General 1,241 ❑✓ 30 A (b) Concrete Pavement— Limited 1,241 0 B (a) Asphalt —with Certified HMA Plant 965 Q 45 C (a) Heavy Grading 970 R1 45 C (b) Light Grading 570 Cl D (a) Bridges Over Water 0 30 D (b) Highway or Railroad Bridge Over Highway 0 ❑ D (c) Bridge Involving Protection of Railroad Tracks ❑ E (a) Traffic Control, Signals and Installations ❑ E (b) Placing Asphalt Pavement 0 45 E (c) Bridge Deck Overlay and Minor Bridge Repair 40 ❑ E (d) Traffic Control, Sign Installations ❑ E (e) Small Structures, Culverts and Drainage Items ❑✓ 28 E (f) Surface Masonry 2,163 ❑ E (g) Traffic Control, Pavement Markings 0 45 E (h) Deep Sewer 7,166 ❑✓ E (i) Seeding and Sodding, Top Soil Excavation 200 ❑ E 0) Landscaping 100 ❑ E (k) Guard Rail and Fence ❑ E (1) Structural Steel Erection ❑ E(m) Cleaning and Painting Bridges ❑✓ 27 E (n) Vegetation Control 0 0 27 E (p) Bridge Deck Sealing 0 ❑ E (q) Concrete Pavement Repairs ❑ E (r) Road Planing 44 E (s) Roadside Mowing 0 ❑ E (t) Demolition SPECIALITY WORK TYPE CLASSIFICATIONS (describe or provide work type code) El El El Page 17 of 28 EXHIBIT'A' - Page 81 of 154 CONTRACTOR'S STATEMENT OF EXPERIENCE 1. How many years has your organization been In business as a contractor: (a) under your present business name? _ 25 „�^ _. years. (b) Under the name of BRACKNEY EXCAVATING for years. 2. How many years experience In construction work has your organization had: (a) As a general contractor? 44 (b) As a subcontractor? 43 3. What other states are you prequaliffed to perform highway work? OHIO DEPARTMENT OF TRANSPORATION; KENTUCKY TRANSPORATION CABINET 4. Has your company ever failed to complete any work awarded to it? ❑ Yes M No If so, where and why? 5. Has any owner or officer of your organization ever been an owner or officer of some other organization that failed to complete a construction contract? ❑ Yes E) No If so, state the name of the individual, other organization and reason. 6. Has any owner or officer of your organization ever failed to complete a construction contract handled in his/her own name? ❑ Yes ® No If so, state the name of the Individual, name of owner and reason. 7. Has any officer, employee or representative of your organization been convicted of a bidding crime (Bid Rigging, RICO) resulting from a jury or bench trial, entered into a plea of guilty or note contendere, made a public admission, made a presentation as an unindicted co-conspirator, or gave testimony, which is protected by a grant of Immunity, in any Jurisdiction within the past five years? Has the applicant, or any officer of the applicant, ever been the subject of a suspension or debarment action by any agency of the federal government? ❑ Yes m No If so, provide the date of the offence and conviction, details of the offense, court documents and other pertinent Information. 8. In what other lines of business are you financially Interested? 9. List equipment that you lease on a regular basis. Describe each piece by listing manufacturer, kind and capacity, and name and address of the lessor. LARGE CRANES (ALL MANUFACTURERS) 50 70 TON 10. Briefly describe the kinds of work you usually perform with your own forces. BRIDGES, WATERLINES, SEWER, GRADING, SLOPE CONTROL, AND GRAVEL HAULING, CARPENTRY AND GENERAL CONSTRUCTION WORK 11. Briefly describe the kinds of work you usually subcontract to others. ELECTRICAL, PLUMBING AND HEATING 12. List owners of the company and any major stockholders, including the percentage owned by each. If owned by a parent company show the name of parent and its ownership interest. KEVIN C. 13RACKNEY... 33.51% CHRISTA M. WILSON... 33.25% ERIC M. BRACKNEY...33,24"/0 Page 18 of 28 EXHIBIT'A' - Page 82 of 154