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HomeMy Public PortalAbout197-2017 - Sanitary - Brackney - NW 13th Street Interceptor Basin Improvements - Part 4CONTRACTOR'S STATEMENT OF EXPERIENCE (Continued) 13. List names and addresses of all subsidiary and affiliate companies. Check if the company is a subsidiary (SUB) or affiliate (AFF). For purposes of this list, concerns are affiliates of each other (except as otherwise provided In 13 CFR part 121) when, either directly or indirectly: (i) one concern controls or has the power to Control the other; or (il) a third party or parties controls or has the power to control both; or (ill) an identity of interest between or among parties exists such that affiliation may be found. In determining whether affiliation exists, It is necessary to consider all appropriate factors Including common ownership, common management, and contractual relationships. NAME OF COMPANY ADDRESS SUB AFF N/A D ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 14. List the projects the company has under contractor pending award. NOTE: A company prepared list of projects maybe substituted for this question If It contains all of the required information. TYPE OF WORK CONTRACT AMOUNT PERCENT COMPLETE CONTRACT ID, LOCATION OF WORK AND FOR WHOM PERFORMED SEWER $ 7,967,003 98% WHITESTOWN, IN - WHITESTOWN MUNICIPAL UTILITIES SEWER $ 392,885. 96% CONNERSVILLE, IN - CITY OF CONNERSVILLE. IN SEWER $ 5,089,168 14% DALY ROAD,OH -METRO SEWER DIST.OF GREATER CINCINNATI WATER $ 892,015 100% GREENFIELD, IN - GREENFIELD BOARD OF PUBLIC WORKS SEWER $ 255,551 90%o COLFAX, IN - TOWN OF COLFAX SEWER $1,337,862 98% PHILLIPSBURG-A, MONTGOMERY CO ENVIRONMENTAL SERV SEWER $ 1,686,070 98% PHILLIPSBURG-B, MONTGOMERY CO ENVIRONMENTAL SERV SEWER $ 634.985 96% PHILLIPSBURG-C, MONTGOMERY CO ENVIRONMENTAL SERV SEWER $ 491,000 100% LIBERTY, IN; SEWER $ 5,200,872 100% BROWNSBURG, IN SEWER $ 2.365,496 100°Jo WILLIAMSDALE, OH WATER $ 3,887,245 99% RICHARD, STREET- MIAMISBURG, OH SEWER $ 2,898,543 99% RIVERVIEW, MIAMISBURG, OH SEWER $ 2,734,844 15% REDKEY, IN SEWER $ 853,810 75% MIDDLETOWN, OH SEWER $ 634,126 96% EDINBURGH,IN WATER $169,000 0% CORDRY (SWEETWATER). IN SEWER $ 442,395 0% FLORENCE AERO PARKWAY, KY SEWER $1,488,910 60% PENDLETOON,IN- SEWER PHASE 1 SEWER $ 306,261 99% ROARING RUN, IN -STORM SEWER 15. List the construction experience of the principal individuals of your present organization. NOTE: New applicants should attach resumLs. NAME OF INDIVIDUAL PRESENT POSITION IN YOUR ORGANIZATION YEARS OF CONSTRUCTION EXPERIENCE MAGNITUDE AND TYPE OF WORK IN WHAT CAPACITY MARK E. BRACKNEY PRESIDENT 49 GENERAL CONSTRUCTION 100 SHELDON STROTHMAN FOREMAN 38 GENERAL CONSTRUCTION 100 DOUG BRUNS SUPERINTENDANT 37 GENERAL CONSTRUCTION 100 STEVE STANG FOREMAN 37 GENERAL CONSTRUCTION 100 NORB FARMER FOREMAN 37 GENERAL CONSTRUCTION 100 KEVIN BRACKNEY ESTIMATOR 23 GENERAL CONSTRUCTION 100 MIKE RAINES FOREMAN 35 GENERAL CONSTRUCTION 100 RYAN KERR FOREMAN 20 GENERAL CONSTRUCTION 100 JEREMY WILSON FOREMAN 11 GENERAL CONSTRUCTION 100 Page 19 of 28 EXHIBIT'A' - Page 83 of 154 C ; O 03 O Q n y N O 3 �� 0 in ID w O o N a U $ N U v► o � LI a V U'U L cm eM- L �. N (cD CU U US_ 4 O tf) O E00_ N O N N co W 4S Q, 4- W.0 U m a ^ O� o wa x ^ V oN W 3' 'A 4 aoi 0 o h IDO 0 o to o r W U.CN L C7 con �N N O C U V m0 Z L r lu `o Q w W y N ° m� C .ler y� O .�.�. N^ 4 N 0 �. 0 O C) IOA lh o r O r V 0N to IS,(A a N O x Z a rn E" a. N O Q O Y O 4. l0 M 0to M M N e�pp Q .N- f= N O N a o -, H O v o N M ano co rn Op o tp N O O O 4 O a C :3 •€ L N m 3 n M Y o W °o O O ~' iq N M N T .0. N O N !+ In r 0 N to O CD+� OC a ID F N = N N to v D N F V1 E C N z O F- N N N Z Q _. N (0 U v d r. L r N C9 a, IL w Q z ? z p p p d Q LU IL aC" m Z a O : Z Y y� a '� z qC m w z N a3 -o �' y p 3 is c d 3 o � w °-�° O m U > z °w ° z a r- U° a EXHIBIT'A' - Page 84 of 154 ORGANIZATION AFFIDAVIT FOR INDIVIDUAL OR SOLE PROPRIETORSHIP The undersigned, being duly sworn, hereby verifies to the Indiana Department of Transportation that: 1. The undersigned is the person submitting herewith the "Contractor's Statement of Experience and Financial Condition" (the "Statement") (CHOOSE ONE: ❑ as a business in his or her individual name ❑ as sole owner of , a sole proprietorship) to the Indiana Department of Transportation ("INDOT') for the purpose of inducing INDOT to issue a Certificate of Qualification to the undersigned that would enable the undersigned to submit bids on (and potentially be awarded) certain future contracts to be entered into by INDOT on behalf of the State of Indiana. 2. That the date of the Statement shall be deemed to be the date that the undersigned has executed and delivered to INDOT this Affidavit. 3. The undersigned has reviewed all of the information in the Statement and has determined (after consultation by the undersigned with any other persons or entities, if necessary) that all such information is complete, accurate, and not materially misleading in any substantive manner as of (a) the date of the undersigned's audited or unaudited financial statement used for any financial information therein, and (b) as of the date of the Statement for all other information therein. 4. The undersigned hereby does expressly authorize (a) INDOT to obtain all information considered pertinent with respect to the financial worth and assets and liabilities of the undersigned from banks or other financial institutions, surety companies, dealers in material, equipment or supplies, as well as all other persons or entities having any business relationship of any nature with the undersigned (ail such persons and entities are, collectively, the "Third Parties"), and (b) each of the Third Parties to furnish all such information requested by INDOT without any further approval or documentation from the undersigned. IN WITNESS WHEREOF, the undersigned has executed and delivered to the Indiana Department of Transportation this Affidavit for Individual or Sole Proprietorship with effect as of this day of , 20 Signature STATE OF ) SS: COUNTY OF Before me, a Notary Public in and for said State and County, personally appeared , and this person executed the foregoing Affidavit for Individual or Sole Proprietorship on this day of , 20 Commission Expiration Date (mrrr/dd/yy) Signature of Notary Public County of Residence Printed Name of Notary Public Page 21 of 28 EXHIBIT'A' - Page 85 of 154 ORGANIZATION AFFIDAVIT FOR APPLICANT (ORGANIZATION) The undersigned, being duly sworn, hereby verifies to the Indiana Department of Transportation that: 1. The undersigned is the PRESIDENT of BRACKNEY, INC. , a (CHOOSE ONE. n/✓ corporation limited liability company limited partnership Lj general partnership) organized and existing under the laws of the State of INDIANA (the "Company"). 2. The undersigned has personal knowledge that the person executing the attached Certified Copy of Resolutions (Applicant) with effect as of DECEMBER 31 , 20116 (the "Resolutions"), has authority to do so on behalf -of the Company. 3. That the Company is submitting herewith the Resolutions and the Company's "Contractor's Statement of Experience and Financial Condition" (the "Statement") to the Indiana Department of Transportation ("iNDOT") for the purpose of inducing INDOT to issue a Certificate of Qualification to the Company that would enable the Company to submit bids on (and potentially be awarded) certain future contracts to be entered into by INDOT on behalf of the State of Indiana. 4. That the date of the Statement shall be deemed to be the date that the undersigned has executed and delivered to INDOT this Affidavit. 5. The undersigned has reviewed all of the information in the Statement and has determined (after consultation by the undersigned with any other persons or entities, if necessary) that all such information is complete, accurate, and not materially misleading in any substantive manner as of (a) the date of the Company's audited or unaudited financial statement used for any financial information therein, and (b) as of the date of the Statement for all other information therein. 6. The current (CHOOSE ONE): 2] officers El members ❑ general partners) of the Company are: FULL PRINTED NAME TITLE KEVIN BRACKNEY PRESIDENT CHRISTA WILSON VICE PRESIDENT 7, The undersigned represents to INDOT that the undersigned has all necessary authority, on behalf of the Company, so that the Company hereby does expressly authorize (a) INDOT to obtain all information considered pertinent with respect to the financial worth and assets and liabilities of the Company from banks or other financial institutions, surety companies, dealers in material, equipment or supplies, as well as all other persons or entities having any business relationship of any nature with the Company (all such persons and entities are, collectively, the "Third Partles"), and (b) each of the Third Parties to furnish all such information requested by INDOT without any further approval or documentation from the Company. Page 22 of 28 EXHIBIT'A' - Page 86 of 154 ORGANIZATION AFFIDAVIT FOR APPLICANT (ORGANIZATION) (Continued) 8. The following persons are authorized to execute contracts and all other documents that will bind the Company (*For each entity listed other than the Company, list the full name of the entity in the FULL.PRINTED NAME line and the Individual who is an authorized signatory in the TITLE line. An Affidavit of Representative Entity AND a Certified Copy of Resolutions (Representative) for each such entity should also be completed and attached to the Statement): FULL PRINTED NAME MARK E. BRACKNEY KEVIN BRACKNEY DOUG BRUNS TITLE FORMER PRESIDENT PRESIDENT SUPERINTENDENT IN WITNESS WHEREOF, the undersigned has executed and delivered to the Indiana Department of Transportation this Affidavit for Applicant (Organization) with effect as of this day of , 20 STATE OF INDIANA COUNTY OF FRANKLIN Signature SS: Before me, a Notary Public in and for said State and County, personally appeared known to be the Of ,and this person executed the foregoing Affidavit for Applicant (Organization) on this day of , 20 , for and on behalf of such entity. Commission Expiration Date (mm/ddlyy) County of Residence Signature of Notary Public Printed Name of Notary Public Page 23 of 28 EXHIBIT'A' - Page 87 of 154 ORGANIZATION CERTIFIED COPY OF RESOLUTIONS (APPLICANT) The undersigned, being the keeper of the records of a (CHOOSE ONE ❑ corporation El limited liability company limited partnership general partnership) organized and existing under the laws of the State of (the "Company"), do hereby certify that the following is a complete and accurate copy of certain resolutions adopted by (CHOOSE ONE): ❑ the governing body of the Company at a regular or special meeting, at which a quorum was present, or otherwise acting through such body via unanimous consent or otherwise in accordance with all applicable provisions of the organizational documents of the Company. ❑ the consent of all owners of the Company, acting In accordance with all applicable provisions of the organizational documents of the Company. some other procedure that validly constitutes the requisite authority of the Company (Explain: ) BE IT RESOLVED that (the "Company") is hereby authorized to submit an application in 20 to the Indiana -Department of Transportation ("INDOT") to request a Certificate of Qualification that would set forth the Company's capacities to bid on contracts that will be entered into by INDOT on behalf of the State of Indiana; and BE IT FURTHER RESOLVED that the officers, employees, and all third parties (including without limitation, accountants, financial institution personnel, vendors, customers, and equipment providers) contacted by INDOT during any investigation or audit of such application are hereby authorized to cooperate with INDOT in providing all information and documents reasonably requested by INDOT to verify any of the information provided in such application; and BE IT FURTHER RESOLVED that each of the persons named as potential signatories in the Company's Affidavit for Applicant (Organization) that is an integral part of such application is hereby confirmed and ratified as having all requisite authority to execute contracts with INDOT and to bind the Company thereto; and BE IT FURTHER RESOLVED that the information provided by the Company in such application and in these resolutions shall be deemed to be representations of the Company for the benefit of the State of Indiana that INDOT may rely upon in making its determination with respect to the Company's application and Certificate of Qualification. The undersigned further certifies that (a) the above resolutions of the Company have not been modified in any manner or rescinded; (b) these resolutions are still in full force and effect as the date of this Certificate; and (c) nothing in any of the Company's organization documentation or past action limits the power of the Company's governing body to adopt any of these resolutions for the benefit of INDOT. IN WITNESS WHEREOF, the undersigned has executed and delivered this Certified Copy of Resolutions (Applicant) with effect as of this day of , 20 Signature of Person Making Certification Printed Name and Title Page 24 of 28 EXHIBIT'N - Page 88 of 154 ORGANIZATION AFFIDAVIT FOR REPRESENTATIVE ENTITY The undersigned, being duly sworn, hereby verifies to the Indiana Department of Transportation that: I. The undersigned is the of , a (CHOOSE ONE: ❑ corporation Lj limited liability company El limited partnership -[:]general partnership) organized and existing under the laws of the State of (the "Representative"), 2. The undersigned has personal knowledge that the person executing the attached Certified Copy of Resolutions (Representative Entity) with effect as of 20 (the "Representative Resolutions"), has authority to do so on behalf of the Representative. The undersigned also has personal knowledge that the person executing the Statement on behalf of the Representative has all necessary authority to do so, and has personal knowledge that the Representative has all necessary authority to execute the Statement on behalf of. (the "Company"). 3. The Representative is submitting herewith the Representative Resolutions and executing the "Contractor's Statement of Experience and Financial Condition" (the "Statement") being submitting herewith to the Indiana Department of Transportation ("INDOT") on behalf of the Company for the purpose of inducing INDOT to issue a Certificate of Qualification to the Company that would enable the Company to submit bids on (and potentially be awarded) certain future contracts to be entered into by INDOT on behalf of the State of Indiana. 4. That the date of the Statement shall be deemed to be the date that the undersigned has executed and delivered to INDOT this Affidavit. In the event of a conflict between the effective date of this Affidavit and the effective date of any other affidavit submitted along with the Statement, the effective date of this Affidavit shall control. 5. The undersigned has reviewed all of the information in the Statement and has determined (after consultation by the undersigned with the Company and any other persons or entities, if necessary) that all such information is complete, accurate, and not materially misleading in any substantive manner as of (a) the date of the Company's audited or unaudited financial statement used for any financial information therein, and (b) as of the date of the Statement for all other information therein. 6. The current (CHOOSE ONE: ❑ officers ❑ members ❑ general partners) of the Representative are: FULL PRINTED NAME TITLE 7. The undersigned represents to INDOT that the undersigned has all necessary authority, on behalf of the Representative acting for the Company, so that the Company hereby does expressly authorize (a) INDOT to obtain all information considered pertinent with respect to the financial worth and assets and liabilities of the Company from banks or other financial institutions, surety companies, dealers in material, equipment or supplies, as well as all other persons or entities having any business relationship of any nature with the Company (all such persons and entities are, collectively, the "Third Parties"), and (b) each of the Third Parties to furnish all such information requested by INDOT without any further approval or documentation from the Company. Page 25 of 28 EXHIBIT'A' - Page 89 of 154 ORGANIZATION AFFIDAVIT FOR REPRESENTATIVE ENTITY (Continued) 8. The following persons are authorized to execute contracts and all other documents that will bind the Representative: FULL PRINTED NAME TITLE IN WITNESS WHEREOF, the undersigned has executed and delivered to the Indiana Department of Transportation this Affidavit for Representative Entity with effect as of this day of ,20 Signature STATE OF SS: COUNTY OF Before me, a Notary Public In and for said State and County, personally appeared known to be the Of and this person executed the foregoing Affidavit for Representative Entity on this day of , 20 , for and on behalf of such entity. I Commission Expiration Date (mm/dd/yy) Signature of Notary Public I County of Residence Printed Name of Notary Public Page 26 of 28 EXHIBIT 'A' - Page 90 of 154 ORGANIZATION CERTIFIED COPY OF RESOLUTIONS (REPRESENTATIVE ENTITY) The undersigned, being the keeper of the records of , a (CHOOSE ONE: ❑ corporation ❑ limited liability company El limited partnership ❑ general partnership) organized and existing under the laws of the State of (the "Representative"), do hereby certify that the following is a complete and accurate copy of certain resolutions adopted by (CHOOSE ONE): ❑ the governing body of the Representative at a regular or special meeting, at which a quorum was present, or otherwise acting through such body via unanimous consent or otherwise in accordance with all applicable provisions of the organizational documents of the Representative. ❑ the consent of all owners of the Representative, acting in accordance with all applicable provisions of the organizational documents of the Representative. ❑ some other procedure that validly constitutes the requisite authority of the Representative. (Explain: BE IT RESOLVED that (the "Company") has been duly authorized to submit an application in 20 to the Indiana Department of Transportation ("INDOT") to request a Certificate of Qualification that would set forth the Company's capacities to bid on contracts that will be entered into by INDOT on behalf of the State of Indiana; and BE IT RESOLVED that the Representative is hereby authorized to execute and deliver this application to INDOT on behalf of the Company; and BE IT FURTHER RESOLVED that each of the persons named as potential signatories in the Representative's Affidavit for Representative Entity that is an integral part of such application is hereby confirmed and ratified as having all requisite authority to execute contracts with INDOT and to bind the Company thereto; and BE IT FURTHER RESOLVED that the information provided by the Company in such application and in these resolutions shall be deemed to be representations of the Company and the Representative, respectively, for the benefit of the State of Indiana that INDOT may rely upon in making its determination with respect to the Company's application and Certificate of Qualification. The undersigned further certifies that (a) the above resolutions of the Representative have not been modified in any manner or rescinded; (b) these resolutions are still in full force and effect as the date of this Certificate; and (c) nothing in any of the Representative's organization documentation or past action limits the power of the Representative's governing body to adopt any of these resolutions for the benefit of INDOT. IN WITNESS WHEREOF, the undersigned has executed and delivered this Certified Copy of Resolutions (Representative Entity) with effect as of this day of , 20 Signature of Person Making Certification Printed Name and Title Page 27 of 28 EXHIBIT'A' - Page 91 of 154 Page 28 of 28 EXHIBIT'N - Page 92 of 154 r L W S C O O O C n M L6 � M ONOp If3 O C ri O t7i t0 N ~ N t9) M 0 h N Nn. r > c o c cR �Nf (p OR M o o ci o o CCL fh0 M (D p O N - O P O O O O ti t O C !Ltfpp_1 C C O G O O O M C r 0 N C9 o$ 0 r o Cl 0$ S U) O � r l'M v C O O pN < N t0 M f0 M o o 41 �o o k g () h o 0 0 r r o 8 c v O/ P to � O N h to N 0) to G p � ~ p u fO co r W tN�pp O P• N O 0 O p r tg � O O C r C4 Q O C It) 6 apo� OMO, r N n tp N � f0 N tb r w Z O z Q a w g w ? m OW w a o a 2 a r N m z tu Z W C t�l W �¢ Z Z Z .n a C O oQ ri1 LL 0 c�, U n v~i & 5 Z O Y m w o 3 O o z z z s o Ix a m 0 n O cn. 0 n O C3, CM v O o in tq r in m tT FL '7 m f- at EXHIBIT W - Page 93 of 154 z W 0 G O r c: o ww LI. 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