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HomeMy Public PortalAbout043-2021 - Culy Contracting - on call services AGREEMENT THIS AGREEMENT made and entered into this 11 day of 4.4 G4r c'li ,2021, by and between the City of Richmond,Indiana, a municipal corporation acting by and through its its Storm Water Management Board, with its office at 50 North 5th Street, Richmond, Indiana, 47374 (hereinafter referred to as the"City") and Culy Contracting, LLC, 5 Industrial Park Drive, Winchester,Indiana 47394(hereinafter referred to as the"Contractor"). SECTION I. STATEMENT AND SUBJECT OF WORK City hereby retains Contractor for on-call construction services, sometimes emergency in nature, or other incidental work with the Richmond Sanitary District or storm water collection system, The Waste Water Treatment Plant or other areas of responsibility of the Richmond Sanitary District. This service is needed because the Richmond Sanitary District has a need for emergency repairs that must be made as quickly as possible to reduce or minimize the chance of property damage and to meet and satisfy requirements of the Indiana Department of Environmental Management (hereinafter referred to as "IDEM"). This contract is only to be used on an as- needed basis as solely determined by City. On February 5, 2021, City sent out a Request for Quotes to five (5) vendors for on-call construction services, emergency services and other incidental work for the Richmond Sanitary District. The City's Request for Quotes is nine (9) pages in length and is attached hereto and incorporated herein by reference as Exhibit"A". On February 15, 2021, Contractor submitted to City the only Response City received. The bid response of Contractor is contained in Exhibit `B", is ten (10) pages in length, and it is hereby incorporated by reference and made a part of this Agreement. Contractor shall provide all services described in Exhibit "A" and at the rates set forth in Exhibit `B". Contractor has performed this service previously for City. Should any provisions,terms, or conditions contained in any of the documents attached hereto as Exhibits, or in any of the documents incorporated by reference herein, 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. 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 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. To reduce or minimize SECTION H. 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. Contract No.43-2021 Page 1 of 6 SECTION III. COMPENSATION City shall pay Contractor for complete and satisfactory performance of the work required hereunder in calendar year 2021, ending on December 31, 2021, but with an option for City to renew as set forth in Section IV below. The monies paid to Contractor are based upon an hourly fee schedule set forth in Exhibit`B", attached hereto with this Agreement. SECTION IV. TERM OF AGREEMENT This Agreement shall become effective when signed by all of the parties hereto and shall continue in effect until and including December 31, 2021, with an option for City to renew for calendar year 2022 (January 1, 2022 through December 31, 2022) at the same rates as set forth in Exhibit "B", and with an option for City to renew in calendar year 2023 (January 1, 2023 through December 31,2023)at the same rates as set forth in Exhibit`B". 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 five (5)working 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. hi the event of such termination, 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. This Agreement may also be terminated, in whole or in part,by mutual Agreement of the parties by setting forth the reasons for such termination, the effective date, and in the case of partial termination,the portion to be terminated. SECTION V. INDEMNIFICATION AND INSURANCE Contractor agrees to obtain insurance and to indemnify the City for damage or injury to person or property or other claims which may arise from the Contractor's conduct or performance of this Agreement; 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. Page 2 of 6 Coverage Limits A. Worker's Compensation& Statutory Disability Requirements B. Employer's Liability $100,000 C. Comprehensive General Liability Section 1. Bodily Injury $1,000,000 each occurrence $2,000,000 aggregate Section 2. Property Damage $1,000,000 each occurrence D. Comprehensive Auto Liability(if applicable) Section 1. Bodily Injury $1,000,000 each person $1,000,000 each occurrence Section 2. Property Damage $1,000,000 each occurrence E. Comprehensive Umbrella Liability $1,000,000 each occurrence $2,000,000 each aggregate F. 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 Page 3 of 6 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 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. 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: 1. 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; 3. 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 Page 4 of 6 4. 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 hannless 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. The City hereby agrees to release and hold harmless the Contractor and all officers,employees or agents of the same from all liability which may arise in the course of City's performance of its obligations pursuant to this Agreement. 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. 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 against Contractor,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. Any person executing this Contract in a representative capacity hereby warrants that he or she has authorization, in writing, by his or her principal to execute this Contract on behalf of the Contractor and that such authorization has not been revoked or rescinded. Page 5 of 6 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" "CONTRACTOR" THE CITY OF RICHMOND,INDIANA CULY CONTRACTING,LLC by and through its Storm Water Management Board By: I I% uI , Gr tus resident l� (Print-.): 1 eYrx(1 4 _�,'j -Par- 'hlksli-Vice-Presi ent Title: P0',S lddC At C Dated: 3 --3\'2 I Sue Miller,Member Dated: 3 -.3 ~ Al APPROVED: `Bavid ICE Sno May Dated: 03 ZG z,11CriA. Page 6 of 6 ?RICE R ►UEST { 'yo ti y U O my OF RICHMOND ITATION 2380 LIBERTY AVENNUE:REPARTMENT OF CHMOND,INDIANA47374 THIS 1S NOT AN ORDER PHONE(765)983-7450.FAX(765)962-2669 _J VENDOR INSTRUCTIONS This is a request for a price for the services of materials described below: Any additional specifications may be attached hereto. This is NOT an order and the City reserves the right to accept all or part, or decline the entire proposal. Please complete your full name and phone number below with signature; itemize all prices and charges where requested; and attach any explanation for any substitution to Specifications altered. Return in a sealed envelope,in care of Richmond Sanitary District Board of Commissioners to the administration building at the address above by the specified date and time to be considered. DATE: REPLY MUST BE IN BY: PAYMENT TERMS: DELIVERY REQUIRED: February 5,2021 February 16,2021 by 9:00AM UPON RECEIPT OF INVOICE DELIVERED DESCRIPTION This is a request for quotes for Construction Services for Emergency Repairs. Please see attached specifications. All E-Verify requirements will apply to this quote. Please include a Certificate of Insurance, which must include Worker's Compensation, and Warranty Information with quote. Return the quote in a sealed envelope addressed to: Richmond Sanitary District Denise Johnson,Customer Svc Mgr 2380 Liberty Avenue: Richmond, IN 47374 Re: Construction Services for Emergency Work Please itemize all charges on attached Bid Sheet. If you have any questions please call Elijah Welch at 765-983-7483. NAME*OF FIRM QUOTING: ST. TAX EXEMPTION#003121909-001 AUTHORIZED BY SIGNATURE / TITLE A. A44 Richmond ' itary District DATE PHONE NUMBER EXHIBIT"A'Page 1 of 9 2021,2022 &2023 On-Call Construction Services and Emergency Repair Contractor Scope of Work February 3,2021 1. This specification is intended for on-call construction services,sometimes emergency irr nature,or other incidental work within the sanitary or stormwater collection system,the WWTP or other areas of responsibility of the Richmond Sanitary District. It will be awarded to a Contractor but only used on an as needed basis. No amount of work can be guaranteed as part of this contract. This work typically consists of point repairs made on storm or sanitary sewers but may include other work as needed. 2. The contractor is required to respond by arriving on-site no later than 1.5 hrs after requested to assess equipment and manpower needs when emergency work is requested. The contractor is then required to have equipment and crews on-site no later than 3 hrs from initial call. Request for service may be made both during and after normal working hours., 3. More than one contractor may be issued a contract under this specification, Bids will be analyzed and a list will be put together naming which contractor will be called first. The contractor shall submit a list includingthe types of work they are capable of completing and the experience they have had with each. They shall also submit a list of at"least3 references that may called. The list,the references,and the individual bid prices will be used to determine'who would be considered the lowest,most responsive, and most responsible bidder and who would then get the first call on a particular type of work.If the first called contractor is unable to complete the work or unable to meet the required response time due to issues such as current equipment allocation,the next Contractor on the list will be called. RSD reserves the right to allow work under this contract to be done by a contractor who is already on-site where emergency work is needed. The on-site contractor must already be under and on-call contract with RSD and will not be allowed to charge mobilization/demobilization for work done with equipment or crews already on-site. 4. A list of emergency names and emergency phone numbers will be requested from the Contractor(s)who are awarded this contract. The first name on the list will be called first. If that person is unable to be reached the next name on the list will be called until all names are exhausted. If nobody from the first contractor's list is able to be immediately reached the RSD will start calling the next contractor in line. The contractor must supply RSD with up to four(4)emergency contacts but no less than two (2). 5. RSD may_ purchase required materials to be used under existing RSD PO's if possible or RSD may supply the material from their own inventory. Tithe EXHIBIT"A'Page 2 of 9 2021,2022&.2023 ON-CALL CONSTRUCTION SERVICES AND EMERGENCY REPAIR WORK BID SHEET • 2/3/2021 Item No. Description Units Unit Price Mobilization/Demobilization 1 1 Man Crew Hr $ $ 2 2 Man Crew Hr $ $ 3 3 Man Crew Hr $ $ 4 4 Man Crew Hr $ $ 5 Tri-Axle Dump Truck with Driver Hr. $ $ 6 Tandem Axle Dump Truck with Driver Hr _$ $ 7 Backhoe without Operator. Hr $ $ 8 Excavator without Operator(30,000 to 44,000 lb) Hr $ $ 9 Excavator without Operator(45,000 to 80,000 lb) Hr $ $ 10 Payloader without Operator Hr $ $ 11 Trench Box(0-10 ft Deep) Day $ $ 12 Trench Box(10-20 ft Deep) Day $ $ 13 Vac Truck w/Jetter Hr $ $ 14 CCTV Truck -Hr $ $ 15 Road Plate Day $ $ • • I have received addendum number(s) ,and the prices in this bid reflect these changes/clarifications. Contractor • Authorized Signature Date EXHIBIT"A'Page 3 of 9 • 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. a n a a a a a a D u n a a a a u a a a a a a a a n a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a a❑n a a n n a a a a a a a 0 n a 0 n a a a a a a a din 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 hued 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. EXHIBIT"A'Page 4 of 9 Affidavit of Employment Eligibility Verification The Contractor, , affirms under the penalties of perjury that Centimeter does not knowingly 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 qualified 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. Pursuant to Indiana Code 22-5-1.7, Contractor has enrolled in and verified the work eligibility status of all newly hired employees of the contractor through the Indiana E- Verify program. The Contractor has required Contractor's subcontractors to certify to the Contractor that the subcontractor does not knowingly.employ or contract with an unauthorized alien and that the subcontractor has enrolled and is participating in the E-Verify program, The Contractor will maintain this certification throughout the duration of the term of a contract with a subcontractor. I hereby verify under the penalty ofpeijury that the foregoing statement is true. Dated This day of ,20 . (signature) (printed ruin e) • EXHIBIT"A'Page 5 of 9 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 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. EXHIBIT"A'Page 6 of 9 DAVE M.SNOW 1 �1 o Mayor $ PAT SMOKER Interim Director CITY OF RICHMONID DEPARTMENT.OF SANITATION 2380 LIBERTY AVENUE•RICHMOND,INDIANA 47374 PHONE(765)983-7450oFAX(765)962-2669 Date: February 8,2021 To: All Bidders From: Denise Johnson RE: Construction Services for Emergency Repairs Quote ADDENDUM#1 This is"Addendum#1". This addendum is in reference to the above-mentioned.services. Please mark Addendum #1 on outside of envelope when returning quote. Revised copy of specifications enclosed. As a reminder quotes are due February 16,.2021 by 9:00 AM. EXHIBIT"A'Page 7 of 9 2021,2022&2023 On-Call Construction Services and Emergency Repair Contractor Scope of Work February 3,2021 1. This specification is intended for on-call construction services, sometimes emergency in nature, or other incidental work within the sanitary or stormwater collection system,the WWTP- or other areas of responsibility of the Richmond Sanitary District. It will be awarded to a Contractor but.only used on an as- needed basis. No amount of work can be guaranteed as part of this contract, This work typically.consists of point repairs made on storm or sanitary sewers but-May include other work as needed. 2. The contractor is required to respond by arriving on-site no later than 1.5 lus after requested to assess equipment and manpower needs when emergency work is requested. The contractor is then required to have equipment and crews on-site no later than 3 his from initial,call. Request for service maybe made both during . and after normal working hours. 3. More than one contractor may be issued a contract under this specification. Bids will be analyzed and a list will be put together naming which contractor will be called first The contractor shall submit a list including the types of work they are capable of completing and the experience they have had with each. They shall also submit a.list of at least 3 references that may be called. The list,the references,and the individual bid prices will be used to determine who would be considered the lowest,most responsive,and most responsible bidder and who would then get the first call on a particular type of work.If the first called contractor is unable to complete the work or unable to meet the required response time due to issues such as current.equipment allocation, the next Contractor on the list will be called. RSD reserves the right to allow work under this contract to be done by a contractor who is already on-site where emergency work is needed. The on-site contractor lutist already be under and on-call contract with RSD and will not be allowed to charge mobilizationldemobilization for work done with equipment or crews already on-site. 4. A list of emergency names and emergency phone numbers will be requested from the Contractoi(s)who are awarded this contract. The first name on the list will be called first. If that person is unable to be reached the next name on the list will be called until all names are exhausted. If nobody from the first contractor's list is able to be immediately reached the RSD will start calling the next contractor in line. The contractor must supply RSD with up to four(4) emergency contacts but no less than two (2). 5. RSD may purchase requited materials to be used under existing RSD PO's if possible or RSD may supply the material from their own inventory. If the EXHIBIT"A'Page 8 of 9 contractor supplies material to be used during repair,RSD will reimburse the Contractor at a rate no greater than COST plus 10%. RSD will require copies of supplier invoices before payment is made. If material used is taken from the Contractor's inventory and no supplier paperwork is available, Contractor shall supply a quote from one of their regular material suppliers to:obtain a fair market value for the product. This quote will be used to pay the contractor for materials used from.their inventory. 6: All bids shall include a unit price and a mobilization/demobilization price for each bid item. The mobilization/demobilization cost will be paid once per project for each item used. No bid items will qualify for multiple mobilization/demobilization billings on a single project,even.if the project takes multiple days to complete. All equipment or man power Will be billed hourly or daily with no minimums. Mobilization/Demobilization costs shall include travel time to and from the job-site. All hourly rates apply only to time spent on-site and while the equipment is being used. '7. Prices for 2 man, 3 man, and 4 man crews shall include all hand and small power tools, tool or service trucks, operators (other than dump truck),supervisors, laborers and traffic control. 8. RSD staff will work with.the Contractor to determine the extent of each project and how the repairs will be made. Repairs will be made per standard city specifications where applicable. 9. The fee for services/equipment provided outside the scope of what has been included in this price re quest will be negotiated on a case-by-case basis at the time of service. 10.The contract will begin once the contract is executed and last through December 31,2023. The contract shall include an option to renew for two (2) additional 1 year periods which may be exercised by RSD at a time prior to contract expiration. All prices Within this bid shall remain the same through the contract and any renewal period. 11.All work completed under this contract shall be warranted for a period no less than one(1)year. EXHIBIT"A'Page 9 of 9 PRICE REQUEST .01 qPF A CITY OF RICHMOND DEPARTMENT OF SANITATION 7r y �7 q �T ORDER q� 2380 LIBERTY AVENUEoRICHMOND,INDIANA47374 THIS IS NOT 1'S11.1I OAdDER PHON1:(765)983-7450oFAX(765)962-2669 VENDOR INSTRUCTIONS This is a request for a price for the services of materials described below. Any additional specifications may be Culy Contracting,c LLC attached hereto. This is NOT an order and the City reserves the right to accept all or part, or decline the entire proposal. PO Box 29 Please complete your full name and phone number below with signature; Itemize all prices and charges where Winchester, IN 47394 requested;and attach any explanation for any substitution to specifications altered. Return in a sealed envelope,in care of Richmond Sanitary District Board of Commissioners to the administration building at the address above by the specified date and time to be considered. DATE: REPLY MUST BE IN BY: PAYMENT TERMS: DELIVERY REQUIRED: February 6,2021 February 16,2021 by 9:00AM UPON RECEIPT OF INVOICE DELIVERED DESCRIPTION This is a request for quotes for Construction Services,for Emergency Repairs. Please see attached specifications. All E-Verify requirements will apply to this quote. Please include.a Certificate of Insurance, which must include Worker's Compensation,and Warranty Information with quote. Return the quote in a sealed envelope addressed to: Richmond Sanitary District Denise Johnson,Customer Svc Mgr 2380 Liberty Avenue • Richmond,IN 47374 Re: Construction Services for Emergency Work Please itemize all charges on attached Bid Sheet. If you have any questions please call Elliah Welch at 765-983-7483. NAME OF FIRM QUOTING: Culy Contracting LLC ,{a-oh Anderson S TE AX EXEMPTION# '31219 9-001 AUTHORIZED 9Y SIGNATURE Vice President J /IC t(` t(1i 2/15/21 TITLE (765) 584-8509 Richmond S n tary District DATE PHONE NUMBER EXHIBIT'B' Page 1 of 10 2021,.2022 &2023 On-Call Construction Services and Emergency Repair Contractor Scope of Work February 3,2021 1. This specification is intended for on-call construction services,sometimes emergency in nature,or other incidental work within the sanitary or.stormwater collection system,the WWTP or other areas of responsibility of the Richmond Sanitary District. It will be awarded to a Contractor but only used on an as- needed basis. No amount of work can be guaranteed as part of this contract. This work typically consists of point repairs made on storm or sanitary sewers but may include other work as needed. 2. The contractor is required to respond by arriving on-site no later than 1.5 hrs after requested to assess equipment and manpower needs when emergency work is requested. The contractor is then required to have equipment and crews on-site no later than 3 his from initial call. Request for service may be made both during and after normal woikinghours, 3. More than one contractor may be issued a contract under this specification. Bids will be analyzed and a list will be put together naming which contractor will be called first. The contractor shall submit a list including the types of work they are capable of completing and the experience they have had with each. They shall also submit a list of at least 3 references that may be called. The list,the references,and the individual bid prices will be used to deterinine who would be considered the lowest,most responsive, and most responsible bidder and who would then get the first call on a particular type of work.If the first called contractor is unable to complete the work or unable to meet the required response time due to issues such as current equipment allocation,the next Contractor on the list will be called. RSD reserves the right to allow work under this contract to be done by a contractor who is already on-site where emergency work is needed. The on-site contractor must already be under and on-call contract with RSD and will not be allowed to charge mobilization/demobilization for work done with equipment or crews already on=site. 4. A list of emergency names and emergency phone numbers will be requested from the Contractor(s)who are awarded this contract. The first name on the list will be called first. If that person is unable to be reached the next name on the list will be called until all names are exhausted. If nobody from the first contractor's list is able to be immediately reached the RSD will start calling the next contractor in line. The contractor must supply RSD with up to four(4)emergency contacts but no less than two(2). 5. RSD may purchase required materials to be used under existing RSD PO!s if possible or RSD may supply the material from their own inventory. If the EXHIBIT'B' Page 2 of 10 2021,2022&2023 ON-CALL CONSTRUCTION SERVICES AND EMERGENCY REPAIR WORK BID SHEET 2/3/2021 Item No. Description Units Unit Price Mobilization/Demobilization 1 1 Man Crew Hr $ 75.00 $ 10.00 2 2 Man Crew Hr $ 120.00 $ 20.00 3 3 Man Crew Hr $ 160.00 $ 30.00 4 4 Man Crew Hr $ 200.00 $ 40.00 5 Tri-Axle Dump Truck with Driver Hr $ 80.00 $ 80.00 6 Tandem Axle.Dump Truck with Driver Hr $ 65.00 $ 65.00 7 Backhoe without Operator Hr $ 40.00 $ 70.00 8 Excavator without Operator(30,000 to 44,000 lb) IIr $ 70.00 $ 120.00 9 Excavator without Operator(45,000 to 80,000 lb) IIr $ 95.00 $ 300.00 10 Payloader.without:Operator Hr $ 65.00 $ 90.00 11 Trench Box(0-10 ft Deep) Day $ 100.00 $ 100.00 12 Trench Box(10-20 ft Deep) Day $ 200.00 $ 200.00 13 Vac Truck w/Jetter Hr $ 205.00 $ 160.00 14 CCTV Truck Hr $ 175.00 $ 160.00 15 Road Plate Day $ 100.00 $ 100.00 I have received addendum number(s) No 1 ,and the prices in this bid reflect these changes/clarifications. Culy Contracting LLC Contractor • 4anii 4rn el'JDI?, Vice President 2/15/21 Authorized Signature Date EXHIBIT'Br Page 3 of 10 • E-Very 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. nun a a a aria aan a um a ann naa a aaaa a Gana aaaa Qaa an an a an an no clarion an aria nun a a an an mho nun a nun a actin COJ PLIANC 1 WITH INDIANA E-VERIIH'Y PROGRAMREQUIREMENTS 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 larowingly 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. • EXHIBIT'B' . Page4of10 • Affidavit of Employment Eligibility Verification The Contractor, Culy Contracting LLC ,affirms under the penalties ofuieJj that perjury 1 Contractor does not knowingly 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 qualified alien. The Contractor has not knowingly employed or contracted with an nnauth.orized alien and shall not retain an employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. Pursuant to Indiana Code 22-5-1.7, Contractor has enrolled in and verified the work eligibility status of all newly hired employees of the contractor through the Indiana E- Verify program. The Contractor has required Contractor's subcontractors to certify to the Contractor that the subcontractor does not knowingly employ or contract with an unauthorized alien and that the subcontractor has enrolled and is participating in the E-Verify program. The Contractor will maintain this certification throughout the duration of the term of a contract with a subcontractor. I"hereby verify under the penalty of perjury that the foregoing statement is true. Dated this 15th day of February ,2021 . Aaron Anderson (signature) Aaron Anderson, Vice President (printed name) • EXHIBIT'B' Page 5 of 10 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 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. • EXHIBIT'B' Page 6 of 10 of" . DAVE M.SNOW Mayor "-Mr'? PATSMOKER 'h ' Interim Director Cm OF RICHMOND DEPARTMENT OF SANITATION 2380 LIBERTY AVENUEoRICHMOND,INDIANA 47374 PHONE(765)983-7450oFAX(765)962 2669 Date: February 8,2021 To: All Bidders From: Denise Johnson RE: Construction Services for Emergency Repairs Quote ADDENDUM#1 This is"Addendum#1".This addendum is in reference to the above-mentioned services. Please mark Addendum#1 on outside of envelope when returning.quote. Revised copy of specifications enclosed. As a reminder quotes are due February 16,2021 by 9:00 AM. EXHIBIT'B' Page 7 of 10 2021,2022 &2023 On-Call Construction Services and Emergency Repair Contractor Scope of Work February 3,2021 1. This.specification is intended for on-call construction services,sometimes emergency in nature, or other incidental workwithin the sanitary or stormwater collection system,the WWTP or Other areas of responsibility of the Richmond Sanitary District. It will be awarded to a Contractor but only used,on an as- needed basis. No amount of work can be guaranteed as part of this contract. This work typically consists of point repairs made on storm or sanitary sewers but may include other work as needed. 2. The contractor is required to respond by arriving on-site no later than 1.5 hrs after requested to assess equipment and manpower needs when emergency work is requested. The contractor is then required to have equipment and crews on-site no later than 3 hrs from initial call. Request for service may be made both during • and after normal working hours. 3. More than one contractor may be issued a contract under this specification. Bids will be analyzed and a list will be put together naming which contractor will be called first. The contractor shall submit a list including the types of work they are capable of completing and the experience they have had with each. They shall also submit a list of at least 3 references that may be called. The list,the references, and the individual bid.prices will be used to determine who would be considered the lowest,most responsive, and most responsible bidder and who would then get the first call on a particular type of work.If the first called contractor is unable to complete the work or unable to meet the required response time due to issues such as current equipment allocation,the next Contractor on the list will be called. RSD reserves the right to allow work under this contract to be done by a contractor who is already on-site where emergency work is needed. The on-site contractor must already be under and on-call contract with RSD and will not be allowed to charge mobilization/demobilization for work done with equipment or crews already on-site. 4. A list of emergency navies_and emergency phone numbers will be requested from the Contractor(s)who are awarded this contract. The fast name on the list will be called first. 'If that person is unable to be reached the next name on the list will be called until all names are exhausted. If nobody from the first contractor's list_ is able to be immediately reached the RSD will start calling the next contractor in line. The contractor must supply RSD with up to four(4) emergency contacts but no less than two(2). 5. RSD may purchase required materials to be used under existing RSD PO's if possible or RSD may supply the material from their own inventory. If the EXHIBIT'B' Page 8 of 10 contractor'supplies material to be used during repair,RSD will reimburse the Contractor at a rate no greater than COST plus 10%. RSD will require copies of supplier invoices before payment is made. If material used is taken from the Contractor's inventory and no supplier paperwork is available, Contractor shall supply a quote from one of their regular material suppliers to obtain a fair market value for the product. This quote will be used to pay the contractor for materials used from their inventory. 6. All bids shall include a unit price and a mobilization/demobilization price for each bid item. The mobilization/demobilization cost will be paid once per project for each item used. No bid items will qualify for multiple mobilization/demobilization billings on a single project, even if the project takes multiple days to complete. All equipment or man power will be billed.hourly or daily with no minimums. Mobilization/Demobilization costs shall include travel time to and from the job-site. All hourly rates apply only to time spent on-site and while the equipment is being used. 7. Prices for 2 man,3 man, and 4 man crews shall include all hand and small power tools, tool or service trucks,operators (other than dump truck),supervisors, laborers and traffic control. 8. RSD staff will work with the Contractor to determine the extent of'each project and how the repairs will be made. Repairs will be made per standard city specifications where applicable. 9. The fee for services/equipment provided outside the scope of what has been included in this price request will be negotiated on a case-by-case basis at the time of service. 10. The contract will begin once the contract is executed and last through December 31,2023. The contract shall include an option to renew for two(2) additional 1 year periods which may be exercised by RSD at a time prior to contract expiration. All prices within this bid shall remain the same through the contract and any renewal period. 11.All work completed under this contract shall be warranted for a period no less than one(1)year, • EXHIBIT'B' Page 9 of 10 -------=',) CULYCO-001 MBAXTER A ccPaw DATE(MM/DDIYYYY) Lf CERTIFICATE OF LIABILITY INSURANCE 4/2/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to,the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CO ACT Melissa Baxter Van Meter Insurance Group Houchens Insurance Group (NCNNo,Est):(859)263-2771 FAX No):(859)263=1999 505 Wellington Way ROMss:_policy@higusa.com Lexington,KY 40503 INSURERS)AFFORDING COVERAGE .__ NAIC11 _ INSURER A:Amerls ure Insurance Company - 19488 INSURED INSURERn:Amerisure Mutual Insurance Company 23396 CulyContracting,LLC INSURERC:AGCS Marine Insurance Company 22837 S Industrial Park Dr PO Box 29 INSURER D: Winchester,IN 47394 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,'TERM OR CONDITION OF ANY 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. INSR( rADDLSUER I POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IINSD WVD POLICY NUMBER (MMIDDIYYYYI IMMIDDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 CLAIMS-MADE X jj OCCUR CPP21143240001 4/1/2020 4/1/2021 DAMAGETORENTED . 100,000 �I X. ._P_BEMISES_(Eaoccurrence) $ MED EXP(Any one person)__ $ 5,000 — PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X jef L-1 LOC PRODUCTS-COMP/OP AGG .S 2,000,000 OTHER' S COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILELIABILITY (EaaccMe l)___ I$ X ANY AUTO CA21143210001 4/1/2020 4/1/2021 BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY AUTOS WNEp BODILY INJURY_(Per accident) S___ AUT OS ONLY AUTOS ONLY JPEtr accidentDAMAGE $ S B X I UMBRELLA LIAB X OCCUR EACH OCCURRENCE 5 5;000,000 EXCESS LIAR CLAIMS-MADE CU21143220002 4/1/2020 4/1/2021 AGGREGATE $ 5'000'000 DED rX RETENTION S 0 $ A WORKERS COMPENSATION .X PER OTH- S AND EMPLOYERS'LIABILITY TATUTE ER Y_IN C21143230001 - 4/1/2020 4/1/2021 1,000,000 ANY PROPRIETOR/PARTNERIEXECUTIVE EL EACH ACCIDENT„ 5 OFFICERMEMBER EXCLUDED? l —�.N!A 1,000,000 (Mandatory In NH) E.L.DISEASE EA EMPLOYEE S Eyes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S C Commercial Inland Ma . MZI93085371 4/1/2020 4/1/2021 Leased/Rented Equip 150,000 C Installation Floater MZ193085371 4/1/2020 4/1/2021 Ded$1,000 150,000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD,101,Additional Remarks Schedule,may be attached if more space Is required) The certificate holder and the City of Richmond,IN are Il ted as additional insureds when required by written contract with respects to the General Liability. CERTIFICATE HOLDER CANCELLATION 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 Richmond Sanitary District 2380 Liberty Avenue z di IRIchmond.IN 47374 ACORD 25(2016/03) ©.1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logielgitered marks of ACORD Page 10 of 10 • CULYCO-001 MBAXTER ACORO" CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 3/26/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Melissa Baxter NAME: Van Meter Insurance Group PHONE FAX Houchens Insurance Group (NC,No,Ext):(859)263-2771I(A/C,No):(859)263-1999 505 Wellington Way ADMDRESS:policy@higusa.com Lexington,KY 40503 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Amerisure Insurance Company 19488 INSURED INSURER a:Amerisure Mutual Insurance Company 23396 Culy Contracting,LLC INSURER C:AGCS Marine Insurance Company 22837 5 Industrial Park Dr PO Box 29 INSURER D: Winchester,IN 47394 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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 ADDLI SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS _ (MMIDDIYYVY) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR CPP21143240001 4/1/2021 4/1/2022 DAMAGES(RENTED 100,000 X PREMISES(Ea occurrence) S X Includes XCU MED EXP(Any one person) 5 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PRO- X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO CA21143210001 4/1/2021 4/1/2022 BODILYINJURY(Perperson) $ — OWNED SCHEDULED AUTOSIOE ONLY AUTOS BODILY BODILY INJURYp (Per accident) $ X AURla ONLY X AI9TOS ONLY ((Perr accident)AMAGE $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE CU21143220002 4/1/2021 4/1/2022 AGGREGATE $ 5,000,000 DED X RETENTIONS 0 $ A WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY WC211432300 4/1/2021 4/1/2022 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $ C Inland Marine MZI93085371 4/1/2021 4/1/2022 Leased/Rented Equip 150,000 C Installation Floater MZI93085371 4/1/2021 4/1/2022 Ded$1,000 150,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached II more space Is required) The certificate holder and the City of Richmond,IN are listed as additional insureds when required by written contract with respects to the General Liability. CERTIFICATE HOLDER CANCELLATION 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 2380 Sanitary District e • dt/e/t/—' 2380 Liberty Avenue ,/� (Richmond.IN 47374 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • Foy ® Request for Taxpayer Give Form to the (Rev.October2018) Identification Number and Certification requester.Do not Department of the Treasury send to the IRS. internal Revenue Service ►Go to www.irs.gov/FormW9 for Instructions and the latest information. 1 Name(as shown on your income tax return):Name<is required on this line do not leave this line blank. CulYCQntractinq LLC 2 Business name/disregarded entity name,-if different from above ' 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1.Check only one of the 4 Exemptions(codes apply only to rg following seven boxes, certain entities,not individuals;see instructions on page 3): p E IndivlduaVsole proprietor or ❑ C Corporation El S Corporation ❑ Partnership ❑Trust/estate ai single-member LLC Exempt payee code(if any) u ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)► - p 2 . Note:Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check: Exemption from FATCA reporting c LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code(If any) a u another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of Its owner. d ❑ Other(see instructions)► _ ... (applies to accounts mahtlelned outside the U.S.) ul 5 Address(number,street,and apt.or suite no.)See instructions,: Requester's name and address(optional) in 5 Industrial Park.Drive , 8 City,state,and ZIP code Winchester,IN 47394 7 List account number(s)here(optional Part I Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid Sochi security number backup withholding.For individuals,this is generally your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later.For other — entities,it is your employer identification number(EIN).If you do not have a number,see How to get a - TIN,later. or Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and Employer Identification number Number To Give the Requester for guidelines on whose number to enter. 8' 4 — 4 8 3 4 7 9 5` Part II Certification Under penalties of perjury,I certify that: 1.The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and 2.I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding;and 3.I am a U.S.citizen or other U.S.person(defined below);and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct. Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid, acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions for Part II,later. Sign Signature of," ` Here us.person► Date► ; 2 6 =2r General Instructions •Form 1099-DIV(dividends,including those from stocks or mutual funds) Section references are to the Internal Revenue Code unless otherwise •Form 1099-MISC(various types of income,prizes,awards,or gross noted. proceeds) Future developments.For the latest information about developments •Form 1099-8(stock or mutual fund sales and certain other related to Form W-9 and its Instructions,such as legislation enacted transactions by brokers) after they were published,go to www.irs.gov/FormW9. •Form 1099-S(proceeds from real estate transactions) Purpose of Form •Form 1099-K(merchant card and third party network transactions) An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage interest),1098-E(student loan interest), information return with the IRS must obtain your correct taxpayer 1098-T(tuition) identification number(TIN)which may be your social security number •Form 1099-C(canceled debt) (SSN),individual taxpayer identification number(ITIN),adoption •Form 1099-A(acquisition or abandonment of secured property) taxpayer identification number(ATIN),or employer identification number (EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident amount reportable on an information return.Examples of information alien),to provide your correct TIN. returns include,but are not limited to,the following. If you do not return Form W-9 to the requester with a TIN,you might •Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding, later. Cat.No.10231X Form W-9(Rev.10-2018)