Loading...
HomeMy Public PortalAbout117-2022 - Street - Pavement Solution Inc - Crack Sealing ORIGINAL AGREEMENT J)Q,h / THIS AGREEMENT made and entered into this 05U day of V , 2022, and referred to as Contract No. 117-2022 by and between the City of Richmond, a municipal corporation acting by and through its Board of Public Works and Safety (hereinafter referred to as the "City") and Pavement Solutions, Inc., 1308 Locust Street, Middletown, Indiana, 47356 (hereinafter referred to as the"Contractor"). SECTION I. STATEMENT AND SUBJECT OF WORK City hereby retains Contractor to conduct pavement crack sealing services for the 2022 season for the Richmond Street Department at certain specified locations (the "Project"). Certain Bid Specifications dated May 5, 2022, have been made available for inspection by Contractor, are on file with the Director of the Office of Purchasing and the Office of the Street Department, are hereby incorporated by reference, and made a part of this Agreement. Contractor agrees to abide by the same. The response of Contractor to said Bid Specifications is attached hereto as "Exhibit A", which Exhibit is dated June 11, 2022, consists of seven (7) pages, and is hereby incorporated by reference and made a part of this Agreement. Contractor agrees to comply with all terms and conditions contained in"Exhibit A." 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 which are incidental to 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. 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. 117-2022 • Page 1 of 6 SECTION III. COMPENSATION City shall pay Contractor a total amount not to exceed One Hundred Thirty Thousand One Hundred Forty-nine Dollars and Zero Cents ($130,149.00) for complete and satisfactory performance of this Agreement. SECTION IV. TERM OF AGREEMENT This Agreement shall become effective when signed by all parties and shall continue in effect until completion of the Project. 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 and proper manner its obligations under this Agreement; b. submission by the Contractor to the City of reports that are incorrect or incomplete 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. In the event of such termination, the City shall be required to make payment for all work performed prior to the effective date by Contractor,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. This Agreement may also be terminated by the City if a force-majeure event occurs and the results or aftereffects of said event causes the performance of this Agreement to become impossible or highly impracticable. Said event or results or aftereffects of said event would include events or effects which the parties to this Agreement could not have anticipated or controlled. Examples of a force- majeure event, or its results, would include, but would not be limited to, events such as an Act of God, an Act of Nature, an Act of Law, or an Emergency Act of Executive Enforcement of the Federal government,the State of Indiana, or local government. Page 2 of 6 SECTION V. INDEMNIFICATION AND INSURANCE Contractor agrees to obtain insurance and to indemnify the City for any damage or injury to person or property or any other claims which may arise from the Contractor's conduct or performance of this Agreement, either intentionally or negligently; provided, however, that nothing contained in this Agreement shall be construed as rendering the Contractor liable for acts of the City, its officers, agents, or employees. Contractor shall as a prerequisite to this Agreement, purchase and thereafter maintain such insurance as will protect it from the claims set forth below which may arise out of or result from the Contractor's operations under this Agreement, whether such operations by the Contractor or by any sub-contractors or by anyone directly or indirectly employed by any of them, or by anyone for whose acts the Contractor may be held responsible. Coverage Limits A. Worker's Compensation& Statutory Disability Requirements B. Employer's Liability $100,000 C. Comprehensive General Liability 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 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 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. Page 3 of 6 SECTION VII. COMPLIANCE WITH INDIANA E-VERIFY PROGRAM REQUIREMENTS Pursuant to Indiana Code 22-5-1.7, Contractor is required to enroll in and verify the work eligibility status of all newly hired employees of the contractor through the Indiana E-Verify program. Contractor is not required to verify the work eligibility status of all newly hired employees of the contractor through the Indiana E-Verify program if the Indiana E-Verify program no longer exists. Prior to the performance of this Agreement, Contractor shall provide to the City its signed Affidavit affirming that Contractor does not knowingly employ an unauthorized alien in accordance with IC 22-5-1.7-11 (a) (2). In the event Contractor violates IC 22-5-1.7 the Contractor shall be required to remedy the violation not later than thirty (30) days after the City notifies the Contractor of the violation. If Contractor fails to remedy the violation within the thirty (30) day period provided above, the City shall consider the Contractor to be in breach of this Agreement and this Agreement will be terminated. If the City determines that terminating this Agreement would be detrimental to the public interest or public property,the City may allow this Agreement to remain in effect until the City procures a new contractor. If this Agreement is terminated under this section, then pursuant to IC 22-5-1.7-13 (c)the Contractor will remain liable to the City for actual damages. SECTION VIII. IRAN INVESTMENT ACTIVITIES Pursuant to Indiana Code (IC) 5-22-16.5, Contractor certifies that Contractor is not engaged in investment activities in Iran. In the event 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 DC. 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, Page 4 of 6 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 acting 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 4. That this Agreement may be canceled or terminated by the City and all monies due or to become due hereunder may be forfeited, for a second or any subsequent violation of the terms or conditions of this section of the Agreement. C. Violation of the terms or conditions of this Agreement relating to discrimination or intimidation shall be considered a material breach of this Agreement. SECTION X. RELEASE OF LIABILITY Contractor hereby agrees to release and hold harmless the City and all officers, employees, or agents of the same from all liability for negligence which may arise in the course of Contractor'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. It shall be controlled by Indiana law and shall be binding upon the parties, their successors and assigns. It 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. 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 suit arising under this Contract, if any, 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. Any person executing this Contract in a representative capacity hereby warrants that he has been duly authorized by his or her principal to execute this Contract. Page 5 of 6 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 due to the enforcement of this Agreement, including but not limited to City's reasonable attorney's fees,whether or not suit is filed. In the event that an ambiguity or 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. 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, PAVEMENT SOLUTIONS,INC. INDIANA by and through its 1308 Locust Street Board of Public Works and Safety Middletown,IN 47356 BY: /Zr A ae- 64��iluuL1 By: 14-4, Vicki Robinson,President • By: Printed: 6lres 4 - (9a-xes Emily Palmer,Member By: Title: 19wrr VP Matt Evans,Mem er Date: Date: g APPROVED: t Davi now, ayo Date: 0 8 v7 7 Page 6 of 6 Pert of State Forth 52414(R2/2-13)/Form 96(Revised 2013) BID OF Pavement Solutions,Inc. • (Contractor) 1308 Locust St (Address) Middletown,IN 47356 FOR PUBLIC WORKS PROJECTS OF City of Richmond Crack Sealing Project Filed Action taken [EXHIBIT CA PAGE % OF 1 I Pavement Solutions, Inc. May 9, 2022 T.L. Bose11 Street Commissioner 700 Richmond Ave. Richmond, IN 47374 Mr. Bose11, We are pleased to submit this quote for approximately 173,532 square yards of Hot Modified Asphalt, Fiberized Crack Sealant, as per attached specifications. Our price is per square yard, and includes all labor, materials, equipment, and traffic control to complete the project. Streets to be crack sealed: • NW/SW 18th US 40 to Peacock. 14,130sys Salisbury Bridge to NW L 19,155sys Main 13th to Salisbury 21,664sys 5th St. US 40 to NW L 24,670sys 5th St. G to Q 15,735sys Garwood Hodgin to US 40 16,208sys Industrial US 40 to Hodgin 18,290sys Hodgin Industrial to Garwood 12,090sys 37th Hodgin to US 40 31,590sys Total 173,532sys Total to complete project : 173,532sys @ $0.75/sy = $130,149.00 (One hundred thirty thousand one hundred forty-nine and 00/100 dollars) Please sign and date your acceptance below. Return a copy to the address shown or fax to 765-444-8230. Via email to brandon.burton cr,paveinent-solutions.net We want to thank you for the opportunity to submit this quote and we look forward to working with you during the upcoming season. $244.41.Kwaci, May 9, 2022 Brandon Burton Date Authorized Signature Date 1308 Locust St. — Mi 1ekLw i� S�6 — Phone: 765-444-8215 CONTRACTOR'S BID FOR PUBLIC WORK - FORM 96 State Form 52414(R2/2-13)/Form 95(Revised 2013) V 00 Prescribed by State Board of Accounts PART I (To be completed for all bids. Please type or print) Date(month;day,year): June 11, 2022 1. Governmental Unit(Owner): City of Richmond 2. County: Wayne County • 3. Bidder(Firm): Pavement Solutions, Inc. Address: 1308 Locust St City/State/ZlPcode: Middletown, IN 47356 • 4. Telephone Number: (765)444-8215 5. Agent of Bidder(if applicable): Pursuant to notices given,the undersigned offers to furnish labor and/or material necessary to complete the public works project of City of Richmond (Governmental Unit)in accordance with plans and specifications prepared by City of Richmond • and dated May 2022 for the sum of see attached $ see attached The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply,the undersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifically referenced at the applicable page. If additional units of material included in the contract are needed, the cost of units must be the same as that shown in the original contract if accepted by the governmental unit. If the bid is to be awarded on a unit basis,the itemization of the units shall be shown on a separate attachment. The contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee, or applicant for employment, to be employed in the performance of this contract, with respect to any matter directly or indirectly related to employment because of race, religion, color, sex, national origin or ancestry. Breach of this covenant may be regarded as a material breach of the contract. CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS (if applicable) I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory obligation to use steel products made in the United States (I.C. 5-16-8-2). I hereby certify that I and all subcontractors employed by me for this project will use U.S. steel products on this project if awarded. I understand that violations hereunder may result in forfeiture of contractual payments. EXHIBIT PAGE 3OF 'l I ACCEPTANCE The above bid is accepted this day of , ,subject to the following conditions: - Contracting Authority Members: - PART II (For projects of$150,000 or more-IC 36 1-12-4) Governmental Unit City of Richmond Bidder(Firm) Pavement Solutions, Inc. Date(month, day,year): June 11,2022 These statements to be submitted under oath by each bidder with and as a part of his bid. Attach additional pages for each section as needed. SECTION I EXPERIENCE QUESTIONNAIRE 1. What public works projects has your organization completed for the period of one(1)year prior to the date of the current bid? Completion Contract Amount Class of Work Date Name and Address of Owner see attached - _ 2: - What public works projects are now in process of construction by your organization? Expected Contract Amount Class of Work Completion Name and Address of Owner Date 150,000.00 Micro-surfacing May 2022 City of Greensburg Street Dept 150,000.00 Micro-surfacing June 2022 Noble County Highway Dept 50,000.00 Crack Seal June 2022 Noble County Highway Dept 300,000.00 Crack Seal August 2022 Porter County Highway Dept 1EXHIBIT I. PAGE LI OF —1 • 3. Have you ever failed to complete any work awarded to you? No If so,where and why? • 4. List references from private firms for which you have performed work. Dirt Works- Parker City, IN E &B Paving -Anderson, IN Walsh &Kelly, Griffith, IN SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE 1. Explain your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, complete the project,number of workers, etc. and any other information which you believe would enable the governmental unit to consider your bid.) The project with begin on an agreed upon date with the City of Richmond.Construction signs will be placed daily and all traffic control will be maintained during the application of the product.The project will be scheduled to complete the project in sufficient time prior to the completion date.We will concentrate our work based on the priority schedule of the provided street list A daily work schedule will be provided to the city engineer,and they will be promptly notified in the event of any changes to the schedule. Material will be in accordance with the requested specs used in the bid. 2. Please list the names and addresses of all subcontractors(i.e.persons or firms outside your own firm who have performed part of the work)that you have used on public works projects during the past five(5) years along with a brief description of the work done by each subcontractor. Accurate Striping -Yorktown, IN -Striping and pavement markings TCS - Knox, IN -striping and pavement markings removal and replacement ARS-South Bend, IN-infrared asphalt repair E)(HIBIT �r PAGE�GF'( • 3. If you intend to sublet any portion of the work, state the name and address of each subcontractor, equipment to be used by the subcontractor,and whether you will require a bond. However, if you are unable to currently provide a listing,please understand a listing must be provided prior to contract approval. Until the completion of the proposed project,you are under a continuing obligation to immediately notify the governmental unit in the event that you subsequently determine that you will use a subcontractor on the proposed project • 4. What equipment do you have available to use for the proposed project? Any equipment to be used by subcontractors may also be required to be listed by the governmental unit see attached 5. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? If not,please explain the rationale used which would corroborate the prices listed. Yes SECTION III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the governing body awarding the contract must be specific enough in detail so that said governing body can make a proper determination of the bidder's capability for completing the project if awarded. 1 EXHIBIT r PAGE i'g, OFF 1 SECTION IV CONTRACTOR'S NON—COLLUSION AFFIDAVIT The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to include anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement,understanding or combination with any other person in reference to such bidding. He further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly,any rebate,fee,gift,commission or thing of value on account of such sale. • SECTION V OATH AND AFFIRMATION I HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS AND INFORMATION CONTAINED IN THE FOREGOING BID FOR PUBLIC WORKS ARE TRUE AND CORRECT. Dated at Middletown, IN this 11th day of June , 2022 Pavement Solutions, Inc. e of 0 zetion1)� Operations Manager (Title of Person Signing) ACKNOWLEDGEMENT STATE OFn aIn r+a )ss COUNTY OF Before me,a Notary Public,personally appeared the above-named /1 a wi e✓'an .h yde( and swore that the statements contained in the foregoing document are true and correct. Subscribed and sworn to before me this I) day of XII e ,✓�OZZ . a.,144‘,44 Notary Public ```1�1111111101 My Commission Expires: 3 —1 tit-20 2(D ��Q�N1SE C BFty O�� ' County of Residence: T71 Q h �/ T: 0 I.p • 0�� item 10 �iiG,�r.;;Olr..A�1'40?� !EXHIBIT Vic PAGE —1 OF ^t f • AC ORE,® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) kr......"-- 08/10/2022 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 Teresa Dulworth NAME: Citizens Insurance Agency PHONE (765)646-8800 FAX 65 646-8607 (A/C.No.Eat): (NC.No): ) 1800 E 19th St,Ste 3 E-MAILDSS: teresacitizens@ameritech.net INSURER(S)AFFORDING COVERAGE NAIC U Anderson IN 46016 INSURER A: Westfield Insurance Company 24112 INSURED INSURER B: BerkleyNet Insurance Company Pavement Solutions Inc INSURER C: Philadelphia Insurance Company 1308 Locust St INSURER D: INSURER E: Middletown IN 47356 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2232801406 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 TYPE OF INSURANCE AUUL-bUttit POLICY EFF POLICY EXP INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM!DD/YYYY) LIMITS . X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE ®OCCUR PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 5,000 A TRA5174381 04/02/2022 04/02/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE UMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY EJECT LOC PRODUCTS-COMP/OPAGG $ 2.000,000 OTHER: limit $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) _ X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED TRA5174381 04/02/2022 04/02/2023 BODILY INJURY(Per accident) $ AUTOS ONLY _AUTOS XHIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESSLIAB CLAIMS-MADE TRA5174381 04/02/2022 04/02/2023 AGGREGATE $ 5,000,000 DED RETENTION$ 0 • $ WORKERS COMPENSATION X STa UTE OTH- ER AND EMPLOYERS'LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVE Y� N!A BNUWC116442 04/02/2022 04/02/2023 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT $ Employment Practices Liability Eash Person 1,000,000 C PHSD1741210 10/01/2022 10/01/2023 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Richmond ACCORDANCE WITH THE POLICY PROVISIONS. 50 N 5th Street AUTHORIZED REPRESENTATIVE Richmond IN 47374 ti�G.Ltn• �1 t� .-.t-l' t- I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) - The ACORD name and logo are registered marks of ACORD . ,,,,,,,i_.-„,-„,„ .,,,,,,,..„,p.,.. c„..,,,,., „„?.., _. e v i,tw.. ...„) ;,-;11,:- ..sr „...,,,,,,, s,,,„,. r r1 xaa.�,,. e.. Company ID Number: 459187 Information;Required for the E Verify Program Information relating to your Company: Pavement Solutions Inc Company Name 1308 Locust St Middletown, IN 47356 Company Facility Address Company Alternate Address County or Parish HENRY Employer Identification Number 352131450 North American Industry 811 Classification Systems Code Parent Company Number of Employees , 20 to 99 Number of Sites Verified for 1 Page 14 of 17 E-Verify MOU for Employers I Revision Date 06/01/13