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Home My WebLink AboutBid Bond ~ ~ THE AMERICAN INSTITUTE OF ARCHITECTS AlA Document A310 Bid Bond @COpy ie KNOW ALL MEN BY THESE PRESENTS, THAT WE Mac Construction & Excavatinq, Inc. 1908 Unruh Court, New Albany, IN 47150 as Principal, hereinafter called the Principal, and Safe~o Insurance Company of America Safeco Plaza, Seattle. WA 98185 a corporation duly organized under the laws of the State of WA as Surety, hereinafter called the Surety, are held and firmly bound unto Jeffersonville Sewer Board of the City of Jeffersonville, IN 500 Quartermaster Court, Jeffersonville, IN 47130 as Obligee, hereinafter called the Obligee, in the sum of Five Percent of Amount Bid , Dollars ($ 5% ), for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administ~g!ors,successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for # 07121, Ewinq Lane Pump Station & Force Main Improvements NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with the Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or Contract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt payment of labor and materials furnished in the prosecution thereof, or in the event of the failure of the Principal to enter such Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the Work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. i Signed and sealed this 20th day of January 2009 ~~~~ (Witness) Mac Construction & Excavatin ,Inc. (Principal) (Seal) A (Title) Safeco Insurance Company of America ,,' (Surety) ~'(Seal) ~ l. I'--~ .' .' I f.\--;....---.. ~ \) t., ('-~'11, I n ;i:u-L B : -"'---'^' V\ () 0 ~,,--.J? ' Attorney-In-Fact Pamela S. Canter (Title) AIA DOCUMENT A310 . BID BOND '. AlA. FEBRUARY 1970 ED. . THE AMERICAN INSTITUTE OF ARCHITECTS, 1135 N.Y. AVE., N.W., WASHINGTON, D.C. 20006 POWER OF ATTORNEY Safeco Insurance Company of America General Insurance Company of America Safeco Plaza Seattle, WA 98185 KNOW ALL BY THESE PRESENTS: That SAFECO INSURANCE COMPANY OF AMERICA and GENERAL INSURANCE COMPANY OF AMERICA, each a Washington corporation, does each hereby appoint No. Pamela S. Canter its true and lawful attorney(s}-in-fact, with full authority to . execute on its behalf fidelity and surety bonds or undertakings and other documents of a similar character issLJed in the course of it~ business, and to bind the respective company thereby. Surety Bond Number: Principal: Obligee: Arnount of Bond: Bid Bond Mac Construction & Excavating, Inc. Jeffersonville Sewer Board of the City of Jeffersonville, IN See Bond Form IN WITNESS WHEREOF, SAFECO INSURANCE COMPANY OF AMERICA and GENERAL INSURANCE COMPANY OF AMERICA have each executed and attested these presents this 20th day of January 2009 8.-2 c, ~ Edmund C. Kenealy. Secretary Timothy A. Mikolajewski, Vice President CERTIFICATE Extract from the By-Laws of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA: "Article V, Section 13. - FIDELITY AND SURETY BONDS ... the President, any Vice President, the Secretary, and any Assistant Vice President appointed for that purpose by the officer in charge of surety operations, shall each have authority to appoint individuals as attorneys-in-fact or under other appropriate titles with authority to execute on behalf of the company fidelity and surety bonds and other documents of similar character issued by the compahy in the course of its business... On any instrument making or evidencing such appointment, the signatures may be affixed by facsimile. On any instrument conferring such authority or on any bond or undertaking of the company, the seal, or a facsimile thereof, may be impressed or affixed or in any other manner reproduced; provided, however, that the seal shall not be necessary to the validity of any such instrument or undertaking." Extract from a Resolution of the Board of Dirl'lctors of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA adopted July 28, 1970. "On any.certificate executed by the Secretary or an assistant secretary of the Company setting out, (I) The provisions of Article V, Section 13 of the By-Laws, and (ii) A copy of the power-of-attorney appointment, ~xecuted pursuant thereto, and (iii) Certifying that said power-of-attorney appointnient is in full force and effect, the signature of the certifying officer may be by facsimile, and the seal of the Company may be a facsimile thereof." , I, Edmund C. Kenealy , Secretary of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA, do hereby certify that the foregoing extracts of the By-Laws and of a Resolution of the Board of Directors of these corporations, and of a Power of Attorney issued pursuant thereto, are true and correct, and that both the By-Laws, the Resolution and the Power of Attorney are still in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the facsimile seal of said corporation this 20th day of January 2009 2:~c, I~ Edmund C. Kenealy, Secretary Safeeo@ and the Safeeo logo are registered trademarks of Safe eo Corporation. S-0974/DS 4/05 WEB PDF .,J, 15.0 BID FORMS CONTRACTOR'S BID FORM JEFFERSONVILLE SEWER BOARD CITY OF JEFFERSONVILLE 500 QUARTERMASTER COURT JEFFERSONVILLE, IN 47130 RE: EWING LANE PUMP StATION & FORCE MAIN IMPROVEMENTS JOB NO. 07121 SRF PROJECT NO. WW06121002 Gentlemen: We submit, herewith, our sealed proposal to furnish all necessary labor, material and equipment to construct the above captioned project, in accordance with the subject plans and specifications at the unit prices listed herein. ll\i\t. Co "stC\.,\.C+, ()('\ '\- Ex COvuo.:ti ()5 I Toc.. adU'1ow~ ed5e5 ". Add en ~ ~ '"i - 'J:> e e. '~.:'). I )..00 & , Adc\-eA\~"Y") t!. ;).... -:r Ou\. ~ I ~C() 9 ~~eJ\~ ~ 3- Jo...f'. \s.,?OOq -AdJe-I\d-Ll..-in.- ~ >i - -cr o..t'\. \v \ :too q S:\SYD NEY\WPDOCS\07l07121\SECA2.DOCX A-2G8 ,)J # BID FOR: EWING LANE PUMP STATION & FORCE MAIN IMPROVEMENTS JOB NO. 07121 CITY OF JEFFERSONVILLE CLARK COUNTY, INDl1\NA RESPECTFULLY SUBMITTED, V'1'\AC.Coi'.b-h-u.rA-i Of\ + ~cava:\-t'B:Ii')C . NAME OF FIRM ' ~ ~r--_ ~ PERSON thOvcl m. \M\.uh- ~Pr f}} '\ cl eJ\+ PERSON . . ~~. ATTEST ])cu-- 'en e ~. C ~ch ('CU\ - Se C-f'04 - . u M. ~O I ')..CO q DATE Accepted this day of , 2009 SEWER BOARD CITY OF JEFFERSONVlLLE, INDIANA Mayor Thomas R. Galligan, President William A. Saegesser, P.E., P.L.S., Member Jeffery A. Caldwell, Member S:\SYDNEY\WPDOCS\D7\D7121\SECA2-1.DOGX A-209 EWING LANE PUMP STATION & FORCE MAIN IMPROVEMENTS = ITEl'v~ APPROXIMATE DESCRIPTION WITH UNIT PRICE NO. QUANTITY WRITTEN IN WORDS JOB NO. 07121 UNI~~RICE TOTALAMT. NUMBERS FOR BID ITEM 1 5464 LF 2 1121 LF 3 12 EA 4 7 EA 5 95 LF 6 169 LF ,7 29Q LF 8 1 EA 9 1 EA Per Each Type 'B' Manhol~ .J!v, .. .!: ?!.._ f!?(0(:::B?~.------~!?~- - -.-- : Dollars ._--_._-------_.-----~---_...------.-_..---_..._---------- ~ ~~-- Per Each . $ t 1',(/(,) 10" PVC Force Main W / Joint Restraints . R?!. .. . _ _ 6?!!-:!!:/. ~ B? .~t:!::: - - - - - - - -. - - . - - - - - - Dollars ._-----------_._------~---------_._..--------------------- Per Linear Foot . $ 12ft RCP Storm S'ewer . . R?!. n _ _ _ E'? _ ~ :::. BY. C. ___. --- -' - n:_ . . . Dollars ._____________________~----------------------.--a.----____ Per Linear Foot ' $ Type 'e' Catch Basins . / For -rHt'~elJ HvAJt?aGV ._------------_._-----~-----~----------------------------- Dollars ._--------------------~---_._----------------------------- Per Each $ , Air Release Valves With Manhole .R?!. _~(!:!Y-:.~'-~-~ - - !!':~~~_n -- Dollars .--------------------------------------------------------- Per Each $ 12" PVC Gravity Sewer . R ?!_ _ _ _. _ _~. ~- ~ f.!.!Y. :-~ ~ -.. - -. - - - - - - - -- Dollars ... .. .... ............ .. ........ .......... -;- .. - - - - - - -.. - - - .. - - -.... - ;.... - - - - -.. - - - -.... -.. Per Linear Foot $ 18" PVC Graviti Sewer For o-<./€ l-IvA.JO/ZCl) -{ 5ev.f::-A.I . - -. - - - - -. -. n_' - - -. - -.- - _n__. - -. - - - - - - - - - - - - -- - -D~lli;; .__..__..__....----------~-_..-_..__.._-_.._-------------_..------- Per Linear Foot $ 6" PVC Force M~in With Joint Restraints." For :se-lG;;lUre-ev ~---------------_.._-_.-----_.._----_.._-_..----_.._----_..----- Dollars ~--------------_..---_.-_..--------_.._-_....------------------ Pej.-Sil"'AI~ Y>l~UU~ Ft>~ $ Type 'A' Manhole . . .!:?_r__!:.~~'Y.::-.~?~~- _f&~~--g--.- , Dollars .--------------------------------------------------------- 44- $ Z~/4?D- 4r;- $ ~oI445- ~306 ~ $ 1~t:::>tJO- 4;9 CJ6 - $ 3173tJO - 72..- c.~gtk;- $ /tJ7- $ 1f5/t9~~- 17 - $ 4t9:pcr- $ 5;600- :5;Sa5- $ $ 414a> - S:\Sydney\WPDDCS\07\07121\unit prices A-210 EWING LANE PUMP STATION & FORCE MAIN IMPROVEMENTS ITEM-' NO. APPROXIMATE QUANTITY DESCRIPTION WITH UNIT PRICE WRITTEN IN WORDS JOB NO. 07121 UNI~~RICE TOTALAMT. NUMBERS FOR BID ITEM -10 11 12 13 14 15 16 17 1 1070 16500 1 2 1 1 1 S:\Sydney\WPDOCS\07\07121\unit prices LS TONS SY LS EA EA LS LS Variable Speed Duplex Lift Station, Building, Piping, Electrical, Conduit, Wet Well, Valve Pit, Emergency Pumpout Manhole, Drop Inlet, Reconnect Telementary, Temporary & Permanent Fencing, Handling Existing Flow, Rain Gauge Reloqtion, Pavement at Lift Station Site, Etc. Complete ,~?!._~. tIu.~.1?!?€Q...~J)fJ/E~::::..... ~~c-::... ~9!-!..? ~ ~............... ~~~~s. Per Lump Sum INDOT Surface Asphalt For S/ X7V - ONE: .~._-~-_.__._-------~-[~'~--------------------------------- Dollars ._-----------_._-----------------~-----------------~------ Per Ton Surface Milling ,~?!.........~(.~~:~tf'.~__~~... ~ .--------------------------------------------------------- PcrS~MeY~d $ Connect N ew For~e Main to Existing . Manhole . ~?!..~.. .'12:tr? .'-t.?: ~.9.......... _. Do~s ._----------------------~--------------------------------- Per Lump Sum Manhole Liner Rehabilitation . -, ~ ?!. :~t7ti?-1!(::: .fJ!.~/!~~'c?/!:r;:7J...n.__~ . Dollars .----------.-------.--.-;.--------------------------------- Per Each Gravity Sewer Con:nection to an Existing Manhole ' ,~?!_ _ _ _E/.E.'C~e:./!.. _~ ~f?::::.~....... --. Dollars ._----------------------:-_._------------------------------ .-----------------------;--..---.-------------------------- Per Lump Sum A- 211 $ "334rtJbt> -- $ 'Ss.+/6){){)- $ (9/- Per Each Maintenance of Traffic ,~?!.. ~!J:f!~~. ..T!:!:?Y. ?!:!!-t?._. Dollars .p~~-L~i;s.~...-----------------------_------m-- $ ! 3rooo - $ Decommissioning 'of Existing Lift Station ,~?!. __ _ _~~Y.€~_,.T/j:.?y?_~~_ -. -....... ; Dollars #f5~ $ . 3/CJD{)- $ 'J /100 - $ 1,500-- $ 7,OO(} $ c,,5";:'l.7o- $ . 14/CJ-t.~ - $ 3...600- $ t.;, 'bt)O - $ //5"00- /'3...0-00 -- $ % 000- EWING LANE PUMP STATION & FORCE MAIN IMPROVEMENTS tIT EM" APPROXIMATE DESCRIPTION WITH UNIT PRICE I . NO. QUANTITY WRITTEN IN WORDS , JOB NO. 07121 UNI;~RICE TOTAL AMT. NUMBERS FOR BID ITEM 18 19 20 21 22 23 24 25 26 '27 l 1 LS 1 LS o TONS o CY ,0 CY o TONS o LBS o SY o SY o TONS S:\Sydney\WPDOCS\07\07121\unit prices Flush and Plug EXisting lOti Force Main , . ~ ?~_ _ _. _q ('f~.. _~!(. f:_~!? - - -.. - - - -...- Dollars .--------------------------------------------------------- Per Lump Sum Parking Lot Restobtion For El.-6--V~~ 77-f,of./,A-tJP ...------...-.----...--r..-----.---..---.....---.i)~ii;~; .--------------------------------------------------------- Per Lump Sum ' ' Bank Run Sand For ~Q./6IVT~ .--------------------------------------------------------- Dollars .______________________~-.---------------------o------____ Per Ton $ Formed Concrete' Non-Reinforced . ~ ?!. _ Er!.. ~@:-.. _ ~N_ e ~ p. - - - _ - - - - -.... - -- Dollars 'P~~-c~bi~-y ;~d - '-r'-' --.-. -. .---- -.. - --- --. -.-..- -.. $ Non-Fonned Co:obete Non-Reinforced .~?!___~~_..Ijy~-e~~--.--..--..- Dollars .-----------------------------------------------------~--- Per Cubic Yard , $ Dense Grade Aggregate Type P (I.D.O.H. Specs) , For S€VrEMrE:"CN .----------..---------------------------------------------- Dollars .......... .... .. .. ........... .. ..., .... -.- -''' ...:.. .. ................. .. ....... ..... ................... ............ ... .......... '" .. ... Per Tons $ Reinforcing Steel . ,. ' .~?!_ __f!.I:!.._~. _. P~~. _Er:!:t-._~ , . Dollars .----------------------'.---------------------------------- Per Pounds Sod For AVtE: ._----~_..._._--------_.~-------------_._----------_._------ Dollars ...-------------------------------------------------------- , , Per Square Yard $ Seed Fertilizer an4 Mulching ... For 5d/G~7t/-l7l/tE eev6 .__________.__________~:-t--------...----------..------------ ~s ._--~-----------------~-----------------------_.._--------- Per Square Yard $ Crushed Limesto*e (Misc. Sizes) For -oc31 e~-rec:-V ._------------~-------~-------------_._---.---------------- $ It 000 II'" Ocx:J--- $ $ /Irooo- $ /1"oi5()- 17- $ o 400- $ o "3ot)' o $ 17- $ o $ I, -50 e $ s- $ o ,75 $ t) .P~~.T;~..---........-...um.---m.mm.-:Q?~~~s. $ 17 - $ () Total Total Bid Items 1 thru 27 = :/I ca.~ 7) 45'5 ~ A-212 Bid of - YY\f\C -CO(\~+f'u.(' 1-1 en ~ Contractor t.x G-o.-v~ tl "8 \-::Ii'''C _ t J, MAC Construction & Excavating, Inc. Ewing Lane Pump Station and Force Main Improvements MBE/WBE Participation Listing Company Items Amount 47-+0 Mp'SO "-I 1> (~71t-1~ \171 0 ,.,j - M f3 t::.. . IV/V1ISJ../. pCNvtp.s k7J t> CA--s f/ v,,~ .$ c,l/SO{) - ~ (/I'viM G"7l.S- , ~-::> I U t, ~ e::~L ee- " WB-tz::...t- ~/ ~t:, ~ 1/eoo- fE;;uce:. /tf..; D -rervrp. FE::1..lc&- ~ cl0/'S ?~Pt?'?>/" i.) /r'(., FE:uce CGJ. " W'8e" A 7 A 6A-vU cuH' ^' t::t l W P;::-e ( Sku; cull-I t.I t1 r( 4,495- ~bJ~ c:.o~~ , WP;E:,. cv1Z5 ~ 7;C,{4 - /4;AJlJle wH-rrm~-7rwauuh .. W17E- --r72.-LLCLY u t,- 1t Zt,rOCJO- ~'Tk1.. \il??E l- t 51 I '151- ~ 7. ; ~ ! (p.1-~1 ..,--oTKt- Nt ~ t= - e:. t t/I? 00- 1 J U.S. ENVIRONMENTAL PROTECTION AGENCY CERTIFICATION OF NONSEGREGATED FACILITIES (Applicable to federally assisted construction contracts and related subcontracts exceeding $10,000 which are not exempt from the Equal Qpportunity clause.) > The federally assisted construction contractor certifies that he does not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The federally assisted construction contractor certifies further that he will not maintain or provide for his employees any segregated facilities at any of his establishments, and that he will not permit his employees to perform their services at any location, under his control, where segregated facilities are maip.tained. The federally assisted construction contractor agrees that a breach of this certification is ~ violation of the Equal Opportunity clause in this contract. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, restrooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive Qr are hi fact segregated on the basis of race, creed, color, or nation origin, because of habit, local custom, or otherwise. The federally assisted construction contractor agrees that (except where he has obtained identical certifications from proposed subcontractors for specific time periods) he will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause, and that he will retain such certification in his files. c~ ~,-- ~ JAN. 20, -2009 Signature Date CHAD M. UNRUH - VICE PRESIDENT Name and Title of Signer (Please type) MM~ C':1N~TRnc.'T'r.:)N & F.xCA VATTNG . me. Firm Name . NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001. OEE-1 (11/79) D-119 J NOTICE TO LABOR UNIONS OR OTHER ORGANIZATIONS OF WORKERS NONDISCRIMINATION IN EMPLOYMENT TO: JEFFERSONVILLE SEWER BOARD OF THE CITY OF JEFFERS:JNVILLE, IN (Name of union or organization of workers) The undersigned currently holds contract(s) with MAC aJNSTRUCTION & EXCAVATING, INC. . (Name of Applicant) , involving funds or credit of the U.S. Government or (a) subcontract(s) with a prime contractor holding such contract(s). You are advised that under the provisions of the above contract( s) or subcontract( s) and in . accordance with Executive Order 11246, as amended, dated September 24, 1965, as amended, the . undersigned is obliged not to discriminate against any employee or applicant for employment because ofrace, color, creed, or national origin. This obligation not to discriminate in employment includes, but is not limited to, the foHowing: HIRING, PLACEMENT, UPGRADING, TRANSFER, OR DEMOTION, RECRUITMENT, ADVERTISING, OR SOLICITATION FOR EMPLOYMENT, TRAINING DURING EMPLOYMENT, RATES OF PAY OR OTHER FORMS OF COMPENSATION, SELECTION FOR TRAINING INCLUDING APPRENTICESHIP, LAYOFF OR TERMINATION. This notice is furnished you pursuant to the provisions ofthe above contract(s) or subcontract(s) and Executive Order 11246, as amended. Copies of this notice will be posed by the undersigned in conspicuous places available to employees or applicants for employment. {"7c::::::' ~ ~ (Contractor or Subcontractor) CHAD M. UNRUH - VICE PRESIDENT ~ JAN. 20, 2009 (Date) OEE-2 (11/79) D-120 ,~ ~ United States Environmental Protection Agency Washington, DC 20460 Certification Regarding Debarment, Suspension, and Other Responsibility Matters The prospective participant certifies to the best of its knowledge and belief that it and its principals: (a) Are not presently debarred, suspended, proposed for debannent, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (b)' Have not within a three-year period preceding this proposal been convicted of or had a civil judgement rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting.to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and (d) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default. I understand that a false statement of this certification may be grounds for rejection of . . this"proposal or termination ofllie award. In addition, under 18 use Sec. 1001, a false statement may result in a fine of up to $10,000 or imprisonment for up to 5 years, or both. CHAD M. UNRUH - VICE PRESIDENT Typed Name & Title of Authorized Representative (?~ ~~ ~ Signature of Authorized Representative .TAN _ ?O. ?OOC) Date MAC . c::NSTRUCTI:N & ~CAVATING, INC. o I am lLTlable to certify the above statements. My explanation is attached. EP A Form 5700-49 (11 :-88) D-122 ~ CJ Z C ~ H <; .., . .., u IJ) .. e -0 f-' C " Z 0 $ () (f) H ~ ~. f-- ~ U :> w ~ """") 0 CJ 0 "" :x: 0::: "" f.t:I 0 N ~ 1.0 0... IJ) u.. c<:I .-i .., 0::: (f) 'S; 0 r;-.. LL IJ) Z E-i o;;j< 0 ~ 0 es. 0 0 0:: LL 0::: 0 c1 co H :::> Z CD 0 0 OJ E-i 0 H Z U U S " E :::> .. ~ <; 0:: =c: :>I U u.. E-i :::> Z Cf.l 0:: ~ -l Z Z CO !D - c c-l <V 0 :::> ...:l ::J ..x::: U ~ 0... 2 co b c u 0 ~ "'0 .f! ~ 0\ r::l ~ ~ U E: .-i Z u: <( Ii J Prescribed by State Board of Accounts Form No. 96 (Revised 2000) CONT'RACTORS BID FOR PUBLIC WORK PART I (To be completed for all bids) (Please type or print) Date: <I{1,t\. d.O) ;;..ooq 1. Governmental Unit CO. wner):.ili.f.f~"MI ~ \ \ ~ Se J+' (> I' 13<'l/':l td of of h e. . (l \ L j . \1-iJ 0 cr e.fE€J'~u' \\e .:r:t0 2. County. L.JtlJ./"-b J 3. Bidder (Firm): MAC CONSTRUCTION & EXCAVATING I INC. Address: 1908 UNRUH COURT City/State: NEW ALBANY I INDIANA 47150 4. Telephone Number. (812) 941-7895 5; Agent of Bidder (if applicable): n/A I Pursuant to notices gIven, the undersigned offers to furnish labor and/or material necessary to complete the public works project of fr..Dt-r I~ 1- ? w, () Q. W (? f> (.Uy"\p S-t~ -l,D () ~ FD f'Ce./na If) TIY\Dr-()u~S (Governmental Unit) in accordance witFl pla\is and specifications prepared by {j a.. c ob, '\ 0 n (Y"\b ~ q.. Ll1.C\ Z- and dated f\ 0 lJ . 1, tor ~()O -g for the sum of , t C?/ "I-fr lioN f),.-t.e1:; -nh f1::7t(- S BJ eu --n-;., l/~D $ 73 '3 ~ 4-L? 7;> - R>c/l'l-- rt-vNn'f7,::r--Y) FIPnf-~ Vd~~ No eedr:. . The undersigned further agrees to furnish a bond 9r certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the unoersigned submits a proposal for each in accordance with the notice. Any addendums attached will be specifiC<:illy 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 p separate attachment . The Contractor and his subcontractors, jf any, shaI! 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 empioyment 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 Uni\ed States. LC, 5-16-8-2. I hereby certify that I arId a/l subcontractors employed by me for this project will llse U.S. steel products on this project if awarded. [ understand that violations hereunder may result in forfeiture of contractual payments. 'AI, ) ACCEPTANCE The above bid is accepted this l'€:> '"" day of d-v~ 2DcA ,subject to the following conditions: ~ Contracting Authority Members: ~oa.:u~~R.. ~lA~ I Pe&s. -' W'.ll,~Nv a. ~-es~(~B.~ ~ L.. OQ56M \ tv.A:1M,e:az PART II (Complete sections I, II, III, and IV for all state and local public works projects as required by statutes if project is one hundred thousand dollars ($100,OOO) or more. (IC 36-1-12-4) Governmental Unit <I ".('fer5o'\<I, \ Ie. 5/"-l, '''8-~~ ~e ~f Bidder (Firm) MAC CONSTRUCTION & EX AVA lNG, INC. Date: <::fM,.;tO I ~q 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? . When Contract Amount Class of Work Completed Name and Address of Owner SEE ATTACF. ED -A 2, What public works projects are now in process of construction by your organization? Contract Amount When to be Com leted Name and Address of Owner " 3. Have you ever failed to complete any work awarded to you? . NO If so, where and why? 4. List referenced from private firms for which you have performed work. PRESNELL ASSOCIATES, 717. W. MAIN STREET, LOUISVILLE, KY 40202 KOETTER CONSTRUCTION, 7393 PETE ANDRES ROAD, FLOYD KNOBS, IN 47119 PINNACLE PROPERTIES, P.O. BOX 43957, LOUISVILLE, KX 49253 SECTION I) 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, completed the project, number of workers, etc. and any other information which you believe would enable the governmental unit to consider your bid.) Mo13I'-/~ _ ~tt:-C6 MktAJ jJl{Jc:- kteJ./'s, - ~jJrj>e: ~/) S~- IVNjJ .f'~Q^/ _ ~ <./~- 'V.t'v-en:r ~<v~ - ~.If<I$$~u.--r ~v~ S~_ MIU--t'IV~- ~,4~ - ~rg~l1~ - @A-~C-.eo S~UC-<r-t7J '&::f S~~ ~tf.,.. 70 J~ 2. 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 expect to require a bond. However, if you are unable to currently provide a listing, please understand a listing 'must be provided prior to contract approval. .A-. ~... .A.. - ~~~ ^ -l3 'S€ jJ;'(!;; V /(.) ev ~ (.,NC/tC- 7'lJ CoIf...J'777Aer r'[ ~.....-.) . -:See t;!3:NCU7St"D M8€ /W~e: fA s riA..l t, . 3. VVhat equipment do you have available to upe for the proposed project? Any equipment to be used by subcontractors may also be required to be listed by the governmental unit. SEE ATTACHED - c... 4. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? Otherwise, please explain the rationale used which would corroborate the prices listed. YES tc " SEGTfON III CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitte9 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. SEE ATTACHED -)) SECTION IV OATH AND AFFIRMATION I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct to the best of my knowledge and belief. . . I Dated at NEW ALBANY, IN this ~Dth day of cr (l.{) . ,J.ooq MAC CONSTRUCTION & EXCAVATING, INC. (Name of Organization) By ~ ~----. ~ thad ~Lt.f)tu.h- VI6€-. Pr-e.5 idm1 (Title of Person Signing) ACKNOWLEDGEMENT STATE OF -:rndiQJ\Q COUNTY OF F\ Q~ d... Cha d. tnJlAruh \h Le.. ~r e-.b I Oef\ t (Title) ) ) L being duly swom, deposes and says that he is mtheabove MAC CONSTRUCTION & EXCAVATING, INC. (Name of Organization) and that the answers to the questions in the foregoing questionnaires and all statements therein contained are day of ~Otl. . iItil_. (4A \p~;~plffi'- My Commission Expires: f\l>V . ;SO 'JO\3 I . ~\O~.A County of Residence: 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 persops, 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. OATH AND AFF!RMA TION r affirm under the penalties of perjury that the foregoing facts and information are true and correct to the best of my knowledge and belief. Dated at NEW ALBANY, IN this ~oth day of "C\/lJ\ . , J-Doq By MAC CONSTRUCTION & EXCAVATING, INC. (Name of Organization) ~...~~ r- ~ rMd.yn. t\nf'-u.h- V~ Ce. P\~<)(deJ\+ . (Title of Person Signing) . ACKNOWLEDGEMENT I STATE OF T(\(\~ aJ)C) ) . . -l"L ..A ~ COUNTYOF~ SS: ----C.hoA rn. Un\'Ll~ ~\ t--e. ~\&~iden-1 (Title) being duly sworn, deposes and says that he is fth b MAC CONSTRUCTION & EXCAVATING, o e a ove (Name of Organization) INC. and that the statements contained in the foregoing bid, certification and affidavit are true and correct. Subscribed and sworn to before me this :lcrth day of U{1(). ,J1>oq qu)A'DQ.~~ ..... . Notary u lic. My Comm ission ExPiresj\ 0 LJ. "3 (0 ,:lO 13 County of Residence: ~ ) 0 ~ d. .; Submitted by { ACt . . MAC CONSTRUCTION & EXCAVATING, INC. orpora 10 '. .. '......,.. m ...., ......... m'......... ... ................ ...........,.......+ .............. ..,............ ....... ......... ..........................:.. ..... ...m.......... A C 0- partners 1 . An Individual Principal Office at 1908 UNRUH COURT ...................................................................................................................................................................................................................................................................-............................................__...................;............................... .mm.m.m... .m. . NEW ALBANY, IN 47150 . . .. ... u....._............................................................................_..........................................................................................................................................................................._............................................................_...;;_~.................__._.........._......_..... . . EXPERIENCE QUESTIONNAIRE The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers tl interrogatories hereinafter made. 1. How many years has your organization been in business as a general contractor under your present business name 25 YEARS 2. H~-;:.~~y..y~;:;;.~~p~~i.~~~~..i~.~~~~t~~ti~~.:;~;k.h~~.y~~~..~;.g~~i~~ti~~~h~d..(~Y";~..~..g~~~~~f~.~~t;~~t;;;..~~~i'(f as a subcontractor? 25 YEARS 3. What projects has y~~~..~;.g~~i~~ti~;;:.~.~~pl~t~d?....sEE....iTTAcH'ii:"ij......:..'A...................................,..............................m.........,.... ,~.~_.........._-.......................................................................................................'!..............,.............................................................................. ,. CONTRACT AMOUNT CLASS OF WORK WHEN COMPLETED NAME AND ADDRESS OF OWNER ................................................................n............................. .................................................................................................... ............................................................................................. .....................................-........................................................ ........n..............................................u......_...._.......................... .................................................................................... ................................................................................ ......................................................................................... , 3::> What projects does your organization now have in process of construction? CONTRACT AMOUNT CLASS OF WORK WHEN COMPLETED NAME AND ADDRESS OF OWNER SEE ATTACHED - B .................................................................................... ............ ............................................................................................... ......................................................................................... ................................................................................. ............................................................................................... ..........................................................................................'..... ..................................................................................................... .................................................................................................. 4. Have you ever failed to complete any work awarded to you? If so, where and why. NO .............................................-........................................................................................................................................................................................................................................................................................................................................................... .........................................~.................................................................................................................................................-...........................~................................................................-............................................................................................................... 5. H~;..~.~.y..;ffi~~;..~~..p.;rt.~~.;.~f.y;.~.;.~.;g;;;i~~ti'~.~..~;~~.b~~.~.~..~ffi~~.;.~~.p~~~~..;f.;.~~~.~th~;..~~.g~~i~~ti~~.th~ failed to complete a construction contract? If so, state name of individual, other organization and reason therefor NO ... .............. ............... ... ...._......... ................. .... ....................... .......... ..................... ......... ............ ....... ........ ~~..... ............ "'l" .................. ............. u .......... ........ ...................... ........ ....... ......... .... ......... ..... ............. ...........-. ... .................... ............. ..... , . 6. H;;.~y.~ffi~.~.;.~;.p.;:rt~~;.~'{y~~;.;;g~i'~~ti~;;:.~~~;.f~il~~ft~..~~~pi~t~..;.~~~~t~~ti.~~..~;.~t~~~t..h~~d'i~~fi;;..hi~7h~ own name? If so, state name of individual, name of owner and reason therefor. J~Q................___..........................................m............:......................................................................................................m...................................................... 7 . I~.;h;t.~th~~.li~~~..~:{b~~i~~~~..;;~.y~~.fi~~~~i~fiy.i~t~;~;t~.d?...................................................m...................................................... NONE. ....................................................................................................................................................................j.................."..................................................................................................................................."..~.................................-..................-................. ..............~.......................... ..... ................................................................,..........................................~........................................................_................,........,..,.................... .......................................... ......~.................................................... .._~ 8. For what corporations or individuals have you performed work, and to whom do you refer? · ..~.~.~.~..J.~}?'.~.. 4 OF PART II FORM 96 ~ .........................................................................~..~........................,...................,.............................,....................................................,.............................................................................................................. ................................... ..............................................................................................................................................................................-:......................................................................................................................................................................................._......04................_.............................. . - , ' ........................................-........................................................................................................................................-....................................................................-............................................................................................................................................................... 9 . F;~.;h~t--~rti.~;.h~;~.y~~..p;~f~.;~;~1";;~k.~.d.t~.;h~~.d~--y;~.;~f~.;?........................................................................................ CITY OF NEW ALBANY, INDIANA ................................................................................................................................-..-....................................;0.........................................................................................................................................................................................................................:...... CITY OF LOUISVILLE, KENTUCKY ................................................................,..................................................................................................................:..~.............................................................................................................................................................. ................................................. TOWN OF CLARKSVILLE, INDIANA ......................................-.......................................~........................................................................................................................................................................................................................................................................................................ 10. F~~.;h~t..~~~~ti.~;.h~;~.y;~.p~a~;~~~f";~;k.~~lt~.;h.~;:.d~..y;~..~.~f~;?..,.............................................................................. ..f..~.9.X!?....9.9..1!.~~X.!.....!.~.!?.J.~~A............................................................................................................................................................................. CLARK COUNTY, INDIANA . ............................................................................................................................................................................................................................................................................................................................................................................................................... , . .~.?.f..F..~R$.QN....C.QJJ.J;iJ.T.Y.L...,KENT.u.C.KY..................,.......................................................................................................................................... .........................................................................................................................................................................................................................................................................-................................................................................................ 11. F~~.;h~t..St~t~..b~~~~~~..;~..d~p.~;~;~;;:t~..h~;~.y~~.p;;f;.;~~d";;~k.~~~Ttb.;h~~..d~.y~~.~.~f~.;?........................n.......... I;J:il}J.!.AN~...P..~.:p.AJ~:A~M:.~.~.'1'....QF....TRAN.S.l?QRTA~.I.ON...................n.................................;........................................................................ :~#.~.?;.!!.s:~~....l?~.~.!\:~~~.~.~~...~.f....~gA.~.~.?.Qg~~J.JgN........................................................................................................................... INDIANA DEPARTMENT OF ADMINISTRATION . .....................................................................................................................................~................................................................................,~................................................................................0:........................... ....................................................... }}~P..!.~.~.~.. .?9..:g.7.'.. .J~9.Nm:.l ~.f?J..QN......... ........ .......... ............... ....... .... ....................... ..................................... ....... ....... ,...,...............,................. .., 12. H~;~..y~.~..~;~;.p~;f;;~~d..~~y..;:~.~I.f~;.th~..U~'S:..G~~;~;;~~;;:trIf"~~:\;"i~;;;.~d.t~";h;~"d;.y~~.;~f~;?"'''''''..'''.'' U.S. ARMY CORPS OF ENGINEERS ............................................................................................................................................................................................................................................................................................................................................................................................ . .................................-......................................................................................................................~....................................................................................,................................................................................................................................ ....................................................-...........................................................................~............................................................................................................................................................................................................................................................. ...................................................................................................................................................................;................................................................................................................................................................................................................................ 13. wh~t..i;.th~.~.~~~t~~tib;;:.~~...~~i.~~~~..;f"th~....;i~~i...~ri;;di;id~.~i~.~r..~.~~..~.;..~i~~ti.~~?....................................................... INDIVIDUALS PRESENT YEARS OF MAGNITUDE AND IN WHAT NAME POSITION OR CONSTRUCTION TYPE OF WORK CAPACITY OFFICE EXPERIENCE .......................................-........................................ ..................................................................................... ...................~...................................................... .....................,....................................................... ............................................................................... .... ......::..~.~.m~~~~.~.~.~~.. ~~!?p..~.~.~....=....~.............. ..........__..................................... ..,........................................--.... .m.................__......................... ....-...-..........................................-...........:............... ............................................................................. ............................................................................. ....'.............................~......................................... ............................................................................. . . . . ...;.........~......................................._........................... ........................................................................... ........................................................................... ................................................................................... .......................................................................... ....--_................................................ .......................... ...................................-........................................... .................:................................................................. ............................~....-............................................. ................................................................................. ............................................ .........................-... ......................................................................... ...................................................................~..... ......................~.............................."........................ ............_.................~................................-.......... ................................................................................ ........................................................................ ........................................................................... .............................................................................. ..........................-........................................................ .......................................................................... .........................................................-...................... .......................................................................... ..................................... ........ ......................................... ..................................~.............._......................... ...................................................................... .............................................................................. ................................................................................. ............................................................................. .......................................-:......................................... PLAN AND EQUIPMENT QUESTIONNAIRE -< The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers t interrogatories hereinafter made. i. In what manner have you inspected this proposed work? Explain in detail. .....RJ;;.1CI;.E..W.B.P.....P..tA~S.....~L..S.p.E..c.I)n;;.c..8..T.IQ~S.................... . . V I SIT TO PROPOS ED SITE'" ..............................................................................,.................................... ............_--~---_._....._-_............_-_..-............__..................................."'......................................................'!........................................................................................................................;..........:.....................'............................................................................................. ..................................-.~..........._.....................................-...............................................................................'!............~................_........................................................-................~..............................-...........................-..........._.............~............. ............~............ ................................................................:......................_..................~"':...............................~..................................;................................;............................................................................................... 2. E.~pi~i~.y~~;.pi~~..;.;T~y~~t.f;.;.p~d;;~~g.th~.p~~p;~~.d..;~.~k.:..................................................................................................... :::::::::::::::::::::~~:::::::::lP~::::::::5!~::::::A?~:::j~:::~:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::-::::: :::::::::::::::~::::~~,f.jk:0!::::::::55.~!?2{!'~::::::7P:::::~:::5ii.~~:::T~~:::~:::::;?~E::::::::::. ................................... ................................................................................................................;.-..........-..... .........................................................~...................................................................................................................... .................................................................................................................................................,......................."!-....................................................................-..................................................................................................... ....................,..................u.................................................................................................................,...........................................................................................................................................................................................-...................... ...........u...........................................................................................................................................-................................................................................................................................................................................................. ................................................................................~....................~....-.....~~...........................~...~......,.............................~.............................................................~.....~................~.............~............................................................ .....~..............................._......................................................................................................................:.......................................................~.................................................................................................................................................. .............................................................................................................................................................................................................................................................................................................................:..........................-.............. ....................-....................................................................................................................................................................................................................................................................................................................................;......................... ..........................................................................~.............................................................~...............-........................................................................... ...............................~......................,..................................................................... , ......................;.......................................~.................~.....................~...................................~............................~..................................................................................................................................................................................................., .' The wQrk, if awarded to you, will have the personal supervision. of whom? .....Y.J;~~9..R...Q.~....P..N.R!J.J.t..................m....................................................................................................................................................................... ..,. . . . 4. ;;<...i)~.y;~.i~t~.;d"t~..d;.th~..h~~li.~g.;;;:.th~..p.;~p~~~~r;~;k':;ith..y~~..~;~.f~;~~~?..I{;.~.:.gi;~.~~~~~t.~d..tYP~"~ equipment to be used. .....................Y..~::::......~f!.~(.&.~...~~~..................:......................................................................................m.................... 5. ;~...rry~~.i~t~;;:d.t~..;~b'i~t.th~.h~~li~;..g.~~.p~a;.;~.it.th~;.~gh.~.;.g~~t.:.~t;t~..~~~;t..~f.~~b~.~~t;~~t.;.;.~g~;t..~~~t;~~ and, if known, the name and address of subcontractor or agent, amount and type of his equipment, and financi" responsib~ 0Jtf7Z.-T//tt...- . ~A.I';VIe: Wlh~~;u ~ :=:::::::::::::::~...::.....::::::::::.:::::::::::::::::::::::::::::~~{c.:::w:ZZ~;.:::z.;r.:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: .................. .............................................~...............................................................................................................~..................................................................................................~................................................... .............~... 6. ;;<..."I)~.y;~.i~t~~d"t~.d~.th~..g;~di~g.~~..th~.p;~p;.;~X.;;;k..;ith.y~~.;.~;;-.f;.;.~~~r........._.......................n......................._... .....;(.E.S.. ........ ............ ..... ..... ............ .... ..... ...m...... ................... ........ ... ..... ........................ ....... ........ .... ................. ..... .m.. .m........ ..... .......... ............. .................. ...u.......~................................._....-...................................................................................................,.....................................................................................................................................................................................~..-....... ...........................-.......................................~.......................................................................~..................:..~..,............................................................................................................~..................~................................................................... ............................................-..;....................................................................................................................~...............................~................................~..................................................................................-............................... . .... .. ......... .................................................................................................................................................,........................................................... .... .i~~,;;;.4:.5:.6.~d 7.~~:;:;;~~.b~ .~ppi;~;,:bi~.;~ 'Ji bci"tdi~.g.~Z~t;,:~~s:. If ndt, omit. .. ,'" If you intend to sublet the grading or perform it through an agent, state amount of subcontract or agent'; contract and, if known, the name and address of subcontractor or agent, amount and type of his equipment ane financial responsibility. . .......Ji!"j.~..............................................m.......m..................................................................................................................................................................... 7. .......................................................................................................................................................................................~.....................................................................................................................................................................................-..................................................:............., ...........................................u................................................................................................................................................................................_..............................................................................................................................................................~.......................... 8. D~.y;~..i;;:t~;~it~.~~bi;t..~~y.~ti~~~.p;rti;~;.;{th~.;~;k?...i{;;:.~t~t~..~~;~~t..~T~~b~~~t~~~t..~~.d~..iTk~.;;~~..th; name and address of the subcontractor, amount and type of his equipment and flllancial responsibility. .........S..E.E....f:QRM....~.Q..............,..........................................................................................................,............................................................................. ..._........._.._.............................-....__............~..............................................-.................................................................................................................................................................................................................................................. ..............................................................................................................................................--................................................................................................................_......................_........................................~.......-..._.......................................... ...................................................................................................................................................................,........................................................................................................................................................................................................ 9. - From which subcontractors or agents do you expect to require a bond? NONE ...............................................................................................................................................................................................................................................................................................................,..............,.......................................................................... .........................";.....................................................................................................................................................,'............................................................................................................,...............................................................";.................................................. ...-............................................... .......................................................................~.................................................1.................................................................................................. .....";................................ .......... ..............................~....................~........ 10. Wh;t..~q~i~.~~~~.d;..~;~..;;:;..th";t..i~..~~;ii~bi~.f;~.th~..~;~;;.~.~d..::;;;.~k~........................................................................................... DESCRTI?TION, SIZE, CAPACITY, CONDITION ETC. QUANTITY ITEM YEARS OF SERVICE PRESENT LOCATION .................................................................................................................................. ..................................................................... ........................................................... .............................................................. ............................................................ ... ....... .......~~:~....~:~! .~.~~ ?....::...c.. .......... ................................... ..... .... ..... ........ ............. .............. .......... ...................... ........ .... ...... ..... ........ .................. . ........ .............. ............................ ..................................... .... ..................... ..................................................................... .... ........... ........... ............. ..... ........................ ..... ............. ..... .............. ................................ ........... ....~.......... .......~.... .....~.... ...........~... ..................................................................... ........................................ ...................... ............................................~.......................... ........................................ ....................... .................................................................. .......................................................... ..... .... ........................................_.....~......... ...............~............................................ .............~..................................................... ...................................................................... .............................................................. .................................................................. ..................................................................... ............................................................. ".....................~................................................. ............................................~..................... .............................................................. .................... ........................................ ..................................................................... .................................................................... .............................................................................. .................................................................. ................................................................... ............................................................... .................................u............................ ................................................................. ....................................................................... .............................................................. .............................................................. .....................................~.................... ...................................................................... ................................................................. .............................................................................. ...-......................................... ................~... .,................................................................... .................................................................. ............................................................... ............................................................ ............. .....................................~..................... ............................................................. ..................................................................... ..................................................... .... ...............................................................-...... .......................................................... ........... ......................................................................... ..................................................................... ................................... ................................. ...................................................~........... ................................................................................................................................... ............................................................................. ..................................................................................................................................... .................................................................. . ... ..................... ......... ....... .......... .., ........ .................,....... ...................... .... ...........1........... ...... ...... ..... ... ..........1................... ......... ...... ......,..... ..... ..... ........... ........ ....... ou intend to urchase for use on the ro osed work, should the contract be awarded to ou APPROXTh1A TE COST DESCRIPTION, SIZE CAPACITY, ETC. QUANTITY ITEM NONE ... ... .................................. ................ ..............................................................-.......... ........._~......__.......... .......--.................................................................................................................................. ................................-.... .................................................................... ............................................,........... ................................................................... .............................................._.....................u...............,.............................................................................................. ..........;................................................... .............................................,............... ..........~............~..~........"................... ....."..............................""...................................................................................................'........... ..............,;....~......... ............................................................. ....................................................... ................................................................. .............~........................................................................................................"....................~................................................. ..:...........;................................................. ........................................................... ..................................~....................................... .......................................................~.............................................................................................~................................................... .........................................~.................... .....-................................................. ............................".."............................... ...............................................~..........................................................................."................................................................. ...............:""............................................... ........... ...................................................... ................................................................ ............~.................................... ..................................................."............................................................................... ............................................. ........ ... 12. How and when will you pay for the equipment purchased? N/A .............................................u.....................................................................................................................~.......".............................................................................................;,..................................................................................;..................................... . 13. D~.y~~.p;~p.~~~..t~..;~;:t.~;:y.~q~ip~~~t..f~~..thi~'.;~.;kY.if";;-;..~t~t~.typ~~..q~.~;titY..~;:~(;~~;~;.f~.~..;~;:ti;g~............... ............~€...7P......~~:c...~@0?r.....~~~.....~~................................................................................................ ..................................".. .................................~....~....................."...............................................~.................................................................................................................................................................................................................. .................. .....................................-.. ....._....-................................................................~................................. .............:..............................................................................................................................................................................-...................................................... 14. H~~~..y;~..~~d~..~~.;t;~~t~..~;.;~~~i:;:~d.fi;~..;"ff~~;.f~.;.;ir~;t~;i~i~..;ithi;.p;i~~~.rt~~d.i~.p;~p~~i;.g.y;~;.p;;-p.;~;;]; Do not give names of dealers or mamrlacturers. YES .............................................................................................................................................................................................................."..........................................................................'............................................................................................... ............................................................................................................................................................................................................................................................................................................................................................................................... Dated at ..c\ew.f:\tb.o.J.\l.j...\~~...............this...............;;lQ1.~...................... day 0 f .............~M...................................... 20..0.9........... MAC CONSTRUCTION & EXCAVATING, INC. ......... .... ......... ................... ...... '(N~;;':~ .;fo;g;,:,;.i;;;~i;.~i" ...................... ................ ........ B .C~ ~ ~ y........ ................................. ...... .......... .... ...... ........ ..................... ................. ....... ......CJ1.~.m..~.Llot.:ub.:::..V.i..C:e.Pf.e.6.i.d.eDt........... (Title of Person Signing) STATE OF .....~&LaoQ..................... ) ) SS: COUNTY OF............E}'O..l~.......................) ............,....Ch.o..a...m:...UDt.y,-:h.........................................................being duly sworn, deposes and says th.at he isa me-:nber oj MAC CONSTRUCTION & EXCA VATING, INC. and that the answers to the questIOns m the foregomg ........... .... ..... ............. ........ ..... ...~~;;,-.;.;f.o;g;,;j;;;;i~;). .......... .......... ...... . .... ................ . questionnaire and aU statements therein contained are true and correct. _ . ~ 'scribed and sworn to me this...................2Q.~.......................day of ..............!J...M..!....................................,.20 ....0.9......................... 1-.-.1 commission expires ......f\D:~.t.....3..Q.+~"OJ..~.................. ~cao.&~ NOTARY .~ ~ Contractor's Financial Statement Submitted by MAC CONSTRUCTION AND EXCAVATING, INC. { !iI A Corporation o A Co-Partnership o An Individual with J2!1oc~ office at 1908 UNRUH cou~ NEW ". LBIINY ~ :N 47150 To lJe ef'&)(\u', \\~ 5el,de5' 'B t'-l\ ,o.f3he. . -ti Df 'J".e.f:f~ I'M{)oi \\e} IA.J Condition at close of business SEE ATTACHMENT - 20 ASSETS. I Dollars Cts. 1. Cash: (a) On hand $ , (b) In bank $ , (c) Elsewhere $ - --- _n ---- n_ ---- ---- ---- ------ 2. Notes receivable: (a) Due within 90 days -- -- --- - --- ---- ---- --- ---- ------ (b) Due after 90 days - --- -- -- _u ---- -- -- --- ---- ------ (c) Past due -- --- -- -- ---- -- --- ----- 3. Accounts payable from completed contracts, exclusive of claims not approved for payment - --- -- -- --- ---- - --- --- ---- ------ 4. Sums earned on uncompleted contracts as shown by engineer's or architect's estimate: ---- ---- - -- - --- ---- --- --- - ------ (a) Amount receivable from deducting retainage -- -- - --- n_ ---- ---- -- - --- - ------ (b) Retainage to date, due upon completi9n of contracts ---- -- -- n_ --- - -- -- --- ---- ------ 5. Accounts receivable from sources other than construction contracts ---- ---- n_ ---- ---- --- ---- ------ 6. Deposits for bids or other guarantees: (a) Recoverable within 90 days -- -- -- -- _u ---- ---- --- --- - ------ (b) Recoverable after 90 days ---- -- -- --- ---- -- -- -- - ---- ------ 7. Interestaccrued on loans,. securities, etc. ---- -- -- n_ ---- -- -- -- - --- - ------ 8. Real estate: (a) Used for business purposes - --- - --- _n -- -- ---- -- - --- - - -- - -- (b) Not used for business purposes ---- ---- _n ---- ---- --- ---- ------ 9. Stocks and bonds: (a) Listed - present market value - --- -- -- --- -- -- ---- --- - --- ------ (b) Unlisted - present value - --- - --- --- ---- ---- --- ---- ------ 10. Materials in' stock not included in Item 4: --- - - --- h_ - -- ---- --- --- - ------ (a) For uncompleted contracts (present value) - --- ---- h_ ---- ---- h_ --- - ------ (b) Other materials (present value) - --- - --- _h - --- ---- -- - ---- ------ 11. Equipment, book value ---- ---- n_ ---- - --- h_ -- -- ------ 12. Furniture and fixtures, book value - --- ---- --- ---- ---- -- - --- - ------ 13. Other assets n_ ---- --- - ---- ---- h_ ---- ------ Total assets --- - ---- _h - --- - --- h_ ---- ------ LIABILITIES - --- - --- _h -- -- -- - ---- ------ 1. Notes receivable: (a) To banks - regular (b) To banks for certified checks ---- - --- _n ---- - --- -- - --- - ------ ---- ---- n_ ---- ---- n_ - --- ------ (c) To others for equipment obligations -- -- ---- h_ - --- -- -- --- ---- ------ (d) To others exclusive of equipment obligations - --- - --- n_ - --- -- -- --- --- - ------ 2. Accounts payable: (a) Not past due ---- - --- - -- ---- ---- --- ---- ------ (b) Past due - --- - --- - -- - --- - --- h_ --- - ------ 3. Real estate encumbrances _h -- -- ---- - --- - --- --- -- -- -- - - -- 4. Other liabiHties -- -- ---- n_ ---- - --- h_ -- -- ------ 5. Reserves - --- - - -- _u ---- - --- -- - --- - ------ 6. Capital stock paid up: (a) Common - --- ---- --- - --- - --- _n - --- ------ (b) Common - --- -- -- --- - --- ---- _n ---- ------ (b) Preferred --- - ---- _n - --- ---- n_ ---- ------ (b) Preferred ---- - --- - -- -"--- ---- --- - --- - - - --- 7. Surplus (net worth) - --- -- - - --- ---- _n ---- - --- ------ Total liabilities ---- - --- - -- - --- --- - -- - - --- ------ CONTINGENT LIABILITIES -- -- ---- _n - --- ---- -- - ---- ------ 1. Liability on notes receivable, discounted or sold - --- - --- on ---- ---- --- ---- --~--- 2. Liability on accounts receivable! pledged, assigned or sold - --- -- -- n_ - --- ---- h_ --- - ------ 3. Liability as bondsman - - -- ---- _n - --- -- -- _n ---- ------ 4. Liability as guarantor on contracts or on account of others ---- --- ---- h_ - --- ---- ------ 5. Other contingent liabilities -- -- - --- _n ---- ---- n_ - --- ------ Total contingent liabilities . - --- ---- -- - ---- ---- _n --- - ------ DETAILS RELATIVE TO ASSETS ,. ,~ " (a) on hand $ 1 Cash (b) deposited in banks and named below $ (c) elsewhere - (state where) $ NAME OF BANK LOCATION DEPOSIT IN NAME OF AMOUNT --------------------------.--------- ----------------------------------- ---------------------------.------- -----------------------------------. ------------------~---------------- ----------------------------------- ----------------------------------- -----------------------------------. ------------------.---------------- -------------------.--------------- ----------------------------------- -----------------------------------. (a) due within 90 days $ 2* Notes receivable (b) due after 90 days $ (c) past due $ DATE OF RECE1VABLE FROM: NAME AND ADDRESS FOR WHAT MATURITY HOW SECURED AMOUNT ------------------------------------------------------ --------------- ------------------- --- - --_.- -- - _.- ---- - - - - - -- -- -- ------------------------. ------------------------------------------------------ --------------- ------------------- --------------------------- ---------------~--------- --------------7--~------------------------------------ --------------- ------------------- --------------------------- ------------------------. ------------------------------------------------------ --------------- ------------------- --------------------------- ------------------------- ------------------------------------------------------ --------------- ------------------- --------------------------- ------------------------~ Have any of the above been discounted or sold? If so, stat!,} amount, to whom, and reason 3* I Accounts receivable from completed contracts exclusive of claims not approved for payment $ AMQUNT NAME AND ADDRESS OF OWNER NATURE OF CONTRACT AMOUNT OF CONTRACT RECEIVABLE .. ------------------------------------------ --------------------------------- ------------------------------ -----------------------------------~ ------------------------------------------ --------------------------------- ------------------------------ -----------~-----------------------. ------------------------------------------ --------------------------------- --------------------.--------- -----------------------------------. ------------------------------~----------- --------------------------------- ------------------------------ ------------------------------------ Have any of the above been assigned, sold, or pledged? If so, state amount, to whom, and reason Sums earned on uncompleted contracts, as shown by engineer's or architect's estimate: 4* (a) Amount receivable after deducting,retainage $ (b) Retainage to date due upon completion of contract $ DESIGNATION OF CONTRACT AMOUNT AND NAME AND ADDRESS AMOUNT OF AMOUNT AMOUNT RETAINAGE EXCLUSIVE OF OWNER CONTRACT EARNED RECEIVED WHEN DUE AMOUNT OF RETAtNAGE ------------------------------------- --------------- -------------- ------------------- ---------------- ----------------- -------------------- ___________________N_________________ --------------- -------------- ------------------- ---------------- ----------------- ---------------~--_. -------------------.----------------- ---------------- -------------- ------------------- ---------------- ----------------- -------------------. ------------------------------------- --------------- -------------- ------------------- ---------------- ----------------- -------------------- Have any of the above been assigned, sold, or pledged? If so, state arnount, to whom, and reason .'f; .f: i *List separately each item amounting to 10 percent or more of the total and combine the remainder. DETAILS RELATIVE TO ASSETS (Continued) 5* I Accounts receivable not from construction contracts .. $ RECEIVABLE FROM: NAME AND ADDRESS FOR WHAT WHEN DUE AMOUNT ------------ ------- ----------------------------------------------- --------- ----- --------------.--------- -------.------------ -----------------~ ---------------------------------------------------------- ---------------------- - - - - - - - - - - - '- -,-..- - - - - - - -.- - -------~----------- ----------------.. . . ------------ ----- ------ .-------------------------------------------------------- .------------.---------- ------------------- ---------.---.---. - - -- -- --- - ----------- ----------------------------------------------------------- --------- ------------,--- ------------..------ -----------------. . What amount, if any, is past due $ 6 Deposits with bids or othelWise guarantees $ DEPOSITED WITH: NAME AND ADDRESS FOR WHAT WHEN RECOVERABLE AMOUNT - -----...----- ------------------------------------------------------------- --------------------~- ---------------------------- ------------------ . . < -------------~---------------------------------~-----------------~-----1- --- - ------------------ -- -,------------------------- -----------------. ----~-------------------------------------------------'------------------- ---------------------- ---------------------------- -----------------. ------------------------------------------------------------------------- ---------------------- ---------------------------- -- ---------------. .. . 7. Interest accrued on loans, securities, etc. $ .. ON WHAT ACCRUED TO BE PAID WHEN AMOUNT ----------------------- --------------------------------------------------- -------------------------------- -----------------------------------. ---------~ --------------------------------------------------------~------- ------------------- -------------- -----------------------------------. ------------------------------------------~------------------------------- --------------------------------- -----------------------------------~ ------------------ ------------------------------------------------~------- -------------------------------- -----------------------------------. 8 Real estate { (a) , Used for busin~ss purposes - $ book value (b) Not used for business purposes $ IMPROVEMENTS TOTAL BOOK DESCRIPTION OF PROPERTY NATURE OF IMPROVEMENTS BOOK VALUE VALUE 1 -------------------- ----- --- -- ...------- -------------- ------ ---------------- - - ---------------------- --------------------- ----------------------- 2 ------------ -------- ---------- ---------------------------- --------- ---------------- --------------- -------------------- ------------------ - ---- 3 --~-------------------- ----------------------------------- ------------------------------ ---------- -------------------- - ----------------------- 4 ------------------------- -------------- ------------------- ---------------------------------- ------ -------------------- ---------------- ------- 5 -------------------------------- -- -------------------- -------------------------------------- ------ -------------------- -------------- --------. 6 ---------------------------------- - ------------------------------------------------ ---------- ----- -------------------- -------------- --------. 7 ASSESSED AMOUNT OF LOCATION HELD IN WHOLE NAME VALUE ENCUMBRANCES 1 ------ - - - -- - ---------------------------------------------------- ---------- ------------------------ --------------------- ----------- -----------. 2 -----~---------------------------------- -- -- ---------------------- ------------------ -------------- -------------------- ----------------------- 3 ------------------------ ---------------- ---------------------------------------------------------- -------------------- ----------------------- 4 - ------------------------------------------- -------------- ----------------------------- ----------- -------------------- ----------------------. 5 ---------------------------------------------- ---------------------------------------- --------'------ -"'----- ---------------------. ------------ - 6 ------ ---- --------------------------------- - - ----- -------------------- -----------------~---_. ------,------------------------------------------ 7 *Listseparately each item amounting to 10 percent or more of the total and combine the remainder. ~ ,.J' t DETAILS RELATIVE TO ASSETS (Continued) 9 Stocks and Bonds (a) Listed - present market value (b) Unlisted - present market value $ $ DESCRIPTION iSSUING COMPANY LAST INTEREST OR DIVIDEND PAID DATE % PAR VALUE PRESENT MARKET VALUE QUANTITY AMOUNT 1 2 3 4 5 6 7 --------------------------- ---~----------------------- ------------ -------- -------------- ------------- --------------- --------------. --------------------------- --------------------------- ------------ ~------- ----------~--- ------------- --------------- --------------- --------------------------- --------------------------- ------------ -------- -------------- ------------- --~------------ --------------. --------------------------- --------------------------- ------------ -------- -------------- ------------- ----------_._--- ----~--------_. WHO HAS POSSESSION 1 2 3 4.. 5 6 7 iF ANY ARE PLEDGED OR IN ESCROW, STATE FOR WHOM AND REASON AMOUNT PLEDGED OR , IN ESCROW ------~----------------~--- ------------------------------------------------------------------------------------------ ------------------~ ---------~----------------- -------------------------------------------------------------------~---------------------- ------------------- 10 Materials in stock and not included in Item 4, Assets: (a) For use on uncompleted contracts (present value) (b) Other materials (present value $ $ DESCRIPTION OF MATERIAL QUANTITY PRESENT VALUE FOR UNCOMPLETED OTHER CONTRACTS MATERIALS . . . __________________________________________________________________'____~_____________ __________________ ______________________________________M _____,_____________________________________________________________________M_________ __________________ ____________________ __________________ . , 11 * Equipment at book value $ QUANTITY DESCRIPTION AND CAPACITY OF ITEMS AGE OF PURCHASE DEPRECIATION ITEMS PRICE CHARGED OFF BOOK VALUE ---------------------------------------------------------------------------- ----------- --------------- ------------------- ------------------ ------------------------ --------------------------------------------------- ----------- --------------- ------------------- ------------------ Are there any liens against the above? If so, state total amount *If two or more items are lumped above, give the sum of their ages. 'C!' ~. ~ DETAilS RELATIVE TO AS~ETS (Continued) 12 Furniture and fixtures at book value $ 1'3 Other assets $ DESCRIPTION AMOUNT ---------------------------------~-------------------------------~--------------------------~------~-----------~----- ----.---------------~-----. .-----------------~----------------------------------------------------------------------------------------------------------------------------. I TOTAL ASSETS $ DETAILS RELATIVE TO LIABILITIES . , { (a) To banks, regular $ 1 Notes Payable (b) i To banks for certified checks $ (c) To others for equipment obligations $ (d) To others exclusive of equipment obligations $ TO WHOM: NAME AND ADDRESS WHAT SECURITY WHEN DUE AMOUNT . - . . ' ., ,_ . . I , ------------------------- --------------------- ---------------------. ------------------------------------------------------------------------- . ' .. I -----------------------------------------------------------------~------- ------------------------- --------------------- ---------------------- 2 Accounts Payable { (a) Not past due $ (b) Past due $ TO WHOM: NAME AND ADDRESS FOR WHAT DATE PAYABLE AMOUNT -----:-------------------------------------------------------------------- ------------------------- --------------------- --------------------_. ------------------------------------------------------------------------- ------------------------- --------------------- ---------------------- 3 Real estate encumbrances (See Item 8, Assets) $ 4 Other liabilities $ DESCRIPTION AMOUNT ------------------------------------------------------------------~---------------------------------------------------- -----------------------. -----:-------------------------------------------------------------~---------------------------------------------------- ------------------------ . . . 5 Reserves $ INTEREST INSURANCE BLDGS. & FIXT. PLANT DEPR. TAXES BAD DEBTS $ $ $ $ $ $ ~ { 6 Capital stock paid up (c) Common $ - (d) Preferred $ . 7 Surplus $ I TOTAL LIABILITIES $ lfO cmporation answer this: Amount for which incorporated $151000.00 Capital paid in cash $ 515,000.00 When incorporated 1980 In what state INDIANA Names and titles of all persons having authority to execute and receipt estimate vouchers and to conduct other business for " " " " the corporation, including its officers, the sig"natures of whom are legally binding. JEAN M. UNRUH - PREsIDENT/C.E.O. VICTOR o. UNRUH - VICE PR,E$IDENT TRAVIS o. UNRUH - VICE PRESIDENT CHAD M. UNRUH" VICE PRRSTDENT BRYAN WINSLOW - CHIEF ESTIMATOR nART.RI\l'R ~ ," : ("fY"HR2I.N - ~RrnF.'T'ARV , Do you have necessary "certificate of authorityn to transact corporate business in this state, under the terms of Chapter 215, Acts of 1929, and acts amendatory thereto? YE S If a co-partnership answer this: Date of organization State whether co-partnership is general, limited or association Give the names, addresses and proportional interests of all parties: ."------"--------"------~-----"------------------_. ------------------------------------------------ ---------------~----------------- -------------------._-----------.~-------------------------. ------------------.--------------------------------------- ------------- -------------------"--------"-------------~-------------------------. ____._~_____c_________________________________________---------- -. -------------------------------------"---------~-"-"---------------------. _____c___________.------------------------------------ -------.-------------- --------------.---"------------------~-------"-----------------. --------------------------------------------- ----------------------------------------- ---"-----------------------~------------------------_. ------------------------------------ ----------------------------------------.--------------.-.--- ------.----------~------------------------_. -------------------------- ----------------------------------------------------------------=---~----------- -------~------------------"-----_. Address Share Th') nmnet:Jf the partnership firm which the above partners are operc:.:ing is Give names and titles of aU persons having authority to execute and receipt estimate vouchers and to conduct other business for the partnership, the signatures of whom are legalfy binding. " The undersigned hereby declares that the foregoing is a true statement of the financial condition of theindividua! co-partnership or corporation herein first named, as of the d~te herein first given;- that this statement is for the express purpose of inducing the party to whom it is submitted to award the submittor a contract; and that any depository, vendor or other agency herein named is hereby authorized to supply such party with any information necessary to verify this statement. - KAC CONSTRUCTION & EXCAVATING, INC. NOTE: A co-partnership must firm name and address and signatures of all partners. A corporation must give full corporate name, signature of official and affix corporate seal ~~ ~~"~ . . C,\-v;.d n'). Un NJi-V i e-e.Pr-esidel\.-t Affidavit for Individual STATE OF COUNTY O"F SS (Member of firm must sign here) day of 20 Notary Public Affidavit for Co-Partnership STATE OF COUNTY OF SS (Member of firm must sign here) day of 20 Notary Public Affidavit for Corporation STATE OF TNnTANA ~ SS COUNTY OF FT.OYD ) r h(l,A m. Ui\ ~\A1) . . being duly sworn, deposes and says that he is a V"'f'~'PC'i6~j_ of the MAC CONSTRUC~ ~~N AND; the corporation described in and which executed the foregoing statement, that he is familiar with the books ~~'iI~~I:>~@r8ti~~wing its financial condition; that the foregoing financial statement; taken from the books of the said corporation, is a true and accurate statement ofthe financial condition of the said corporation as of the date thereof and that the answers to the foregoing interrogatories are true. .:! ootl\ 'pY)a' . <:r $. {~PID. DQPAU 20 Dq c~~~ (Member of firm must sign hereA 1. COO-a m. l1J ru.h -VJ Ge.-y('es id~1 Subscribed and sworn to before me this Notary Public