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HomeMy WebLinkAboutAccepted bid P • Slate '.:um:i24 ■'C -J751 Prescribed by Stale Boerd of Accounts Form ` :>. 95 Rcvi::ed2005� CONTRACTOR'S BID FOR PUBLIC WORK - FORM 96 PART I ORIG (To be completed for all bids. Please type or print) Date: 2.17.2011 1. Governmental Unit (Owner): The City of Jeffersonvil 2. County : Clark 3. Bidder(Firm): Excel Excavating Inc. Address: P.O. Box 548 City /State: Jeffersonville, IN. 47130 4. Telephone Number: 812.246 .0857 5. Agent of Bidder (if applicable): Mike Flynn Pursuant to notices given, the undersigned offers to furnish labor and /or material necessary to complete • the public works project of The City of Jeffersonville ( Govemmental Unit) in accordance with plans and specifications prepared by Jacobi, Toombs & Lanz, Inc. and dated 1.24.2011 for the sum of See Below $ 373,171.25 Three hundred seventy three thousand one hundred seventy one & 25/100 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 (he United States (LC. 5.1E -8 -2). I hereby certify that I and all suboontractors 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. C ACCEPTANCE © The above bid is accepted this 3 M day of 2011 , subject to the following conditions: — N o NE — /// � ContractingAuthorityMembers: — � f // // ''l••f\\ _ , Gnu, c ars\ t Yirsier � /,�� N. late (Deem- Mcem en_ , PART II (For projects of $100,000 or more — IC 36 -1 -124) Governmental Unit: The City of Jeffersonville Bidder (Firm) Excel Excavating Inc. Date: 2.17.2011 • 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 I. 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 $1,050,000 Road 10 /10 City of New Albany $309,000 Sanitary 12/10 City of Jeffersonville 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 $298,000 Storm 4/11 City of Jeffersonville $1,800,000 Road 9/11 City of New Albany • 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. Branacum Const. Icon Properties Nick Jones Builders 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.) Follow Bid Document e 2. Please list the names and addresses of all subcontractors (i.e. persons or fines 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. Undetermined at this t ime 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. N/A 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. Excavators , Dozers, Trucks 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. Yee SECTION 111 CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. My 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 goveming body can make a proper determination of the bidder's capability for completing the project if awarded. See attached C 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 5710 Utica this 17th day of February 2011 Sellersburg Rd Excel Excavating Inc. (Name of Organization) By Mike Flynn Project Manager (Title of Poison Signing) ACKNOWLEDGEMENT STATE OF Indiana 1 ) ss COUNTY OF Clark Before me. a Notary Public, personally appeared the above -named Mike Flynn and swore that the statements contained in the foregoing document are true and correct. Subscribed and sworn to before me this 17 th day of February 2001 . Ci nv No18ry Public My Commission Expires: 04 /9/ 2 0 1 4 County of Residence: Clark • 0 In a Z k § , (/) - | . • W .-I / cv • 0 ri } ! . . 0. • \ / I-1 - ) J o \ d CO § \ . ! § ] o ill 2 D k 11 Ca 0 ] a § tia Da § I, Z 2 u « • ANNEXATION AREA B-1 JOB NO. 0802 HERB LEWIS ROAD SANITARY SEWERS Revised 02/15/11 • NO. QUANTITY DESCRIPTION UNIT PRICE TOTAL AMT. 1 1 LS Mobilization & Demobilization $ 0340 - $ b,990 - 2 1 LS Maintenance of Traffic $ 4,3oo - S 4,306 - 3 1 LS Clearing of Right -of-way _ $11,40 - $1%, t50 - 4 1 LS Construction Stakeout _ $4,410- $4,410 - 5 1 LS Erosion Control - $ 1,S1S - $ t eSig - 6 2,345 LF 8" Sanitary Sewer, SDR 35 $ 49 i 5 $ t1tait/63 7 700 LP 8" Sanitary Sewer, SDR 26 $ 90 - $ 4.3 - -_ _ 8 2,925 12 10" Sanitary Sewer, SDR 35 $ t co 1 9 $ 4t 555 9 12 BA Manhole Type B' , $ t , (,teb - $ 1c1,32 10 9 EA Manhole Type 'C' $ t,S6S - $ 13.545 11 2 EA Manhole Type' _._ S Z,35c - $ - 16o - 12 22 RA Property Service Connections $ l,3ee - $ /C inoo - 13 95 LF Concrete Encasement $ 20 - $ t ,4 oo - 14 65 L F 12" PVC Culvert Pipe �_�___..... $ Z2- $ I,43o - 15 1 EA Bolt Down Lid $ 29S - _ $ Zc1S - 16 225 CY Undercut & Stabilization of Unsuitable Subgrade $ 4te 8-0 $ to, 44.2. S= 17 90 CY Unidentified Rock Removal S 13 69 $ (. , ( t S - • 18 325 TON Surface Asphalt S 16 _ $ x¢, -So - 19 1 LS Linea' WaterLineLocation $ t,'13o - $ 1,030 - 20 4,000 1 2 Silt Pence _ $ t 2S $ 5.000 -- 21 8 EA Stone Bag Inlet Protection $ 25 - $ Z 0 0 - - TOTAL BID PRICE = Total of items 1 thru 19 = 53,3 191 " £ Evcwsn•.,t, Inc, Contractor - 4. 11.11 • xcop„".wruotyxemmam_emu.a. A -207 • TO TIE BIDDER - The following Form 96a is not required by the State Board of Accounts. 1 lowever, the bidder must • tither use this form or one similar to it prepared by their accountant. JACOBI, TOOMBS AND LANZ, INC. • asa..•.wTUxSmItm...mi.Mrra . e. oW }-107 • • Gist/ lnm No le Duni 4:44,e GJbn ex.W vry STANDARD QUESTIONNAIRES AND FINANCIAL STATEMENT FOR BIDDERS Prescribed by THE STATE BOARD OF ACCOUNTS OF INDIANA For use in investigating and determining the qualifications of bidders on public construction when the aggregate cost of any such work or improvement will be Five Thousand Dollars or more. 'These statements to be submitted under oath by each bidder with and as a part of his bid, as provided by Chapter 305, page 1248, Acts of 1947. Submitted to The City of Jeffersonville Excel Excavating nc _ ( A Corporation IIy .._._._.._.._._._._.._.._._.___._._ g ._._._ .. {l A Ca partnership An individual • Address P.O. Box 598 Jeffersonville, IN. 47130 Date submitted February 17th_ _._._._.._._._._._._. __. 20 11 Filed • 3*I ne, WIIX [S.nave:lur:oaMASIr0.'An'II.Ard 13-108 Submitted by Excel Excavating Inc. ( A Corporation ----- ._._._.._._.._.._._.._._._.__.__._.__._._._._._._.._._.._.._.._.._..---- _._._.._._._.___.---- { A Co- partnership An individual O r ncipal Office at 5710 Utica Sellersburg Rd. Sellersburg, IN. 47172 o The Citx of Jeffresonville_,_.._._.._.._._._._.._._._._.__._._._._._._. __._.__.._._.__._._._._._.__._. -- EXPERIENCE QUESTIONNAIRE The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers to interrogatories hereinafter made. 1. How many years has your organization been in business as a general contractor under your present business name? Twelve (12) Years 2. Now man y ears experience in construction work has your organization had (a} as a general contractor, and (bJ as a subcontractor? Twelve (12) Years __ _________ 3. What projects has your organization completed? .._._._r _._ __._._.__._._._ _._._. ------ CONTRACT AMOUNT CL ASS OF WORK WHEN COMPLETED NAME AND ADDRESS OF OWNER $ 1,050,000 Road 10/10 City of New Albany $ 304,000 Sanitary 12/10 City of Jeff 3a. What projects does your organization now have in process of construction? • CONTRACTAMOUN'I' CLASS OF WOIt WHEN COMPI,WIE.D NAh'CE AND ADDRESS OF OWNER $ 298,000 Storm 4/11 City of Jeff $ 1,800,000 Road 9/11 ��__� ^ ^_ City of New Albany _ 4. Have you ever failed to complete any work awarded to you? If so, where and why. No 5. Haaany officer or partner of your organization ever been an officer or partner of some other organization that failed to complete a construction contract? If so, state name of individual, other organization and reason therefor. No 6. Has any officer or partner of your organization ever failed to complete a construction contract handled in his /her own name? If so, state name of individual, name of owner and reason therefor. No 7. In wbat other lines of business are you financially Nnerest • sispuo.WPWrimansw.iiMAstsbaas 8-109 , • 8. For what corporations or individuals have you performed work, and to whom do you refer? ICON Properties Nick Jones Builders • ' " ' " •• • ----------------------- 9. For what cities have you performed work and to whom do you refer? City of Jef fersonville Cit --------------------------------- . ... . ..... . .... . . ....... . .... . . . . . . 10. For what counties have you performed work and to whom do you refer? Clark . . * " ........... " ..... ... . ...... ..... ..... . . . -----------------------___ 11. For what State bureaus or departments have you performed work and to whom do you refer? N/A --------------------------------------------------_____________ 12. Have you ever performed any work for the U.S. Government? If so, when and to whom do you ' s refer? N/A • . . 13. What is the construction experience of the principal individuals of your organization? YEARS OF INDIVIDUALS PRESENT POSMON MAGNITUDE AND CONSTRUCTION IN WHAT CAPACITY NAME OR OFFICE TYPE OF WORK EXP ER IEN CE Chas. Galligan Pres. 20 Site Pres. Wm. Gall igen V. Pres. 2 0 Site • ------------ -----------_______ • tiNyene■AWNNI(NrmatIlmeateMAWERWevil 13-1 10 PLAN AND EQUIPMENT QUESTIONNAIRE 'The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers to interrogatories �ereinafiermade. 1. In what manner have you inspected this proposed work? Explain in detail. Site Visit 2. Explain your plan or layout for performing the proposed work. _._._._.._..._.._.. _..._._.._.._.._._._._._._PFfrc w 'PTaris • 'an<Tgpecifica ' ionsr --- " ---------- 3. the work, if awarded to you, will have the personal supervision of whom? Wm. Galligan 4. * twintmdt ddothc hauling on the proposed work with you own forces? If so, give amount and type of equipment to be used. Yes 5. r Ifyouitarnd to sublet the hauling 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, and financial responsibility. N/A 6. * Do you intend to do the grading on Lite proposed work with your own forces? Yes -' w::;t'W a ? u."y,,:ts..vI iiWcc,mIa(u uooi o mi -"_._.._._._._._.._.._._._.._._._._._._._.._.._._._ .__._._._._._.._.._._._.._._._. S'$AN'K' OCNmiolIarsW.WATEMd.6 .pl 13. 111 ' • , 7. • Ifyouintendtosiblet the grading or perform it through an agent, state amount of subcontract or agent's contract and, if known, thc name and address of subcontractor or agent, amount and type of his equipment and financial responsibility 0 . NA .. .. _ ..... . . __ _ ___._._.__._____________.______._._.__________________________._____._.______ .. . ...... . .... .. 8. Doycuintmdto sublet any other pardons of the work? If so, state amount of subcontract and, if known, the name and address of the subcontractor, amount and type of his equipment and financial responsibility- Undecided at this time ..-. -----.-- ---------. - ..... . .......... ......._.--.-..----- ---..----..-----.. 9. from which subcontractors or agents do you expect to require a bond? N/A ------- -.-.-.--.-.- .. . .. ... ...... . • • ..----. ------------_____— ..... --------------.-.--_____ . . . . . . . . 10. What equipment do you own that is available for the pnvosed work? See Attached DESC717110N, YEARS OF PR ESENT QUANTITY ITEM SIZE, CAPACITY, CONDITION SERVICE LOCATION ETC • -••-••-•-••-•-•• • -•-•-•-•-•-•-• • --.-. . ----- - _ .---.---.. -- -- -----. --•-•—••---- ^ • • -.-.-.-.--. . -----------. - _ ----.-.-.-. • ••-•-•-•-•------• • •-•-•••-•--- ---- - . .. ...... - ------. . -----------.---- --••-- ----- ------ . . ._._.--.--.-.--. -.-------. . ---- -------. . - -••-••-••-•-• ----.---- . --------•-•-•--------- ---.--- ------ ---- • roRyJnyAVIOOrtrrindlumw4MASIER•s3.ssid 11-1 12 1 • 11. What equipment do you intcnd to purchase for use on the proposed work, should thc contract be awarded to you? QU&NT1TY ITEM DESCRIPTION, SIZE CAPACITY, ETC. APPROXIMATE COST • -------- See Attached 12. How and when will you pay for the equipment purchased? N/A 13. Do you propose to rent any equipment for this work? If so, state type, quantity and reasons for renting. ....._............__ ................................................ ............................... N. /A........,.. ............................... _...._.............................. _. .............. 14. Itvely a made contracts or received firm offers for all materials within prices used in preparing your proposal? Do not give names of dealers or manufacturers. Yes 710 Utica Sellersburg Road 17th day of Feburary 20 11 Excel Excavating Inc. to - - • - rb.,, nr, �„r._.._._._.._.._.._._._.._._. B Mike Flynn • - ._._ L Project Manager STATE Indiana ) SS: COUNIYOI: Clark Mike Flynn - _ - - , being duly sworn, deposes and says that he is a number of _.__. Excel Excavatin .Inc .. .. .. __._._•_._.. ._. that the answers to the questions in thc foregoing questionnaire and all statements therein contained are true and correct. Subscribed and sworn to me this 17th day of Feburary ' 11 My commission expires 4. - 1._.L ._._._. 0A- nn -t t � L • "3 -t G ���e suo.y..wrrgcs.hwu,ssTosi.n.p 13-113 e CONTRACTOR'S FINANCIAL STATEMENT Submitted by Excel Excavating inc. _ ( A Corporation • .._.._._.._..._._._.._.._._._._._. ._.._.._._._._._._._._._.._.._. _.._.__._._._ ._._._._._._.__._ ._._.__._._._ f A Co-partncrsbip An Individual with principal office at 5710 Utica Sellersbur Road Sellersbur , IN. 47172 To City of Jeffersonville Conditions at close of business (See Attached) ASSETS Dollars Cts. 1 fish: (a) on Fend f _, (b) in bank $ ._._._._.._._._._._.___ elsewhere 5 — 2 Notes receivable (a) due within 90 days _._._.____._._._.__ ._._._._.___._._.__._._.___.__. (b) due after 90 days ............. ................ ................ ............................... .. .............. ........... (c) past due Y •._.._.._._._._. _._._.. _.._.._......._.._._. _.._._._._._.._.__._.._._._ 3 Accounts receivable from mmpl COnIrACC3, Cse - IYSRC OfCla n0[ AppN"Cl�l�nr papmcn[ _._._ 4 Snms eamcd on uncompleted wnlraCla IS shown by engineer's or arelutaes estimate (a) amount receivable after deducting aetainage ( Retainage to date, due upon completion of contracts _ . _ —. _ 5 Accounts receivable from sources other than anutmetion contnaa -._._._ 6 Deposits for bids or other gantlets (a) Recoverable within 90 days ..... . .. ........... (b) Recoverable after 90 days ._._.__._.___._.__. 7 Interest accrued on lvm, sawities, ea. ______ ____ 8 Real F.siatc: (a) Used for business pwposes _._._._._._._ —._._ _._._._._.__._.__._. _._.___. (b) Not used for business putposes 9 Stacks and bonds: (a) fasted - present market value _._._._.__._ (b) Unlisted - pr cnt value _._._._. 10 Materials in stock not included in Item 4 (a) for uncompleted concocts (present value) (b) other materak (present value) ......................... 11 Equipment, book value Furniture and fatwes, book VIAIC ...... ,_,_,_,_._._._._._._.__._._.............. . _.._._.._.._.._._.._._._._._.__ Other assets OM :tracts LIABILITIES 1 Notes payable (a) to banks regain _ _ _ _ _ _ (b) to banks for certified checks ._. ......._.._.._.._.__._._.__.__. _ _ __ __ (c) to °then for equipment obligation .._._ _._._._.._._.._.___.__._._._._. (d) to others exclusive of equipment oblgaionst 2 Accounts payable (a) Not past due (b) Past due ....___.. ...____...... .._ ... .. 3 Real estate encumbrances _ _ _____ __________ ____ _________ 4 Other liabilities „•••_._._._.___� _..__._ .._._._._� _._._.___._.__._._.__._. 3 Restive' . .................. 6 Capital stock paid up (a) Common , ,,, ,,, (b) Comment ._._._.._.._.._._._._. _._.._.._.._.._._ (c) Preferred ..... (d) Preferred _._.._.._.._.._.._._.__._.._.._._ .._._._.__._._._.__._._.__._.._ 7 Surplus (net worth) .....,..., .. _...... ........ ........... ............................... .........._............... Teal Liabilities CONTINGENT LIABILITIES 1 Liability on notes receivable, discounted or solo .._.._._._ .___._._._._._____._.___._._._. ___ 2 liability on amounts receivable, pledged, assigsed or sold 3 Lability as bondsman ,•»,•_•_, _._._._.._.._._.._. _ ._._._._.._._.._._ ._._._. _._._._._ ._.__._._._._.__.._._. 4 Liability as guarantor on contracts or on amounts of othcrs 5 Other contingent liabilities Total Camtmacm 1.rabrL•tics _ • aSSaywnxKAmm.nano MMaCisA•d.a wet f3 -114 Y DETAILS RELATIVE TO ASSETS (a) on hand 5 1 Cash (b) deposited in banks named below 5 • (c) elsewhere - (state where) ... 5 NAME OF BANK LOCATION DEPOSIT IN NAME AMOUNT - (a) due within 90 days 2* Notes receivable (b) due after 90 days (c) past due ............ DATE OF MATURFFY RECIUVABLES FROM: NAME AND ADDRESS FOR WI IAT AMOUNT HOW SECURED - Have any of thc above discounted or sold? If so, state amount, to whom, and reason. 3* Accounts receivable from completed contracts exclusive of claims not approved for payment NAME AND ADDRESS OF OWNE NATURE OF ANIOUNT OF R AMOUNT RECEIVABLE CONTRACI CONTRACT • Have any of the above discounted or sold? If so, state amount, to whom, and reason. Sums tamed on uncompleted contracts, as shown by engineer's or architect's estimate 4* (a) Amount receivable after deducting retainer (b) Rctainage to date due upon completion of contract DESIGNATION 01 RETAINAGE AMOUNT AMOUNT OF AMOUNT AMOUNT CONITLiCT AND NAME EXCLUSIVE OF AND ADDRESS 0I OWNER WNT EARNED RECEI WHEN DUE AMOUNT RETAINAGE Have any of the above been sold, assigned or pledged? If so, amount, to whom and reason. - Ian stvacutly emh rte nnauminA lit Ione of the tool and combine ke wnsiudix • WyttorAW PDOCRaircell AsemACNATIWO tit opS B 11 r e 5* ( A ccounts receivable not from construction mtttracts RECEIVABLES FROM: NAME AND ADDRESS FOR WHAT WHEN DUE AMOUNT R•'hat amount, if any, is past due 6* I Deposits with bids or otherwise asguarantocs DEPOSITED WITH: NAME AND ADDRESS FOR WEIAT WHEN AMOUNT RECEIVABLE 7 Interest accrued on loans, securities, etc. ON WHAT ACCRUED TO BE PAID WI IEN AMOUNT • 8 Real estate J (a) used for business purposes 1 book value 1 (b) not used for business purposes 1 IMPROVEMENTS TOTAL BOOK DESCRIPTION OF PROP( {R'IY NATURE OF BOOK VALUE VALUE 1MPROVEME :N'IS 1 2 3 4 3 6 7 LOCATION HELD IN WHOSE ASSESSED AMOUNT OF NAME VALUE ENCUMBRANCES 1 3 4 5 6 7 • ism wp int * each Hem amemSagx. 10 percent or mole of the roof eod combine dw mmtindcc • SIS OnOVP90r9mleellomon/.> ASlratEre....1 B-116 • DETAILS RELATIVE TO ASSETS (Continued) 9 Stocks and bonds (a) Listed - present market value (b) Unlisted - present value • LIST NT. OR PRESENT DESCRIPTION ISSUING COMPANY DIV. PAID PAR VALUE MARKET QUANTITY AMOUNT DA VALUE TE % 1 3 4 5 6 7 AMOUNT WHO HAS IF ANY ARE PLEDGED OR IN ESCROW, STATE FOR WHOM AND PLEDGED POSSESSION? REASON OR IN ESCROW 1 2 3 4 5 6 7 Materials in stock and not included in Item 4, Assets: 10 (a) For use on uncompleted contracts (present value) (b) Other materials (present value) PRESENT VALUE DESCRIPTION OF MATERIAL QUANITIY FOR UNCOMPLETED OTHER MATERIALS CONTRACTS ------------------------------------------------------------------------------------------------------------ 11* Equipment at book value 3 BOOK QUANITIY DESCRIPTION AND CAPACITY OF ITEMS AGE OF PURCHASE DEPRECIATION ITEhf PRICE CHARGE:I) OFF VALUE Are there any liens appinst the above? If so, state total amount u two at ma aim an limped thow. goe the sena awn aos • S'SylreyWIPCOCteixeMnottsOuSTER•ala v4 B-117 DETAILS RELATIVE TO ASSETS (Continued) 12 Furniture and fixtures at book value • 13 Other assets DESCR I 1 AMOUNT Total Assets: DETAILS FtELAI TO LIABILITIES (a) To banks, regular 1 (b) To banks for certified checks (e) To others for equipment obligations 5 (d) To others exclusive of equipment obligations $ TO WHOM: NAME AND ADDRESS WHAT SECURITY WHEN DUE AMOUNT 2 (L N p d u e $ TO WHOM: NAME AND ADDRESS FOR WHAT DATE PAYABLE AMOUNT C. -) Real estate encumbrances (see Item R , Assets) 4 <Aber liabilities DESCRIPTION AMOUNT 5 Reserves WIERBST I INSURANCE BLDGS & FIX PLANT DEPT. TAXES BAD DEBTS g (a) Common 6 Capital Stock paid upt (b) Preferred 7 Surplus Total Liabilities: S9itsY.WMXfl .. muIswM%VSTE'B 0' • 8-118 If a corporation, answer this: S own for which incorporated $1,000_00 Capital paid in cash $ 1,000.00 When incorporated 1/1999 In what state Indiana Nanxsandtitlesofall persons having authority to execute and receipt estimate vouchers and to conduct other business for thc corporation, including its officers, the signatures of wham are legally binding. Charles Galligan William Galligan Do you have the necessary "certificate of authority" to transact corporate business in this state, under thc terms of Chapter 215, Acts of 1929, and acts amendatory thereto? Yes If a co- partnership, answer this: • ate of organization State whether co- partnership is general, limited or association Give the names, addresses and proportional interests of all parties NAME ADDRESS SHARE $ $ $ $ S $ $ $ • • ES4lAVIVBr9athallutC WWnEK.M1.B 1.1-119 The nine of the patmenhip flan under which the above panners are operating is ._._._.._._.._._._.__._._._ (rte romes a:xl tiles of sV persons having authodn• to execute and retzipt estimwe vrwchers and to conduct rnher btuincas faa the pannealup, the ipunuxs of whom ate kgrtlr binding. iIrundenig cd hereby dechres that the foregoing i a Irue statnnem of the t uncial condicon of the individual, co-paztnc hip or cotpon Aetun &enured as of the date herein first given; that this statement is for the express purpose of inducing the pay to whom it it sulnnitral to award the submit= a comae; and that any drpoaitory, vendor or oiler agency herein named is hereby authorized to supply such party with any information necessary to verify this staremcm. NOTE: A co-panne:ship must give Gan name and signature d1 partners. .1 • - _._.__._._.__._._.__._. _._ a ru co rporation muss 6nve full corporate name, signmre of of5cial and affix corporate — •_.._....._.._._._._._.__.__._._ ._._._._.._._._.._.._._._.._.._ sal _.._.._ _._._._._.__._._._._.._.. _.._..._.._........_..._.._.... AfadaVn for Individual STATE. OF ) SS: COUNTY OF .._. ._._._._._._._._._._._._._.._.) being duly sworn, deposes and saps thereof dot the foregoing, Sunda! statement, taken er accurate s t_._.._.__ .. sutemr, tak from her hooks, is a true and accunre statement t of f his financial condition as of the date thereof and that the answer to the forgoing interrogatories are true. • ( Applicant must slg77lcscr _._._. Subsedbed and sworn to me the day of 20 Notary Pubr ..... Affidavit fat Co-Partnership dTF OF ) )tiS: Ili )UN•IY OF ._.___) being duly swam, deposes and saps that he a a member of the (true of and that he is familiar with the Iwoks of said firm sheaving as fironad oadition; that the iurtguing fmantdai statemmr, taker Imin the honks of said (ern, is a true and accurate sot rat of the Sendai conditio of s ' fern as of the date dlncof and that the answers to the foregoing intevogatolias are tare. • - TTi c'+ //.Ls • m r .,•. must sgn bertj .._._._..• Subsuibed and swom to me this _._�._._._._._._._.._ of ............................................ ............................... Notary Public Affidavit for Corporation STATE OF Indiana COUNTY OF Clark ) SS: ........ ........................ ... ... William Gall igan being duly sworn, deposes and says that he is a member of the corporation of Excel EXCaVat Sag inc . - - -- �� dwaiba1 in and %which awaited the foregoing statement; that he is familiar whe iht b ooks of said c nponian showing its financed conditio n that the foregoing financial statement, taken from the books of said corporation is R Inle. and anLnite Statement of the fma,, sI condition Of said co:poahzon as Of the date thereof and t tthe to the f tg intarogptoties ate [mO (Of 'er sign here) Sub. ' and s � to f( l i+pr \ ` 1c 1 the 17th day of Feb. 20 11 • S'Skth ..ENSTEK56•B y,! B-120