1-2024 State-Funded Projects Procurement Bid Packet Fillable .pdf

ALLEGHENY COUNTY ECONOMIC DEVELOPMENT

STATE-FUNDED PROJECTS

PROCUREMENT

PACKET

Revised April 2024

Allegheny County Economic Development

State-Funded Projects

Procurement Compliance Package Checklist

Project Name:

Project Number:

Grantee:

Project Manager:

Project Location:

This checklist should accompany all required procurement documentation submitted by Grantees to Allegheny

County Economic Development (ACED). All required documents should be collected by the Grantee and submitted to the ACED Project Manager as a single submission or packet. If questions arise throughout the document collection process, the Grantee should contact the Project Manager.

The ACED Project Managers and ACED Operations staff will conduct a pre-bid meeting, and a pre-construction meeting with each Grantee to review this packet and other procurement-related requirements pertaining to the

CITF-GEDF program.

PROCUREMENT DOCUMENTS TO BE SUBMITTED BY THE

GRANTEE

INITIAL TO INDICATE THE DOCUMENTS HAVE BEEN PROVIDED

Grantee / Project Manager

Request for PA Prevailing Wage Determination

The Grantee is required to submit a Prevailing Wage Rates Determination Request (provided in the packet) to the ACED Project Manager two weeks prior to expected bid advertisement date. The Wage Determination will indicate the wage rates that must be applied to all labor classifications utilized to complete the project, which must be included the bid specifications. Wage Determinations are valid for 120 days.

Notification to Minority Agencies

Notification must be sent to Minority Agencies prior to bids being advertised; Project Managers must be copied on bid notification communication. Email notifications are acceptable as long as the Project Manager is copied in the email.

Copies of Newspaper Advertisements - Pittsburgh Post Gazette/twice at least 3 days apart A photo copy of the ad with the proof of publication, including the date of publication, must be submitted. Use exact language contained in the ADVERTISING GUIDANCE page enclosed in this packet. Note: Advertising time requirements.

Bid Package Recipients (Prospective Bidders)

This is a list of all the firms who picked up a copy of the bid specifications. This must be filled out as each prospective bidder picks up bid specifications.

Actual Bids Received

This is a list of all firms who actually submitted bids. This must be completed in its entirety.

2.

Instructions: Complete the following – all information is required. Additional information may be submitted on a separate 8- 1/2” x 11” sheet of paper. Submit the completed request to: YOUR ACED PROJECT MANAGER

Department of Labor & Industry Bureau of Labor Law Compliance 651 Boas Street, Room 1301 Harrisburg, PA 17121-0750 Telephone: 1.800.932.0665 Fax: 717.787.0517

Project Information (Print or type all information)

County location of project:

Administrator/Awarding Agency Contact:

Contract Award Date: Proposed Start Date: Estimated Completion Date:

mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy

Contact Information

Name: Title:

Telephone: E-mail:

Address:

Street City State Zip Code

Signature: Date:

Title:

Auxiliary aids and services are available upon request to individuals with disabilities.

Equal Opportunity Employer/Program

3.

Revised April 2024

Funds to be furnished: Yes No If the federal government or any of its agencies will be furnishing funds to be used on your contract (such as loans or grants) or if a federal agency will be prescribing a schedule of prevailing wage rates, go to https://beta.sam.gov Project Number: ________________________________

Descriptive Project Name:

Project Description:

X Allegheny http://www.wdol.gov/ T113882 Highlight

Drew Williams Veteran Career Development Director Veterans Leadership Program 2934 Smallman St, Pittsburgh, PA 15201 (412) 481-8200 x 257 (phone)

(412) 481-8202 (fax) williamsd@vlpwpa.org

Juan Garrett Executive Director Riverside Center for Innovation 700 River Avenue Suite 531 Pittsburgh, Pa 15212 (412)-325-4054 (phone) JG@riversidecenterforinnovation.com

Allegheny County Economic Development (ACED) Koppers Building 436 Seventh Avenue, Suite 500 Pittsburgh, PA 15219

(412) 350-1001 (phone)

(412) 642-2217 (fax) ACEDMBO@AlleghenyCounty.us

Barata Bey African American Chamber of Commerce Koppers Building 436 Seventh Avenue, Suite 2220 Pittsburgh, PA 15219

(412) 392-0610 (phone)

(412) 392-0612 (fax) information@aaccwp.com

Melanie Boyer Pittsburgh Metropolitan Area Hispanic Chamber of Commerce One Oxford Centre 301 Grant Street , Suite 4300 Pittsburgh, PA 15219

(412) 577-4008 (phone) (412)-291-3369 (fax) chamber@pmahcc.org

4.

NOTIFICATION TO MBE / WBE / VOSB / SECTION 3 REFERRAL AGENCIES

Bid notifications must be submitted to these five agencies. A brief project description that identifies the type of work included in the project must be submitted to the following five agencies in the form of: RFQ (request for qualifications), RFP (request for proposal) or IFB (invitation for bid). An accompanying letter should ask the agency to distribute the RFQ, RFP or IFB for MBE/ WBE/ VOSB referrals (and eligible Section 3 employees and/ or Section 3 businesses when applicable).

Allegheny County Economic Development Project Managers must be copied on email or receive signed copies of letters to these organizations as verification. It is easiest to send one email with IFB attachment to all five agencies simultaneously. The attached Bid Notice will then be sent to businesses within these networks:

Notification to the following five agencies must occur prior to bid advertisements running in the Pittsburgh Post-Gazette.

Revised April 2024 mailto:information@aaccwp.com mailto:carrie@pmahcc.org mailto:DN@riversidecenterforinnovation.com mailto:gaineym@vlpwpa.org mailto:Aletwin@county.allegheny.pa.us mailto:information@aaccwp.comDonald mailto:information@aaccwp.comDonald mailto:325-4054DN@riversidecenterforinnovation.com mailto:325-4054DN@riversidecenterforinnovation.com mailto:325-4054DN@riversidecenterforinnovation.com mailto:gaineym@vlpwpa.org mailto:ACEDMBO@AlleghenyCounty.us

Date

Mr. John Veteran

Dept. of Veteran Affairs-Pittsburgh Regional Office

Minority Business Opportunity Center

Suite 1626 Federal Building- 1000 Liberty Avenue

Re: RFP for ABC Corporation

Project Name X Township, Allegheny County

Dear Mr. Veteran:

Please be advised that a Request for Proposals/Bids for a construction project, <<Project Name>>, funded in part by the Allegheny County <<State Funding Source>> will be released on

<<Date of Publication(s)>> in The Pittsburgh Post Gazette. Your office has expressed a desire to receive such notifications. Please note proposals will be accepted up to <<Date/Time>> and opened immediately thereafter.

The project consists of the following trades/ supplies:

Carpenter, Plumbers, Laborers

Concrete, Masonry, Fencing

Copiers, desktops, mobile devices

Plans, specifications and all associated ITB/RFP documents are available from <<Engineering Firm (Office/Other)>> located at <<Address>> & <<telephone number/email address>> on <<Date>> between <<times>> until <<Date/ Time>>.

We respectfully request that your office forward notification of the availability of this project to qualified business concerns.

If you should have further questions, please contact our office at <<telephone number/email address>>.

Sincerely, Jane Doe

Director

ABC Corporation

Cc: Project Manager, Allegheny County Economic Development

5.

EXAMPLE

mailto:JDOE@ABCCorporation.org

Allegheny County Economic Development Projects Procurement Compliance - Bid Package Documents

ADVERTISING GUIDANCE

Allegheny County Economic Development requires that several steps are taken when you place your Bid Advertisement.

ADVERTISING LANGUAGE

The following paragraph MUST APPEAR in each "Invitation for Bid" advertisement made by the operating agency:

"Compliance is required with the Pennsylvania Prevailing Wage Act of 1961, P.L. 987, No. 442; Title VI and other applicable provisions of the Civil Rights Act of 1964; the Department of Labor Equal Opportunity Clause (41 CFR 60 -1.4); Executive Order 11625 (Utilization of Minority Business Enterprise); Executive Order 12138 (Utilization of Female Business Enterprise); in compliance with Section 504 of Rehabilitation Act of 1973 and Americans with Disabilities Act of 1990; the Allegheny County MBE/WBE Program enacted July, 1981, which sets forth goals of 13 percent Minority and 2 percent Female Business Enterprise; and the Allegheny County Ordinance #6867-12, setting forth goals of 5 percent Veteran Owned Small Businesses."

WHERE AND WHEN TO PLACE ADVERTISEMENT

1. Bids whose total value exceeds $30,000 must be advertised.

2. The advertisement shall be run twice and at least three days apart preferably in the Online/

Print edition of the Pittsburgh Post Gazette. The second advertisement cannot be posted less than ten (10) days from the bid opening. (Other Print Newspapers can be considered upon request)

3. Municipalities must follow their individual bidding and procurement guidelines (must meet or exceed RAAC guidelines). Non-municipal grantees are required to follow RAAC’s guidelines, that adhere to the Urban Redevelopment Law, which state that only print advertising is acceptable;

therefore, digital advertising is not acceptable.

4. Purchases and contracts shall not be divided into separate purchases and contracts to avoid the financial thresholds for the competitive purchasing process.

5. The advertisement must contain all appropriate Local, State, and Federal language including the date, time, and place of the bid opening.

6. All bids must be publicly opened.

VERIFYING ADVERTISEMENT

A copy of the bid advertisement, including its date of publication, and proof of publication MUST BE SENT to your Project Manager at Allegheny County Economic Development.

Remember to keep copies of the advertisement and proof of publication for your files.

6.

Revised April 2024

T113882 Highlight

T113882 Highlight

EXAMPLE

Invitation for Bids (IFB)

NOTICE IS HEREBY GIVEN that specifications and proposal forms for furnishing all labor and materials and professional consulting and/ or construction services for the following project(s) entitled:

Project Name – Project Number may be obtained at the offices of the ABC Corporation located on the first floor of the XYZ Building, Room 100, 200 Any Street, X Township, PA 15100, from 9:00 A.M. to 4:00 P.M., beginning MM/DD/

YYYY.

This project requires a non-returnable fee of $50.00 (plus $ 7.00 postage & handling) for copies of bid specifications. BIDS FOR ALL PROJECTS WILL BE RECEIVED until 1PM on MM/DD/YYYY.

Bids will be publicly opened at TIME on MM/DD/YYYY at the ABC Corporation offices at location indicated above.

Bids must be on standard proposal forms in the manner therein described and be enclosed in a sealed envelope, bearing the name and address of the bidder on the outside, addressed to the ABC Corporation and marked with the project name.

Bids must be accompanied by a certified check upon a National or State bank, drawn and made payable without condition to ABC Corporation in an amount not less than five percent (5%) of the bid, or a bid bond of not less than 5%, and be delivered to the place and hour named.

Compliance is required with the Pennsylvania Prevailing Wage Act of 1961, P.L. 987, No. 442; Title VI and other applicable provisions of the Civil Rights Act of 1964; the Department of Labor Equal Opportunity Clause (41 CFR 60 -1.4); Executive Order 11625 (Utilization of Minority Business Enterprise); Executive Order 12138 (Utilization of Female Business Enterprise); in compliance with Section 504 of Rehabilitation Act of 1973 and Americans with Disabilities Act of 1990; the Allegheny County MBE/WBE Program enacted July, 1981, which sets forth goals of 13 percent Minority and 2 percent Female Business Enterprise; and the Allegheny County Ordinance #6867-12, setting forth goals of 5 percent Veteran-Owned Small Businesses.

If there are additional questions, please contact Jane Doe, Director, at ABC Corporation.

7.

Revised April 2024

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Allegheny County Economic Development State-Funded Projects Procurement Compliance / Bid Package Documents

BID PACKAGE RECIPIENTS (PROSPECTIVE BIDDERS)

PROJECT #

PROJECT NAME

PROJECT LOCATION

GRANTEE

ADDRESS PHONE

PLEASE INDICATE COMPANIES WHICH ARE MBE/ WBE/ DBE/ VOSB

MBE= Minority-owned Business Enterprise, WBE= Woman-owned Business Enterprise, DBE= Disadvantaged Business Enterprise, VOSB= Veteran-owned Small Business

MBE WBE DBE VOSB

1. FIRM

ADDRESS

CITY

AUTHORIZED OFFICIAL

PHONE

EMAIL

MBE WBE DBE VOSB

2. FIRM

ADDRESS

CITY

AUTHORIZED OFFICIAL

PHONE

EMAIL

MBE WBE DBE VOSB

3. FIRM

ADDRESS

CITY

AUTHORIZED OFFICIAL

PHONE

EMAIL

MBE WBE DBE VOSB

4. FIRM

ADDRESS

CITY

AUTHORIZED OFFICIAL

PHONE

EMAIL

MBE WBE DBE VOSB

5. FIRM

ADDRESS

CITY

AUTHORIZED OFFICIAL

PHONE

EMAIL

MBE WBE DBE VOSB

6. FIRM

ADDRESS

CITY

AUTHORIZED OFFICIAL

PHONE

EMAIL

8.

STATE ZIP STATE ZIP

STATE ZIP STATE ZIP

STATE ZIP STATE ZIP

ACTUAL BIDS RECEIVED

PROJECT #:

PROJECT NAME:

PROJECT LOCATION:

AGENCY:

PLEASE INDICATE COMPANIES WHICH ARE MBE/ WBE/ DBE/ VOSB

Single Bids May Require Additional Procedures

MBE WBE DBE VOSB

1. FIRM

Bid Amount $

Date Bid Submitted

Notice to Prime/Subcontractors Form Affirmative Action Certification/ Utilization Form Award Verification for Prime/Subcontractors-PL3/PL4 M/W/DBE/VOSB Solicitation & Commitment Form Fringe Benefit Letter New Hires - Pennsylvania Act 127

MBE WBE DBE VOSB MBE WBE DBE VOSB

Notice to Prime/Subcontractors Form Affirmative Action Certification/ Utilization Form Award Verification for Prime/Subcontractors-PL3/PL4 M/W/DBE/VOSB Solicitation & Commitment Form Fringe Benefit Letter New Hires - Pennsylvania Act 127

MBE WBE DBE VOSB

Notice to Prime/Subcontractors Form Affirmative Action Certification/ Utilization Form Award Verification for Prime/Subcontractors-PL3/PL4 M/W/DBE/VOSB Solicitation & Commitment Form Fringe Benefit Letter New Hires - Pennsylvania Act 127

MBE WBE DBE VOSB

Notice to Prime/Subcontractors Form Affirmative Action Certification/ Utilization Form Award Verification for Prime/Subcontractors-PL3/PL4 M/W/DBE/VOSB Solicitation & Commitment Form Fringe Benefit Letter New Hires - Pennsylvania Act 127

9.

Revised April 2024

FORMS SUBMITTED:

MBE WBE DBE VOSB

2. FIRM

Bid Amount $

Date Bid Submitted

Notice to Prime/Subcontractors Form Affirmative Action Certification/ Utilization Form Award Verification for Prime/Subcontractors-PL3/PL4 M/W/DBE/VOSB Solicitation & Commitment Form Fringe Benefit Letter New Hires - Pennsylvania Act 127

FORMS SUBMITTED:

3. FIRM

Bid Amount $

Date Bid Submitted

FORMS SUBMITTED:

4. FIRM

Bid Amount $

Date Bid Submitted

FORMS SUBMITTED:

Notice to Prime/Subcontractors Form Affirmative Action Certification/ Utilization Form Award Verification for Prime/Subcontractors-PL3/PL4 M/W/DBE/VOSB Solicitation & Commitment Form Fringe Benefit Letter New Hires - Pennsylvania Act 127

5. FIRM

Bid Amount $

Date Bid Submitted

FORMS SUBMITTED:

6. FIRM

Bid Amount $

Date Bid Submitted

FORMS SUBMITTED:

INCLUDE IN BID

SPECIFICATIONS

Project Name:

Project Number:

Grantee:

Project Manager:

Project Location:

Allegheny County Economic Development

State-Funded Projects

Procurement Compliance Package Checklist

PROCUREMENT DOCUMENTS TO BE SUBMITTED BY THE PRIME CONTRACTOR/SUBCONTRACTOR/SUPPLIER

The documents listed on this checklist must be included in your bid submission, unless otherwise noted below. These documents are to be submitted to the Grantee by all contractors and forwarded to the ACED Project Manager for final approval. The documents pertaining to Subcontractors must be provided within 10 days of the project award letter, if not included with the Prime Contractor’s original bid proposal.

INITIAL TO INDICATE THE DOCUMENTS HAVE BEEN PROVIDED

Grantee / Project Manager

Notice to Prime Contractors/Subcontractors This document must be included in the bid package and completed by the Prime Contractor/Subcontractor as part of the original bid proposal.

Affirmative Action / MWBE Certification This document must be included in the bid package and completed by the Prime Contractor/Subcontractor as part of the original bid proposal.

M/W/DBE/VOSB Solicitation & Commitment Statement This document must be included in the bid package and completed by the Prime Contractor/Subcontractor as part of the original bid proposal.

Award Verification for Prime/ Subcontractors (Form-PL3/PL4) This document must be included in the bid package and completed by the Agency/Prime Contractor/Subcontractor as part of the original bid proposal.

Schedule of Subcontractors This document must be included in the bid package and submitted no more than 10 days after contract is awarded.

Agency Prime Contractor/Subcontractor Verification This document must be included in the bid package and submitted no more than 10 days after contract is awarded.

Fringe Benefit Letter This document must be included in the bid package and completed by the Prime Contractor/Subcontractor as part of the original bid proposal.

Pennsylvania Certified Payrolls/ Apprentice Registrations Upon being awarded the contract, all contractors must submit a weekly certified payroll sheet to the Project Manager. The first and last payroll sheets must be notarized. This document is two (2) pages; include deduction explanations. Provide valid apprenticeship program documents for all apprentices.

Construction Stoppage Statement This document is provided to the Project Manager if the project requires a delay of work for six weeks or more.

New Hires-Pennsylvania Act 127 (Pennsylvania Public Works Employment Verification Program) This document is required for projects with estimated total cost greater than $25,000.

Award Verification for Suppliers / Professional Services -PL5 This document is to be submitted for all suppliers or professional services receiving $1,000 or more.

Agency/Prime Contractor/SubcontractorSupplier / Professional Services Verification This document must be included in the bid package and submitted no more than 10 days after contract is awarded.

10.

Allegheny County Economic Development State-Funded Projects Procurement Compliance / Bid Package Documents

NOTICE TO PRIME CONTRACTORS/SUBCONTRACTORS

PROJECT NAME_ PROJECT #

Acknowledgement by Prime Contractor Subcontractor

Company Name_

Authorized Official:

Signature: Date:

PROJECT LOCATION

GRANTEE_

All contractors for the above-named project understand that any payment request for the project will not be processed by the Redevelopment Authority of Allegheny County until all requirements are met. It is the responsibility of the Grantee to make sure that all the paperwork is submitted by everyone on the project before request for payments are submitted.

It is further understood that the Prime Contractor is responsible for collecting all paperwork for each Subcontractor hired and must submit it to the Grantee, along with a signed agreement between the Prime and Subcontractor(s). Both Prime and Subcontractors are required to retain copies of all paperwork for this State-funded project for a period of three years after completion of the project.

The contractor understands that no basic wage can be lower than the wage issued: if fringe benefits are not paid into a special fund, the fringe benefits listed for any particular trade in the wage decision is added to, and becomes part of, the basic hourly wage for the employee performing the work.

All payrolls must be forwarded within seven days after the pay period. Payrolls must be certified on the reverse side and the signatures must be hand written in blue ink. No Stamped, initialed, or photo copied signatures are accepted. THE FIRST (INITIAL) AND LAST (FINAL) PAYROLLS MUST BE

NOTARIZED.

This form must be signed by the Prime Contractor or Subcontractor

11.

AFFIRMATIVE ACTION /MWBE CERTIFICATION

PRIME / SUBCONTRACTOR AFFIRMATIVE ACTION CERTIFICATION

PRIME/SUBCONTRACTOR — Agrees to comply with the U.S. Department of Labor Model Affirmative Action (41-CFR-60-

1.4) Plan.

MINORITY BUSINESS AND FEMALE UTILIZATION CERTIFICATION

(Company Name) , Contractor, will abide by and initiate all of my subcontracts to the greatest extent feasible, the requirements of Executive Order 11625 and Executive Order 12138 regarding utilization of Minority and Female Business on this project.

SIGNATURE _DATE

NAME_ TITLE

CONTRACTOR’S FEDERAL ID NUMBER_ PHONE#

PROJECT NAME_

LOCATION PROJECT #

INCLUDE IN BID

SPECIFICATIONS

12.

Allegheny County Economic Development

M/W/DBE/VOSB Solicitation and Commitment Statement A good faith effort must be made to meet the ACED M/W/DBE/VOSB contract goals of 13% MBE, 2% WBE, and 5% VOSB PARTICIPATION.

ALL COLUMNS MUST BE COMPLETELY FILLED IN FOR ALL MWDBE/VOSB SUBCONTRACTORS AND SUPPLIERS

SOLICITATION AND COMMITMENT

MINORITY, WOMEN AND DISADVANTAGED BUSINESS ENTERPRISES and VETERAN-OWNED SMALL BUSINESSES

PROJECT

NUMBER

NAME OF FIRM ADDRESS PHONE NUMBER

List below ALL M/W/DBE/VOSB solicited - whether or not commitment was obtained - Copy this form as necessary

MBE_ WBE DBE_ VOSB_ TYPE(S) OF SUBCONTRACT WORK

OR MATERIALS

DATE SOLICITED COMMITMENT MADE GIVE REASON(S) IF NO

COMMITMENT MADE CERTIFIED BY: YES(IF YES GIVE DATE)

MONTH DAY YR

NO

COMPANY NAME

SOLICITATION METHOD

ADDRESS AMOUNT COMMITTED

QUOTE RECEIVED

$ AMOUNT

% OF TOTAL BID

CONTACT PERSON / PHONE # YES NO

MBE_ WBE DBE_ VOSB_ TYPE(S) OF SUBCONTRACT WORK

OR MATERIALS

DATE SOLICITED COMMITMENT MADE GIVE REASON(S) IF NO

COMMITMENT MADE CERTIFIED BY: YES(IF YES GIVE DATE)

MONTH DAY YR

NO

COMPANY NAME

SOLICITATION METHOD

ADDRESS AMOUNT COMMITTED

QUOTE RECEIVED

$ AMOUNT

% OF TOTAL BID CONTACT PERSON / PHONE # YES NO

MBE_ WBE DBE_ VOSB_ TYPE(S) OF SUBCONTRACT WORK

OR MATERIALS

DATE SOLICITED COMMITMENT MADE GIVE REASON(S) IF NO

COMMITMENT MADE CERTIFIED BY: YES(IF YES GIVE DATE)

MONTH DAY YR

NO

COMPANY NAME

SOLICITATION METHOD

ADDRESS AMOUNT COMMITTED

QUOTE RECEIVED

$ AMOUNT

% OF TOTAL BID

CONTACT PERSON / PHONE # YES NO

Prepared by: Signature: Title:_ Date:

13.

AWARD VERIFICATION FOR PRIME/ SUBCONTRACTORS - PL3/PL4

THIS FORM MUST BE COMPLETED, SIGNED, AND SUBMITTED FOR ALL CONTRACTORS USED ON THE JOB.

ALL INFORMATION MUST BE FILLED IN COMPLETELY OR FORM MUST BE RESUBMITTED.

PL3 - Award Notice for Prime Contractor PL4 - Award Notice for Subcontractor

State City

Email IRS ID #

No WBE: Yes No DBE: Yes No VOSB: Yes No

If your company is a MBE/ WBE/ DBE/ VOSB company is it certified with Allegheny County’s Office of Minority & Women Business? Yes No_ Certification #_ Expiration Date

No If yes, Certification #_ Is it certified under the PAUCP? (PA Unified Certification Program) Yes Expiration Date Other Certification? (type, #, expiration date)

RACIAL / ETHNIC CODES:

1. White American 2. Black American 3. Native American 4. Hispanic American

6. Hasidic Jews

Date: Contractor Signature:

Print Name: Title:

THIS PART IS TO BE FILLED OUT BY OPERATING AGENCY ONLY:

Project Contract Award Amount $

Project Location:

Contractor Contract Amount $

Date

Project #:

Project Name:

Title

14.

Zip Code

INCLUDE IN BID

SPECIFICATIONS

Revised April 2024

Is Prime Contractor/Subcontractor: MBE: Yes

Company Name

Address

Telephone Number

DUNS # CAGE # CAGE Expiration

5. Asian/Pacific American

This portion to be completed by Prime Contractor / Subcontractor:

Date Contract Awarded to Contractor Above:

Estimated Construction Start Date:

Agency Signature:

Print Name t106346 Pencil

SCHEDULE OF SUBCONTRACTORS

PRIME CONTRACTORS: This form must be submitted to the GRANTEE no more than ten days after you have received a bid award letter notifying you that you have been awarded the contract. Failure to submit this form could disqualify your bid.

SUB CONTRACTORS: This form must be completed and submitted to the prime contractor

PROJECT NAME

PROJECT LOCATION PROJECT #

CONTRACTOR’S NAME

IRS ID#_ DATE

COMPANY NAME

ADDRESS

CITY STATE

IRS ID# TELEPHONE#

Is Subcontractor a MBE? Yes Is Subcontractor a WBE? Yes Is Subcontractor a DBE? Yes Is Subcontractor a VOSB? Yes

Type of Work

COMPANY NAME

ADDRESS

CITY ZIP

IRS ID#

No No No

No

TELEPHONE#

Is Subcontractor a MBE? Yes Is Subcontractor a WBE? Yes Is Subcontractor a DBE? Yes Is Subcontractor a VOSB? Yes

Type of Work

COMPANY NAME

ADDRESS

CITY ZIP

IRS ID#

No No No No

TELEPHONE#

Is Subcontractor a MBE? Yes Is Subcontractor a WBE? Yes Is Subcontractor a DBE? Yes Is Subcontractor a VOSB? Yes

Type of Work

COMPANY NAME

ADDRESS

CITY ZIP

IRS ID#

No No No

No

TELEPHONE#

Is Subcontractor a MBE? Yes Is Subcontractor a WBE? Yes Is Subcontractor a DBE? Yes Is Subcontractor a VOSB? Yes

Type of Work

INCLUDE IN BID

SPECIFICATIONS

15.

ZIP

No No No No

Check here if no sub contractors will be utilized by the above contractor

STATE

STATE STATE

AGENCY > PRIME CONTRACTOR / SUBCONTRACTOR VERIFICATION

(Agency/Prime/Subcontractor Legal Name) has an agreement with

(Prime/Subcontractor Legal Name) to work on the

(Project Name)_ located in the area of , PA.

If awarded the contract, the above Agency/Prime Contractor/Subcontractor intends to have a written, binding contract with the above Prime Contractor or Subcontractor to perform the following work:

(Provide Brief Description of the Type of Work Agreed Upon)

$ . _. The contract dollar amount as specified in the written agreement is

Agency’s Authorized Signature:_____________________________________________ Date:

Agency’s Printed Name:___________________________________________________ Title:

Prime Contractor’s Authorized Signature:_____________________________________ Date:

Prime Contractor’s Printed Name: __________________________________________ Title:

Subcontractor’s Authorized Signature:_______________________________________ Date:

Subcontractor’s Printed Name: _____________________________________________ Title

INCLUDE IN BID

SPECIFICATIONS

16.

Revised April 2024

The portion of the above to be reimbursed/paid with State funds is

THIS FORM MUST BE SUBMITTED FOR EVERY PRIME / SUBCONTRACTOR HIRED FOR THIS STATE-FUNDED PROJECT AND SUBMITTED TO THE AGENCY. THIS FORM IS TO BE SUBMITTED 10 DAYS AFTER CONTRACT IS AWARDED.

Project #:

FRINGE BENEFIT LETTER

Wage Decision Serial #

IRS ID#

City State

Project Name_

Project #

Contract Amount $

Prime/Subcontractor Company Name (Circle One)_

Address:

FRINGE BENEFITS:

All Fringe Benefits will be paid as follows:

_Fringes will be included in the basic hourly wage rates.

_Fringes will be paid into the following Benefit Plans: (List Hourly Fringe Benefit Rate)

Name of Plan:

Address:

City:

Classification: Hourly Fringe Benefit Rate

Name of Plan:

Address:

City:

Classification: Hourly Fringe Benefit Rate

Name of Plan:

Address:

City:

Classification: Hourly Fringe Benefit Rate

Prime/ Subcontractor’s Signature

Printed Name: Date:

INCLUDE IN BID

SPECIFICATIONS

17.

Zip Code

State: Zip Code:

State: Zip Code:

State: Zip Code:

Contractor or

WEEKLY PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS

ALL INFORMATION MUST BE COMPLETED

CONTRACTOR

ADDRESS

SUBCONTRACTOR

ADDRESS

BUREAU OF LABOR LAW COMPLIANCE

PREVAILING WAGE DIVISION

7TH & FORSTER STREETS

HARRISBURG, PA 17120 1-800-932-

PAYROLL NUMBER WEEK ENDING DATE PROJECT AND LOCATION

PROJECT SERIAL # PROJECT #

EMPLOYEE NAME

APPR.

RATE

WORK

CLASSIFICATION

DAY AND DATE

S-

TIME

0-

TIME

BASE

HOURY

RATE

TOTAL FRINGE

BENEFITS

(C=Cash)

(FB=Contributio)n*

TOTAL

DEDUCTIONS

s

GROSS PAY

FOR

PREVAILIN

G RATE

JOB(S)

CHECK #

HOURS WORKED EACH DAY

C:

FB:

C:

FB:

C:

FB:

C:

FB:

C:

FB:

LLC -25 REV 10-03 (Page 1)

18.

THE NOTARIZATION MUST BE COMPLETED ON FIRST AND LAST SUBMISSIONS ONLY. ALL OTHER

INFORMATION MUST BE COMPLETED WEEKLY.

*FRINGE BENEFITS EXPLANATION (FB): Bona fide benefits contribution, except those required by Federal or State

Law (unemployment tax, workers’ compensation, income taxes, etc.)

Please specify the type of benefits provided and contributions per hour:

1) Medical or hospital care

2) Pension or retirement

3) Life insurance

4) Disability

5) Vacation, holiday

6) Other (please specify)

CERTIFIED STATEMENT OF COMPLIANCE

1. The undersigned, having executed a contract with

(AWARDING AGENCY, CONTRACTOR OR SUBCONTRACTOR)

for the construction of the above-identified project, acknowledges that:

(a) The prevailing wage requirements and the predetermined rates are included in the aforesaid contract.

(b) Correction of any infractions of the aforesaid conditions is the contractor’s or subcontractor’s responsibility.

(c) It is the contractor’s responsibility to include the Prevailing Wage requirements and the predetermined rates in any subcontract or lower tier subcontract for this project.

2. The undersigned certifies that:

(a) Neither he nor his firm, nor any firm, corporation or partnership in which he or his firm has an interest is debarred by the Secretary of Labor and Industry pursuant to Section 11(e) of the PA Prevailing Wage Act, Act of August

15, 1961, P.L. 987 as amended, 43 P.S.§ 165-11(e).

(b) No part of this contract has been or will be subcontracted to any subcontractor if such subcontractor or any firm, corporation or partnership in which such subcontractor has an interest is debarred pursuant to the aforementioned statute.

3. The undersigned certifies that:

(a) the legal name and the business address of the contractor or subcontractor are:

(b) The undersigned is: a single proprietorship a corporation organized in the state of partnership other organization (describe)

(c) (c)The name, title and address of the owner, partners or officers of the contractor/subcontractor are:

NAME TITLE ADDRESS

The willful falsification of any of the above statements may subject the contractor to civil or criminal prosecution, provided in the PA Prevailing Wage Act of August 15, 1961, P.L. 987, as amended, August 9, 1963, 43 P.S. § 165.1 through 165.17.

(DATE)

(SEAL)

(TITLE)

Taken, sworn and subscribed before me this Day

LLC -25 REV 10-03 (Page 2) of A .D., 19.

CONSTRUCTION STOPPAGE STATEMENT

If there is no work performed on the project for SIX WEEKS or MORE, this form must be completed and submitted to the Grantee by the Contractor.

State Zip Code

Company Name

Company Address

City

Telephone Number

Project #

Project Name

Project Address City Zip Code

I certify that work on this project will be delayed for a period of six (6) weeks or more effective as of this date _. The work on this project will resume on (date)_ .

The payroll number which was last submitted to the GRANTEE was payroll number .

Therefore when the work resumes, the payrolls will be numbered starting with the next sequential number from the last payroll submitted.

Authorized Signature: Prime Contractor_ Date

Print Name Prime Contractor

Authorized Signature: Subcontractor_ Date

Print Name Subcontractor

This form must be submitted to the GRANTEE to be forwarded to the Project Manager at the Allegheny

County Economic Development.

Received by (Grantee Name)

Authorized Signature Date

Received by ACED Project Manager_

Signature Date

INCLUDE IN BID

SPECIFICATIONS

20.

State

Allegheny County Economic Development State-Funded Projects

Pennsylvania Public Works Employment Verification Program

The Commonwealth of Pennsylvania enacted Act 127 of 2012, known as the Public Works

Employment Verification Act (‘the Act’) which requires all public work contractors and subcontractors to utilize the Federal Government’s E-Verify system to ensure that all employees performing work on public work projects are authorized to work in the United States.

The Department defines a “Public Work” to be construction, reconstruction, demolition, alteration and/or repair work other than maintenance work, done under contract and paid for in whole or in part out of the funds of a public body where the estimated cost of the total project is in excess of twenty-five thousand dollars ($25,000) but shall not include work performed under a rehabilitation or manpower training program.

The Department of General Services’ Public Works Employment Verification Compliance

Program is responsible for the administration, education and enforcement of the Public Works

Employment Verification Act 127 of 2012. It provides contractors and subcontractors with educational outreach, conducts investigations when complaints are received and random audits to ensure compliance with the requirements of this Act.

Please direct your questions to the Public Works Employment Verification Compliance Office

Mail: Department of General Services Public Works

Employment Verification Compliance Office

Room 105 Tent Bldg.

18th & Herr Streets Harrisburg, PA 17125

Phone: 717-214-3668

Fax: 717-214-3669

To reference the following helpful links below go to:

http://www.portal.state.pa.us/portal/server.pt/community/construction_and_public_works/

1235/public_works_employment_verification/1357211

Statement of Policy as published in the Pennsylvania Bulletin, December 29, 2012, and effective

January 1, 2013.

Public Works Employment Verification Form

Public Works Employment Verification Complaint Form

Overview Presentation of the Public Works Employment Verification Act

Frequently Asked Questions

U.S. Department of Homeland Security Employment Verification web site

21.

http://www.portal.state.pa.us/portal/server.pt/community/construction_and_public_works/

As a contractor/subcontractor for the above referenced public works contract, I hereby affirm that as of the above date, our company is in compliance with the Public Works Employment Verification Act

(‘the Act’) through utilization of the federal E‐Verify Program (EVP) operated by the United States

Department of Homeland Security. To the best of my/our knowledge, all employees hired post January

1, 2013 are authorized to work in the United States.

It is also agreed to that all public works contractors/subcontractors will utilize the federal EVP to verify the employment eligibility of each new hire within five (5) business days of the employee start date throughout the duration of the public works contract. Documentation confirming the use of the federal

EVP upon each new hire shall be maintained in the event of an investigation or audit.

I, , authorized representative of the company above, attest that the information contained in this verification form is true and correct and understand that the submission of false or misleading information in connection with the above verification shall be subject to sanctions provided by law.

COMMONWEALTH OF PENNSYLVANIA

PUBLIC WORKS EMPLOYMENT VERIFICATION FORM

NEW HIRES PENNSYLVANIA ACT 127

Date

Business or Organization Name (Employer)

Address

City State Zip Code

Contracting Public Body

Contract/Project No.

Project Description

Project Location

Authorized Representative Signature

INCLUDE IN BID

SPECIFICATIONS

22.

Contractor

Sub Contractor

Redevelopment Authority of Allegheny County

Project #

Project Name:

Date Contract Awarded to Company Above:

Agency Signature

Print Name

AWARD VERIFICATION FOR SUPPLIERS AND PROFESSIONAL SERVICES–PL5

THIS FORM MUST BE COMPLETED, SIGNED, AND SUBMITTED FOR SUPPLIERS ($1,000 or more) AND ALL PROFESSIONAL SERVICES USED ON THE JOB. ALL INFORMATION MUST BE FILLED IN COMPLETELY OR FORM MUST BE RESUBMITTED.

PL5—Award Notice for Suppliers and Professional Services

INCLUDE IN BID

SPECIFICATIONS

Is Company: MBE: Yes No WBE: Yes No DBE: Yes No VOSB: Yes No

If your company is a MBE/ WBE/ DBE/ VOSB Company? Is it certified with Allegheny County’s Office of Minority & Women Business? Yes No_ Certification #_ Expiration Date

Are you certified under the PAUCP? (PA Unified Certification Program) Yes No If yes, Certification #_ Expiration Date Other Certification? (type, #, expiration date)

RACIAL / ETHNIC CODES:

1. White American 2. Black American 3. Native American 4. Hispanic American

5. Asian/Pacific American 6. Hasidic Jews

Date:Company Signature:

Title:

THIS PORTION IS TO BE COMPLETED BY OPERATING AGENCY ONLY:

Project Contract Award Amount $

Project Location:

Date

Title

23.

RevisedApril 2024

State City

Email IRS ID # ) Zip Code

Company Name

Address

Telephone Number (

DUNS # CAGE # CAGE Expiration

Print Name:

Allegheny County Economic Development State-Funded Projects Procurement Compliance / Bid Package Documents

This portion to be completed by Supplier / Professional Service Provider:

Contract Amount: $

AGENCY / PRIME CONTRACTOR / SUBCONTRACTOR > SUPPLIER/

PROFESSIONAL SERVICES VERIFICATION FORM

THIS FORM MUST BE SUBMITTED FOR EVERY SUPPLIER ($1,000 or more) and ALL PROFESSIONAL SERVICES

HIRED FOR THIS STATE-FUNDED PROJECT AND SUBMITTED TO THE GRANTEE.

(Agency/Prime/Subcontractor Legal Name) has an agreement with

(Supplier/ Professional Service Legal Name/ Address) to work on the

(Project Name) _ located in the area of _, PA.

If awarded the contract, the above Agency/Prime Contractor/Subcontractor intends to have a binding contract with the above supplier or professional service to provide the following materials or services:

(Provide a Brief Description of the Supplies or Professional Services Agreed Upon)

Grantee’s Authorized Signature: ______________________________________________Date: ______________________

Grantee’s Printed Name: _____________________________________________Title: _____________________________

Prime Contractor’s Authorized Signature: ______________________________________Date: ______________________

INCLUDE IN BID

SPECIFICATIONS

Prime Contractor’s Printed Name: ______________________________________ Title: ____________________________

Subcontractor’s Authorized Signature: ________________________________________ Date: ______________________

Subcontractor’s Printed Name: _________________________________________ Title: ____________________________

Supplier / Service Authorized Signature: _______________________________________Date: ______________________

Supplier / Service Printed Name: ________________________________________Title: ____________________________

24.

RevisedApril 2024

Project #:

. . The contract dollar amount as specified in the written agreement is $

The portion of the above to be reimbursed/paid with State funds is $ . .