1-2026 SEAL COAT BID PACKAGE (002).pdf

-MS-944 03-07

DISTRICT 5-0

PROPOSAL & CONTRACT (THIS PROPOSAL INCLUDES

(WHEN EXECUTED) INSTRUCTIONS TO BIDDERS)

A. DEPOSIT OF PROPOSALS.

All Envelopes containing Bid proposals shall Plainfield Township________________ 610-759-6944____

Be clearly marked “2026 Seal Coat Municipality Name and Type Telephone

Bid Proposal for Letting on Friday, August 7, 2026

Date Paige Stefanelli__ _________________________________

Township Manager

Sealed Proposals will be received on or before.

11:00 am, Friday, August 7, 2026 6292 Sullivan Trail______________________

Time and Date Address

Bids will be opened and read at approximately Nazareth, PA 18064_____________________________

6:00 pm, Wednesday, August 12, 2026 Proposals must be mailed or otherwise.

Time and Date delivered to the above address.

1. The contractor proposes to furnish and deliver all materials (including Form CS-4171, Certificate of Compliance, TR-465 Daily Asphalt Mixture Certification or other form pre-approved by PennDOT) and to do and perform all work on the following project as more specifically set forth in the Schedule of Prices (Attachment), in accordance with drawings and specifications on file at the Plainfield Township Municipal Building at the above address.

As well as the supplements and special requirements contained herein and/or attached hereto and current PennDOT specifications (Publication 408), bidders need to be prequalified by PennDOT (Sec. 102.01).

2. If designated as the successful bidder, the contractor will begin work on the date specified in the notice to proceed. Or as otherwise provided in the special requirements and will complete all work on or before November 6, 2026 or 60 days from the Notice to Proceed, whichever is later. If all work is not completed on time, liquidated damages will be assessed at the rate of $850.00 per additional calendar day.

3. Accompanying this proposal is a certified check or bid Bond in the amount of 10% made payable to the municipality as a proposal guarantee which, it is understood, will be forfeited in case the contractor fails to comply with the requirement of the proposal.

B. PROPOSAL OF: _____________________________________________________________________________ Name of Contractor

Address

CONTRACTOR’S CERTIFICATION

It is hereby certified as follows:

1. The only person(s) interested in this proposal as principal(s) is (are): ________________________________

2. None of the above persons are employees of the municipality.

3. This proposal is made without collusion with any other person, firm, or corporation.

4. All plans and specifications referred to above and the site of the work have been examined by the contractor.

The contractor understands that the quantities indicated herein are approximate and are subject to change as may be required; and that all work is payable on the basis of the unit prices listed on the Schedule of Prices (Attachment 1).

5. The contractor will comply with all requirements of the laws and implementing regulations of the Commonwealth of Pennsylvania and the United States relating to human relations, equal opportunity and non-discrimination in employment, and will pay to workmen employed in the performance of the contract the wages to which they may be entitled.

6. The contractor will provide the municipality with a performance bond, conditioned upon the faithful performance of the contractor in accordance with the plans, specifications and conditions thereof, and a payment bond conditioned on the prompt payment of all material furnished and labor supplied or performed in the prosecution of the work, in accordance with the Public Work’s Contractors’ Bond Law of 1967; and an affidavit accepting the provisions of the

Workmen’s Compensation Act of 1915, as amended.

7. “The parties agree that the relationship between the Contractor and the Municipality is one of independent contractor and not the employer/employee and that the individual employees of the Contractor who will be performing the work pursuant to this contract are not employees of the Municipality. Contractor hereby certifies, represents and warrants to the Municipality that all persons performing any aspect of the work pursuant to this

Contract who are required to have commercial driver’s license are subject to a program for drug and alcohol testing in accordance with the Omnibus Transportation Employee Testing Act of 1991 and the federal regulations adopted pursuant thereto.”

Contractor

WITNESSED OR ATTESTED BY:

BY: ______________________________________

Title (Seal)

Title

SEAL

TO BE EXECUTED ONLY IN THE EVENT THE ABOVE PROPOSAL IS ACCEPTED

ACCEPTED ON: _______________________________________

Date

Municipality

ATTESTED BY:

________________________________________ BY:_______________________________________ Title Title

SEAL

County: Northampton Municipality: Plainfield Township Project No.: 2026 Asphalt Seal Coat

ATTACHMENT #1

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LOCATION OF WORK:

See Below and on List of Roads on Attachment 1-A

DESCRIPTION OF WORK:

As indicated below and in Attachments 1-A

Contractor is to place either a Single Asphalt Seal Coat using a Polymer Modified Emulsion, CRS-2PM (E-

3M) or RS-2PM (E-2M) and #8 Stone with a 1.0% Loss by Wash. All material to be complete in place in conformance with PENNDOT Pub.408, Section 470.

ESCALATOR CLAUSE: (If adopted by the Municipality)

Contract contains an Escalator Clause for quantities of Asphalt material of less than 100 tons of asphalt cement including asphalt cement residue contained in emulsions or cutbacks. PennDOT Pub. 408, Section 110.04 will apply to quantities of Asphalt materials greater than 100 tons of asphalt cement including asphalt cement residue contained in emulsions or cutbacks. (See Attachment 1-A for more information)

SCHEDULE OF PRICES

1.

Item

No.

2.

Approximate

Quantities

3.

Units

4.

*Description

5.

Unit

Price

6.

Total

1.

2.

3.

4.

5.

6.

5,917

2,886

4,753

7,577

3,630

5,758

SY

Base Bid

T716 Rudolph Road – From Rasleytown Road to Cul-de-sac

Single Asphalt Seal Coat using a Polymer

Modified Emulsion and #8 Stone with a 1.0% Loss by Wash, Surface Category Condition “C”, ADT 101-500

T717 David Drive – From Rasleytown Road to Jane Lane

T718 Jane Lane – From Rudolph Road to Cul-de-sac

T727 Briar Road – From Sandt Road to Plainfield Drive

Surface Category Condition “D”, ADT 101-500

T728 Green Lane – From Briar Road to Plainfield Drive

T729 Plainfield Drive – From Sandt Road to Briar Road

Continued Next Page

Item

No.

7.

Approximate

Quantities

3,317

Units

Description

T635 Gum Road – From Heimer Road to Merwarth Road

Surface Category Condition “D”, ADT <100

Unit

Price

Total

*DESCRIPTION

Must include ADT on Wearing surfaces.

USE OF CUTBACK ASPHALT IS PROHIBITED

BETWEEN MAY 1st and OCTOBER 31st EXCEPT

AS NOTED IN BULLETIN NO. 25.

SUBTOTAL

SUBTOTAL(S) FROM OTHER

ATTACHMENT(S)

TOTAL AMOUNT OF BID

Attachment 1-A

Plainfield Township

2026 Asphalt Seal Coat Program

List of Roads

Asphalt Seal Coat Data – SINGLE or DOUBLE Alternative No. 1

ROAD FROM – TO LENGTH/WIDTH

(FT)

SY SURFACE

CATEGORY

CONDITIONS

ADT

T716 Rudolph Road (T716) From Rasleytown Road

(T629) to Cul-de-sac

1,580 x 30

+ Intersections

+Cul-de-sac

5,917 Single C

101-500

T717 David Drive (T717)

From Rasleytown Road

(T629) to Jane Lane (T718)

828 x 30 +

Intersection

2,886 Single C

T718 Jane Lane (T718) From Rudolph Road (T716) to Cul-de-sac

1,231 x 30

+ Intersections

+Cul-de-sac

4,753

Single C

T727 Briar Road (T727) From Sandt Road (T657) to

Plainfield Drive (T729)

2,400 x 30

+ Intersections

8,110 Single D

T728 Green Lane (T728) From Briar Road (T727) to

Plainfield Drive (T729)

1,154 x 30

3,887 Single D

T729 Plainfield Drive (T729) From Sandt Road (T657) to

Briar Road (T727)

1,832 x 30

+ Intersection

6,165

Single D

T365 Gum Road (T635) Heimer Road (T649) to

Merwarth Road (T652)

1,540 x 19

3,317 Single D

Measurements and calculations of quantities are for bidding purposes only, final measurements will be conducted by a representative from the Contractor and a representative from the Municipality and final payment will be based on these mutually agreed to measurements and quantities. These areas will be measured jointly and agreed to by both the Township and the Contractor prior to any payment being made.

My signature signifies that I have read and understand the above conditions a special provision to this contract, and by being authorized by this company to act as their authorized representative, and on their behalf hereby agree to adhere to any and all of the provisions pertaining to this contract.

Contractor’s Representative Date Municipality’s Representative Date

Company Municipality

SPECIFICATIONS AND SPECIAL PROVISIONS TO CONTRACT MS-944

CONTAINS IMPORTANT INFORMATION FOR THE CONTRACTOR

The Prime Contractor and Subcontractors must comply with all of the following provisions:

TRAFFIC CONTROL

- Traffic Control and Safety Devices to be provided by the Contractor. (Maintenance and Protection of Traffic to comply with current MUTCD, PennDOT Publication 212 and PennDOT Publication 213.)

- The Contractor may close roads where practical and must provide all road closed and detour signs as per Pub. 213. Road closures must be pre-approved by the Township Roadmaster or his Representative.

GENERAL

- Bidders should review the proposed project with the Township. For further information contact Will Hughes, Public Works Director at 610-759-6944 between the hours of 8:00 a.m. to 3:00 p.m. Monday through Thursday.

- Bidder must contact the Roadmaster prior to scheduling any work.

- A pre-construction meeting will not be mandatory.

- Delivery tickets required for all materials used on the project.

- CS-4171 Certificate of Compliance required for all materials.

- The Bidder must supply certified truck weight slips for Asphalt material and aggregate used on the job.

- No payments will be made until the bidder has supplied all required designs, delivery slips and certifications.

- The Contractor shall notify the Municipality 5 calendar days prior to the start of the project.

- Work schedule must be coordinated with the Municipality and work must be completed on or before November 6, 2026 or

60 days from the Notice to Proceed; whichever is later.

If all work is not completed on time, liquidated damages will be assessed at the rate of $850.00 per additional calendar day.

- Roadway to be power broomed by the Contractor prior to start of project.

- Township facilities are available for temporary storage with prior approval from the Roadmaster.

- Loose stone shall be swept up and removed from road shoulders and intersections by the Contractor prior to completion. Excess material to be delivered to the Township public works facility. Please coordinate with the

Roadmaster.

- Municipality will inspect the project.

- Need Bill of Lading for each shipment of Asphalt material per Section 702.1(c) of PENNDOT Specifications Form

408.

- Municipality reserves the right to limit work completed.

- Completion of NON-COLLUSION AFFIDAVIT required.

- Incidental preparation and clean up required. (Project Construction Materials)

- Contractor is responsible for defects that occur within one year of applications.

- Final Completion Certificate and Notice of Completion is required.

- Future award of Contracts will be based on quality of work as determined by the Municipality.

- Bidders and their Sub-Contractors need to be PennDOT pre-qualified and proof of pre-qualification is required.

Bidders must be pre-qualified for Work Class Code “F4” Asphalt Surface Treatments, Seal Coats.

- Contractor to supply proof of CDL Drug and Alcohol Compliance upon award of the bid.

- The successful bidder must provide a 100% Performance Bond and a 100% Payment Bond within 20 days of the award of the contract.

Award of the Contract Bid Items

The Municipal intends to award the contract to one Bidder, Bidders need to bid on all items and Bidders must bid on documents provided by the Municipality. The Municipality reserves the right to accept or reject any and or all proposals or portions thereof, and to delete projects and or portions of the project depending on budgetary constraints.

Pennsylvania Prevailing Wages

Due to this contract containing maintenance elements only Pennsylvania Prevailing Wages do not apply.

SEAL COAT

- The Contractor will provide the Municipality with a PENNDOT Approved Asphalt Seal Coat Design using the methods in Appendix E of Bulletin 27 at least 5 days prior to beginning work. Asphalt Application Range is .20 to

.40 gallons per square yard and Stone Application Range is 15 to 25 pounds per square yard; the actual rate will be determined by the seal coat design, ADT counts will be provided by the Municipality, surface category conditions to be provided by the Municipality and confirmed by the Contractor.

- The contractor is to place either a Single or Double Asphalt Seal Coat in conformance with PENNDOT Pub.408, Section 470. The Contractor will provide a bill of lading and a signed CS-4171 for each load of Asphalt material and delivery tickets and a daily signed CS-4171 for each day’s placement of stone.

- Use of a rubber tire roller is required.

- Oil samples required from each lot of Asphalt material. Samples to be collected by the Contractor. Minimum sample frequency (1) 0ne quart: A.M. and P.M. per day. Collections of the samples are to be witnessed by the Municipality and samples are to be retained by the Municipality. (Oil samples must be placed in an approved type container that is compatible with the oil sample.)

- At least (3) three random stone samples are to be collected by the Contractor on the project site. Collection of the samples are to be witnessed by the Municipality and samples are to be retained by the Municipality.

- The Contractor will provide all sample containers or sample bags.

Price Adjustment of Asphalt Materials (Escalator Clause)

This contract contains an escalator clause for the Price Adjustment of Asphalt Materials for small quantities. See the attached

Resolution. A small quantity is a contract that uses or indicates for placement 100 tons or less of asphalt cement based on the actual mix designs or material specifications for the materials incorporated into the project. If the Asphalt materials incorporated into this project exceed the 100-ton threshold then a Asphalt price adjustment will be allowed as per PennDOT

Specifications Form 408, Current Edition, Section 110.04 Price Adjustment of Asphalt Materials. If the Asphalt material incorporates RAP in the mix design the 100-ton limit and the Asphalt price adjustment will only be calculated on the virgin asphalt. The Base Bid Price Index (IB) will be calculated using the month in which the project is first advertised, and the work is in the applicable Zone. The Bidder will be responsible for completing a CS-1PA Price Adjustment of Asphalt

Materials calculation form if applicable. The bidder will provide this form with the invoices and the invoices will show the per ton or per SY price in the bid and the lump sum price increase or decrease supported with CS-1PA calculation form. The bidder shall also supply the Municipality with a copy of the Asphalt mix design for each material supplied with the initial

CS-1PA form or if the Asphalt mix design changes. Prior to the start of the work the bidder shall provide the Municipality with the per ton or per SY calculation of the Asphalt price adjustment. The Contractor shall not be able to pass on any additional cost for any material placed beyond the November 6, 2026 cutoff date. Any material placed after November 6, 2026 shall only be subject to the Asphalt price adjustment for November 6, 2026 unless the Asphalt price adjustment falls then the Asphalt price adjustment applicable at that time shall be calculated for material placed after November 6, 2026.

Insurance Requirements

The awarded contractor shall purchase and maintain, at its expense, during the term of this contract and any renewals or extensions thereof, insurance issued by companies acceptable to the Municipality. See the “Insurance Requirement”

Attachment. Plainfield Township MUST be named as an additional insured on the policy.

Public Works Employment Verification Act

General. In accordance with Act 127 of 2012, known as the Public Works Employment Verification Act (“the Act”), effective January 1, 2013, 43 P.S. §§167.1-167.11, the Contractor shall use the Federal Government’s E-Verify system to ensure that all employees performing work on the project, including subcontractor’s employees, are authorized to work in the

United States.

Verification Form. The Contractor shall verify the employment eligibility of each new employee hired after January 1, 2013 and submit the Commonwealth Public Works Employment Verification Form (“Form”) included in the bid package attachments to the Municipality.

Contractor. Mail the Form, signed by an authorized representative of the Contractor to the Municipality along with the

Performance and Payment Bonds as specified by the contract documents. Failure or refusal to provide the Form will be considered a refusal to comply with bidding requirements, will result in rejection of the bid, and may subject the Contractor to the enforcement activities, sanctions and civil penalties specified in the Act.

Subcontractor. The Prime Contractor will obtain a Form signed by an authorized representative of any subcontractor performing work on the project, possessing sufficient knowledge to make the representations and certifications on the Form.

The Prime Contractor shall submit the Form to the Municipality prior to requesting subcontractor approval and before the subcontractor performs any work. Failure or refusal to provide the Form will be considered a refusal to comply with subcontractor approval requirements, will result in rejection of the subcontractor request, and may subject the subcontractor to the enforcement activities, sanctions and civil penalties specified in the Act.

The Prime Contractor shall include information about the requirements of the Act in all subcontracts.

Department of General Services. The Department of General Services is the Commonwealth agency responsible for enforcement and administration of the Act. Please direct questions about the Act to:

Department of General Services Public Works

Employment Verification Compliance Office

Room 105 Tent Building

18th and Herr Streets

Harrisburg, PA 17125

Fax: 717-214-3669

MS-944

PROPOSAL AND CONTRACT INSTRUCTIONS – FORM 944

1. The proposal must be typewritten or printed.

2. If more than one proposal on any project is submitted by any individual, firm or partnership, corporation, or association under the same names, only one lowest proposal will be considered.

3. Description of work------

A. If additional space is needed insert appropriately numbered attachment and note “Continued on

Attachment No. __________________________.”

B. Where Wearing Surfaces are a part of this Contract, Average Daily Traffic (ADT) Count or SRL determination must be included in the description.

4. Part A of Page 1 to be completed by municipality. Part B of Page 1 to be completed by contractor. Schedule of

Prices – Column #1 (Item), #2 (Approximate Quantities), #3 (Unit, i.e., ton, square yard, linear feet, etc.) and #4

(Description, i.e., Asphalt materials – ID-2, FJ1, FB1, BCBC, etc.) must be filled in by the municipality to insure equitable bidding. Column #5 (Unit Price), #6 (Total), and total amount of bid must be filled in by the contractor. If more space is needed, add note at bottom of the page: Continued on Attachment No. 1-A,” and add additional sheet designated as Attachment No. 1-A, 1-B, etc. Repeat for each additional sheet required.

5. If liquidated damages are to be assessed, add the following sentence to Part A #2. “If all work is not completed on time, liquidated damages will be assessed at the rate of $ ___________$850.00____________per additional working day.” (OR” … as set forth in the attached schedule.”)

6. Payment and Performance bonds are provided only by the successful bidder. Contracts under $5,000 – bonds must be in 50% of the contract amount. Contracts in excess of $5,000 – bonds must be in 100% of the contract amount.

Bond Form MS-944 Attachments 2 and 3 and Workmen’s Compensation Affidavit Attachment 4 must be submitted by the successful bidder within 20 days of the contract award. Failure to submit the bonds shall constitute grounds to cancel the contract.

7. *Construction projects, where the estimated cost of the total project exceeds $25,000, are subject to the provisions of the Pennsylvania Prevailing Wage Act 442. It is the responsibility of the municipality to obtain the Prevailing Wage

Scale for the area and include it in the proposal. IF the Prevailing Wage Act applies, this fact shall be noted in the advertisement.

On projects utilizing Federal Revenue Sharing Funds, if the project cost exceeds $2,000 and is financed with 25% or more Federal Revenue Sharing Funds, the Davis Bacon Act applies. Again, it is the responsibility of the municipality to obtain the Davis Bacon Wage Rates, include them in the proposal and note the fact in the advertisement. If both Acts are applicable, the Davis Bacon Act has preference over the Pennsylvania Prevailing

Wage Act.

8. An ESCALATOR CLAUSE is optional; however, if used, it must be included in the proposal prepared by the municipality. An escalator clause may not be inserted by the contractor.

*(1961, Aug. 15, P.L. 987; 43 P.S. 165)

MS-944 (02-01)

PERFORMANCE BOND Attachment 2 (REPRODUCE LOCALLY) (With Corporate Surety)

KNOW ALL MEN BY THESE PRESENTS, that we, _______________________________________________

(NAME AND ADDRESS OF CONTRACTOR)

as Principal and ____________________________________________________________________________________

(SURETY COMPANY)

a corporation incorporated under the laws of the State of _____________________________________________as Surety

(NAME OF STATE)

are held and firmly bound unto ____________________________________________________. In the full and just sum of _________________________________________________________ ($ _____________________________) dollars lawful money of the United States of America, to be paid to the above Municipality or its assigns, to which payment well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents.

WHEREAS, the above bonded Principal has entered into a contract with the above Municipality, bearing even date herewith, for the undertaking of certain obligations as therein set forth.

NOW, THEREFORE, the condition of this obligations such that if the bounden Principal, as Contractor, shall in all respects comply with and faithfully perform the terms and conditions of said Contract, including the Specifications and conditions referred to and made a part thereof, and such alterations as may be made in said Specifications as therein provided, and shall well and truly, and in a manner satisfactory to the Municipality fulfill all obligations as therein set forth, then this

Obligation shall be void, but otherwise the same shall be and remain in full force, virtue and effect.

It is further provided that any alteration which may be made in the terms of the contract or its specifications with the express approval of the Municipality or the Principal to the other, shall not in any way release the Principal and Surety or either or any of them, their heirs, executors, administrators, successors or assigns from their liability hereunder, notice to the

Surety of any such alteration or forbearance being hereby waived.

IN WITNESS WHEREOF, the said Principal and Surety have duly executed this Bond under Seal, pursuant to due and legal action authorizing the same to be done on ____________________________________________________

(DATE OF BOND)

SEAL Attest / Witness CONTRACTOR

_____________________________________ BY: ___________________________________________________

TITLE TITLE

SEAL Attest / Witness ___________________________________________________

SURETY COMPANY

____________________________________ BY: ____________________________________________________

TITLE TITLE

PAYMENT BOND Attachment 3

KNOW ALL MEN BY THESE PRESENTS, that we, _______________________________________________ of _____________________________________, as PRINCIPAL and ________________________________________ corporation incorporated under the laws of the State of _______________________________________as SURETY, are held and firmly bond unto the ___________________________________________________, in the full and just sum of

____________________________________________ ($ _____________________) dollars, lawful money of the United

States of America, to be paid to the said __________________ or its assigns, to which payment well and true to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.

WHEREAS, the above bounden Principal has entered into a contract with the above municipality, hereinafter called

Obligee, bearing even date herewith, for the improvement of a certain section of highway or bridge in said Municipality consisting of: ___________________________________________________________________________ for approximately the sum of ____________________________________________ ($ _________________) dollars.

NOW, THEREFORE, the condition of this obligation is such that if the above bounden PRINCIPAL shall and will promptly pay or cause to be paid in full all sums of money which may be due to contract or otherwise, to any individual, firm, partnership, association or corporation, for all material furnished or labor supplied or performed in the prosecution of the work, whether or not the said material or labor entered into and became component parts of the work and for rental of the equipment used and services rendered by public utilities in, or in connection with the prosecution of such work, then this obligation to be void, otherwise to remain in full force and effect.

The PRINCIPAL and SURETY, hereby, jointly and severally, agree with the Obligee herein that any individual firm, partnership, association or corporation, which has performed labor or furnished material in the prosecution of the work as provided, and any public utility which has not been paid in full therefore, may sue in assumpsit’s on this Payment bond in his, their, or it own name and may prosecute the same to final for such sum or sums as may be justly due him, them or it, and have execution thereon. Provided, however, that the Obligee shall not be liable for the payment of any costs of expenses of such suit.

RECOVERY by any individual, firm, partnership, association, or corporation hereunder shall be subject to the provisions of the “Public Works Contractors’ Bond Law of 1967”, Act No. 385, approved December 20, 1967, P.L. 869, which Act shall be incorporated herein and made a part hereof, as fully and completely as though its provisions were fully and at length herein recited.

It is further provided that any alterations which may be made in the terms of the contract or in the work to be done or materials to be furnished or labor to be supplied or performed under it or the giving by the Obligee of any extension or forbearance being hereby waived.

IN WITNESS WHEREOF, the said PRINCIPAL and SURETY have duly executed this Bond under seal this

_______________________________________Day of _________________________________, 20 ___________.

WITNESS:

CONTRACTOR

_____________________________________________________ BY: _______________________________________________

TITLE TITLE

WITNESS:

SURETY COMPANY

______________________________________ BY: ______________________________________________

TITLE TITLE

Attachment 4

AFFIDAVIT RE

ACCEPTING PROVISIONS OF THE WORKMEN’S COMPENSATION ACT

State of )

) SS:

County of ) he has

Being duly sworn according to law deposes and says that they have it accepted the provisions of the Workmen’s Compensation Act of 1915 of the Commonwealth of Pennsylvania, with its supplements and amendments, and have insured their liability hereunder in it accordance with the terms of said

Act with _________________________________________________________________________________________

(SURETY COMPANY)

(TYPE OR PRINT) CONTRACTOR

BY: ______________________________________

SIGNATURE

Sworn to and subscribed before me this ________________________________________________________ day of

_______________________________________A.D. 20 ____________

My Commission Expires ___________________________

(DATE)

D-7126 ( 6-99 )

ANTI-COLLUSION AFFIDAVIT

County Northampton

Municipality Plainfield Township

Project Number 2026 Asphalt Seal Coat

State of Fed. Project No.

(If Applicable)

County of

The undersigned deponent deposes and says that he is the of the Company: that he is authorized to make this affidavit on behalf of said company in compliance with section 102.06 (e) of Department Specifications, Publication 408, as amended and that the said company has not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive bidding in connection with such contract.

(Contractor)

BY

Sworn to and subscribed before me the undersigned notary public this day of , .

Notary Public

My Commission expires

CS-1PA

PRICE ADJUSTMENT OF ASPHALT MATERIAL

Project.

NO.

2026 Asphalt Seal Coat

REV (10-00) (ENGLISH) PAGE NO.

ATTACH

SR / SEC.

ITEM NO.: MONTH PLACED:

GALLON TON SQ. YARD

IP = PRICE INDEX FOR MONTH MATERIAL WAS PLACED =

IB = PRICE INDEX IN THE BID PROPOSAL =

IP / IB =

WHEN THE RATIO IP/IB FALLS WITHIN THE RANGE OF 0.90 TO 1.10 NO PRICE ADJUSTMENT IS NEEDED

WHEN THE RATIO IP/1B IS CALCULATED TO BE LESS THAN 0.90, THE DEPT. WILL RECEIVE A PRICE REBATE WHEN THE RATIO IP/IB IS CALCULATED TO BE GREATER THAN 1.10, THE CONTRACTOR WILL RECEIVE A PRICE

INCREASE

MATERIAL PLACED:

DATE GALLON DATE TON DATE SQ. YARD

TOTAL TOTAL TOTAL

GALLON BASIS:

ASPHALT TONNAGE (Q) = 0.004164 x SPEC.GRAV. OF BIT. MAT. x % ASPHALT IN EMULSION x NO. OF GALLONS

SPECIFIC GRAVITY OF BIT. MAT. = NO. OF GALLONS =

% ASPHALT IN EMULSION =

Q =

GALLONS PER SQUARE YARD BASIS:

ASPHALT TONNAGE (Q) = 0.004164 x AREA (SY) x APPL. RATE (Gallons / SY) x SPEC.GRAV. OF BIT.MAT.

ACTUAL RESIDUE APPL. RATE = SURFACE AREA =

SPECIFIC GRAVITY OF BIT. MAT. =

Q =

SQUARE YARD BASIS:

BIT. MIX. TONNAGE PLACED = 0.000375 x AREA (SY) x DESIGN DEPTH (inches) x DESIGN DENSITY ( lb. / ft3)

DESIGN DEPTH = SURFACE AREA =

DESIGN DENSITY* =

BIT. MIX. TONNAGE PLACED =

BITUMEN TONNAGE (Q) = BIT. MIXTURE TONNAGE PLACED x % BITUMEN BY WEIGHT

% BITUMEN BY WEIGHT* =

Q =

*DESIGN DENSITY AND % BITUMEN TO BE OBTAINED FROM FORM TR-448A. DENSITY OF WATER = 62.4 lb. / ft3.

TONNAGE BASIS:

BITUMEN TONNAGE (Q) = BIT. MIXTURE TONNAGE PLACED x % BITUMEN BY WEIGHT

% BITUMEN BY WEIGHT* = BIT. MIXTURE TONNAGE =

Q =

*% BITUMEN TO BE OBTAINED FROM FORM TR-448A.

PRICE INCREASE = ( IP / IB - 1.10 ) x BITUMEN TONNAGE (Q) x IB

= ( - 1.10) x ( ) x ( ) =

PRICE REBATE = ( 0.90 - IP / IB ) x BITUMEN TONNAGE (Q) x IB

= (0.90 - ) x ( ) x ( ) =

MS-NCP

MUNICIPALITY Plainfield Township, Northampton County

NOTICE OF COMPLETION

IN REFERENCE TO PROJECT NO.: 2026 Asphalt Seal Coat

Name of Contractor _____________________________________________________

Performance of work as specified on the above numbered contract is completed and final pavement inspection has been made by the contractor and municipality in accordance with the terms of the contract awarded.

DATE OF AWARD: ____________________

Signature of Municipality

Signature of Contractor

Both copies of this form to be filled by the Contractor-Municipality on completion of final pavement restoration.

THIS PORTION TO BE COMPLETED BY MUNICIPALITY

FINAL COMPLETION CERTIFICATE

By the affixing of my signature I hereby certify that final inspection has been made and all work has been performed in accordance with the above contract # and is hereby accepted by the municipality as completed.

Authorized Agent for the Municipality

*DATE: _______________

• The Bidder is responsible for maintenance of permanent pavement repairs for a period of one year from this date.

COMMONWEALTH OF PENNSYLVANIA

PUBLIC WORKS EMPLOYMENT VERIFICATION FORM

Date__________________

Business or Organization Name (Employer) _________________________________________________

Address ______________________________________________________________________________

City ___________________________________ State ___________________ Zip Code _____________

____ Contractor ____ Subcontractor (Check One)

Contracting Public Body: _______________________________________________________________

Contract/Project No.: __________________________________________________________________

Project Description: ___________________________________________________________________

Project Location: _____________________________________________________________________

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.

Authorized Representative Signature

INSURANCE REQUIREMENTS

The awarded Contractor shall purchase and maintain, at its expense, during the term of this contract and any renewals or extensions thereof, the following types of insurance issued by companies acceptable to the

Municipality.

1. Workmen’s compensation insurance sufficient to cover all of the employees of the contractor working to perform this contract, as required by the laws of the Commonwealth.

2. Comprehensive general liability insurance, property damage insurance, and where appropriate automobile liability insurance. The minimum amount of coverage shall be $250,000.00 per person and $1,000,000.00 per occurrence for bodily injury, including death and $250,000.00 per person and $1,000,000.00 per occurrence for property damage.

These coverages shall be occurrence-based. The policy shall name the Municipality as an additional insured and shall contain a provision that the coverages afforded thereunder shall not be cancelled or changed unless at least thirty (30) days prior written notice has been given to the Municipality.

Prior to the commencement of work, the Contractor shall provide the Municipality with a current certificate(s) of insurance showing the required coverages and provisions.

3. Your attention is directed to the hold harmless and indemnification provision:

“The Contractor shall hold the Municipality harmless from any indemnify the Municipality against any and all claims, demands, and actions based upon or arising out of any activities performed by the Contractor and its employees and agents under this Contract and shall, at the request of the Municipality, defend any and all actions brought against the Municipality based upon any such claims or demands.”

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