1-4663 Letcher County 736024 Culvert Damage Group 7 RFB Final Due 7.9.26.pdf

Scope of Work

LETCHER COUNTY FISCAL COURT

PROJECT NAME: 736024 Culvert Damage Group 7 – Culvert Repair

Questions: email judgeadams@letchercounty.ky.gov and procurement@erassist.com

Responses are due no later than July 9, 2026; 9:00 AM ET.

Any contractor with overdue work for the county is ineligible for additional work from the county until overdue projects are completed.

Required Documents for Submission in DFS Procurement Portal:

Copy of Insurance Copy of Drug Free Workplace Policy

RESPONSE DELIVERY:

Bid and all required forms shall be submitted through the DFS Procurement Portal:

dfs.bonfirehub.com

Procurement Notes:

● All requested information must be filled out to be considered a valid bid.

● Bids and all required forms shall be submitted through the DFS Procurement Portal at dfs.bonfirehub.com/portal no later than July 9, 2026, 9:00 AM ET. Submissions received after the due date and time will be considered non-responsive and will not be considered.

● Bids will be opened on July 9, 2026, 10:00 AM ET at the Letcher County Judge Executive's

Office at 156 Main St. Suite 107, Whitesburg, KY 41858.

● Award will occur at a special call of the Letcher County Fiscal Court meeting on July 10, 2026 at 10:00 AM EST at 156 Main St. Suite 107, Whitesburg, KY 41858.

● WORK MUST BE COMPLETE BY JULY 29th 2026.

● Work will not be considered complete until all invoice documents are provided and invoice validation is complete. Final invoice with all required documents must be provided in a single transmission (email or link to a dropbox , google drive, or other file sharing service).

Multi-part transmission of invoice documentation will cause a delay in validation which will affect payment processing timelines and designation of completion.

● Work will follow all best construction practices. All work shall conform to Division 400 of the KY Department of Highways 2019 Standard Specifications for Road and Bridge Construction, which can be found at http://transportation.ky.gov/Construction/Pages/Kentucky-Standard-Specifications.aspx

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 1 mailto:judgeadams@letchercounty.ky.gov mailto:procurement@erassist.com http://dfs.bonfirehub.com http://transportation.ky.gov/Construction/Pages/Kentucky-Standard-Specifications.aspx

● For Ditching Projects or culvert clean out projects. Earthen Material from Ditching or Culvert Clean Out may be worked into surrounding embankment at appropriate angles, especially in locations under which Channel Lining will be installed. Remaining Sediment or Earthen Material must be hauled to a government borrow pit (location/tickets/photos must be included on invoice) or hauled to a landfill. Debris must be hauled to a landfill. Landfill tickets are required to be submitted with an invoice.

● Invoices must include at least 4 Photos of “Before” and 4 Photos “After” work completion.

Photos must be taken with an app (such as Solocator or GPS Camera) that displays the GPS (and preferably road name) and date.

● If rock/aggregate or fill material is supplied as part of this work, the Invoice must list the quarry location of aggregate or the source location of the fill. If rock/aggregate is supplied from a third party, must provide documentation from the third party of the original location of the aggregate or fill. Third party documentation must be signed and submitted on third party letterhead.

● This work is for a specific site/repair with quantities listed on a FEMA grant; as such documentation supporting the quantities must be provided (e.g. quarry tickets, or load counts/truck capacities). Invoices must list the haul off location of any debris, spoils, or waste (example: permitted landfill, recycling location, or road dept for reuse).

● Payment will follow only after work is completed, all documentation is received from the Contractor and reconciled by the Grants Management Team, and after approval by the Fiscal Court. (Documentation to include items such as before/after photos (always required), quarry documentation, quantity documentation, and documentation of disposal).

● Successful bidders, assigns, subcontractors must be compliant with all applicable Federal, State and Local laws.

● Letcher County reserves the right to accept or reject any and all bids. Letcher County reserves the right to seek clarification from bidders.

● Letcher County Fiscal Court is an Equal Opportunity Employer and encourages all qualified businesses to respond to this request, including minority, women, veteran owned businesses, as well as hub-zone businesses.

● Work can not start until the contract agreement is fully executed and the contractor has made contact with Letcher County Matt Amburgey at (606) 595-8710 to schedule work and work supervision/inspection.

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 2

Using Care to not destroy pavement or place equipment in water:

Site # Scope GPS /Map Picture

Dove Rd Site 1

1. Unclog and Clean 30 LF of 15 in Diameter

Corrugated Metal Pipe (CMP)

2. Clean and reshape 10 LF of roadside ditch on each side of culvert ( 20 LF Total)

3. Install 9.33 SY (12’ L x 7’W) of Geotextile Fabric on each side of culvert (18.67 SY Total)

4. Install 2.59 Tons (10’L x 5’W x 1’D) of Class II

Channel Lining to each side of culvert (5.19

Tons Total)

37.16891, -82.82494

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 3 https://www.google.com/maps/place/37%C2%B010'08.1%22N+82%C2%B049'29.8%22W/@37.1708381,-82.8269399,17z/data=!4m4!3m3!8m2!3d37.16891!4d-82.82494?entry=ttu

Great Oak Rd Site 5

1. Remove existing CMP Culvert and replace with

36 LF of 36 in Diameter HDPE culvert

2. Install 72 SY of Geotextile Fabric around culvert according to specifications

3. Install 45.86 Tons of Crushed Limestone

Backfill around culvert

4. Install 5.88 Tons of DGA Base on top of Culvert as road base.

5. Clean and Reshape 10 LF of roadside ditch at the culvert inlet

6. Install 9.33 SY (12’L x 7’W) of Geotextile Fabric to each end of Culvert (18.67 SY Total)

7. Install 2.59 Tons (10’L x 5’W x 1’D) of Class II

Channel Lining at culvert inlet

8. Install 3.89 Tons (10’L x 5’W x 1.5’D) of Class III

Channel Lining at culvert outlet

37.10788, -82.77447

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 4 https://www.google.com/maps/place/37%C2%B006'28.4%22N+82%C2%B046'28.1%22W/@37.1079655,-82.7744244,2847m/data=!3m1!1e3!4m4!3m3!8m2!3d37.10788!4d-82.77447?entry=ttu&g_ep=EgoyMDI2MDYyMy4wIKXMDSoASAFQAw%3D%3D

Emerson Drive Site 1

1. Remove existing Corrugated Metal Pipe (CMP)

Culvert and replace with 20 LF of 52 in

Diameter High Density Polyethylene (HDPE) culvert

2. Install 57.77 SY of Geotextile Fabric around culvert and rock bedding according to specifications

3. Install 35.22 Tons of Crushed Limestone

Backfill around the culvert.

4. Install 11.67 Tons of Dense Graded Aggregate

(DGA) Base on top of culvert as road base.

5. Install 54 in Diameter pipe culvert headwalls with wingwalls and apron to each end of culvert (2 Headwalls Total)

6. Install 2.75 SY of Geotextile Fabric to each end of the culvert (5.5 SY Total)

7. Install 1.75 Tons of Class II Channel Lining to each end of the culvert (3.5 Tons Total)

37.11140, -82.77763

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 5 https://www.google.com/maps/place/37%C2%B006'41.0%22N+82%C2%B046'39.5%22W/@37.1155295,-82.7764284,15.08z/data=!4m4!3m3!8m2!3d37.1114!4d-82.77763?entry=ttu

Driftwood Loop Site 2

1. Remove existing Culvert and replace with 20

LF of 24 in Diameter High Density Polyethylene

(HDPE) culvert

2. Install 26.67 SY of Geotextile Fabric around culvert and rock bedding according to specifications

3. Install 18.73 Tons of Crushed Limestone

Backfill around culvert.

4. Install 6.30 Tons of Dense Graded Aggregate

(DGA) Base under and around culvert

5. Clean and reshape 10 LF of roadside ditch on each side of culvert ( 20 LF Total)

6. Install 9.33 SY (12’ L x 7’W) of Geotextile Fabric on each side of culvert (18.67 SY Total)

7. Install 3.89 Tons (10’L x 5’W x 1.5’D) of Class III

Channel Lining to each side of culvert (7.78

37.12055, -82.84888

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 6 https://www.google.com/maps/place/37%C2%B007'14.0%22N+82%C2%B050'56.0%22W/@37.1209193,-82.8546957,15.5z/data=!4m4!3m3!8m2!3d37.12055!4d-82.84888?entry=ttu

Haymond Hill Rd Site 1

LF of 36in Diameter High Density Polyethylene

(HDPE) culvert

2. Install 40 SY of Geotextile Fabric around culvert and rock bedding according to specifications

3. Install 25.48 Tons of Crushed Limestone

Backfill around culvert

4. Install 8.4 Tons of Dense Graded Aggregate

(DGA) Base under and around culvert

5. Clean and reshape 10 LF of roadside ditch on each side of culvert ( 20 LF Total)

6. Install 9.33 SY (12’ L x 7’W) of Geotextile Fabric on each side of culvert (18.67 SY Total)

7. Install 3.89 Tons (10’L x 5’W x 1.5’D) of Class III

37.18663, -82.69820

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 7 https://www.google.com/maps/place/37%C2%B011'11.9%22N+82%C2%B041'53.5%22W/@37.1905944,-82.7057179,15.09z/data=!4m4!3m3!8m2!3d37.18663!4d-82.6982?entry=ttu

El paso Dr Site 1

1. Remove existing Culvert and replace with 16

LF of 18in Diameter High Density Polyethylene

(HDPE) culvert

2. Install 16 SY of Geotextile Fabric around culvert and rock bedding according to specifications

3. Install 12.43 Tons of Crushed Limestone

Backfill around culvert.

4. Install 1.11 Tons of Dense Graded Aggregate

(DGA) Base on top of culvert as road base.

5. Clean and reshape 10 LF of roadside ditch on each side of culvert ( 20 LF Total)

6. Install 9.33 SY (12’ L x 7’W) of Geotextile Fabric on each side of culvert (18.67 SY Total)

7. Install 3.89 Tons (10’L x 5’W x 1.5’D) of Class III

37.12878, -82.86425

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 8 https://www.google.com/maps/place/37%C2%B007'43.6%22N+82%C2%B051'51.3%22W/@37.1283577,-82.8705444,15.71z/data=!4m4!3m3!8m2!3d37.12878!4d-82.86425?entry=ttu

Flower Rd Site 4

1. Remove existing Culvert and replace with 18

LF of 18 in Diameter High Density Polyethylene

(HDPE) culvert

2. Install 16 SY of Geotextile Fabric around culvert and rock bedding according to specifications

3. Install 13.98 Tons of Crushed Limestone

Backfill around culvert.

4. Install 5.67 Tons of Dense Graded Aggregate

(DGA) Base on top of culvert as road base.

5. Clean and reshape 10 LF of roadside ditch on each side of culvert ( 20 LF Total)

6. Install 9.33 SY (12’ L x 7’W) of Geotextile Fabric on each side of culvert (18.67 SY Total)

7. Install 3.89 Tons (10’L x 5’W x 1.5’D) of Class III

37.13314, -82.87123

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 9 https://www.google.com/maps/place/37%C2%B007'59.3%22N+82%C2%B052'16.4%22W/@37.1301131,-82.8775686,15.25z/data=!4m4!3m3!8m2!3d37.13314!4d-82.87123?entry=ttu

Four Wheel Drive Site 3

1. Unclog and Clean 30 LF of 18 in Diameter

Corrugated Metal Pipe (CMP)

2. Clean and reshape 10 LF of roadside ditch on each side of culvert ( 20 LF Total)

3. Install 9.33 SY (12’ L x 7’W) of Geotextile Fabric on each side of culvert (18.67 SY Total)

4. Install 3.89 Tons (10’L x 5’W x 1.5’D) of Class III

37.19466, -82.87769

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 10 https://www.google.com/maps/place/37%C2%B011'40.8%22N+82%C2%B052'39.7%22W/@37.1944855,-82.8818781,16.25z/data=!4m4!3m3!8m2!3d37.19466!4d-82.87769?entry=ttu

Eagle Road Site 3

1. Remove existing Culvert and replace with 16

LF of 18in Diameter High Density Polyethylene

(HDPE) culvert

2. Install 16 SY of Geotextile Fabric around culvert and rock bedding according to specifications

3. Install 12.43 Tons of Crushed Limestone

Backfill around culvert.

4. Install 1.11 Tons of Dense Graded Aggregate

(DGA) Base on top of culvert as road base.

5. Clean and reshape 10 LF of roadside ditch on each side of culvert ( 20 LF Total)

6. Install 9.33 SY (12’ L x 7’W) of Geotextile Fabric on each side of culvert (18.67 SY Total)

7. Install 3.89 Tons (10’L x 5’W x 1.5’D) of Class III

37.17740, -82.82655

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 11 https://www.google.com/maps/place/37%C2%B010'38.6%22N+82%C2%B049'35.6%22W/@37.1773544,-82.8287405,16.5z/data=!4m4!3m3!8m2!3d37.1774!4d-82.82655?entry=ttu

Grays Branch Site 22

1. Unclog and Clean 40 LF of 24 in Diameter

Corrugated Metal Pipe (CMP)

2. Clean and reshape 10 LF of roadside ditch on each side of culvert ( 20 LF Total)

3. Install 9.33 SY (12’L x 7’W) of Geotextile Fabric to each end of Culvert (18.67 SY Total)

4. Install 2.59 Tons (10’L x 5’W x 1’D) of Class II

Channel Lining at culvert inlet

5. Install 3.89 Tons (10’L x 5’W x 1.5’D) of Class III

Channel Lining at culvert outlet

37.18629 -82.67249

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 12 https://www.google.com/maps/place/37%C2%B011'10.6%22N+82%C2%B040'21.0%22W/@37.18526,-82.6740564,17z/data=!4m4!3m3!8m2!3d37.18629!4d-82.67249?entry=ttu

Grays Branch Site 26

LF of 36in Diameter HDPE culvert

2. Install 40 SY of Geotextile Fabric around culvert and rock bedding according to specifications

3. Install 25.48 Tons of Crushed Limestone

Backfill around culvert.

4. Install 9.8 Tons of DGA Base on top of culvert as road base

5. Install 9.33 SY (12’ L x 7’W) of Geotextile Fabric on each side of culvert (18.67 SY Total)

6. Install 3.89 Tons (10’L x 5’W x 1.5’D) of Class III

Channel Lining to each side of culvert (7.78

37.18452 -82.67192

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 13 https://www.google.com/maps/place/37%C2%B011'04.3%22N+82%C2%B040'18.9%22W/@37.1869218,-82.676233,16z/data=!4m4!3m3!8m2!3d37.18452!4d-82.67192?entry=ttu

The following forms are provided in this RFB for reference. Bidders must review each form and enter their response as directed in the Portal’s Required Information section. The confirmation or declaration statement for each form for which a response is required is provided in a gray box at the bottom of each form in this document. All responses must be true and accurate and shall be considered the equivalent of a legally-binding electronic signature.

1. Attachment 1: Bid Certification and Cost Proposal Form

2. Attachment 2: NON-COLLUSION DECLARATION

3. Attachment 3: CERTIFICATION REGARDING LOBBYING

4. Attachment 4: FORM 200.321 AFFIRMATIVE STEPS

5. Attachment5: CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY and VOLUNTARY EXCLUSION

6. Attachment 6: CONFLICT/NON-CONFLICT OF INTEREST STATEMENT

7. Attachment 7: DRUG-FREE WORKPLACE AFFIDAVIT

8. Attachment 8: INSURANCE COVERAGE DECLARATION

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 14

Attachment 1: Certification and Cost Proposal Form

Bidding Certification: I have carefully examined the Request for Bids and any other documents accompanying or made a part of this Request for Bids.

I hereby propose to furnish the goods or services specified in the Request for Bids at the rates quoted in my Bid. I agree that my Bid will remain in effect for a period of up to one hundred eighty (180) days.

I agree to abide by all conditions of this Bid l and understand that a background investigation may be conducted prior to award.

I certify that all information contained in this Bid is truthful to the best of my knowledge and belief. I further certify that I am duly authorized to submit this Bid on behalf of the Bidder as its act and deed and that the Bidder is ready, willing and able to perform if awarded the Contract.

I certify this Bid is made without prior understanding, agreement, connection, discussion, or collusion with any other person, firm or corporation submitting a Bid for the same product or service. I further certify that no officer, employee or agent of

County or of any other Bidder has a financial interest in this Bid. I further certify that the undersigned executed this Bidder's Certification with full knowledge and understanding of the matters therein contained and was duly authorized to do so.

DFS Portal Confirmation / Declaration:

By completing and submitting the Cost Proposal Form, you are certifying all of the above as well as the prices and data entered in the Cost Proposal Form in the DFS Portal. The following

Cost Proposal Form is provided for reference only.

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 15

Attachment 1: Certification and Cost Proposal Form

Total Quantity List

Unit pricing shall be all-inclusive and include all labor (including equipment programming), equipment, material, and supply costs and shall not be increased or changed for any reason other than changes requested or approved by the County.

Bid item

Description Unit of

Measure Appx Qty

1 Clean and Unclog 15 IN Diameter HDPE Culvert LF 30

2 Clean and Unclog 18 IN Diameter HDPE Culvert LF 30

3 Clean and Unclog 24 IN Diameter HDPE Culvert LF 40

Remove existing culvert and replace with 18 IN Diameter HDPE Culvert

LF 50

Remove existing culvert and replace with 24 IN Diameter HDPE Culvert

LF 20

Remove existing culvert and replace with 36 IN Diameter HDPE Culvert

LF 76

Remove existing culvert and replace with 52 IN Diameter HDPE Culvert

LF 20

Provision and Installation of Crushed Limestone Backfill

TON 189.61

9 Provision and Installation of Geotextile Fabric SY 476.64

10 Provision and Installation of DGA Road base TON 44.06

Provision and Installation of Class II Channel Lining

TON 6.09

Provision and Installation of Class III Channel Lining

TON 57.49

13 Clean and Reshape Ditch at Culvert Inlet/Outlet LF 170

Provision and Installation of 54 in Diameter pipe culvert headwalls with wingwalls and apron

EA 2

15 Mobilization/Demobilization and Traffic Control Lump Sum

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 16

Attachment 2: NON-COLLUSION DECLARATION

The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The bidder has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding. The bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder.

All statements contained in the bid are true. The bidder has not, directly or indirectly, submitted his or her bid price of any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose.

Any person executing this declaration on behalf of a bidder that is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the bidder.

I declare under penalty of perjury under the applicable laws that the foregoing is true and correct.

Do you confirm that you have read the Non-Collusion declaration and therefore declare under penalty of perjury under the applicable laws that the Non-Collusion Declaration is true and correct? (Y/N)

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 17

Attachment 3: CERTIFICATION REGARDING LOBBYING

The undersigned certifies that, to the best of their knowledge and belief, that:

1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a

Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, “Disclosure

Form to Report Lobbying,” in accordance with its instruction.

3. The undersigned shall require that the language of this certification be included in the award document for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31

U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

Do you, the Contractor, confirm that you have read the Certification Regarding Lobbying form and certify or affirm the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31

U.S.C. Chap. 38, Administrative Remedies for False Claims and Statements, apply to this certification and disclosure, if any. (True/False)

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 18

Attachment 4: FORM 200.321 AFFIRMATIVE STEPS

CONTRACTING WITH SMALL AND MINORITY BUSINESSES, WOMEN’S BUSINESS

ENTERPRISES, AND LABOR SURPLUS AREA FIRMS §200.321

The County is required to take all necessary affirmative steps to assure that minority business, women's business enterprises, and labor surplus area firms are used when possible. If contractor uses subcontractors, they are also required to take the following affirmative steps:

1. Placing qualified enterprises on solicitation lists.

2. Assuring that enterprises are solicited whenever they are potential sources.

3. Dividing total requirements when economically feasible into smaller tasks or quantities to permit maximum participation by enterprises.

4. Establishing delivery schedules, where the requirement permits, which encourage participation by enterprises.

5. Using the services and assistance, as appropriate, of such organizations as the Small

Business Administration and the Minority Business Development Agency of the

Department of Commerce.

Do you confirm that you have read the 200.321 Affirmative Steps Confirmation and agree to take the listed affirmative steps when using subcontractors. (Y/N)

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 19

Attachment 5: CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY and

VOLUNTARY EXCLUSION

Neither the entity or its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation by any federal department or agency.

Do you confirm that neither the entity nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation by any federal department or agency? (Y/N)

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 20

Attachment 6: CONFLICT/NON-CONFLICT OF INTEREST STATEMENT

To the best of our knowledge the bidder has no potential conflict of interest due to any other clients, contracts, or property interest for this project. [ SELECT YES IF TRUE ]

OR

The bidder, by attachment, submits information which may be a potential conflict of interest due to other clients, contracts, or property interest for this project. [ SELECT NO

IF TRUE & UPLOAD DOCUMENTATION ]

Failure to answer appropriately may result in disqualification of your bid.

Do you confirm that to the best of your knowledge the undersigned bidder has no potential conflict of interest due to any other clients, contracts, or property interest for this project?

(Y/N)

If answered no, documentation must be uploaded containing information regarding what may be a potential conflict of interest due to other clients, contracts, or property interest for this project.

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 21

Attachment 7: DRUG-FREE WORKPLACE AFFIDAVIT

The undersigned certifies that the responding firm has taken steps to :

1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition.

2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations.

3. Give each employee engaged in providing the commodities or contractual services that are proposed, a copy of the drug- free workplace statement.

4. In the statement specified in drug-free workplace statement, notify the employees that as a condition of working on the commodities or contractual services that are under bid the employee will abide by the terms of the statement and will notify the employer of any conviction of or plea of guilty or nolo contendere to any violation of any controlled substance law of the United States or any state for a violation occurring in the workplace no later than five (5) days after such conviction.

5. Impose a sanction on or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community by any employee who is so convicted.

6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section.

I certify that this firm complies fully with the above requirements.

Do you confirm that you have read the Drug-Free Workplace Affidavit and certify that the responding company complies fully with the listed requirements? (Y/N)

- Upload the contractor's Drug Free Workplace Policy

4663 Letcher County Fiscal Court 736024 Culvert Damage Group 7 Page 22