1-4864 - 962472 Butler Community Center Repairs - Construction - RFB.pdf
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- Attached to
- Butler Community Center Repairs - Construction
- Solicitation number
- 4864 - 962472
- Issued by
- Breckinridge County, Brooksville City, Kentucky
About this file
This is a Request for Bids issued by the City of Butler, Kentucky, for construction repairs to the Butler Community Center. The project aims to restore the facility to its pre-disaster design, function, and capacity within the existing footprint, with partial funding from FEMA's Public Assistance Program. The scope of work includes 24 line items covering removal and replacement of structural and mechanical components, including breaker boxes, meters, electrical posts and outlets, flooring materials, HVAC units, insulation, wooden cabinets and studs, concrete surfaces, doors, door frames, wall paneling, plywood stage platforms, and a garage door opener. Bids must be submitted online to the DFS Procurement Portal at dfs.bonfirehub.com no later than Friday, May 15, 2026, at 9:00 A.M. EST. Questions must be submitted by May 11, 2026, at 5:00 PM. Site visits may be requested by contacting Mayor Mason Taylor at 859-453-7377 during office hours, though availability is not guaranteed. Bid opening and award will occur at the Butler City Council meeting at Butler City Hall (102 Front Street, Butler, KY 41006) on Monday, May 18, 2026, at 6:00 PM. All bid prices must remain in effect for ninety calendar days following submission, and work is expected to be completed within sixty days of contract award.
Bidders must submit a bid guarantee equal to 10 percent of the total bid price in the form of a bid bond, postal money order, certified check, cashier's check, or irrevocable letter of credit. Unit pricing must be all-inclusive of removal and disposal, labor, equipment, materials, and contingency costs. Contractors are responsible for all project expenses, permits, inspections, engineering approvals, and compliance with federal, state, and local codes and regulations. The contractor must provide documentation supporting quantities and disposal locations for all debris and waste. Payment will be made only after work completion, receipt of all documentation including before/after photos and quantity verification, and approval by the Fiscal Court. Bidders must provide proof of commercial general liability insurance ($2,000,000 aggregate/$1,000,000 per occurrence), comprehensive automobile liability ($1,000,000 per occurrence), and worker's compensation coverage ($1,000,000 per occurrence) upon submission. Additionally, bidders must execute multiple certifications and declarations regarding non-collusion, debarment status, conflict of interest, drug-free workplace compliance, and affirmative steps for small and minority business participation.
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REQUEST FOR BIDS
CITY OF BUTLER
4864 - 962472 Butler Community Center Repairs - Construction
REQUEST FOR BIDS
City of Butler Community Center Repairs
City of Butler (CITY) is seeking sealed bids for repairs to the Butler Community Center.
This project will be partially funded through FEMA’s Public Assistance Program with the purpose of repairing the Butler Community Center to restore the facility back to pre-disaster design, function and capacity (in-kind) within the existing footprint.
BID SUBMISSION
Bids and all required documents must be submitted online to the DFS Procurement Portal (hereinafter “DFS Portal” or “Portal”) at dfs.bonfirehub.com no later than Friday, May 15, 2026 at 9:00 A.M., local time (EST).
Bids received after the due date and time will be considered non-responsive and will not be considered.
Questions regarding this RFB are to be submitted within the Portal at dfs.bonfirehub.com by May 11, 2026 at 5:00 PM. For questions regarding portal registration or navigation, please email: procurement@erassist.com.
Bid opening will occur and be awarded at the Butler City Council meeting in Butler City Hall, located at 102 Front St, Butler, KY 41006 on Monday, May 18, 2026 at 6:00 PM.
Site visits may be requested by contacting the Mayor, Mason Taylor at 859-453-7377 during office hours. Site visits are not guaranteed and are contingent upon availability.
Submission of any bid signifies the Contractor’s agreement that their bid and the content thereof, are valid for ninety (90) calendar days following the submission deadline and will become part of the contract that is negotiated between the City of Butler and the successful bidder. All prices submitted with the bid shall remain in effect for the ninety (90) day period.
Bidders must provide insurance policies in the DFS Procurement Portal showing proof of general and professional liability coverage upon submission.
http://dfs.bonfirehub.com http://dfs.bonfirehub.com mailto:procurement@erassist.com
Bidders shall submit a bid guarantee in the amount of 10% percent of the total bid price, which shall be in the form of a firm commitment such as a bid bond, postal money order, certified check, cashier’s check, or irrevocable letter of credit. Bid guaranteed other than bid bonds will be returned (a) to unsuccessful bidders after the opening of bids; and (b) to the successful bidder upon execution of such further contractual documents (i.e., insurance coverage) and bonds as may be required by the bid. Hard copies shall be delivered to the City of Butler City Hall, at 102 Front St, Butler, KY 41006. Soft copies shall be uploaded to the DFS Procurement Portal.
GENERAL TERMS & INFORMATION
All requested information fields in the Portal must be filled out to be considered a valid bid.
Work is expected to be completed within 60 days of contract award.
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.
Project locations and site photos are provided in Appendix A of this RFB.
Contractor shall be responsible for all expenses incurred while performing services under this Agreement. This includes automobile, truck, and other travel expenses; vehicle maintenance and repair costs; vehicle and other license fees and permits; insurance premiums; road, fuel, and other taxes; fines; radio, pager, or cell phone expenses; meals;
and all salary, expenses, and other compensation paid to employees or contract personnel the Contractor hires to complete the work under this Agreement.
The contractor will restore any landscaping, asphalt, concrete, etc. disturbed during construction to its original state or approved alternative. Any damage to the City’s property caused during construction will be repaired at the contractor’s expense.
Contractors will be responsible for determining all requirements and permits needed to complete the reconstruction work and any associated components needed to ensure the proper, efficient, and safe completion of this project. The awarded contractor will also be responsible for obtaining any and all engineering approvals mandated and required by federal, state, or local codes or regulations. All permits, inspections, engineering approvals and associated requirements are the responsibility of the selected Contractor.
Copies of required permits and approvals must be provided to the CITY upon receipt.
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).
4864-962472 CITY OF BUTLER — COMMUNITY CENTER REPAIRS Page 2
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.
The City of Butler reserves the right to accept or reject any or all bids. The right is also reserved to waive any minor irregularities in this bid, and to award the bid to the bidder whose offer is most advantageous to the CITY and in the best interests of the CITY.
The City of Butler is an Equal Opportunity Employer. All companies, including women, minority, and veteran owned businesses are encouraged to submit a bid
Work can not start until the contract agreement is fully executed and the contractor has made contact with the City of Butler to schedule work and work supervision/inspection.
DFS Portal Confirmation and Declarations
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.
Attachment 1: Bid Certification and Cost Proposal Form
Attachment 2: NON-COLLUSION DECLARATION
Attachment 3: CERTIFICATION REGARDING LOBBYING
Attachment 4: FORM 200.321 AFFIRMATIVE STEPS
Attachment5: CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY and VOLUNTARY EXCLUSION
Attachment 6: CONFLICT/NON-CONFLICT OF INTEREST STATEMENT
Attachment 7: DRUG-FREE WORKPLACE AFFIDAVIT
Attachment 8: INSURANCE COVERAGE DECLARATION
4864-962472 CITY OF BUTLER — COMMUNITY CENTER REPAIRS Page 3
Appendix A
SCOPE OF WORK
CONTRACTOR will make repairs to the Butler Community Center to restore the facilities back to pre-disaster design, function and capacity (in-kind) within the existing footprint.
Community Center Location: 110 Mill St, Butler, KY 41006 (38.78909, -84.36963)
Link to Community Center Photos
Start 38.78984, -84.37041 End 38.78918, -84.36992: Festival Grounds Electrical
● Remove and replace 2 EA of Breaker Box
● Remove and replace 1 EA of Meter
● Remove and replace 6 EA of 4-In X 4-In, Vinyl Posts
● Remove and replace 9 EA of 4-In X 6-In, Wooden Posts
● Remove and replace 45 EA of Outdoor Duplex Outlets
GPS 38.78909,
-84.36963: Bathrooms Corridor
● Remove and replace 24 SF of Plywood, painted, 12 FT long x 2 FT high
GPS 38.78909,
-84.36963: Dressing Room
● Remove and replace 49 SF of 10-inch square Porcelain Tile Floor, 7 FT long x 7 FT wide
GPS 38.78909,
-84.36963: Handicap Bathroom
● Remove and replace 49 SF of 10-inch square Porcelain Tile Floor, 7 FT long x 7 FT wide
GPS 38.78909,
-84.36963: Kitchen
● Remove and replace 1 EA of Tempstar/5000/1002612-A HVAC Unit
● Remove and replace 1,130 SF of Insulation, 113 FT long x 10 FT high
● Remove and replace 2 EA of Wood Cabinets, 34 IN long x 12 IN wide x 2 FT deep
● Remove and replace 1 EA of Wood Cabinets, 34 IN long x 17.5 IN wide x 2 FT deep
● Remove and replace 1 EA of Wood Cabinets, 34 IN long x 21.5 IN wide x 2 FT deep
● Remove and replace 1 EA of Wood Cabinets, 34 IN long x 36 IN wide x 2 FT deep
● Remove and replace 150 EA of Wooden 2-in x 4-in Wall studs spanning 199 Linear Ft, spaced 16-inch on center, 8 FT high
● Remove and replace 756 SF of Concrete, surface coat Floor, 42 FT long x 18 FT wide
GPS 38.78909,
-84.36963:Main Room
● Remove and replace 3 EA of Plywood Stage platforms, 8 FT long x 4 FT wide x 8.5 IN high
● Remove and replace 1 EA of Chamberlain Garage Door Opener
4864-962472 CITY OF BUTLER — COMMUNITY CENTER REPAIRS Page 4 https://maps.app.goo.gl/8GkxwNJnFGPgN3eN9 https://erassist-files.s3.amazonaws.com/media/uploads/DR_4864-KY_BUTLER_WO_113777_DI_1729111_Photos.pdf
Appendix A
● Remove and replace 1 EA of Breaker Box
● Remove and replace 1,215 SF of Concrete, surface coat Floor, 45 FT long x 27 FT wide
● Remove and replace Base board, wooden, 106.5 FT long x 0.75 IN wide x 12 IN high
GPS 38.78909,
-84.36963: Men’s Bathroom
● Remove and replace 39.1 SF of 8-inch square Porcelain Tile Floor,
8.5 FT long x 4.6 FT wide
● Remove and replace 1 EA of Wooden door, 77 IN long x 28 IN wide x
1.5 IN deep
● Remove and replace 1 EA of Wooden door frame, 3 FT long x 31 IN wide x 6 IN deep
GPS 38.78909,
-84.36963: Office
● Remove and replace 56 SF of Wooden wall paneling, 16 FT long x 3.5 FT high
GPS 38.78909,
-84.36963: Women’s Bathroom
● Remove and replace 39.1 SF of 8-inch square Porcelain Tile Floor,
8.5 FT long x 4.6 FT wide
● Remove and replace 1 EA of Wooden door frame, 3 FT long x 31 IN wide x 6 IN deep
● Remove and replace 1 EA of Wooden door, 77 IN long x 28 IN wide x
1.5 IN deep
4864-962472 CITY OF BUTLER — COMMUNITY CENTER REPAIRS Page 5
Bid Tab / Quantity List
Total Quantity List Unit pricing shall be all-inclusive and include removal and disposal of damages as well as all labor (including equipment programming), equipment, material, contingency, and supply costs and shall not be increased or changed for any reason other than changes requested or approved by the City.
Bid item Description Unit of
Measure Appx Qty
BUTLER COMMUNITY CENTER
1 Remove and replace Breaker Box EA 3
2 Remove and replace Meter EA 1
3 Remove and replace 4-In X 4-In, Vinyl Posts EA 6
4 Remove and replace 4-In X 6-In, Wooden Posts EA 9
5 Remove and replace Outdoor Duplex Outlets EA 45
6 Remove and replace Plywood, painted, 12 FT long x 2 FT high SF 24
Remove and replace 10-inch square Porcelain Tile Floor, 7 FT long x 7 FT wide SF 98
8 Remove and replace Tempstar/5000/1002612-A HVAC Unit EA 1
9 Remove and replace Insulation, 113 FT long x 10 FT high SF 1,130
10 Remove and replace Wood Cabinets, 34 IN long x 12 IN wide x 2 FT deep EA 2
Remove and replace Wood Cabinets, 34 IN long x 17.5 IN wide x 2 FT deep EA 1
Remove and replace Wood Cabinets, 34 IN long x 21.5 IN wide x 2 FT deep EA 1
13 Remove and replace Wood Cabinets, 34 IN long x 36 IN wide x 2 FT deep EA 1
Remove and replace Wooden 2-in x 4-in Wall studs spanning 199 Linear Ft, spaced 16-inch on center, 8 FT high EA 150
Remove and replace Concrete, surface coat Floor, 42 FT long x 18 FT wide SF 756
Remove and replace Plywood Stage platforms, 8 FT long x 4 FT wide x 8.5 IN high EA 3
17 Remove and replace Chamberlain Garage Door Opener EA 1
Remove and replace Concrete, surface coat Floor, 45 FT long x 27 FT wide SF 1,215
4864-962472 CITY OF BUTLER — COMMUNITY CENTER REPAIRS Page 6
Bid Tab / Quantity List
Remove and replace Base board, wooden, 106.5 FT long x 0.75 IN wide x 12 IN high FT 106.5
Remove and replace 8-inch square Porcelain Tile Floor, 8.5 FT long x 4.6 FT wide
SF 78.2
21 Remove and replace Wooden door, 77 IN long x 28 IN wide x 1.5 IN deep EA 2
Remove and replace Wooden door frame, 3 FT long x 31 IN wide x 6 IN deep EA 2
23 Remove and replace Wooden wall paneling, 16 FT long x 3.5 FT high SF 56
24 Mobilization/Demobilization and Traffic Control Lump Sum 1
4864-962472 CITY OF BUTLER — COMMUNITY CENTER REPAIRS Page 7
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 City 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.
4864-962472 CITY OF BUTLER — COMMUNITY CENTER REPAIRS Page 8
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)
4864-962472 CITY OF BUTLER — COMMUNITY CENTER REPAIRS Page 9
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)
4864-962472 CITY OF BUTLER — COMMUNITY CENTER REPAIRS Page 10
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 City 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)
4864-962472 CITY OF BUTLER — COMMUNITY CENTER REPAIRS Page 11
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)
4864-962472 CITY OF BUTLER — COMMUNITY CENTER REPAIRS Page 12
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.
4864-962472 CITY OF BUTLER — COMMUNITY CENTER REPAIRS Page 13
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
4864-962472 CITY OF BUTLER — COMMUNITY CENTER REPAIRS Page 14
Attachment 8: Insurance Coverage Declaration
Contractor shall provide information of the following insurance requirements below and attach the following insurance policies (including all endorsements) to this proposal. Failure to do so, may result in a rejected Bid.
1. Commercial General Liability – in the amount of two million dollars ($2,000,000.00) aggregate/one million dollars ($1,000,000.00) per occurrence. The General Aggregate limit shall either apply separately to the resulting Contractor or shall be at least twice the required occurrence limit.
2. Comprehensive Automobile and Water Vehicle Liability – covering any automotive equipment to be used in performance of the service, with a minimum limit in the amount of One Million Dollars ($1,000,000.00) per occurrence combined single limit / any auto.
Physical Damage Insurance covering owned or rented machinery, tools, equipment, office trailers, and vehicles.
3. Worker’s Compensation – Proposer shall provide a policy with employer’s liability coverage with limits of not less than One Million Dollars ($1,000,000.00) per occurrence for each accident or illness. The Worker’s Compensation policy shall state that it cannot be canceled or materially changed without first giving thirty (30) days prior notice thereof in writing to the City. Firms that have owner/operators that have filed a “Notice of Election to be Exempt” shall supply a signed copy of said notice. Any such exemption shall meet the requirements that qualify for an exemption under the applicable Worker’s Compensation law.
Do you confirm that you have read the Insurance Coverage Declaration and agree to provide copies of the insurance policies prior to contract award. (Y/N)
4864-962472 CITY OF BUTLER — COMMUNITY CENTER REPAIRS Page 15
| Attachment 1: Certification and Cost Proposal Form |
| Attachment 2: NON-COLLUSION DECLARATION |
| Attachment 3: CERTIFICATION REGARDING LOBBYING |
| Attachment 4: FORM 200.321 AFFIRMATIVE STEPS |
| Attachment 5: CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY and VOLUNTARY EXCLUSION |
| Attachment 6: CONFLICT/NON-CONFLICT OF INTEREST STATEMENT |
| Attachment 7: DRUG-FREE WORKPLACE AFFIDAVIT |
| Attachment 8: Insurance Coverage Declaration |
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