1-83000-126-B-FY25-CDBG REQUIRED Bid Documents.pdf
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- Solicitation number
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- Delaware County, Riceville CDP, Pennsylvania
About this file
This is a bid document package for the Township of Ridley in Delaware County, Pennsylvania, for the Dougherty-Gillespie Field Park Improvements project funded through the Community Development Block Grant (CDBG) program. The project scope includes concrete curb and sidewalk installation, pavement removal, full-depth paving, drainage improvements including rain gardens, and related site work. Specific bid items include 185 linear feet of curb removal, 175 linear feet of apron removal, 1,115 square yards of pavement removal, 350 linear feet of concrete curb, 525 square feet of concrete sidewalk, 2 ADA curb ramps, 335 square yards of full-depth driveway paving, 42 square yards of street/gutter restoration, 2 Type M inlets with weirs, 1 manhole with PADOT Type 4 base, 1 Type 4 inlet with weir and trash rack, and 1 rain garden installation. Sealed bids must be submitted online via the PennBid Program at www.PennBid.Bonfirehub.com by 10:00 A.M. on April 16, 2026, with public opening and reading scheduled for April 22, 2026, at the Township Meeting. The contract completion period is 90 consecutive calendar days from the Notice to Proceed, with liquidated damages assessed at $885.00 per day for delays beyond this timeframe.
Bidders must submit a bid bond in the amount of 10 percent of the total bid price, payable to the Township of Ridley, and the successful bidder will be responsible for paying the PennBid Program a fee of one-third percent of the contract award value with a minimum fee of $100.00 and maximum of $5,000.00. The contract requires performance and payment bonds equal to 100 percent of the contract price and a one-year maintenance bond for 10 percent of the contract price. All contractors and subcontractors must comply with Federal Labor Standards Provisions, Davis-Bacon and Related Acts prevailing wage requirements, Section 3 of the Housing and Community Development Act requirements, Public Works Employment Verification using the federal E-Verify system, nondiscrimination and equal opportunity provisions, and Township of Ridley Ordinance No. 2048 regarding Minimum Standards of Contractor Responsibility. Contractors must actively recruit minority and women-owned subcontractors, solicit at least 5 bids from minority- or female-owned businesses, and report Section 3 labor hours and Section 3 business concern certifications. The project is funded through the CDBG program and requires compliance with all applicable federal, state, and local regulations governing employment, non-discrimination, environmental protection, and contractor eligibility.
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NONCOLLUSION AFFIDAVIT
State of
BID Identification
CONTRACTOR , being first duly sworn, deposes and says that he is (sole owner, a partner, president, secretary, etc.) of the party making the foregoing BID; that such BID is not made in the interest of or on behalf of any undisclosed person, partnership, company, association, organization, or corporation; that such BID is genuine and not collusive or sham; that said BIDDER has not directly or indirectly induced or solicited any other BIDDER to put in a false or sham BID, and has not directly or indirectly colluded, conspired, connived, or agreed with any BIDDER or any one else to put in a sham BID, or that any one shall refrain from bidding; that said BIDDER has not in any manner, directly or indirectly, sought by agreement, communication or conference with any one to fix the BID price of said BIDDER or of any other BIDDER, or to fix any overhead, profit, or cost element of such BID price, or of that of any other BIDDER, or to secure any advantage against the OWNER awarding the contract or anyone interested in the proposed contract; that all statements contained in such BID are true; and, further, that said BIDDER has not, directly or indirectly, submitted his BID price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid and will not pay any fee in connection therewith, to any corporation, partnership, company, association, organization, BID depository, or to any member or agent thereof, or to any other individual except to such person or persons as have a partnership or other financial interest with said BIDDER in his general business.
Signed:
Subscribed and sworn to before me this day of , 20 .
Seal of Notary
BID BOND
KNOW ALL MEN BY THESE PRESENTS, THAT WE, as PRINCIPAL, and as SURETY, are held and firmly bound unto the (hereinafter called the OWNER), in the penal sum of DOLLARS ($ ) lawful money of the United States, for payment of which sum well and truly to be made, we bond ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents.
THE CONDITION OF THE OBLIGATION IS SUCH that whereas the Principal has submitted the accompanying Bid dated for .
NOW, THEREFORE, if the Principal shall not withdraw said Bid within the time specified therein after the opening of the same, and shall within ten (10) days after the Principal is notified by the Owner of the award of such Contract to him, enter into a written contract with the Owner, in accordance with the Bid as accepted; and give bond with good and sufficient surety or sureties as may be required for the faithful performance and proper fulfillment and labor supplied, if required in said Contract; or in event of the withdrawal of said Bid within the period specified, or the failure to enter into such Contract and give such bonds within the time specified if the Principal shall pay the Owner the difference between the amount specified in said Bid and the amount for which the Owner may procure the required materials or supplies, or both, if the latter amount of the former, together with any other expenses and costs that may have been incurred by the Owner, then the above obligation shall be void and of no effect, otherwise to remain in full force and virtue.
IN WITNESS WHEREOF, the above bonded parties have executed this instrument under their several seals this day of , 20 , the name and corporate seal of each corporate party being hereto affixed and these presents duly signed by its undersigned representative, pursuant to authority of its governing body.
WITNESSED BY:
(Individual Principal)
Business Address:
ATTEST:
Corporate Principal Corporate Surety
By:
SEAL
(Power of Attorney for person signing for Surety Company must be attached to bond.)
6-1
BID FOR UNIT PRICE CONTRACTS
Proposal of (hereinafter called "Bidder")* a corporation, organized and existing under the laws of the State of ,** a partnership, or an individual doing business as .
To the Township of Ridley (hereinafter called "Owner")
The Bidder, in compliance with your invitation for bids for the CDBG Dougherty-Gillespie Field Park Improvements having examined the plans and specifications with related documents and the site of the proposed work, and being familiar with all of the conditions surrounding the construction of the proposed project including the availability of materials and labor, hereby proposes to furnish all labor, materials, and supplies, and to construct the project in accordance with the contract documents, within the time set forth therein, and at the prices stated below. These prices are to cover all expenses incurred in performing the work required under the contract documents, of which this proposal is a part.
Bidder hereby agrees to commence work under this contract on or after a date to be specified in written "Notice to Proceed" of the Owner and to fully complete the project within 90 consecutive calendar days thereafter as stipulated in the specifications. Bidder further agrees to pay as liquidated damages, the sum of $885.00 for each consecutive calendar day thereafter as hereinafter provided in Paragraph of the General Conditions.
Bidder acknowledges receipt of the following addendum:
Bidder agrees to perform all the work described in the specifications and shown on the plans, for the following unit prices:
Item Description Quantity Unit Price Total
1 Curb Removal 185 LF $ /LF $
2 Apron Removal 175 LF $ /LF $
3 Pavement Removal 1115 SY $ /SY $
4 Miscellaneous Item Removal 1 LS $ /LS $
5 Concrete Curb 350 LF $ /LF $
6 Concrete Sidewalk 525 SF $ /SF $
7 ADA Curb Ramps 2 EA $ /EA $
8 Full Depth Paving – Driveway 335 SY $ /SY $
9 Full Depth Street/Gutter Restoration 42 SY $ /SY $
10 Type M Inlet with Weirs 2 EA $ /EA $
11 MH with PADOT Type 4 Base 1 EA $ /EA $
12 Type 4 Inlet With Weir and Trash Rack 1 EA /EA $
13 Rain Garden 1 LS $ /LS $ 13 Stop Sign and Stop Bar Pavement Marking 1 EA $ /EA $ 14 Park Sign 1 EA $ /EA $
TOTAL $
6-2
TOTAL BID PRICE $
(Amounts are to be shown in both words and figures. In case of discrepancy, the amount shown in words will govern.)
The above unit prices shall include all labor, materials, bailing, shoring, removal, overhead, profit, insurance, etc., to cover the finished work of the several kinds called for.
Bidder understands that the Owner reserves the right to reject any or all bids and to waive any informalities in the bidding.
The bidder agrees that this bid shall be good and may not be withdrawn for a period of 30 calendar days after the scheduled closing time for receiving bids.
Upon receipt of written notice of the acceptance of this bid, bidder will execute the formal contract attached within 10 days and deliver a Surety Bond or Bonds as required by Paragraph of the General Conditions. The bid security attached in the sum of ($ ) is to become the property of the Owner in the event the contract and bond are not executed within the time above set forth, as liquidated damages for the delay and additional expense to the Owner caused thereby.
Respectfully submitted:
(SEAL - if bid is By:
by a corporation)
Business Address and Zip Code
DUNS Number
UEI Number
SUBCONTRACTOR DECLARATION FORM
Each prime contractor is required to submit a list of subcontractors it intends to use on the project.
Subcontractor Business Address Type of Work
Project Name
Prime Contractor
Signature Title Date
12-1
15-1
51-35A
Ridley Township
CDBG Dougherty-Gillespie Park Improvements
Charles Catania
NONDISCRIMINATION CLAUSE
During the term of this contract, Contractor agrees as follows:
1. Contractor shall not discriminate against any employee, applicant for employment, independent contractor, or any other person because of race, color, religious creed, ancestral national origin, age, or sex. Contractor shall take affirmative action to ensure that applicants employed, and that employees or agents are treated during employment, without regard to their race, color, religious creed, handicap, ancestry, national origin, age, or sex. Such affirmative action shall include, but is not limited to employment, upgrading, demotion or transfer, recruitment, recruitment advertising; layoff or termination; rates of pay or other forms of compensation; or selection for training. Contractor shall post in conspicuous places, available to employees, agency of applicants for employment, and other persons, a notice to be provided by the contracting agencies setting forth the provisions of this nondiscrimination clause.
2. Contractor shall, in advertisements or requests for employment placed by it or on its behalf, state that all qualified applicants will receive consideration for employment without regard to race, color, religious creed, handicap, ancestry, national origin, age or sex.
3. Contractor shall send each labor union or workers' representative with which it has collective bargaining agreement or other contract or understanding, a notice advising said labor union or workers' representative of its commitment to this nondiscrimination clause. Similar notice shall be sent to every other source of recruitment regularly utilized by Contractor.
4. It shall be no defense to a finding of noncompliance with this nondiscrimination clause that Contractor had delegated some of its employment practices to any union, training program or other source of recruitment which prevents it from meeting its obligations. However, if any evidence indicates that the Contractor was not on notice of the third-party discrimination or made good faith effort to correct it, such factor shall be considered in mitigation in determining appropriate sanctions.
5. Where the practices of a union or any training program or other source of recruitment will result in the exclusion of minority group persons, so that Contractor will be unable to meet the obligations under this nondiscrimination clause. Contractor shall then employ and fill vacancy through other nondiscriminatory employment procedures.
6. Contractor shall comply with all state and federal laws prohibiting discriminatory hiring or employment opportunities. In the event of Contractor's noncompliance with the nondiscrimination clause of this contract or with any such laws, this contract may be terminated, suspended, in whole or in part, and Contractor may be declared temporarily ineligible for future Commonwealth contracts, and other sanctions may be imposed and remedies invoked.
7. Contractor shall furnish all necessary employment documents and records to, and permit access to its books, records, and accounts by the contracting agency for purposes of investigation to ascertain compliance with the provisions of this clause. If Contractor does not possess documentation records reflecting the necessary information requested, it shall furnish such information on reporting forms supplied by the contracting agency.
8. Contractor shall actively recruit minority and women subcontractors or subcontractors with substantial minority representation among their employees.
9. Contractor shall include the provisions of this nondiscrimination clause in any subcontract, so that such provisions will be binding upon each Subcontractor.
10. Contractor obligations under this clause are limited to the Contractor's facilities in Pennsylvania or, where the contract is for purchase of goods manufactured outside of Pennsylvania, the facilities at which such goods are actually produced.
CONTRACTOR Date
CONFLICT OF INTEREST
Interest of Local Public Officials
No member of the governing body of the locality or entity and no other officer, employee, agent or public official of such locality, who exercises any functions or responsibilities in connection with the planning and carrying out of the program, shall have any personal financial interest, direct or indirect, in this contract; and the governing body contractor shall take appropriate steps to assure compliance.
Interest of Contractor and Employees
The Contractor covenants that he presently has no interest and shall not acquire interest, direct or indirect, in the study area or any parcels therein or any other interest which would conflict in any manner or degree with the performance of his services hereunder. The Contractor further covenants that in the performance of this Contract, no person having any such interest shall be employed.
RECORDS AND AUDITS
The Contractor shall maintain accounts and records, including personnel, property and financial records, adequate to identify and account for all costs pertaining to the Contract and such other records as may be deemed necessary by the Municipality and County to assure proper accounting for all project funds. These records will be made available for audit purposes to the Municipality and County or any authorized representative and will be retained for three years after the close out of the project by the County unless stipulated otherwise by the County.
The undersigned contractor agrees to abide by the above provisions.
Contractor Date
MBE/WBE Outreach
The undersigned prime contractor agrees to solicit at least 5 bids and/or quotes from minority-/female-owned businesses and record them on the MBE/WBE Contact/Solicitation Statement form. The prime contractor is not required to use these businesses, but these contacts must at least be made. An MBE/WBE directory of minority-and/or female-owned contractors and businesses in the Delaware County area is available and can be used to facilitate this requirement, although Primes are free to use any other MBE/WBE contractors as well. This form must be submitted with the Prime Contractor Questionnaire.
Contractor Date
Section 3 Certification Training, Employment and Contracting Opportunities
For Businesses and Lower Income Persons
The project assisted under this contract is a provision of the Housing and Urban Development Act of 1968 (12 U.S.C. of 1701u) that is regulated by the provisions of 24 CFR 75. Section 3 regulations ensure that employment and other economic opportunities generated by certain HUD financial assistance shall, to the greatest extent feasible, and consistent with existing Federal, State and local laws and regulations, be directed to low- and very low-income persons, particularly those who are recipients of government assistance for housing and to business concerns which provide economic opportunities to low- and very low-income persons. Section 3 requires that to the greatest extent feasible, opportunities for training and employment be given to lower income residents of the project area and contracts for work in connection with the project be awarded to business concerns which are located in or owned in substantial part by persons residing in the area of the project.
Notwithstanding any other provision of this contract, the Contractor shall carry out the provisions of said Section 3 and the regulations issued pursuant thereto by the Secretary set forth in 24 CFR Part 75 (published in 85 Federal Register 60907, September 29, 2020) and all applicable rules and orders of the Secretary issued thereunder. The requirements of said regulations include but are not limited to the development and implementation of an affirmative action plan for utilizing business concerns located within or owned in substantial part by persons residing in the area of the project; the making of a good faith effort, as defined by the regulations, to provide training, employment and business opportunities required by Section 3; and incorporation of the “Benchmark Notice” specified by Section 24 CFR 75.23 (b)(1) and (b)(2) of the regulations in all contracts for work in connection with the project. The Contractor certifies and agrees that it is under no contractual or other disability that would prevent it from complying with these regulations.
Compliance with the provisions of Section 3, the regulations set forth in 24 CFR Part 75, and all applicable rules and orders of the Secretary issued thereunder prior to approval by the Government of the application for this contract shall be a condition of the Federal financial assistance provided to the project, binding upon the Contractor, its successors and assigns. Failure to fulfill these requirements shall subject the Contractor, its contractors and subcontractors, its successors, and assigns to the sanctions specified by this Contract and to such sanctions as are specified by 24 CFR 75.
Company
Authorized Signature
Title:
Date:
CERTIFICATION OF COMPLIANCE WITH AIR AND WATER ACTS
(Applicable to Federally assisted construction contracts and related subcontracts exceeding $100,000)
Compliance with Air and Water Acts
During the performance of this contract, the contractor and all subcontractors shall comply with the requirements of the Clean Air Act, as amended, 42 USC 1857 et seq., the Federal Water Pollution Control Act, as amended, 33 USC 1251 et seq., and the regulations of the Environmental Protection Agency with respect thereto, at 40 CFR Part 15, as amended.
In addition to the foregoing requirements, all nonexempt contractors and subcontractors shall furnish to the owner, the following:
(1) A stipulation by the Contractor or subcontractors, that any facility to be utilized in the performance of any nonexempt contract or subcontract, is not listed on the List of Violating Facilities issued by the Environmental Protection Agency (EPA) pursuant to 40 CFR 15.20.
(2) Agreement by the contractor to comply with all the requirements of Section 114 of the Clean Air Act, as amended, (42 USC 1857c-8) and Section 308 of the Federal Water Pollution Control Act, as amended, (33 USC 1318) relating to inspection, monitoring, entry, reports and information, as well as all other requirements specified in said Section 114 and Section 308, and all regulations and guidelines issued thereunder.
(3) A stipulation that as a condition for the award of the contract, prompt notice will be given of any notification received from the Director, Office of Federal Activities, EPA, indicating that a facility utilized, or to be utilized for the contract, is under consideration to be listed on the EPA List of Violating Facilities.
(4) Agreement by the Contractor that he/she will include, or cause to be included, the criteria and requirements in paragraph (1) through (4) of this section in every nonexempt subcontract and requiring that the Contractor will take such action as the Government may direct as a means of enforcing such provisions.
Name and Title of Signer (Print or type)
Signature Date
AFFIDAVIT RE
ACCEPTING PROVISIONS OF THE WORKMEN'S COMPENSATION ACT
State of )
) ss:
County of ) being duly sworn according to law deposes and says that he/she/it has (they have) accepted the provisions of the Workmen's Compensation Act of 1916 of the Commonwealth of Pennsylvania, with its supplements and amendments, and has (have) insured his/her (their) liability thereunder in 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
26-1
Certificate of Compliance with Federal Labor Standards Provisions
I, the undersigned __________________________________________, the duly authorized representative of _________________________________________________ (hereinafter referred to as the "contractor"), do hereby certify that I have examined the Federal Labor Standards Provisions (HUD-4010) with related certificates and documents, and all of the conditions surrounding these provisions including, but not limited to the following:
1. The contractor is responsible for employing only eligible subcontractors who have certified eligibility in written contracts containing Federal Labor Standards Provisions.
2. The contractor is responsible for the payment of federal prevailing wage rates by its subcontractors while performing work under this contract. If the subcontractor fails to pay the prevailing wages as specified in this contract, the prime contractor may be required to make appropriate restitution to the underpaid workers.
3. The contractor is responsible for collecting weekly certified payrolls from its subcontractors, review said payrolls for compliance with the federal wage rates, and forward same to the local government contract authority.
4. The contractor also understands that only those classifications listed in the original bid documents are applicable to this job, and no special classifications may be incorporated after contract award.
The prime contractor hereby agrees to perform all of its responsibilities in conformance with the Federal Labor Standards Provisions both diligently and effectively.
BY: __________________________________ DATE: _____________________________
TITLE: _______________________________
HUD 4010
27-2
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
30-1
30-2
30-3
Economic Opportunity Notification *
The following positions and subcontractor opportunities will be opening in connection with the following project:
Name/Description of Project
Please inform any interested persons/subcontractors of these opportunities. The contact’s name for these positions are:
Name of Contact Company Name
Phone Number Address
1. Positions that will be available are:
Position Number Min. Qualifications
2. The subcontracting opportunities that will be available:
Trade/Services/Supplies Min. Qualifications
Signature: Date:
Company:
* This form must be forwarded to the contacts in the attached Section 3 Contract List.
Send to relevant contractors in the Section 3 Contractor Directory, at Prime Contractor’s discretion
30-5
Contractor Name: Project Name:
Contract Amount: $ TOTAL Contract Labor Hours:
☐ Is your business a Section 3 Business Concern?
(Must have approved Section3 Business Concern Certification on file)
Employee Name Address Trade Section 3
Worker Targeted Section 3 Worker
Race / Ethnicity
Labor Hours Actual
TOTAL
I hereby certify, under penalty of law, that the information presented on this form is correct to the best of my knowledge and that workers identified as Section 3 have annualized wages that fall below HUD’s income limit.
Signature: Date:
Print Name:
See Over for Definitions and Income Limits
Delaware County Office of Housing & Community Development
SECTION 3 LABOR HOURS REPORTING
30-6
Section 3 Worker Definitions Section 3 Worker:
• A low or very low-income resident (the worker’s income for the previous or annualized calendar year is below the income limit established by HUD); or
• Employed by a Section 3 business concern: or
• A Youth Build participant.
Targeted Section 3 Worker
• Employed by a Section 3 business concern: or
• Currently meets or when hired met at least one of the following categories as documented within the past five years:
- Resides within a 1-mile radius of project location; or
- A Youth Build participant.
Income Limits
Household Size:
1 2 3 4 5 6 7 8
Max.
Annual Income: *
$66,850 $76,400 $85,950 $95,500 $103,150 $110,800 $118,450 $126,100
*Income limits as determined by HUD based on 80% AMI, effective 6/1/2025
30-7
30-8
Delaware County Office of Housing & Community Development
SECTION 3 BUSINESS CONCERN CERTIFICATION
Instructions: Enter the following information and select the criteria that applies to your business.
1. Business Information
Name of Business:
Address of Business: City Zip
Trade:
Name of Business Owner:
Phone Number: Email Address:
Preferred Contact Information ☐Same as Above
Name of Preferred Contact: Phone Number:
Type of Business (Select from the following options):
☐ Corporation ☐ Partnership ☐ Sole Proprietorship ☐ Joint Venture
2. Eligibility for Section 3 Business Concern Status
Select from ONE of the following three options:
☐ At least 51 percent (%) of the business is owned and controlled by low- or very low-income persons
(Refer to chart on back side of this form).
☐ At least 51 percent (%) of the business is owned and controlled by current public housing residents or residents who currently live in Section 8-assisted housing.
☐ Over 75 percent (%) of the labor hours performed for the business over the prior three-month period are performed by Section 3 workers. Refer to the chart on the back of this form for income limits.
3. Certification
I affirm that the above statements are true, complete, and correct to the best of my knowledge. I understand that businesses who misrepresent themselves as Section 3 business concerns and report false information to Delaware County Office of Housing and Community Development and/or its subrecipients may have their contracts terminated as default and be barred from ongoing and future considerations for contracting opportunities. I hereby certify, under penalty of law, that the information is correct to the best of my knowledge.
Print Name:
Signature: Date:
Certification expires five (5) years from date of signature.
See over for Income Limits
Income Limits
Household Size: 1 2 3 4 5 6 7 8
Max. Annual Income: *
$66,850 $76,400 $85,950 $95,500 $103,150 $110,800 $118,450 $126,100
*Income limits as determined by HUD based on 80% AMI, effective 6/1/2025
Information regarding Section 3 Business Concerns can be found at 24 CFR 75.5
BUSINESSES MUST RETAIN A COPY OF THIS FORM
FOR FIVE (5) YEARS
For Administrative Use Only:
Is the business a Section 3 business concern based upon this certification? YES NO
Date of Certification
31-1
31-2
CERTIFICATION OF NON-SEGREGATED FACILITIES
The Bidder certified that he does not maintain or provide for his employees any segregated facilities at any of his establishments and that he does not permit his employees to perform their services at any location under his control where segregated facilities are maintained. The Bidder certifies further that he will not maintain or provide for his employees any segregated facilities at any of his establishments, and that he will not permit his employees to perform their services at any location under his control where segregated facilities are maintained. The Bidder agrees that a breach of his certification will be a violation of the Equal Opportunity Clause in any contract resulting from acceptance of this Bid.
As used in this certification, the term “segregated facilities” means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, timeclocks, locker rooms and other storage areas, transportation and facilities provided for employees which are segregated on the basis of race, color, religion or national origin, because of habit, local custom.
NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. Paragraph 1001.
DATE: ___________
NAME OF BIDDER: ____________________
BY: __________________________________
TITLE: ______________________________ _
OFFICIAL ADDRESS (INCLUDING ZIP CODE)
PHONE NO.: __________________________
DELAWARE COUNTY
COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM
VERIFICATION OF CONTRACTOR ELIGIBILITY AND
TERMINATION OF INELIGIBLE CONTRACTOR
I hereby certify that I / we am / are eligible for award of a Federally assisted or insured Contract.
In the event I / we am / are found ineligible after an award of Contract, said Contract shall be terminated and the matter will be referred to the Department of Labor for its action.
Signature Date
Name of Firm
Subcontractor Date
Name of Firm
MBE/WBE Contact/Solicitation Statement
The Subrecipient and Prime Contractor are encouraged to solicit a minimum of 5 quotes/bids from minority/female owned businesses for all CDBG/HOME funded projects. Please refer to the MBE/WBE directory as needed.
Project Name Subrecipient or Company Name
Contact Person Telephone Number
Please list the minority- and/or woman-owned businesses and contractors from which you solicited quotes or bids in regard to this contract.
Company Name &
Telephone #
MBE
WBE
Type of Work and/or Material to be Supplied
Dollar Amount of Quote
Authorized Signature Print Name
Title Date
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