1-Bid Forms- Appendix A Section 1.pdf

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APPENDIX A

FORMS AND CERTIFICATES

BID FORMS – SECTION I

AWARD FORMS AND POSTERS – SECTION II

REQUIREMENTS, PAYMENT AND CLOSEOUT-SECTION III

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BID FORMS – SECTION I

Forms to be submitted with Bid:

Bid Form I-1

Non – Collusion Affidavit of Prime Bidder Form I-3

Bid Bond I-4

Certificate as to Corporate Principal I-6

Statement of Bidder’s Qualifications I-7

Affidavit Acceptance of Provisions of the Workmen’s Compensation Act I-9

Certification of Non-Segregated facilities and Non-Employment of Illegal Alien

Labor I-10

Affidavit of Review of Insurance and Indemnification I-12

Non – Collusion Affidavit of Prime Bidder Form I-13

Statement of Bidder’s Qualifications I-14

Affidavit of Eligibility for Public Works I-16

Public Works Employment Verification Form – Prime Contractor I-18

CDBG Special Forms

Minority/ Women/ Section 3 Business Enterprises I-19

Section 3 Clause I-20

MBE/WBE Contract Solicitation and Commitment Statement I-21

Certification of Bidder Regarding Equal Employment Opportunity I-22

Minority/Women/Section 3 Business Certification I-23

Certification of Non-Segregated Facilities I-24

Debarment Certification Form I-25

2026 Maple Avenue and Berwick Heights Road Paving Project for East Stroudsburg Borough

Appendix A – Bid Forms – 1- 1

BID FORM

Gentlemen:

1. The undersigned, having familiarized (himself) (themselves) (itself) with the existing conditions on the Project Area affecting the cost of the work, and with the Contract Documents (which include the Invitation to Bid, Instructions to Bidders, the form of Bid, the form of the Bid Bond, the form of Contract (or Agreement), the form of Non-Collusion Affidavit, Addenda (if any), GENERAL CONDITIONS, GENERAL CONDITIONS - PART II, , SPECIAL CONDITIONS, TECHNICAL SPECIFICATIONS, and Form of Surety Bond or Bonds; as prepared by: RKR Hess, a Division of UTRS, Inc.

2. In the event quantities need to be added or deleted, the following unit prices on the following pages shall apply:

Incidentals to the items includes removal/disposal of debris, maintenance and protection of traffic, site restoration, mobilization, demobilization, testing, superintendence, bonding and insurance costs. Resetting of signs includes removal from the existing location and all new hardware necessary to reset the sign

Hereby proposes to furnish all supervision, technical personnel, labor, materials, machinery, tools, equipment and services including utility, transportation and security services and to perform and complete all work specified under individual contract for the 2026 Maple Avenue and Berwick Heights Road Paving Project for East Stroudsburg Borough.

3. In submitting this bid, the Bidder understands that the unrestricted right is reserved by the Borough of East Stroudsburg to reject any and all bids, or parts thereof. If written notice of the acceptance of this bid is mailed, faxed or delivered to the undersigned within forty-five (45) days after the opening thereof (or ninety (90) days under conditions specified under Section 115 of Instruction to Bidders), or at any time thereafter before this Bid is withdrawn, the undersigned agrees to execute and deliver an agreement in the prescribed form and furnish the required bonds within ten (10) days after the Agreement is presented to him for signature.

4. Security in the sum of ________________________________________________ Dollars

($________________________________) in the form of _________________________________

_______________________________________, payable to the Borough of East Stroudsburg, is submitted herewith in accordance with the INSTRUCTIONS TO BIDDERS.

5. Attached hereto is an affidavit in proof that the undersigned has not entered into collusive agreement with any person in respect to this Bid or any other Bid or the submitting of Bids for the Contract for which this Bid is submitted.

6. The Bidder is prepared to submit a financial and experience statement upon request.

7. The Bidder hereby acknowledged the receipt of the following addendum, if any, via Penn Bid.

8. Bidder will complete the work for the prices outlined in the attached bid sheets.

9. Bidder agrees that the work will be substantially completed on or before the dates indicated in the Agreement. .

10. Bidder accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the work on time.

11. Bidder accepts the bonding requirements as set forth in the Contract Documents.

12. Bidder agrees that they have visited the site of the proposed work and have familiarized themselves with the project, the existing conditions relating to construction and labor, the difficulties and restrictions attending the performance of the Contract, and have thoroughly examined the Contract Documents, Technical Specifications, and all other Contract Documents. The Bidder agrees to bring to the Owner’s and Engineer’s attention immediately, any discrepancies, inconsistencies, or any other variation between existing and proposed conditions in the Contract Documents.

13. Bidder Tax Identification Number: ___________________________________

Appendix A – Bid Forms – 1- 2

BID FORM (Continued)

14. Bidder Dun & Bradstreet Number: ___________________________________

15. Contact Information – Name, Address, Telephone Number, Cell Phone Number, e-mail address

SUBMITTED this ____ day of _________________________, _20_____.

If BIDDER is:

An Individual

By ________________________________ (SEAL) (Individual’s Name)

Doing Business as:

Business address: ___________________________________

Phone No.: __________________________

A Partnership

____________________________________ (SEAL)

(Firm’s Name)

By _____________________________________ (General Partner)

Business address: _________________________________

A Corporation

____________________________________ (SEAL) __________________________________

(Corporation’s Name) (State of Incorporation)

By _____________________________________ __________________________________ (Name of Person Authorized to Sign) (Title)

Attest ________________________________________ (Secretary or Corporate Officer)

Business address: _________________________________

Appendix A – Bid Forms – 1- 3

NON-COLLUSION AFFIDAVIT OF PRIME BIDDER

State of ____________________________________) ss

County of __________________________________)

________________________________________________ being first duly sworn deposes and says that:

(1) He is ______________________________________________________________ (owner, partner, officer, representative or agent) of _____________________________________________________________________________________________________.

(2) He is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid;

(3) Such Bid is genuine and is not a collusive or sham bid;

(4) Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, has in any way colluded, conspired, connived, or agreed, directly or indirectly, with any other Bidder, firm or person to submit a collusive or sham Bid in connection with such Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other Bidder, firm or person to fix the price or prices in attached Bid or of any other Bidder, or, to fix any overhead, profit, or cost element of the bid price or the bid price of any other Bidder, or to secure through collusion, conspiracy, connivance, or unlawful agreement any advantage against any other Bidder, or any person interested in the proposed Contract;

(5) The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, representatives, owners, employees, or parties in interest, including this affiant.

(Signed)

Title

Subscribed and sworn to before me this ____________________ day of ____________________ 20_____

Title

My commission expires_____________________________________

Appendix A – Bid Forms – 1- 4

BID BOND

KNOW ALL MEN BY THESE PRESENTS, That we the undersigned, _________________________________________________________ as PRINCIPAL, and _________________________ (Name of Principal) as SURETY are held and firmly bound onto the Borough of East Stroudsburg hereinafter called the Owner, in the penal sum of

_________________________________________________________________ Dollars ($____________________________) lawful money of the United States for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assign, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION

IS SUCH, that whereas the Principal has submitted the accompanying Bid, dated __________________________ 20_____, for the

2026 Maple Avenue and Berwick Heights Road Paving Project for East Stroudsburg Borough.

NOW, THEREFORE, if the Principal shall not withdraw said Bid within the period specified therein after the opening of the same, or, if no period is specified, within ninety (90) days after the said opening, and shall within the period specified therefor, or, if no period be specified within ten (10) days after the prescribed forms are presented to him for signature, 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 of such Contract; or in the event of the withdrawal of said Bid within the period specified, or the failure to enter into such Contract and give such bond 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 work or supplies or both, if the latter amount be in excess of the former, then the above obligation shall be void and of no effect, otherwise to remain in full force and virtue.

IN WITNESS WHEREOF, the above bounded parties have executed this instrument under their several seals this

____ day of _____________________ 20_________, the name and corporate seal of each corporate party being thereto affixed and these presents duly signed by its undersigned representative, pursuant to authority of its governing body.

Appendix A – Bid Forms – 1- 5

BID BOND

(Continued)

In presence of:

_________________________________ ____________________________(SEAL)

(Individual Principal)

(Business Address including City, State and Zip Code)

___________________________(SEAL)

(Individual Principal)

(Business Address including City, State and Zip Code)

Attest:

(Corporate Principal)

(Business address including City, State and Zip Code)

By __________________________________

Attest:

(Countersigned) (Corporate Surety)

By ______________________________ Attorney-in-Fact, State of

(power of attorney for person signing for surety company must be attached to bond)

Appendix A – Bid Forms – 1- 6

CERTIFICATE AS TO CORPORATE PRINCIPAL

I, _____________________________, certify that I am the __________________________ of the corporation named as

Principal in the within bond; that ___________________________________, who signed the said bond on behalf of the

Principal was then _____________________________ of said corporation; that I know his signature, and his signature thereto is genuine; and that said bond was duly signed, sealed and attested to, for and in behalf of said corporation by authority of its governing body.

______________________________(Corporate)

______________________________(Seal)

TITLE

DATE

Appendix A – Bid Forms – 1- 7

STATEMENT OF BIDDER'S QUALIFICATIONS

(To be submitted by the Bidder with Bid.)

All questions must be answered and the data given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate attached sheets. The Bidder may submit any additional information he desires.

1. Name of Bidder.

2. Permanent main office address, including City, State and Zip Code.

3. When organized.

4. If a corporation, where incorporated.

5. How many years have you been engaged in the contracting business under your present firm or trade name?

6. Contracts on hand: (List a schedule of these contracts, showing gross amount of each contract and the appropriate anticipated dates of completion).

7. General character of work performed by your company.

8. Have you ever failed to complete any work awarded to you? If so, where and why?

9. Have you ever defaulted on a contract? If so, where and why?

10. List the more important contracts recently completed by you, stating approximate gross final contract amount for each, and the month and year completed.

11. List your major equipment available for this contract.

12. Experience in work similar in character to this project. Similar means contracts for installing pavement and, curb with similar conditions including but not limited to similar quantities.

13. Background and experience of the principal members of your organization including the officers and key personnel who will be assigned to this project such as the project manager, site superintendent and/or site foreman.

14. Credit available: $______________________________.

15. Give bank reference.

16. Will you upon request, fill out a detailed financial statement and furnish any other information that may be required by the Owner.

17. (a) Have you ever been a party to or otherwise involved in any action or legal proceeding involving matters related to age, sex, race, color, nationality, or religion? If so, give full details.

(b) Have you ever been accused of discrimination based upon age, sex, race, color, nationality, or religion in any action or legal proceeding, including any proceeding related to any Federal Agency? If so, give full details.

18. The undersigned hereby authorizes and requests any person, firm or corporation to furnish any information requested by the Owner in verification of the recitals comprising this Statement of Bidder’s Qualifications.

Appendix A – Bid Forms – 1- 8

STATEMENT OF BIDDER'S QUALIFICATIONS

(CONTINUED)

Date at ___________________________ this _____________ day of _____________________20______

(Name of Bidder)

By ______________________________________

Title ______________________________________

State of ____________________________)

SS

County of __________________________)

_____________________________________________________ being duly sworn, deposes and says that he is the __________________________________ of __________________________________________ (Name of Organization) and that the answers to the foregoing questions and all statements therein contained are true and correct.

Subscribed and sworn to before me this ____ day of ______________________ 20____.

Notary Public

My Commission expires _____________________________

Appendix A – Bid Forms – 1- 9

AFFIDAVIT

ACCEPTANCE OF PROVISIONS OF THE WORKMEN’S COMPENSATION

ACT

State of ) ) ss:

County of )

____________________________ being duly sworn according to the law that (they have/it has/he has) accepted the provisions of the Workmen’s Compensation Act of 1915 of the Commonwealth of

Pennsylvania, with its supplements and amendments, and (have/has) insured (his/their/its) liability thereunder in accordance with the terms of said Act with ____________________________________.

(Insurance Company)

(Print or Type Contractor)

BY:________________________________

Signature

Sworn to and subscribed before me this ________ day of ___________________________ A.D., 20___.

My commission expires ________________

Appendix A – Bid Forms – 1- 10

CERTIFICATE OF COMPLIANCE WITH THE PROHIBITION OF

ILLEGAL ALIEN LABOR ON ASSISTED PROJECTS ACT

State of ____________________________________) ss

County of __________________________________)

________________________________________________ being first duly sworn deposes and says that:

I. He is __________________________________ of ____________________________________________________, (owner, partner, or officer) hereinafter called the “Contractor”.

II. During the term of the Contract, the said Contractor agrees to the following provisions as listed on this page and in the Contract Documents and Specifications;

(1) The Contractor agrees to comply with the Prohibition of Illegal Alien Labor on Assisted Projects Act.

(2) Pursuant to the Act of May 11, 2006 (P.L. 173, No. 43), known as the Prohibition of Illegal Alien Labor on Assisted Projects Act, the Contractor shall not knowingly employ, or knowingly permit any of its subcontractors to knowingly employ, the labor services of an illegal alien on activities funded in whole or in part by a grant or loan issued by the Commonwealth of Pennsylvania.

(3) In the event that the Contractor

i. Knowingly employs, or knowingly permits any of its subcontractors to knowingly employ, the labor services of an illegal alien on activities funded in whole or in part by grants or loans issued by an executive agency of the Commonwealth of Pennsylvania; and

ii. the Contractor or any of its subcontractors are sentenced under Federal law for an offense involving knowing use of labor by an illegal alien on activities funded in whole or in part by grants or loans issued by an executive agency of the Commonwealth of Pennsylvania, The Contractor shall forfeit and repay to the Borough of East Stroudsburg all moneys paid to the Contractor in the performance of the Contract.

(4) The Contractor shall include the provisions of this Certificate of Compliance with the Prohibition of Illegal Alien Labor on Assisted Projects Act in every subcontract so that such provisions will be binding upon each subcontractor.

(5) The Borough of East Stroudsburg may cancel or terminate the Contract, and all money due or to become due under the Contract may be forfeited for a violation of the Prohibition of Illegal Alien Labor on assisted Projects Act. In addition, the (DCED) may proceed with debarment or suspension and may place the Contractor in the agencies’ Contractor Responsibility File.

(Signed)

Appendix A – Bid Forms – 1- 11

Subscribed and sworn to before me this ____________________ day of ____________________ 20________

Title

My commission expires________________________________________

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AFFIDAVIT OF REVIEW AND ACKNOWLEDGEMENT OF INSURANCE

REQUIREMENTS

STATE OF : COUNTY OF _________________________:

I, , being duly sworn according to law, depose and say that:

1. (S)He is (Owner, Partner, Officer, or Representative or Agent) of

, hereinafter called the “Contractor”.

2. I have personally reviewed the insurance requirements set forth in Section 231 of this Contract.

3. I have personally reviewed conditions of application for Partial Payments and Final Payment set forth in Section 210 of this Contract.

4. I am aware of that the Borough of East Stroudsburg (“Borough”) has conditionally approved a modification, requested by the Contractor, to retain The Blanket Notification to Other of Cancellation or Non-Renewal Endorsement Paragraph c. of the insurance endorsement documents. This paragraph would appear to make 30-day notice to the Township of cancellation of insurance coverage more of a courtesy of the Contractor’s insurance company rather than a strict requirement.

5. Penalty Perjury. I understand that the statements herein are made subject to the penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities.

Title Sworn to and subscribed before me this day of ____ _______________, 20____.

Notary Public My Commission Expires:

Appendix A – Bid Forms I-12

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NONCOLLUSION AFFIDAVIT OF PRIME BIDDER

State of __________________________________

SS

County of _________________________________

________________________________________________, being first duly sworn, deposes and says that:

(1) He/She is __________________________________________________________________ (Owner, partner, officer, representative or agent) of ____________________________________________. the Bidder that had submitted the attached Bid:

(2) He/She is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid;

(3) Such Bid is genuine and is not a collusive or sham Bid.;

(4) Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly with any other Bidder, firm, or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion of communication or conference with any other Bidder, firm or person to fix the price or prices in the attached Bid or of any other Bidder, or to fix any overhead, profit or cost element for the Bid Price or the Bid Price of any other Bidder, or to secure through any collusion, conspiracy connivance or unlawful agreement any advantage against the Borough of Stroudsburg or any person interested in the proposed Contract; and

(5) The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, representatives, owners, employees, or parties in interest, including this affiant.

(Signed)

(Title)

Subscribed and sworn to before me this _________day of _________________, 20_________

Title

My commission expires ____________________________

Appendix A – Bid Forms – I-13

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Appendix A – Bid Forms – I-14

STATEMENT OF BIDDER'S QUALIFICATIONS

(To be submitted by the Bidder with Bid) (CDBG required form)

All questions must be answered and the date given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate attached sheets. The Bidder may submit any additional information he desires.

1. Bidder’s Legal Operating Name: ___________________________________________________________________

2. Permanent Main Office Address: __________________________________________________________________

3. Telephone Number and Email Address: _____________________________________________________________

4. Pennsylvania Attorney General # (Home Improvement Contractor Registration # If applicable) ________________

5. Date of Organization: ___________________________________________________________________________

6. State of Incorporated: ___________________________________________________________________________

7. How many years have you been engaged in the contracting business under your present firm or trade name?

8. Contracts on hand: (List these, showing amount of each contract and the appropriate anticipated dates of completion.) _________________________________________________________________________________

9. General character of work performed by your company. _______________________________________________

10. Have you ever failed to complete any work awarded to you? If yes, where and why? ________________________

11. Have you ever defaulted on a contract? If yes, where and why? _________________________________________

12. List the more important projects recently completed by your company, stating the Owner’s name and address, stating the Project’s Manager’s name for the Owner, the approximate cost for each, and the month and year completed. __________________________________________________________________________________

13. List your major equipment available for this contract. ________________________________________________

14. List all proposed subcontractors you will use for this project. ___________________________________________

15. Experience in construction work of similarity to this project. ________________________________

16. Attach resume(s) with background and experience of the principal members of your organization, including the officers and key personnel who will be assigned to this project such as the project manager, site superintendent and/or site foreman. __________________________________________________________________________

17. Credit Available: $_____________________________________________________________________________

18. FEIN Number: _____________________________________ Unique Entity ID: _________________________

19. Give Bank Reference: __________________________________________________________________________

20. Will you upon request, fill out a detailed financial statement, and furnish any other information that may be required by the Owner? ________________________________________________________________________

Appendix A – Bid Forms – I - 15

21. (a) Have you ever been a party to or otherwise involved in any action or legal proceeding involving matters related to age, sex, race, color, nationality, or religion? If so, give full details.

(b) Have you ever been accused of discrimination based upon age, race, color, nationality, or religion in any action or legal proceeding, including any proceeding related to any Federal Agency? If so, give full details.

22. The undersigned hereby authorizes and requests any person, firm, or corporation to furnish any information requested by the Owner in verification of the recitals comprising this Statement of Bidder's Qualifications.

Dated _________________ this __________day of____________________, 20 ______.

(Name of Bidder) _________________________________________________________

By: ________________________________________________________

Title: ______________________________________________________

State of___________________________________________) County of ____________________________________)

SS

________________________________________________________________________ being duly sworn deposes and says that he/she is__________________________________________ of _______________________________________

(Title) (Name of Organization) and that the answers to the foregoing questions and all statements therein contained are true and correct.

Subscribed and sworn to before me this ________________________day of________________________, 20_________.

Notary Public

My commission expires ________________________________, 20__________.

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Appendix A – Bid Forms – I-16

AFFIDAVIT OF ELIGIBILITY FOR PUBLIC WORKS

State of ) ss

County of ) being first duly sworn deposes and says that:

(1) (S)He is of (Bidder).

(owner, partner, officer, representative or agent)

(2) (S)He is fully informed of the business affairs of bidder including the existence of all permits and contracts held, and the ability of bidder to perform public contracts in any Federal, State and/or local jurisdiction.

(3) That neither bidder or any of its officers, partners, owners, shareholders, agents, representatives, employees, or parties of interest, including affiant, have been disbarred, prohibited, suspended, banned or otherwise restricted from working on any publicly funded work projects in any Federal, State, and/or local jurisdiction in the United States within the last ten (IO) years.

(4) Further, that neither bidder or any of its officers, partners, owners, shareholders, agents, representatives, employees or parties of interest, including affiant, have had any contracts with any Federal, State, and/or local jurisdiction terminated as a result of a violation of law or ethical rule.

(5) If the answer to either or both paragraphs 2 and 3 are in the affirmative, please state for each action taken:

(a) The reason for each action taken __________________________

(b) The person, entity, business or governmental agency taking the action.

(Include name, address, and telephone number.)_____________________

(c) Resolution of any action taken __________________________________

(6) Penalty of Perjury. I understand that the statements herein are made subject to the penalties of 18 Pa. C.S.A. §4904 relating to unsworn falsifications to authorities.

(Signed) ___________________________

Appendix A – Bid Forms – 1- 17

Subscribed and sworn to before me the day of _______________, 20__

Notary Public

State of _______________________ My commission expires __________

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Ann Wingert Typewriter Borough of East Stroudsburg

Ann Wingert Typewriter 10205.616

Ann Wingert Typewriter 2026 Paving Project for East Stroudsburg Borough

Ann Wingert Typewriter Maple Avenue and Berwick Heights Road in the Borough of East Stroudsburg

Ann Wingert

Appendix A - Bid Forms I-18

Appendix A – Bid Forms – I-19

MINORITY/WOMEN/SECTION 3 BUSINESS ENTERPRISES

BIDDER INSTRUCTIONS

This Project is funded in all or in part with Community Development Block Grant (CDBG) funds. In accordance with CDBG rules and regulations, municipalities must uphold the conditions of Minority/Women Business Enterprise (MBE/WBE) and Section 3 Covered Assistance Plans. The objective of the plans is to facilitate the strengthening and expansion of MBE/WBE and Section 3 businesses. Complete copies of the Plans are available by contacting Redevelopment Authority of the County of Monroe, 701 Main Street, Suite 502, Stroudsburg, PA 18360, or calling (570) 421-4300.

The goals for this project are MBE 5% and WBE 3%; the Section 3 goal is 10%. The successful bidder will be required to submit evidence of efforts to meet these goals either through his/her own employment practices or through the use of MBE/WBE and Section 3 subcontractors and vendors. Failure to comply may result in the bidder being determined not responsible.

In preparation of your bid, you are expected to contact MBE/WBE firms. These firms can be found listed on the both Department of General Services (DGS) AND Pennsylvania Housing Finance Agency (PHFA):

http://www.dgs.internet.state.pa.us/SmallDiverseBusinessSearch https://mwbe.phfa.org/

The counties that we are required to search are Carbon, Lackawanna, Northampton, Pike and Wayne. You may also contact other MBE/WBE firms of which you are aware.

Any interested contractor and/or supplier is required to check the both websites and refer back for each bid submitted.

As part of your bid, you are expected to complete and submit the Bidder Projection of Minority/Women/Section 3 Business Utilization form. This process is required and no exceptions will be made. This form will be used during bid review to ascertain your level of MBE/WBE and Section 3 utilization. Your efforts and success in utilizing these firms will be one of the tests of bidder responsibility. Failure to meet this Project’s MBE/WBE and Section 3 goals does not automatically disqualify your bid.

Finally, at the completion of the Project and before final payment, you will be required to furnish a completed Minority/Women/Section 3 Business Enterprise Utilization Report along with Minority/Women/Section 3 Certification form.

Appendix A – Bid Forms – I-20

SECTION 3 CLAUSE

All contracts subject to the Section 3 requirements will include the following clause:

A. The work to be performed under this contract is subject to the requirements of Section 3 of the Housing and Urban Development Act of 1968, as amended, 12 U.S.C. 1701u (Section 3). The purpose of Section 3 is to ensure that employment and other economic opportunities generated by HUD assistance or HUD-assisted project covered by Section 3 shall, to the greatest extent feasible, be directed to low-and very low-income persons, particularly persons who are recipients of HUD assistance for Housing.

B. The parties to this contract agree to comply with HUD’s regulations in 24 CFR Part 135, which implement Section

3. As evidenced by their execution of this contract, the parties to this contract certify that they are under no contractual or other impediment that would prevent them from complying with part 135 of the regulations.

C. The contractor agrees to send to each labor organization or representative of workers with which the contractor has a collective bargaining agreement or other understanding, if any, a notice advising the labor organization of worker’s representative of the contractor’s commitments under this Section 3 clause, and will post copies of the notice in conspicuous places at the work site where both employees and applicants for training and employment positions can see the notice. The notice shall describe the Section 3 preference, shall set forth minimum number and job titles subject to hire, availability of apprenticeship and training positions, the qualification for each; and the name and location of the person(s) taking applications for each of the positions; and the anticipated date the work shall begin.

D. The contractor agrees to include this Section 3 Clause in every subcontract subject to compliance with regulations in 24 CFR Part 135, and agrees to take appropriate action, as provided in an applicable provision of the subcontract or in this Section 3 clause, upon finding that the subcontractor is in violation of the regulations in 24 CFR part 135. The contractor will not subcontract with any subcontractor where the contractor has notice or knowledge that the subcontractor has been found in violation of the regulations in 24 CFR Part 135.

E. The contractor will certify that any vacant employment positions, including training positions, that are filled (1) after the contractor is selected but before the contract is executed, and (2) with persons other than those to whom the regulations of 24 CFR Part 135 require employment opportunities to be directed were not filled to circumvent the contractor’s obligations under 24 CFR Part 135.

F. Noncompliance with HUD’s regulations in 24 CFR Part 135 may result in sanctions, termination of this contract for default, and debarment or suspension from future HUD assisted contracts.

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CERTIFICATION OF BIDDER REGARDING EQUAL EMPLOYMENT OPPORTUNITY

INSTRUCTIONS

This certification is required pursuant to Executive Order 11246 (30 F.R. 12319-25). The implementing rules and regulations provide that any bidder or prospective contractor, or any of their proposed subcontractors, shall state as an initial part of the bid or negotiations of the contract whether it has participated in any previous contract or subcontract subject to the equal opportunity clause; and, if so, whether it has filed all compliance reports due under applicable instructions.

Where the certification indicates that the bidder has not filed a compliance report due under applicable instructions, such bidder shall be required to submit a compliance report within seven calendar days after bid opening. No contract shall be awarded unless such report is submitted.

CERTIFICATION BY BIDDER

NAME AND ADDRESS OF BIDDER (Include ZIP Code)

1. Bidder has participated in a previous contract or subcontract subject to the Equal Opportunity Clause.

� Yes � No

2. Compliance reports were required to be filed in connection with subject contract or subcontract.

� Yes � No

3. Bidder has filed all compliance reports due under applicable instructions including SF-100.

� Yes � No � None Required

4. Have you ever been or are you being considered for sanction due to violation of Executive Order 11246, as amended?

� Yes � No

NAME AND TITLE OF SIGNER (Please type)

SIGNATURE DATE

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Appendix A – Bid Forms – I-22

Appendix A- Bid Forms I-25

Ann Wingert

CERTIFICATION OF NON-SEGREGATED FACILITIES

The Bidder certifies that he/she does not maintain or provide for his/her employees any segregated facilities at any of his/her establishments, and that he/she does not permit his/her employees to perform their services at any location, under his/her control, where segregated facilities are maintained. The Bidder certifies further that he/she will not maintain or provide for his/her employees any segregated facilities at any of his/her establishments, and that he/she will not permit his/her employees to perform their services at any location under his/her control where segregated facilities are maintained. The Bidder agrees that a breach of this certification will be a violation of the Equal Employment 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, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in fact segregated on the basis of race, color, religion, or national origin, because of habit, local custom, or otherwise. The Bidder agrees that (except where he/she has obtained identical certifications from proposed subcontractors) prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Employment Opportunity Clause, that he/she will retain such certifications in his/her files.

NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. § 1001.

Date: __________________________, 20_________

(Name of Bidder)

Official Address (Including ZIP CODE):

By: __________________________________________

Title: ________________________________________

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Appendix A – Bid Forms I-24

DEBARMENT CERTIFICATION FORM

The prospective participant certifies to the best of its knowledge and belief that it and its principals:

(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal or State department or agency;

(b) Have not within a three year period preceding this proposal been convicted of or had a civil judgement rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or Local) transaction or contract under a public transaction; violation of Federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

(c) Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal, State or local) with the commission of any of the offenses enumerated in paragraph (b) of this certification; and

(d) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default.

(e) The Bidder is “actively” registered with SAMS (Service for Award Management), and has been assigned the following Unique Entity ID Number: _____________________________________.

I understand that a false statement on this certification may be grounds for rejection of this proposal or termination of the award.

Name and Title of Authorized Representative

Signature of Authorized Representative Date

Name of Firm: ___________________________________________________

Appendix A – Bid Forms I-25

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NONCOLLUSION AFFIDAVIT OF SUBCONTRACTOR

State of __________________________________

SS

County of _________________________________

________________________________________________, being first duly sworn, deposes and says that:

(1) He/She is _________________________________ of ____________________________________________, herein referred to as the “Subcontractor”;

(2) He/She is fully informed respecting the preparation and contents of the Subcontractor Proposal submitted to ________________, the contractor for certain work in connection with the ______________________________________ Contract pertaining to the Project in ____________________________________________________________________;

(City or County and State)

(3) Such Subcontractor’s proposal is genuine and is not a collusive or sham Bid;

(4) Neither the subcontractor nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly with any other Bidder, firm, or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion of communication or conference with any other Bidder, firm or person to fix the price or prices in the attached Bid or of any other Bidder, or to fix any overhead, profit or cost element for the Bid Price or the Bid Price of any other Bidder, or to secure through any collusion, conspiracy connivance or unlawful agreement any advantage against the Borough of Stroudsburg or any person interested in the proposed Contract; and

(5) The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, representatives, owners, employees, or parties in interest, including this affiant.

(Signed)

(Title)

Subscribed and sworn to before me this _________day of _________________, 20_________

Title

My commission expires ____________________________

Appendix A – Award Forms II-10

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