1-Bid Package - Hannah Street Park Project, Bids Open 10.29.26.pdf

BID PACKAGE

HOUTZDALE BOROUGH

HANNAH STREET PARK PROJECT

FOR

CLEARFIELD COUNTY

Bid is to be submitted electronically via PennBid at https://pennbid.net

BID OPENING DATE: Thursday, October 29, 2026

BID OPENING TIME: 10:00 A.M. (Prevailing Time)

Submitted By:

Address:

Phone No.:

Fax No.:

E-Mail:

EIN:

BID DOCUMENTS:

• Bid Form (Form Of Proposal)

• Bid Bond

• Qualifications Statement

• Non-Collusion Affidavit Of Prime Bidder

• Certification Of Non-Segregated Facilities & Non-Employment Of

Illegal Alien Labor

• Public Works Employment Verification Form

• Pa Worker Protection & Investment Certification Form

• Grant Agreement & Nondiscrimination/Sexual Harassment Provisions, Acknowledgement Of Prime Bidder

Bid Form 004143 - i This document is a MODIFIED version of EJCDC® C-410, Bid Form for Construction Contracts.

Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

BID FORM

Clearfield County, Pennsylvania

TABLE OF CONTENTS

Page

Article 1 – Bid Recipient

Article 2 – Bidder’s Acknowledgements

Article 3 – Bidder’s Representations

Article 4 – Bidder’s Certification

Article 5 – Basis of Bid

Article 6 – Time of Completion

Article 7 – Attachments to this Bid

Article 8 – Defined Terms

Article 9 – Bid Submittal

Bid Form 004143 - 1

Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

BID FORM

Clearfield County, Pennsylvania

ARTICLE 1 – BID RECIPIENT

1.01 Sealed bids must be submitted online via PennBid (https://pennbid.net) by 10:00 A.M. (E.S.T) on

Thursday, October 29, 2026.

1.02 The undersigned Bidder proposes and agrees, if this Bid is accepted, to enter into an Agreement with

Owner in the form included in the Bidding Documents to perform all Work as specified or indicated in the Bidding Documents for the prices and within the times indicated in this Bid and in accordance with the other terms and conditions of the Bidding Documents.

ARTICLE 2 – BIDDER’S ACKNOWLEDGEMENTS

2.01 Bidder accepts all of the terms and conditions of the Instructions to Bidders, including without limitation those dealing with the disposition of Bid security. This Bid will remain subject to acceptance for 60 days after the Bid opening. If the award is delayed by the required approval of another government agency, the sale of bonds or the award of a grant, this Bid will remain subject to acceptance for 120 days after the Bid opening. Extensions of the date for the award may be made by mutual written consent of the Owner and

Bidder.

2.02 Bidder consents that alternates, if any, as presented in the Bid Form may be applied in any order and the award may be made to the Successful Bidder on its base Bid and any combination of its alternate Bids for which the Owner determines funds will be available at the time of award.

ARTICLE 3 – BIDDER’S REPRESENTATIONS

3.01 In submitting this Bid, Bidder represents that:

A. Bidder has examined and carefully studied the Bidding Documents, and any data and reference items identified in the Bidding Documents, and hereby acknowledges receipt of the following Addenda:

Addendum No. Addendum, Date

B. Bidder has visited the Site, conducted a thorough, alert visual examination of the Site and adjacent areas, and become familiar with and satisfied itself as to the general, local, and Site conditions that may affect cost, progress, and performance of the Work.

C. Bidder is familiar with and has satisfied itself as to all Laws and Regulations that may affect cost, progress, and performance of the Work.

D. Bidder has carefully studied all: (1) reports of explorations and tests of subsurface conditions at or adjacent to the Site and all drawings of physical conditions relating to existing surface or subsurface structures at the Site that have been identified in the Supplementary Conditions, especially with respect to Technical Data in such reports and drawings, and (2) reports and drawings relating to

Hazardous Environmental Conditions, if any, at or adjacent to the Site that have been identified in

Bid Form 004143 - 2

Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

the Supplementary Conditions, especially with respect to Technical Data in such reports and drawings.

E. Bidder has considered the information known to Bidder itself; information commonly known to contractors doing business in the locality of the Site; information and observations obtained from visits to the Site; the Bidding Documents; and any Site-related reports and drawings identified in the

Bidding Documents, with respect to the effect of such information, observations, and documents on

(1) the cost, progress, and performance of the Work; (2) the means, methods, techniques, sequences, and procedures of construction to be employed by Bidder; and (3) Bidder’s safety precautions and programs.

F. Bidder agrees, based on the information and observations referred to in the preceding paragraph, that no further examinations, investigations, explorations, tests, studies, or data are necessary for the determination of this Bid for performance of the Work at the price bid and within the times required, and in accordance with the other terms and conditions of the Bidding Documents.

G. Bidder is aware of the general nature of work to be performed by Owner and others at the Site that relates to the Work as indicated in the Bidding Documents.

H. Bidder has given Engineer written notice of all conflicts, errors, ambiguities, or discrepancies that

Bidder has discovered in the Bidding Documents and confirms that the written resolution thereof by

Engineer is acceptable to Bidder.

I. The Bidding Documents are generally sufficient to indicate and convey understanding of all terms and conditions for the performance and furnishing of the Work.

J. The submission of this Bid constitutes an incontrovertible representation by Bidder that Bidder has complied with every requirement of this Article, and that without exception the Bid and all prices in the Bid are premised upon performing and furnishing the Work required by the Bidding Documents.

ARTICLE 4 – BIDDER’S CERTIFICATION

4.01 Bidder certifies that:

A. This Bid is genuine and not made in the interest of or on behalf of any undisclosed individual or entity and is not submitted in conformity with any collusive agreement or rules of any group, association, organization, or corporation;

B. Bidder has not directly or indirectly induced or solicited any other Bidder to submit a false or sham

Bid;

C. Bidder has not solicited or induced any individual or entity to refrain from bidding; and

D. Bidder has not engaged in corrupt, fraudulent, collusive, or coercive practices in competing for the

Contract. For the purposes of this Paragraph 4.01.D:

1. “corrupt practice” means the offering, giving, receiving, or soliciting of any thing of value likely to influence the action of a public official in the bidding process;

2. “fraudulent practice” means an intentional misrepresentation of facts made (a) to influence the bidding process to the detriment of Owner, (b) to establish bid prices at artificial non-competitive levels, or (c) to deprive Owner of the benefits of free and open competition;

3. “collusive practice” means a scheme or arrangement between two or more Bidders, with or without the knowledge of Owner, a purpose of which is to establish bid prices at artificial, non-competitive levels; and

4. “coercive practice” means harming or threatening to harm, directly or indirectly, persons or their property to influence their participation in the bidding process or affect the execution of the Contract.

Bid Form 004143 - 3

Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

E. The _________________________________________is a corporation organized and existing under the laws of ____________________________________and has (has not) been granted certificate of authority to do business in Pennsylvania as required by the business corporation law, approved May

5, 1933, PL 364, as amended.

F. The_________________________________________ is an individual or partnership trading under a fictitious or assumed name and has (has not) registered under the Fictitious Name Act of

Pennsylvania; namely, the Act of May 24, 1945, PL 967.

ARTICLE 5 – BASIS OF BID

5.01 All bids must be submitted electronically via PennBid (www.pennbid.net) and shall include the required bid forms. All blank spaces for bid prices must be filled in and the bid form must be fully completed and executed when submitted, and any omission of bid prices, where a bid is made, will be sufficient to cause rejection of bid as informal. Owner reserves the right to reject any and all bids, and to waive any informalities, defects, or irregularities in the bids.

5.02 Bidder will complete the Work in accordance with the Contract Documents for the following price(s):

BID SCHEDULE

No. Description Quantity Unit Unit Price Total Price

1 Mobilization / Demobilization / General Contract Provisions 1 LS $ $

2 Maintenance and Protection of Traffic 1 LS $ $

3 Demolition - Sawcut and remove existing pavement, pieces of wall, vegetation, and all other necessary demolition items. 1 LS $ $

4 Cement Concrete Sidewalk, 5" Depth 60 SY $ $

5 Gazebo concrete pad and foundation 1 LS $ $

6 Bituminous Pavement Restoration 9.5mm Superpave Wearing

Course, 1.5" Depth 130 SY $ $

7 Bituminous Pavement Restoration 25mm Superpave Base

Course, 4" Depth 130 SY $ $

8 Subbase, 6" Depth (No. 2A) 130 SY $ $

9 Topsoil, Seed/Mulch 1 LS $ $

10 Line Striping- Including Parking Stall Lines, Handicap Parking

Symbol, and Hatched Parking Lines 1 LS $ $

11 Handicap Parking Sign 1 EA $ $

12 Tree Removal 2 EA $ $

13 Furnish and Install Erosion and Sedimentation Controls 1 LS $ $

14 Construction Photos/Video 1 LS $ $

$Houtzdale Borough Hannah Street Park Project Total Base Bid =

Bidder acknowledges that (1) each Bid Unit Price includes an amount considered by Bidder to be adequate to cover

Contractor’s overhead and profit for each separately identified item, and (2) estimated quantities are not guaranteed, and are solely for the purpose of comparison of Bids, and final payment for all unit price Bid items will be based on actual quantities, determined as provided in the Contract Documents.

Bid Form MODIFIED version of EJCDC® C-410, Bid Form.Copyright © 2013 NSPE, ACEC, and ASCE. All rights reserved. 004143 - 4

Bid Form 004143 - 5

Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

ARTICLE 6 – TIME OF COMPLETION

6.01 Bidder agrees that the Work will be substantially complete by May 21, 2027 within calendar days after the date when the Contract Times commence to run as provided in Paragraph 4.01 of the General

Conditions and will be completed and ready for final payment in accordance with Paragraph 15.06 of the General Conditions within calendar days after the date when the Contract Times commence to run no later than May 31, 2027. Construction must be completed by Monday, May 31, 2027.

6.02 Bidder accepts the provisions of the Agreement as to liquidated damages.

ARTICLE 7 – ATTACHMENTS TO THIS BID

7.01 The following documents are submitted with and made a condition of this Bid:

A. Required Bid security;

B. List of Project References;

C. Required Bidder Qualification Statement with supporting data

D. Non-Collusion Affidavit of Prime Bidder

E. Certification of Non-Segregated Facilities & Illegal Alien Labor

F. Public Works Employment Verification Form

G. PA Worker Protection & Investment Certification Form

H. Grant Agreement & Nondiscrimination/Sexual Harassment Provisions Acknowledgement of Prime

Bidder

ARTICLE 8 – DEFINED TERMS

8.01 The terms used in this Bid with initial capital letters have the meanings stated in the Instructions to

Bidders, the General Conditions, and the Supplementary Conditions.

Bid Form 004143 - 6

Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

ARTICLE 9 – BID SUBMITTAL

BIDDER: [Indicate correct name of bidding entity]

By:

[Signature]

[Printed name]

(If Bidder is a corporation, a limited liability company, a partnership, or a joint venture, attach evidence of authority to sign.)

Attest:

[Signature]

[Printed name]

Title:

Submittal Date:

Address for giving notices:

Telephone Number:

Fax Number:

Contact Name and e-mail address:

Bidder’s License No.:

PENAL SUM FORM

EJCDC® C-430, Bid Bond (Penal Sum Form). Published 2013.

Prepared by the Engineers Joint Contract Documents Committee.

Bid Bond 004313-1

BID BOND

Any singular reference to Bidder, Surety, Owner or other party shall be considered plural where applicable.

BIDDER (Name and Address):

SURETY (Name, and Address of Principal Place of Business):

OWNER (Name and Address):

BID

Bid Due Date:

Description (Project Name— Include Location):

BOND

Bond Number:

Date:

Penal sum $

(Words) (Figures) Surety and Bidder, intending to be legally bound hereby, subject to the terms set forth below, do each cause this Bid Bond to be duly executed by an authorized officer, agent, or representative.

BIDDER SURETY

(Seal) (Seal)

Bidder’s Name and Corporate Seal Surety’s Name and Corporate Seal

By: By:

Signature Signature (Attach Power of Attorney)

Print Name Print Name

Title Title

Attest: Attest:

Signature Signature

Title Title

Note: Addresses are to be used for giving any required notice.

Provide execution by any additional parties, such as joint venturers, if necessary.

PENAL SUM FORM

EJCDC® C-430, Bid Bond (Penal Sum Form). Published 2013.

Prepared by the Engineers Joint Contract Documents Committee.

Bid Bond 004313-2

1. Bidder and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors, and assigns to pay to Owner upon default of Bidder the penal sum set forth on the face of this Bond. Payment of the penal sum is the extent of Bidder’s and Surety’s liability. Recovery of such penal sum under the terms of this Bond shall be Owner’s sole and exclusive remedy upon default of Bidder.

2. Default of Bidder shall occur upon the failure of Bidder to deliver within the time required by the Bidding Documents (or any extension thereof agreed to in writing by Owner) the executed Agreement required by the Bidding Documents and any performance and payment bonds required by the Bidding Documents.

3. This obligation shall be null and void if:

3.1 Owner accepts Bidder’s Bid and Bidder delivers within the time required by the Bidding Documents (or any extension thereof agreed to in writing by Owner) the executed Agreement required by the Bidding Documents and any performance and payment bonds required by the Bidding Documents, or

3.2 All Bids are rejected by Owner, or

3.3 Owner fails to issue a Notice of Award to Bidder within the time specified in the Bidding Documents (or any extension thereof agreed to in writing by Bidder and, if applicable, consented to by Surety when required by Paragraph 5 hereof).

4. Payment under this Bond will be due and payable upon default of Bidder and within 30 calendar days after receipt by Bidder and Surety of written notice of default from Owner, which notice will be given with reasonable promptness, identifying this Bond and the Project and including a statement of the amount due.

5. Surety waives notice of any and all defenses based on or arising out of any time extension to issue Notice of Award agreed to in writing by Owner and Bidder, provided that the total time for issuing Notice of Award including extensions shall not in the aggregate exceed 120 days from the Bid due date without Surety’s written consent.

6. No suit or action shall be commenced under this Bond prior to 30 calendar days after the notice of default required in Paragraph 4 above is received by Bidder and Surety and in no case later than one year after the Bid due date.

7. Any suit or action under this Bond shall be commenced only in a court of competent jurisdiction located in the state in which the Project is located.

8. Notices required hereunder shall be in writing and sent to Bidder and Surety at their respective addresses shown on the face of this Bond. Such notices may be sent by personal delivery, commercial courier, or by United States Registered or Certified Mail, return receipt requested, postage pre-paid, and shall be deemed to be effective upon receipt by the party concerned.

9. Surety shall cause to be attached to this Bond a current and effective Power of Attorney evidencing the authority of the officer, agent, or representative who executed this Bond on behalf of Surety to execute, seal, and deliver such Bond and bind the Surety thereby.

10. This Bond is intended to conform to all applicable statutory requirements. Any applicable requirement of any applicable statute that has been omitted from this Bond shall be deemed to be included herein as if set forth at length. If any provision of this Bond conflicts with any applicable statute, then the provision of said statute shall govern and the remainder of this Bond that is not in conflict therewith shall continue in full force and effect.

11. The term “Bid” as used herein includes a Bid, offer, or proposal as applicable.

Qualifications Statement 004513 - 1 This document is a MODIFIED version of EJCDC® C-451, Qualifications Statement.

Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, QUALIFICATIONS STATEMENT

THE INFORMATION SUPPLIED IN THIS DOCUMENT IS CONFIDENTIAL TO THE EXTENT

PERMITTED BY LAWS AND REGULATIONS

1. SUBMITTED BY:

Official Name of Firm:

2. SUBMITTED TO:

3. SUBMITTED FOR:

Owner:

Project Name:

TYPE OF WORK:

4. CONTRACTOR'S CONTACT INFORMATION

Contact Person:

Title:

Phone:

Email:

5. AFFILIATED COMPANIES:

Name:

Qualifications Statement 004513 - 2

Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies,

6. TYPE OF ORGANIZATION:

SOLE PROPRIETORSHIP

Name of Owner:

Doing Business As:

Date of Organization:

PARTNERSHIP

Date of Organization:

Type of Partnership:

Name of General Partner(s):

CORPORATION

State of Organization:

Date of Organization:

Executive Officers:

- President:

- Vice President(s):

- Treasurer:

- Secretary:

LIMITED LIABILITY COMPANY

State of Organization:

Date of Organization:

Members:

Qualifications Statement 004513 - 3

Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, JOINT VENTURE

Sate of Organization:

Date of Organization:

Form of Organization:

Joint Venture Managing Partner

- Name:

- Address:

Joint Venture Managing Partner

Joint Venture Managing Partner

7. LICENSING

Jurisdiction:

Type of License:

License Number:

Jurisdiction:

Type of License:

License Number:

Qualifications Statement 004513 - 4

Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies,

8. CERTIFICATIONS CERTIFIED BY:

Disadvantage Business Enterprise:

Minority Business Enterprise:

Woman Owned Enterprise:

Small Business Enterprise:

Other ( ):

9. BONDING INFORMATION

Bonding Company:

Bonding Agent:

Contact Name:

Phone:

Aggregate Bonding Capacity:

Available Bonding Capacity as of date of this submittal:

10. FINANCIAL INFORMATION NOT USED INTENTIONALLY

Financial Institution:

Account Manager:

Phone:

INCLUDE AS AN ATTACHMENT AN AUDITED BALANCE SHEET FOR EACH

OF THE LAST 3 YEARS

Qualifications Statement 004513 - 5

Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies,

11. CONSTRUCTION EXPERIENCE:

Current Experience:

List on Schedule A all uncompleted projects currently under contract (If Joint Venture list each participant's projects separately).

Previous Experience:

List on Schedule B all projects completed within the last 5 Years (If Joint Venture list each participant's projects separately).

Has firm listed in Section 1 ever failed to complete a construction contract awarded to it?

YES NO

If YES, attach as an Attachment details including Project Owner's contact information.

Has any Corporate Officer, Partner, Joint Venture participant or Proprietor ever failed to complete a construction contract awarded to them in their name or when acting as a principal of another entity?

YES NO

If YES, attach as an Attachment details including Project Owner's contact information.

Are there any judgments, claims, disputes or litigation pending or outstanding involving the firm listed in

Section 1 or any of its officers (or any of its partners if a partnership or any of the individual entities if a joint venture)?

YES NO

If YES, attach as an Attachment details including Project Owner's contact information.

12. SAFETY PROGRAM:

Name of Contractor's Safety Officer:

Include the following as attachments:

Provide as an Attachment Contractor's (and Contractor's proposed Subcontractors and Suppliers furnishing or performing Work having a value in excess of 10 percent of the total amount of the Bid)

OSHA No. 300 - Log & Summary of Occupational Injuries & Illnesses for the past 5 years.

Provide as an Attachment Contractor's (and Contractor's proposed Subcontractors and Suppliers furnishing or performing Work having a value in excess of 10 percent of the total amount of the Bid) list of all OSHA Citations & Notifications of Penalty (monetary or other) received within the last 5 years (indicate disposition as applicable) - IF NONE SO STATE HERE: .

Provide as an Attachment Contractor's (and Contractor's proposed Subcontractors and Suppliers furnishing or performing Work having a value in excess of 10 percent of the total amount of the Bid) list of all safety citations or violations under any state all received within the last 5 years (indicate disposition as applicable) - IF NONE SO STATE HERE: .

Qualifications Statement 004513 - 6

Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, Provide the following for the firm listed in Section V (and for each proposed Subcontractor furnishing or performing Work having a value in excess of 10 percent of the total amount of the Bid) the following (attach additional sheets as necessary):

Workers' compensation Experience Modification Rate (EMR) for the last 5 years:

YEAR EMR

YEAR EMR

YEAR EMR

YEAR EMR

YEAR EMR

Total Recordable Frequency Rate (TRFR) for the last 5 years:

YEAR TRFR

YEAR TRFR

YEAR TRFR

YEAR TRFR

YEAR TRFR

Total number of man-hours worked for the last 5 Years:

YEAR TOTAL NUMBER OF MAN-HOURS

YEAR TOTAL NUMBER OF MAN-HOURS

YEAR TOTAL NUMBER OF MAN-HOURS

YEAR TOTAL NUMBER OF MAN-HOURS

YEAR TOTAL NUMBER OF MAN-HOURS

Provide Contractor's (and Contractor's proposed Subcontractors and Suppliers furnishing or performing Work having a value in excess of 10 percent of the total amount of the Bid) Days Away

From Work, Days of Restricted Work Activity or Job Transfer (DART) incidence rate for the particular industry or type of Work to be performed by Contractor and each of Contractor's proposed

Subcontractors and Suppliers) for the last 5 years:

YEAR DART

YEAR DART

YEAR DART

YEAR DART

YEAR DART

13. EQUIPMENT:

MAJOR EQUIPMENT:

List on Schedule C all pieces of major equipment available for use on Owner's Project.

Qualifications Statement 004513 - 7

Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, I HEREBY CERTIFY THAT THE INFORMATION SUBMITTED HEREWITH, INCLUDING ANY

ATTACHMENTS, IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF.

NAME OF ORGANIZATION:

BY:

TITLE:

DATED:

NOTARY ATTEST:

SUBSCRIBED AND SWORN TO BEFORE ME

THIS DAY OF , 20___

NOTARY PUBLIC - STATE OF

MY COMMISSION EXPIRES:

REQUIRED ATTACHMENTS

1. Schedule A (Current Experience).

2. Schedule B (Previous Experience).

3. Schedule C (Major Equipment).

4. Audited balance sheet for each of the last 3 years for firm named in Section 1. NOT USED

INTENTIONALLY

5. Evidence of authority for individuals listed in Section 6 to bind organization to an agreement.

6. Resumes of officers and key individuals (including Safety Officer) of firm named in Section 1.

7. Required safety program submittals listed in Section 12.

8. Additional items as pertinent.

Qualifications Statement 004513 - 8

Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, SCHEDULE A

CURRENT EXPERIENCE

Project Name Owner's Contact Person Design Engineer Contract Date Type of Work Status Cost of Work

Telephone:

Name:

Company:

Telephone:

Telephone:

Name:

Telephone:

Name:

Telephone:

Name:

Telephone:

Name:

Telephone:

Name:

Telephone:

Name:

Qualifications Statement 004513 - 9

Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, SCHEDULE B

PREVIOUS EXPERIENCE (Include ALL Projects Completed within last 5 years)

Telephone:

Name:

Telephone:

Name:

Telephone:

Name:

Telephone:

Name:

Telephone:

Name:

Telephone:

Name:

Telephone:

Name:

SCHEDULE B

Qualifications Statement 004513 - 10

Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, PREVIOUS EXPERIENCE (Include ALL Projects Completed within last 5 years)

Telephone:

Name:

Telephone:

Name:

Telephone:

Name:

Telephone:

Name:

Telephone:

Name:

Telephone:

Name:

Telephone:

Name:

Qualifications Statement 004513 - 11

Copyright © 2013 National Society of Professional Engineers, American Council of Engineering Companies, SCHEDULE C - LIST OF MAJOR EQUIPMENT AVAILABLE

ITEM PURCHASE DATE CONDITION ACQUIRED VALUE

004519-1

NON-COLLUSION AFFIDAVIT

OF PRIME BIDDER

State of

County of

, being first duly sworn, disposes and says that:

(1) S/He is Owner, partner, officer, representative, or agent) of , the Bidder that has submitted the attached Bid:

(2) S/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 affidavit, 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 or 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 prices or the Bid price of any Bidder, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against the or any person interest 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 affidavit.

(Signed)

(Title)

Subscribed and sworn to before me this day of , 20 .

Notary Public Signature (Notary Seal)

My commission expires .

004533-1

CERTIFICATION OF NON-SEGREGATED FACILITIES

& NON-EMPLOYMENT OF ILLEGAL ALIEN LABOR

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 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 explicitly directive or 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 award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity Clause, that he/she will retain such certifications in his/her files.

The Bidder further certified in accordance with Act 43 (PL May 11, 2006) that he/she shall not knowingly employ, or knowingly permit any of its subcontractors to knowingly employ, the labor services of an illegal alien.

In the event that the Bidder

a) Knowingly employs or knowingly permits any of its subcontractors to knowingly employ, the labor services of an illegal alien; and

b) The Bidder or any of its subcontractors are sentenced under Federal Law for an offense involving knowing use of labor by an illegal alien, the Bidder shall be subject to penalty as prescribed in Pennsylvania Act 43 (PL May 11, 2006).

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

Date___________________, 20____ __________________________________

(Name of Bidder)

Official Address By_________________________________

(Including ZIP CODE): (Signature)

(Title)

Employer Identification Number

Street Address 2

City State Zip Code

Doing Business As:

(if different from Legal Name)

Commonwealth of Pennsylvania Public Works Employment Verification Form

Complete and return the form to the contracting Public Body prior to the award of the contract.

Company Legal Name: ___________________________________________________________

Mailing Address: ______________________________________________________

Check one: Contractor Subcontractor

Contracting Public Body: _________________________________________________________

Contract/Project Number: ________________________________________________________

Project Description: _____________________________________________________________

Project Location: _______________________________________________________________

Date Enrolled in E-Verify (MM/DD/YYYY): ___________________________________________ As a contractor/subcontractor for the above referenced public works contract, I hereby affirm that as of today’s 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 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 Date of Signature

Printed Name: _________________________________________________________________

Phone Number: ______________________ Email: ____________________________________

Street Address 1

004546.14-1

004599-1

GRANT AGREEMENT & NONDISCRIMINATION/SEXUAL HARASSMENT PROVISIONS

ACKNOWLEDGEMENT OF PRIME BIDDER

This Statement relates to a proposed contract with Houtzdale Borough (Name of

Borrower or Grantee) who expects to finance the Hannah Street Park Project with assistance from the

Commonwealth of Pennsylvania, Commonwealth Financing Authority. I am the undersigned bidder or prospective contractor.

I represent that I understand the provisions of the Greenways, Trails, and Recreation Program

Grant Agreement (Contract No. C000083673), between the Borrower/Grantee and

Commonwealth as contained in the Contract Documents (Project Manual) for this project. I agree to performing all activities authorized by this Grant and the Borrower/Grantee to be in accordance with applicable statutes, regulations, conditions, directives, guidelines and such additional requirements as may be included in the agreement or otherwise provided by the Commonwealth of Pennsylvania. I acknowledge that this Grant is subject to all requirements set forth in the agreement and further agree to comply with future requirements by the Commonwealth as necessary.

I further acknowledge the “Nondiscrimination/Sexual Harassment Provisions” as stated in the grant agreement and agree to comply to these said provisions.

Date Signature

Name and Title

Bidder Company Name

Address

City, State Zip

Phone Number

Email Address

004599-2

Extracted from:

Greenways, Trails, and Recreation Program Grant Agreement (Contract No. C000083673)

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