HONEY BROOK TOWNSHIP

500 SUPLEE ROAD

HONEY BROOK, PA 19344

BID DOCUMENTS

FOR

CUPOLA ROAD OVERLAY

2026 ROAD WORK

BID PROPOSALS DUE: THURSDAY, JULY 2, 2026 by 11:00 AM

VIA PENNBID

BID OPENING: THURSDAY, JULY 2, 2026 AT 11:30AM

VIA PENNBID

BID AWARD: WEDNESDAY, JULY 8, 2026 AT 7:00PM

AT THE HONEY BROOK TOWNSHIP

BUILDING

INVITATION TO BIDDERS

Bid proposals will be received by the Honey Brook Township, Chester County, Board of Supervisors until

11 AM, prevailing time, Thursday July 2, 2026 via PennBID (https://pennbid.bonfirehub.com) only for the following scope of work:

Cupola Road Overlay - 2026 Roadwork - Includes placement of ½” 9.5mm Scratch Course (551 tons) and 12.5 mm wearing course overlay (1,651 Tons) and other work as specified in the Bid

Documents.

Bids will be opened via PennBID and results posted online at approximately 11:30 A.M., prevailing time, Thursday July 2, 2026. The contract will be awarded or rejected, during the Honey Brook Township Board of

Supervisors meeting held on Wednesday, July 8, 2026 at 7:00 p.m. at the Honey Brook Township Municipal

Building, 500 Suplee Road, Honey Brook, PA 19344.

Contract documents are available through the PennBID system; Bids must be submitted on forms furnished by the Township and available on PennBID.

A pre-bid project review with the Municipality’s representative is mandatory and will be held on June 17, 2026 at 9 am and June 25, 2026 at 3:30 PM at the Honey Brook Township Building, 500 Suplee Road, Honey

Brook, PA 19344. Bidders must attend one of the two dates.

Work must be completed by October 9, 2026. Liquidated damages apply at a rate of $885.00 per calendar day.

Pennsylvania Prevailing Wage Rates apply to this Contract.

A certified check or bank draft, payable to Honey Brook Township or a satisfactory bid bond executed by the bidder and acceptable sureties in an amount equal to ten percent (10%) of the bid shall be submitted with the bid. In addition, the following documents must be included with the bid package: proof of PennDOT prequalification, workman’s compensation affidavit, anti-collusion affidavit, CDL compliance certificate, public works employee verification and proof of insurance.

A performance bond or certified check in the amount of 100% of the contract price and associated payment bond and official insurance certificate shall be furnished by the successful bidder within 20 days after contract is awarded.

Honey Brook Township reserves the right to reject any or all bids submitted or any part thereof or item therein that may not be in the public’s best interest. The Township also reserves the right to waive any defects, errors, omissions, irregularities or informalities in bids received.

Township of Honey Brook

Kristy Deischer-Eddy, Interim Township Manager https://pennbid.bonfirehub.com/

MS-944 02-01 PROPOSAL & CONTRACT (THIS PROPOSAL INCLUDES

(WHEN EXECUTED) INSTRUCTIONS TO BIDDERS)

A. DEPOSIT OF PROPOSALS.

Bids shall be submitted via PennBID for HONEY BROOK TOWNSHIP

“Cupola Road Overlay - 2026 Roadwork” Municipality Name and Type for Letting of

July 2, 2026 KRISTY DEISCHER-EDDY

Date Interim Township Manager

Sealed Proposals will be received on or before

11:00 A.M., on July 2, 2026 via PennBID 500 SUPLEE RD

Time Address

Bids will be opened on PennBID and posted approximately HONEY BROOK, PA 19344

11:30 A. M. on the above Bid Due Date. Proposals must be submitted via PennBID.

1. The contractor proposes to furnish and deliver all materials (including Form TR-465 Daily Bituminous Mixture

Certification) and to do and perform all work in the bid for the following project as more specifically set forth in the

Schedule of Prices (Attachment), in accordance with drawings and specifications on file with PennBID

(www.pennbid.bonfirehub.com)as well as the supplements and special requirements contained herein and/or attached hereto and current PennDOT specifications (Publication 408), except (a) volumetric testing of bituminous paving materials is not required (Sec. 409). Bidders need to be prequalified by PennDOT (Sec. 102.01).

2. If designated as the successful bidder, the contractor may begin work on the date specified in the notice to proceed, or as otherwise provided in the special requirements, and will complete all work on or before October 9, 2026. If all work is not completed on time, liquidated damages will be assessed at the rate of $_885.00 per additional calendar day.

3. Accompanying this proposal is a certified check or bid Bond in the amount of 10% of the bid made payable to the municipality as a proposal guarantee which, it is understood, will be forfeited in case the contractor fails to comply with the requirement of the proposal.

B. PROPOSAL OF: _____________________________________________________________________________ Name of Contractor

Address

CONTRACTOR’S CERTIFICATION

It is hereby certified as follows:

1. The only person(s) interested in this proposal as principal(s) is (are): ________________________________

2. None of the above persons are employees of the municipality.

3. This proposal is made without collusion with any other person, firm, or corporation.

4. All plans and specifications referred to above and the site of the work have been examined by the contractor.

The contractor understands that the quantities indicated herein are approximate and are subject to change as may be required; and that all work is payable on the basis of the unit prices listed on the Schedule of Prices (Attachment

1).

- 1 -http://www.pennbid.bonfirehub.com/

5. The contractor will comply with all requirements of the laws and implementing regulations of the Commonwealth of

Pennsylvania and the United States relating to human relations, equal opportunity and non-discrimination in employment, and will pay to workmen employed in the performance of the contract the wages to which they may be entitled.

6. The contractor will provide the municipality with a 100% performance bond, conditioned upon the faithful performance of the contractor in accordance with the plans, specifications and conditions thereof, and a 100% payment bond conditioned on the prompt payment of all material furnished and labor supplied or performed in the prosecution of the work, in accordance with the Public Work’s Contractors’ Bond Law of 1967; These items shall be submitted within 20 days of notice of award.

7. The contractor, with the bid submission, shall include a dually signed copy of the project specifications, an affidavit accepting the provisions of the Workmen’s Compensation Act of 1915, as amended, an insurance certificate, an anti-collusion affidavit, a public works employment verification form, CDL compliance certificate and proof of PennDOT prequalification.

8. “The parties agree that the relationship between the Contractor and Honey Brook Township is one of independent contractor and not the employer/employee and that the individual employees of the Contractor who will be performing the work pursuant to this contract are not employees of Honey Brook Township. Contractor hereby certifies, represents and warrants to the Township that all persons performing any aspect of the work pursuant to this Contract who are required to have commercial driver’s license are subject to a program for drug and alcohol testing in accordance with the Omnibus

Transportation Employee Testing Act of 1991 and the federal regulations adopted pursuant thereto.”

Contractor

WITNESSED OR ATTESTED BY:

BY:______________________________________

Title (Seal)

Title

SEAL

TO BE EXECUTED ONLY IN THE EVENT THE ABOVE PROPOSAL IS ACCEPTED

ACCEPTED ON:_______________________________________

Date

Municipality

ATTESTED BY:

________________________________________ BY:_______________________________________ Title Title

- 2 -

ATTACHMENT #1 (page 1 of 3)

County: Chester Municipality: Honey Brook Township Project No.: Cupola Road Overlay

– 2026 Road Work

T H

IS

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LOCATION OF WORK

Cupola Road between Chestnut Tree Road and Rockville Mennonite Church (210 Cupola Rd)

(All ADTs > 1000).

DESCRIPTION OF WORK:

As indicated below and in Attachments. Follow PADOT Pub. 408.

ESCALATOR CLAUSE:

Per Pub. 408 Section 110.04 Current Edition. Bituminous Price Adjustment applies to this contract.

Contractor required to supply Form CS-1-PA when applicable. Bid index is June 2026

SCHEDULE OF PRICES

1.Item

No.

2. Approx.

Quantities

3.

Units

4.*Description 5. Unit

Price

6. Total

Tons

Tons

Cupola Road (5100’ long x 22’ wide and 1800’ x 21’ wide)

From Chestnut Tree Road to Grieson Rd and Grieson Road to 210

Cupola (Rockville Mennonite Church)

Sweep and apply tack coat, pave Superpave, HMA overlay Wearing

Course, PG-64S-22, 0.3 to 3.0 million ESAL’s, 12.5 mm mix, 1.5” minimum compacted depth, SRL-H, and seal joints.

Place 1/2" leveling 9.5mm Superpave, 0.3 – 3.0 ESALS, PG-64-22, SRL

"H"

Only

Put

Pricing

On

PennBID

Pricing

Sheet

Only

Put

Pricing

On

PennBID

Pricing

Sheet

*DESCRIPTION

Must include ADT on Wearing surfaces.

USE OF CUTBACK ASPHALT IS PROHIBITED BETWEEN MAY 1st

AND OCTOBER 31st EXCEPT AS NOTED IN BULLETIN NO. 25.

County: Chester Municipality: Honey Brook Township Project No.: Cupola Road Overlay –

2026 Road Work

Attachment 1-A

SPECIFICATIONS AND SPECIAL PROVISIONS TO CONTRACT MS-944

CONTAINS IMPORTANT INFORMATION FOR THE CONTRACTOR(S)

The Prime Contractor(s) and subcontractors must comply with all of the following provisions:

TRAFFIC CONTROL

- Traffic Control and Safety Devices to be provided by the Contractor(s) in compliance with the current MUTCD, PennDOT Publication 212 and Publication 213.

- Roadways may be closed to through traffic, however, school buses, emergency vehicles and residents in the work area must be able to pass through during work hours.

GENERAL

- A pre-bid project review with the Municipality’s representative is mandatory and will be held on June 17, 2026 at 9 am and June 25, 2026 at 3:30 PM at the Honey Brook Township Building, 500 Suplee Road, Honey Brook, PA 19344.

Bidders must attend one of the two dates.

- Contractor(s) to supply proof of CDL Drug and Alcohol Compliance and completed non-collusion affidavit, public works verification form and Workman’s Compensation affidavit with the bid package.

- Proof of Insurance showing the required coverages as shown herein the bid documents must be submitted with bid to be considered a valid bid

- Contractor(s) shall be PENNDOT prequalified and must supply proof of prequalification with the bid package.

- Prevailing wages apply to this project.

- Work to be completed on or before October 9, 2026. After 10/9/26, liquidated damages apply at $885/day.

- The Contractor(s) shall notify the Municipality and public five (5) calendar days prior to the start of the project.

- Delivery tickets shall be submitted for all materials.

- Submit Bill of Lading for each shipment of bituminous material per Section 702.1(c) of PENNDOT Spec. Form 408.

- CS-4171 Certificate of Compliance and/or TR-465 Daily Bituminous Mixture Certification is required for all materials.

- Final Completion Certificate & Notice of Completion required

- Where Contract references current PennDOT specifications (Publication 408) or PennDOT Specifications Form 408, the latest version applies.

- Contractor(s) is (are) responsible for defects that occur within one year of applications.

- A 2-year maintenance bond is required (100% first year, 50% second year) covering any and all workmanship or material related defects, as determined by the municipality.

- Municipality will inspect the project and has the right to reject work not up to specifications.

- Municipality reserves the right to limit work completed.

- Municipality reserves the right to procure material which best suits their requirements after all bids & items are reviewed.

- Municipality reserves the right to make an award on the basis of the aggregate total for all like items on which quotations are received.

- Future award of Contracts will be based on quality of work as determined by the Municipality.

- The successful bidder(s) must provide a 100% Performance Bond and a 100% Payment Bond within 20 days of the award of the contract.

- Certificate of insurance listing Honey Brook Township as the Certificate Holder and HBT and Technicon Enterprises Inc

II as additional insured with coverages as established in the bid documents must be submitted within 20 days of Notice of

Award.

- Honey Brook Township will issue a Notice to Proceed when all executed documents and paperwork have been received.

- No payments will be made until bidder has supplied all required delivery slips, certifications and payroll records, and maintenance bond.

- Contractor(s) must complete and submit CS-1PA, Price Adjustment of Bituminous Material if applicable.

- Contractor’s equipment may not leave project location until the contracted work has been completed.

- Incidental preparation and clean up required by Contractor. (Project Construction Materials)

- Township is responsible for replacing permanent paving markings.

- Township is responsible for obtaining any necessary water box and manhole risers.

- No nighttime work permitted.

- 4 -

County: Chester Municipality: Honey Brook Township Project No.: Cupola Road Overlay

– 2026 Roadwork

Attachment 1-A

SPECIFICATIONS AND SPECIAL PROVISIONS TO CONTRACT MS-944

CONTAINS IMPORTANT INFORMATION FOR THE CONTRACTOR(S)

BITUMINOUS PAVING

- Complete all testing in accordance with PENNDOT Specifications Form 408 Section 409 except volumetric testing.

- Tack Coat is required per Section 460 / 409 of PennDOT Specifications Form 408 and is incidental to paving.

- Bituminous Seal on all abutting pavement, manholes, inlets and curbs, and stop points required after wearing course.

- Existing driveways shall be transitioned to maintain positive drainage along roadway gutterline and sufficient access to property as necessary.

- Milling of driveway notches, and 4’ milled transitions at either side of the bridge and at roadway intersections will be done by the municipality.

- Material to be placed in driveway entrances and rolled as needed.

- Material depth at edges must meet minimum requirement.

- Roadway is to be power broomed by the Contractor prior to start of paving.

- Contractor to remove all excess material from the project site.

- Roadway cross-slope shall match existing unless otherwise directed by Township inspector. Minimum cross-slope to be

¼” per foot and if existing cross-slope does not meet this, then leveling course shall be utilized to achieve said grade.

-Scratch/leveling course to be placed at discretion of appointed inspector(s).

-Scratch/leveling course must be compacted with a pneumatic tired roller.

- Paving must be done in two passes.

- Vendor must place material with paver on tracks. JMFs must be submitted for review

- 10-ton roller(s) required for the roadway, 2 minimum. A 2-5 ton roller must be available for driveways, 1 minimum.

- Care must be taken when placing and rolling for smooth surface. No parking of roller on material just placed.

- Township reserves the right to have the 1st pass to be static rolled.

- Paver must have slope sensor to ensure placement of 2.5% cross-slope with +/- slope to be at discretion of Township

- If frequent stops and starts occur, the Township reserves the right to have cooled material removed from paver and/or require several trucks to be in light before restarting paver to prevent stopping.

- Vendor to match trucks to paving operations for continuous paver movement as per Superpave requirements.

- Paver must keep moving between trucks at a very slow speed; starts and stops to be at a very slow pace to eliminate quick up/down movement of cut-off bar.

- Paver crew foreman will be required to check tonnage per 100’ to maintain lbs/SY requirement with equal depth on both outside edges.

My signature signifies that I have read and understand the above conditions and special provisions to this contract, and by being authorized by this company to act as their authorized representative, and on their behalf hereby agree to adhere to any and all of the provisions pertaining to this contract.

Contractor’s Representative Date Municipality’s Representative Date

______________________________________________ _____ HONEY BROOK TOWNSHIP_ _

Company Municipality

- 5 -

MS-944-S (7-09)

Attachment 2

PERFORMANCE BOND

(With Corporate Surety)

KNOW ALL MEN BY THESE PRESENTS, That we, as Principal and a corporation incorporated under the laws of the State of are held and firmly bound unto

(NAME AND ADDRESS OF CONTRACTOR)

(SURETY COMPANY)

as Surety

(NAME OF STATE)

in the full and just sum of

(NAME OF MUNICIPALITY)

($ ) dollars lawful money to the United States of America, to be paid to the above Municipality or its assigns, to which payment well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.

WHEREAS, the above bounden Principal has entered into a contract with the above Municipality, bearing even date herewith, for the undertaking of certain obligations as therein set forth.

NOW, THEREFORE, the condition of this obligation is such that if the above bounden Principal, as Contractor, shall in all respects comply with and faithfully perform the terms and conditions of said Contract, including the Specifications and conditions referred to and made a part thereof, and such alterations as may be made in said Specifications as therein provided, and shall well and truly, and in a manner satisfactory to the municipality fulfill all obligations as therein set forth, then this Obligation shall be void, but otherwise the same shall be and remain in full force, virtue and effect.

It is further provided that any alteration which may be made in the terms of the contractor or its specifications with the express approval of the Municipality or the Principal to the other, shall not in any way release the Principal and the Surety or either or any of them, their heirs, executors, administrators, successors or assigns from their liability hereunder, notice to the surety of any such alteration or forbearance being hereby waived.

IN WITNESS WHEREOF, the said Principal and Surety have duly executed this Bond under Seal, pursuant to due and legal action authorizing the same to be done on .

(DATE OF BOND)

PLACE

HERE

Attest / Witness:

CONTRACTOR

BY

TITLE:

HERE

Attest / Witness:

SURETY COMPANY

TITLE: -7-

MS-944S PAYMENT BOND Attachment 3

KNOW ALL MEN BY THESE PRESENTS, that we as PRINCIPAL and a corporation incorporated under the laws of the State of as SURETY, are held and firmly bond unto the , in the full and just sum of

($ )dollars, lawful money of the United States of America, to be paid to the said or its assigns, to which payment well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.

WHEREAS, the above bounden Principal has entered into a contract with the above municipality hereinafter called Obligee, bearing even date herewith, for the improvement of a certain section of highway or bridge in said Municipality consisting of:

for approximately the sum of: ($ ) dollars.

NOW, THEREFORE, the condition of this obligation is such that if the above bounden PRINCIPAL shall and will promptly pay or cause to be paid in full all sums of money which may be due by contract or otherwise, to any individual, firm, partnership, association or corporation, for all material furnished or labor supplied or performed in the prosecution of the work, whether or not the said for material or labor entered into and became component parts of the work and for rental of the equipment used and services rendered by public utilities in, or in connection with the prosecution of such work, then this obligation to be void, otherwise to remain in full force and effect.

The PRINCIPAL and SURETY, hereby, jointly and severally, agree with the Obligee herein that any individual firm, partnership, association or corporation, which has performed labor or furnished material in the prosecution of the work as provided, and any public utility which has not been paid in full therefor, may sue in assumpsit on this Payment Bond in his, their, or its own name and may prosecute the same to final for such sum or sums as maybe justly due him, them or it, and have execution thereon.

Provided, however, that the Obligee shall not be liable for the payment of any costs of expenses of such suit.

RECOVERY by any individual, firm, partnership, association or corporation hereunder shall be subject to the provisions of the “Public Works Contractors’ Bond Law of 1967", Act No. 385, approved December 20, 1967,P.L. 869, which Act shall be incorporated herein and made a part hereof, as fully and completely as though its provisions were fully and at length herein recited.

It is further provided that any alterations which may be made in the terms of the contract or in the work to be done or materials to be furnished or labor to be supplied or performed under it or the giving by the Obligee of any extension of time for the performance of the contract or any other forbearance on the part of either the Obligee or the Principal to the other, shall not in any way release the PRINCIPAL and the SURETY or SURETIES of any such alteration, extension of forbearance being hereby waived.

IN WITNESS WHEREOF, the said PRINCIPAL and SURETY have duly executed this Bond under seal this day of ,20 .

WITNESS:

CONTRACTOR

BY:

WITNESS:

SURETY COMPANY

TITLE: TITLE:

AFFIDAVIT RE

Attachment 4

ACCEPTING PROVISIONS OF THE WORKMEN’S COMPENSATION ACT

State of )

) ss:

County of ) he has being duly sworn according to law deposes and says that they have it has accepted the provisions of the Workmen’s Compensation Act of 1915 of the Commonwealth of Pennsylvania, with has his its supplements and amendments, and have insured their liability thereunder in accordance with the terms of said its

Act with .

(SURETY COMPANY)

( TYPE OR PRINT) CONTRACTOR

SIGNATURE

Sworn to and subscribed before me this day of A.D. 20 .

SIGNATURE

My Commission Expires ( DATE )

- 9 -

D-7126 ( 7-09 )

ANTI-COLLUSION AFFIDAVIT

County Chester

Municipality Honey Brook Twp

Project Number Cupola Road Overlay

- 2026 Road Work

State of Fed. Project No.

( If Applicable )

County of

The undersigned deponent deposes and says that he is the ____________________ of the Company; that he is authorized to make this affidavit on behalf of said company in compliance with section 102.06 (e) of Department Specifications, Publication 408, as amended and that the said company has not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive bidding in connection with such contract.

(Contractor)

Sworn to and subscribed before me the undersigned notary public this day of , .

Notary Public

My Commission expires

- 10-

Rev 2/15 PSATS CDL Program Form Contractor

Contractor’s Statement of Compliance with

CDL Testing Program Requirements

Due to the nature of the work that this contractor may perform for this employer, this contractor must use employees who perform safety-sensitive functions for which a Commercial

Driver’s License (CDL) is typically required. Section 49 CFR 382.301(c)(2) of the federal CDL regulations requires that, prior to the first time an employer uses a CDL employee employed by another entity (i.e., a contractor to whom the township is awarding a contract), and every six months of the contract, this employer must certify that any CDL employees used by each contractor remain covered by a qualified CDL drug and alcohol testing program.

An original signed copy of this form must be permanently retained by the employer with this contract and a new form received every 6 months of the contract’s duration.

If the contractor is not participating in a qualified CDL drug and alcohol testing program at the time of the awarding of the contract, or at any six-month re-certification point, then all the contractor’s CDL employees must obtain a negative result on a pre-employment drug test before beginning (or continuing) contracted work for this employer.

Contractor Name__________________________________________________________________________

By signing here, I, as the contractor’s authorized representative, verify that the contractor named above is a current participant in the below identified CDL testing program conforming to 49 CFR Part 40.

Contractor’s Authorized Representative ________________________________________________________

Today’s Date ____/____/____

Signature of Authorized Representative ________________________________________________________

CDL Testing Program Name ________________________________________________________________

Testing Program Contact Person ____________________________________________________________

Testing Program Address __________________________________________________________________

Phone #: ( ) City ______________________________ State _____ Zip __________

Contact person confirms program conforms to 49 CFR Part 40? (_____) Yes (______) No

Contact person confirms list of contractor’s CDL employees covered in this program and that all drivers are qualified to driver under 49 CFR Part 382.301? (_____) Yes (______) No

Commonwealth of Pennsylvania

Public Works Employment Verification Form

Public Works Employment Verification Office Department of General Services Bureau of Procurement 6th floor, Forum Place 555 Walnut Street

Harrisburg, PA 17101-1914

717-346-8115 ra-gsgseverify.pa.gov

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

Business or Organization Name (Employer)

Address

City State Zip Code

Check One:

Contractor

Subcontractor

Contracting Public Body

Contract/Project No.

Project Description

Project Location

Date enrolled in E-Verify

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 Date of Signature

Name (print):

Running Avg. of 5

%AC

Daily No. 1

Wearing Course

Specimen #1Test Results Pass #8

Plant:

Location:

Binder Course Base Course

Signature:

Title:

Publication 408, Section:

P.O. No.

Consigned to:

Material Class:

Plant Code:

Daily No. 2

County

PennDOT Maintenance

Municipality

Contractor S.R.

Group / P.O.C. No. ECMS No.

ESALS SRL PG Grade

Section

County

Date Shipped:

Daily No. 3

Daily AASHTO T209 Density:

Pass #200

Daily Avg.

Specimen #2 Specimen #1 Specimen #2

Air Voids VMA

CS-4171B (2-16) Formerly TR-465

CERTIFICATE OF COMPLIANCE

FOR DAILY BITUMINOUS MIXTURES

Please select the Payment factor percentage below, based on Pub 408 Sec.409.4(a) Table H:

Defective Pavement: The material as listed above shipped on this date does not conform to the certification tolerances for 100% pay as listed in Pub 408 Sec. 409.2(e) Table A. QC test results are being forwarded to the Inspector-In-Charge which indicate material must be removed and replaced or accepted at 50% CUP with District Executive approval in writing. Our records attesting to this statement are open for inspection by a Department Representative for not less than THREE years from the date of shipment.

Job Mix Formula: (Year-Number):

100% Payment Factor: The material as listed above shipped on this date conforms fully with the specification requirements of the Pennsylvania Department of Transportation. Our records, attesting to this statement, are open for inspection by a Department Representative for not less than THREE years from the date of shipment.

85% Payment Factor: The material as listed above shipped on this date does not conform to the certification tolerances for 100% pay as listed in Pub 408 Sec. 409.2(e) Table A. A reduced pay factor has been applied and QC test results are being forwarded to the Inspector-In-Charge. Our records attesting to this statement are open for inspection by a Department Representative for not less than THREE years from the date of shipment.

Tons Shipped:

MS-NCP

MUNICIPALITY

Name of Contractor

Performance of work as specified on the above numbered contract is completed and final pavement inspection has been made by the contractor and municipality in accordance with the terms of the contract awarded.

DATE OF AWARD

Both copies of this form to be filled by the Contractor-Municipality on completion of final pavement restoration

NOTICE OF COMPLETION

IN REFERENCE TO PROJECT #

Signature of Contractor

Signature of Municipality pavement restoration.

*DATE

period of one year from this date.

* The contractor is responsible for maintenance of permanent pavement repairs for a

By the affixing of my signature I hereby certify that final accordance with the above contract # and is hereby accepted inspection has been made and all work has been performed in

FINAL COMPLETION CERTIFICATE

THIS PORTION TO BE COMPLETED BY MUNICIPALITY

Authorized Agent for the Municipality by the municipality as completed.

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