1-Documents to be submitted with Bid.pdf

Madisonburg Water Works – Chlorine Contact Piping Project – Project No. 0000-032069.02 BID FORM Section 004116

BID FORM – CONTRACT A Section 004116 – Page 1

SECTION 004116- BID FORM

1.1 BID INFORMATION

A. Bidder: ________________________________________________________________.

B. Prime Contract: Madisonburg Water Works – Chlorine Contact Piping Project

C. Project Identification: Pennvest Project.

D. Project Location: Madisonburg Water Work’s 260 Madisonburg Pike Madisonburg, PA 16852

E. Owner: Madisonburg Water Work’s

F. Owner's Representative: Timothy Clouser, System Operator

G. Project Manager: Madisonburg Water Work’s will provide all project management with in-house staff.

H. Engineer: The Project Engineer shall be the Madisonburg Water Work’s in-house engineering staff.

I. Owner Project Number: (N/A).

1.2 CERTIFICATIONS AND BASE BID

A. Base Bid, Single-Prime (Single-Trade) Contract for Madisonburg Water Works – Chlorine Contact Piping Project.

B. Project:

The undersigned Bidder; having carefully completed an on-site investigation, is fully familiar with work required and conditions, acknowledges critical schedule requirements, examined all documents, carefully reviewed all Contracting Requirements, understands the conditions of the Contract including existing conditions, Drawings, Specifications, and all subsequent Addenda, as prepared by Owner/Engineer, acknowledges requirements and expectations of the Work, hereby agrees to furnish all material, labor, equipment, and services,, including owner supplied equipment or material, along with all unit prices and scheduled allowances, necessary to complete the Chlorine Contact Piping Project.

Work for above-named Project, according to the requirements of the Contract Documents, for the stipulated sum of:

1. Total of all Bid Prices

2. Total of all Bid Prices (words)

3. The above amount may be modified or adjusted prior to award by any amount indicated by the Bidder on the Bid Breakdown Form as submitted if submitted with Bid based online items or unit prices requested by Owner.

BID FORM – CONTRACT A Section 004116 – Page 2

1.3 BID GUARANTEE

A. The undersigned Bidder agrees to execute a contract for this Work in the above amount and to furnish surety as specified within 5 days after a written Notice of Award, if offered within 60 days after receipt of bids, and on failure to do so agrees to forfeit to Owner the attached cash, cashier's check, certified check, U.S. money order, or bid bond, as liquidated damages for such failure, in the following amount constituting ten percent (10%) of the Base Bid amount above:

1. ________________________________________________Dollars ($______________).

B. In the event Owner does not offer a Notice of Award within the time limits stated above, Owner will return to the undersigned the cash, cashier's check, certified check, U.S. money order, or bid bond.

1.4 SUBCONTRACTORS AND SUPPLIERS

A. The following companies shall execute subcontracts for the portions of the Work indicated:

1. Sub-Contractor Name:________________________ Work:___________________________.

2. Sub-Contractor Name:________________________ Work:___________________________.

3. Supplier Name:________________________ Work:___________________________.

4. Supplier Name:________________________ Work:___________________________.

1.5 TIME OF COMPLETION

A. The undersigned Bidder proposes and agrees hereby to commence the Work of the Contract Documents on a date specified in the written Notice to Proceed as issued by Owner, and shall fully cooperate with all Prime Contracts to complete the Work in accordance with final approved construction schedule for a final completion refer to Form of Agreement, Article 4.

1.6 ACKNOWLEDGEMENT OF ADDENDA

A. The undersigned Bidder acknowledges receipt of and use of the following Addenda in the preparation of this Bid:

1. Addendum No. 1, dated ____________________.

2. Addendum No. 2, dated ____________________.

3. Addendum No. 3, dated ____________________.

1.7 BID SUPPLEMENTS

A. The following supplements are a part of this Bid Form and are attached hereto:

1. Bid Form Supplement.

2. Bid Form Supplement - Bid Bond Form (AIA Document A310).

3. Hold Harmless Agreement

4. Non-Collusion Affidavit

5. Contractor Qualification Statement

BID FORM – CONTRACT A Section 004116 – Page 3

6. PW Employment Verification form

1.8 CONTRACTOR'S LICENSE

A. The undersigned further states that it is a duly licensed Contractor, for the type of work proposed, in the municipality and/or city in which the proposed work is located, and that all fees, permits, etc., pursuant to submitting this proposal have been paid in full.

1.9 SUBMISSION OF BID

A. Respectfully submitted this _________ day of ____________, 20__.

B. Submitted By:____________________________________________________________ (Name of bidding firm or corporation).

C. Authorized Signature:___________________________________(Handwritten signature).

D. Signed By:______________________________________________(Type or print name).

E. Title:___________________________________(Owner/Partner/President/Vice President).

F. Witnessed By:_________________________________________(Handwritten signature).

G. Attest:________________________________________________(Handwritten signature).

H. By:____________________________________________________(Type or print name).

I. Title:_________________________________(Corporate Secretary or Assistant Secretary).

J. Street Address:___________________________________________________________.

K. City, State, Zip:___________________________________________________________.

L. Phone:________________________________________________________________.

M. License/Federal ID No.:_____________________________________________________

(Affix Corporate Seal Here)

END OF DOCUMENT

AS-1

(Note: This Agreement must be properly executed and must accompany the certified check or bid bond, whichever is furnished as proposal security).

AGREEMENT OF SURETY

KNOW ALL MEN BY THESE PRESENTS, that we , as Surety, a corporation existing under the laws of the State of _________________________________________________ and authorized to transact business in the Commonwealth of Pennsylvania, hereby agree to execute within the time limit specified in the Contract, the Bonds, in the forms and in the amounts required for to faithful performance and proper fulfillment of the Contract for the ________________________________________________________ on behalf of hereinafter called the Bidder, provided that the above Contract be awarded to the Bidder within sixty

(60) days after the date of receipt of Bids; and the Surety further agrees that should the Surety, after notification of such award, omit or refuse to execute the required bonds, then the Surety shall pay to ______________________________________________________, any difference between the total amount specified in said Bidder's proposal for the required work and the amount for which said Owner may procure the same work, if the latter amount be in excess of the former, and after deduction therefrom of payment made by reason of the forfeiture of the Proposal Security.

DATE CORPORATE SURETY

CORPORATE SEAL

BY

TITLE

BUSINESS ADDRESS

Application for Review as Substitute - 1

APPLICATION FOR REVIEW AS SUBSTITUTE

Title: Chlorine Contact Piping Project

To: Madisonburg Water Works 260 Madisonburg Pike Madisonburg, PA 16852

In accordance with Section 6, Paragraph 6.05 of the General Conditions, I hereby submit the following material and/or equipment for review as a substitute for the specified equipment or material indicated in the Contract Documents:

In connection with this submittal, I/we hereby represent, warrant and certify that the substitute material and/or equipment will adequately perform the functions required by the Project's general design, will be similar and of equal substance to that specified and will be suited to the same use and be capable of performing the same function as the specified material and/or equipment.

In addition, I/we hereby represent that any license fee or royalty required on the material and/or equipment intended for incorporation, or use in, or connection with this Project has been paid. The material and/or equipment are the equivalent in all respects to the specified material and/or equipment except as follows:

If this substitute material and/or equipment is accepted, an amount of $____________________ may be deducted from the Contract Price, and I/we warrant that if the substitutes are accepted, no major changes in the function or general design of the Project will result. Incidental changes or extra component parts required to accommodate the substitute will be made without a change in the Contract Price or Contract Time.

Submitted this day of , 20_____.

ATTEST:

Contractor

Supplier

Bid Bond - 1

BID BOND

KNOW ALL MEN BY THESE PRESENTS,

that we ___________________________________________________________________(hereinafter called the "Principal") as Principal, and ______________________________________________________, a Corporation authorized to transact business in Pennsylvania and having its principal office at ___________________________________________________________________________(hereinafter called the "Surety") as Surety, are held and firmly bound unto the MADISONBURG WATER WORKS (hereinafter called the Obligee), in the sum of_________________________ DOLLARS ($_______________________), lawful money of the United States of America; for payment of which we may bind ourselves, and each of our respective heirs, legal representatives, successors and assigns, jointly and severally, by these presents on the ______ day of _______________ , 20_____.

WHEREAS, said Principal is herewith submitting to the Obligee a proposal to perform the Work under this Contract for the Obligee's proposed Chlorine Contact Piping Project pursuant to Drawings, Specifications and other Contract Documents incorporated into said proposal by reference; and it is a condition of the Obligee's receipt and consideration of said proposal that the proposal be accompanied by bid security to be held by the Obligee on terms embodied herein.

NOW, THEREFORE, the condition of this obligation is that if said Principal shall furnish Performance Bond, Labor and Material Payment Bond, and Insurance Certificates to the Obligee upon the Obligee's delivery to the Principal of notice of intention to accept his proposal and to make a formal award of contract to him, and shall enter into such contract, all as required by said Contract Documents, then this obligation shall be void; otherwise it shall remain in full force, and the Principal and Surety will pay to the Obligee the full amount of this Bond as liquidated damages and not as a penalty.

IN WITNESS WHEREOF, the Principal and Surety, intending to be legally bound, have executed this Bond the day and year aforementioned.

Witness or Attest:

(Principal)

By:

Witness:

Attest

Witness or Attest:

(Surety)

Attest

EJCDC® C-625, Certificate of Substantial Completion.

Copyright© 2018 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

CERTIFICATE OF SUBSTANTIAL COMPLETION

Owner: Owner’s Project No.:

Engineer: Engineer’s Project No.:

Contractor: Contractor’s Project No.:

Project:

Contract Name:

This ☐ Preliminary ☐ Final Certificate of Substantial Completion applies to:

☐ All Work ☐ The following specified portions of the Work:

[Describe the portion of the work for which Certificate of Substantial Completion is issued]

Date of Substantial Completion: [Enter date, as determined by Engineer]

The Work to which this Certificate applies has been inspected by authorized representatives of Owner, Contractor, and Engineer, and found to be substantially complete. The Date of Substantial Completion of the Work or portion thereof designated above is hereby established, subject to the provisions of the Contract pertaining to Substantial Completion. The date of Substantial Completion in the final Certificate of Substantial Completion marks the commencement of the contractual correction period and applicable warranties required by the Contract.

A punch list of items to be completed or corrected is attached to this Certificate. This list may not be all-inclusive, and the failure to include any items on such list does not alter the responsibility of the Contractor to complete all Work in accordance with the Contract Documents.

Amendments of contractual responsibilities recorded in this Certificate should be the product of mutual agreement of Owner and Contractor; see Paragraph 14.04. of the General Conditions.

The responsibilities between Owner and Contractor for security, operation, safety, maintenance, heat, utilities, insurance, and warranties upon Owner's use or occupancy of the Work must be as provided in the Contract, except as amended as follows:

Amendments to Owner’s Responsibilities: ☐ None ☐ As follows:

[List amendments to Owner’s Responsibilities]

Amendments to Contractor’s Responsibilities: ☐ None ☐ As follows:

[List amendments to Contractor’s Responsibilities]

The following documents are attached to and made a part of this Certificate:

[List attachments such as punch list; other documents]

This Certificate does not constitute an acceptance of Work not in accordance with the Contract Documents, nor is it a release of Contractor's obligation to complete the Work in accordance with the Contract Documents.

Engineer

By (signature):

Name (printed):

Title:

CONTRACTOR’S CERTIFICATION OF COMPLETION

To: Date:

Project:

C/O:

Project No.:

ATTN:

Engineer/Project Manager

From:

(Firm or Corporation)

This is to certify that I, , am an authorized official of working in the capacity of and have been properly authorized by said firm or corporation to sign the following statements pertaining to the subject Contract:

I know of my owner personal knowledge, and do hereby certify, that the Work of the Contract described above has been performed, and materials used and installed in every particular, in accordance with, and in conformity to, the contract Drawings and Specifications.

The Contract Work is now complete in all parts and requirements, and ready for your final inspection.

I understand that neither the determination by the Engineer that the Work is complete, nor the acceptance thereof by the Owner, shall operate as a bar to claim against the Contractor under the terms of the guarantee provisions of the Contract Documents.

WITNESS:

Hold Harmless Agreement - 1

HOLD HARMLESS AGREEMENT

KNOW ALL MEN BY THESE PRESENTS,

that

(Contractor) hereinafter called Contractor, has entered or will enter into an Agreement with the Madisonburg Water

Works, hereinafter called the Owner for the Chlorine Contact Piping Project.

NOW, THEREFORE, in consideration of the award of said Contract to the Contractor, as well as other good and valuable consideration. Contractor, intending to be legally bound hereby, agrees to indemnify and save harmless the Owner and Engineer from and against all claims, damages, losses and expenses

(including attorney’s fees and other expenses) arising out of or resulting from the performance of the Work, provided that any such claim, damage, loss, or expense (a) is attributable to bodily injury, sickness, disease or death, or to injury or destruction of property (real or person) including loss of use resulting therefrom and (b) is also caused in whole or in part by any negligent act or omission of the Contractor, any subcontractor, anyone directly or indirectly employed or controlled by any one of them regardless of whether or not said claim, damage, loss or expense is caused in part by any of the names parties above.

In any and all claims any of the names parties above, or any of their agents or employees, or any employee of the Contractor, or any Subcontractor, or anyone directly or indirectly employed by any of them, or anyone for whose acts anyone or more of them may be liable, the indemnification obligation of the

Contractor hereunder shall not be limited in any way by any limits on the amount of type of damages, compensation or benefits payable by or for the Contractor or any Subcontractor under the Workmens’

Compensation Act, or any disability benefit acts or any other employee benefit act of the Commonwealth of Pennsylvania or any other state.

CONTRACTOR

Attest:

Date:

(SEAL)

Bidder Information - 1

INFORMATION TO BE FURNISHED BY THE BIDDER

(NOTICE: This Form must be executed in ink or by typed entries and must not be removed from this document.)

Bid of: _______________________________________________________________ (Bidder's Name)

Description: Chlorine Contact Piping Project

To: Madisonburg Water Works herein called the Owner.

Engineer: Madisonburg Water Works

PART A - LIST OF INTENDED SUBCONTRACTORS

Subcontractor (Name and Address) Work To Be Performed

NOTE:

1. The Owner in no way implies acceptance of the intended Subcontractor(s) by acceptance of bids.

2. The Contractor will not be permitted to substitute Subcontractors not listed on this form without written approval of the Owner.

PART B - LIST OF INTENDED MANUFACTURERS

1. The undersigned proposes to furnish the following equipment contingent upon its conformity to the Specifications and its review by the Engineer. The Manufacturer's name must be stated. Use of the words "as specified" or similar wording will not be acceptable in lieu of the manufacturer's name.

2. Only one manufacturer's name shall be listed. If the Bidder in contravention of this instruction names more than one, the Owner will consider only the name of the first manufacturer listed. The Owner also reserves the right to reject all manufacturers named by the Bidder whose products do not meet the requirements of the Specifications.

Bidder Information - 2

UNIT/EQUIP. MANUFACTURER

Bidder must attach a written guarantee from the pipe manufacturer that the proposed pipe and fittings will be designed to and withstand working pressures of 300 PSI and resulting AWWA test pressures and leakage tests.

Note:

1. If listed equipment is by manufacturers not specified, the Owner in no way implies acceptance of such listed equipment by acceptance of the Bids.

2. The Contractor shall not be permitted to substitute manufacturer's names not listed on this form without written approval of the Owner.

(We) (I), the undersigned agree that the Subcontractors and/or manufacturers listed above will perform the noted work or furnish the listed equipment subject to acceptance by the Owner.

Date Sign

Title Type or Print

A preliminary approved Equipment Manufacturer's list will be incorporated as part of the Contract Documents and will be subject to detailed review by the Engineers after submittal of the Shop Drawings. The components, if accepted, are to be purchased by the Contractor under this original bid price at no additional cost to the Owner.

Maintenance Bond – 1

MAINTENANCE BOND

KNOW ALL MEN BY THESE PRESENTS:

That we, the undersigned ________________________________________________________________ (Here insert the name or legal title and address of CONTRACTOR)

As PRINCIPAL, and (Here insert the legal title and address of SURETY) a corporation organized and existing under the laws of the Commonwealth of Pennsylvania as SURETY are held and firmly bound the Madisonburg Water Works, (herein after referred to as OWNER).

As OBLIGEE, for the use and benefit of CLAIMANTS as herein below defined, in the full and just several sums of DOLLARS ($ ) lawful money of the United States of America, to be paid to the said OBLIGEE, or its attorney, successors or assigns, to the payment of which sums well and truly to be made, the said PRINCIPAL and SURETY bind themselves, their heirs, administrators, executors, successors and assigns, jointly and severally, by these presents:

WHEREAS, said PRINCIPAL is about to enter into a certain CONTRACT with said OBLIGEE, dated , 20 , (hereinafter called the CONTRACT) for Chlorine Contact Piping Project which CONTRACT and the CONTRACT DOCUMENTS for said WORK shall be deemed a part hereof as fully as if set forth herein.

Now, therefore, the conditions of this BOND shall be such that:

If the PRINCIPAL shall remedy, without cost to the OBLIGEE, all defects which may develop during the period of one (1) year from the date of completion by the PRINCIPAL and final acceptance of the OBLIGEE of the WORK performed in accordance with the CONTRACT DOCUMENTS, which defects, in the sole judgment of the OBLIGEE, shall be caused by or shall result from defective or inferior materials or workmanship, and if the PRINCIPAL shall satisfy all claims and demands arising from or related to such defects or growing out of such defects, and if the PRINCIPAL shall indemnify completely and shall save harmless the OBLIGEE from any and all costs and damages which the OBLIGEE may sustain or suffer by reason of the failure so to do; and if the PRINCIPAL shall reimburse completely and shall pay to the OBLIGEE any and all costs and expenses which the OBLIGEE may incur by reason of any such default or failure of the PRINCIPAL, then this BOND shall be void; otherwise, this BOND shall be and shall remain in full force and effect.

The PRINCIPAL and the SURETY agree that any alterations, changes and/or additions to the CONTRACT DOCUMENTS, and/or any alterations, changes and/or additions to the WORK to be performed in accordance with the CONTRACT DOCUMENTS, and/or any alterations, changes, and/or additions to the CONTRACT, and/or any giving by the OBLIGEE of any extensions of time for the performance of the WORK in accordance with the CONTRACT DOCUMENTS, and/or any act of forbearance of either the PRINCIPAL or the OBLIGEE toward the other with respect to the CONTRACT DOCUMENTS, and/or the reduction of any percentage to be retained by the OBLIGEE as permitted by the CONTRACT

Maintenance Bond – 2

DOCUMENTS, shall not release, in any manner whatsoever, the PRINCIPAL and the SURETY, or either of them, or their heirs, executors, administrators, successors, and assigns from liability and obligations under this BOND; and the SURETY for value received, does waive notice of any such alterations, changes, additions, extensions of time, acts of forbearance and/or reduction of retained percentage.

In Witness Whereof, the PRINCIPAL and the SURETY cause this BOND to be signed, sealed, and delivered this day of ,20_____ .

IN WITNESS WHEREOF, the PRINCIPAL and SURETY have executed this instrument under their several seals this day of , 20 , the name and corporate seal of each corporate party being hereto affixed and these presents duly signed by its proper officers, pursuant to authority of its governing body.

In presence of:

(Individual or Partnership Principal)

(Address) (Business Address)

(Individual or Partnership Principal)

(Address) (Business Address)

(Corporate Principal) (Business Address)

BY:

(Affix Corporate SEAL)

(Corporate Surety)

(Business Address):

Attest:

(Secretary) (Affix Corporate Seal)

Non-Collusion Affidavit - 1

NON-COLLUSION AFFIDAVIT

COMMONWEALTH OF PENNSYLVANIA

COUNTY OF _______________________

ss: MADISONBURG WATER WORKS

I, ______________________________, of ________________________, in the County of

_____________________________ and the State of __________________________, of full age, being duly sworn according to law on my oath depose and say that:

I am of the firm of _______________________________________ the bidder making the Proposal for the above named project, and that I executed the said Proposal with full authority so to do; that said bidder has not, 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 the above named project; and that all statements contained in said Proposal and in this affidavit are true and correct, and made with full knowledge that the Madisonburg Water Works relies upon the truth of the statements contained in said Proposal and in the statements contained in this affidavit in awarding the contract for the said project.

I further warrant that no person or selling agency has been employed or retained to solicit or secure such contract upon agreement or understanding for a commission, percentage, brokerage or contingent fee, except bona fide employees or bona fide established commercial or selling agencies maintained by

(Name of Contractor) (Sign)

(Type or Print Name of Affiant)

Subscribed and sworn to _________________________________ before me this ____________ day of ______________________________, 20______.

Notary Public

My Commission Expires _______________________, 20_____.

NONDISCRIMINATION/SEXUAL HARASSMENT CLAUSE

The Contractor agrees:

1. In the hiring of any employee(s) for the manufacture of supplies, performance of work, or any other activity required under the contract or any subcontract, the Contractor, each subcontractor, or any person acting on behalf of the Contractor or subcontractor shall not discriminate by reason of race, gender, creed, color, sexual orientation, gender identity or expression, or in violation of the Pennsylvania Human Relations Act (PHRA) and applicable federal laws, against any citizen of this commonwealth who is qualified and available to perform the work to which the employment relates.

2. Neither the Contractor nor any subcontractor nor any person on their behalf shall in any manner discriminate by reason of race, gender, creed, color, sexual orientation, gender identity or expression, or in violation of the PHRA and applicable federal laws, against or intimidate any employee involved in the manufacture of supplies, the performance of work, or any other activity required under the contract.

3. Neither the Contractor nor any subcontractor nor any person on their behalf shall in any manner discriminate by reason of race, gender, creed, color, sexual orientation, gender identity or expression, or in violation of the PHRA and applicable federal laws, in the provision of services under the contract.

4. Neither the Contractor nor any subcontractor nor any person on their behalf shall in any manner discriminate against employees by reason of participation in or decision to refrain from participating in labor activities protected under the Public Employee Relations Act, Pennsylvania Labor Relations Act or National Labor Relations Act, as applicable and to the extent determined by entities charged with such Acts' enforcement, and shall comply with any provision of law establishing organizations as employees' exclusive representatives.

5. The Contractor and each subcontractor shall establish and maintain a written nondiscrimination and sexual harassment policy and shall inform their employees in writing of the policy. The policy must contain a provision that sexual harassment will not be tolerated and employees who practice it will be disciplined. Posting this Nondiscrimination/Sexual Harassment Clause conspicuously in easily-accessible and well-lighted places customarily frequented by employees and at or near where the contracted services are performed shall satisfy this requirement for employees with an established work site.

6. The Contractor and each subcontractor shall not discriminate by reason of race, gender, creed, color, sexual orientation, gender identity or expression, or in violation of PHRA and applicable federal laws, against any subcontractor or supplier who is qualified to perform the work to which the contract relates.

7. The Contractor and each subcontractor represents that it is presently in compliance with and will maintain compliance with all applicable federal, state, and local laws, regulations and policies relating to nondiscrimination and sexual harassment. The Contractor and each subcontractor further represents that it has filed a Standard Form 100 Employer Information Report ("EE0-1") with the U.S. Equal Employment Opportunity Commission ("EEOC") and shall file an annual EE0-1 report with the EEOC as required for employers' subject to Title VII of the Civil Rights Act of 1964, as amended, that have 100 or more employees and employers that have federal government contracts or first-tier subcontracts and have 50 or more employees. The Contractor and each subcontractor shall, upon request and within the time periods requested by the commonwealth, furnish all necessary employment documents and records, including EE0-1 reports, and permit access to their books, records, and accounts by the contracting agency and the Bureau of Diversity, Inclusion and Small Business Opportunities for purpose of ascertaining compliance with provisions of this Nondiscrimination/Sexual Harassment Clause.

8. The Contractor shall include the provisions of this Nondiscrimination/Sexual Harassment Clause in every subcontract so that those provisions applicable to subcontractors will be binding upon each subcontractor.

9. The Contractor's and each subcontractor's obligations pursuant to these provisions are ongoing from and after the effective date of the contract through the termination date thereof. Accordingly, the Contractor and each subcontractor shall have an obligation to inform the commonwealth if, at any time during the term of the contract, it becomes aware of any actions or occurrences that would result in violation of these provisions.

10. The commonwealth 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 terms and conditions of this Nondiscrimination/Sexual Harassment Clause. In addition, the agency may proceed with debarment or suspension and may place the Contractor in the Contractor Responsibility File.

Management Directive 215.16 Amended (August 2, 2018)

This directive replaces, in its entirety, Management Directive 215.16, dated May 11, 2017.

Name:

Signed:

Rev. 02/15 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 this 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 contractors’ CDL employees covered in this program and that all drivers are qualified to driver under 49 CFR Part 382.301? ( ) Yes ( ) No

BQ-1

STATEMENT OF BIDDER’S QUALIFICATIONS

All questions must be answered, and the data given must be clear and comprehensive. 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.

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: (schedule, showing 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, for whom and why?

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

10. List the more important projects recently completed by your company, stating the approximate cost for each, the month and year completed, and project references.

11. List your major equipment available for this contract?

12. Experience in construction work similar in importance to this project.

13. Background and experience of the principal members of your organization, including the officers.

14. Credit available: ($_____________________)

15. Give Bank references.

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

17. The undersigned hereby authorizes and requests any persons, firm, or corporation to furnish any information requested by the , County, Pennsylvania, in verification of the information provided in this STATEMENT OF BIDDER’S QUALIFICTIONS.

Dated this ______ day of ___________________, 20_____.

(Name of Bidder) By: ______________________________________ Title: _____________________________________

WAIVER OF APPLICATION OF PENNSYLVANIA UNIFORM ELECTRONIC

TRANSACTIONS ACT AND FEDERAL ELECTRONIC SIGNATURES IN GLOBAL AND

NATIONAL COMMERCE ACT

Madisonburg Water Works – Chlorine Contact Piping Project

The prospective bidder by signing below waives the Application of the Uniform Electronic Transactions Act, 73 P.S. §2260.101 et seq., and the Electronic Signatures in Global and National Commerce Act, 15 U.S.C.S. §7001 et seq.

The Madisonburg Water Works (hereinafter MWW) and the prospective bidder agree that they opt out/waive any application of the statutes pertaining to the bidding process, award process, contractual process, construction process, closeout process, and bonding period as contemplated by the MWW’s bidding documents.

The MWW and the prospective bidder who has signed below specifically intend and require each other to execute written documents including but not limited to contracts, notices of intent to award, change orders, etc. after the bidding process is completed and acted upon pursuant to law. This requirement of written documents shall continue through completion of all work required and any bond time periods which extend beyond completion of contract.

The MWW and the prospective bidder who has signed below agree that the signature of an authorized MWW Board Member on specific MWW documents is required along with signatures of the prospective bidder’s authorized representatives.

The MWW and the prospective bidder both enter into this opt out/waiver agreement voluntarily and knowingly. Both parties acknowledge that they sought legal advice pertaining to this opt out/waiver agreement. The prospective bidder’s signature below acts as its acknowledgment that the signature was made after legal consultation pertaining to this agreement.

Signature of Board Member Signature of Prospective Bidder

Title Title

Name of Company Name of Company

Address of Company Address of Company

CERTIFICATION OF NON SEGREGATED FACILITIES

The Bidder certifies that he does not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The Bidder certifies further that he will not maintain or provide for his employees any segregated facilities at any of his establishments, and that he will not permit his employees to perform their services at any location under his control where segregated facilities are maintained. The Bidder agrees that a breach of 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 has obtained identical certification from proposed subcontractors for specific time periods) he will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause, and that he will retain such certifications in his 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 By_________________________________ (Including ZIP CODE):

(Title)

Compliance with the Prohibition of Illegal Alien Labor on Assisted Projects Act.

Compliance with the Prohibition of Illegal Alien Labor on Assisted Projects Act. 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 Grantee 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 an executive agency of the Commonwealth of Pennsylvania.

Violation of the Prohibition of Illegal Alien Labor on Assisted Projects Act.

A. 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 repay to the Granter all grant funds received by the Grantee from the Grantor pursuant to this Grant. A check shall be written, payable to the Commonwealth of Pennsylvania, and forwarded to the Granter.

Name: _____________________________________

Title: ______________________________________

Signed: _____________________________________

Date: ________________________________________

Compliance with the State Contractor Responsibility Program

The Contractor and all subcontractors agree as follows:

For the purpose of these provisions, the term Contractor is defined as any person, including, but not limited to, a bidder, offeror, loan recipient, grantee, or subgrantee, who has furnished or seeks to furnish goods, supplies, services, or leased space, or who has performed or seeks to perform construction activity under contract, subcontract, grant, or subgrant with the Commonwealth, or with a person under contract, subcontract, grant, or subgrant with the Commonwealth or its state-affiliated entities, and state-related institutions. The term Contractor may include a permittee, licensee, or any agency, political subdivision, instrumentality, public authority, or other entity of the Commonwealth.

1. The Contractor must certify, in writing, for itself and all its subcontractors, that as of the date of its execution of any Commonwealth contract, that neither the Contractor, nor any subcontractors, nor any suppliers are under suspension or debarment by the Commonwealth or any governmental entity, instrumentality, or authority and, if the Contractor cannot so certify, then it agrees to submit, along with the bid/proposal, a written explanation of why such certification cannot be made.

2. The Contractor must also certify, in writing, that as of the date of its execution, of any Commonwealth contract it has no tax liabilities or other Commonwealth obligations.

3. The Contractor's obligations pursuant to these provisions are ongoing from and after the effective date of the Grant through the termination date thereof. Accordingly, the Contractor shall have an obligation to inform the Grantor if, at any time during the term of the Grant, it becomes delinquent in the payment of taxes, or other Commonwealth obligations, or if it or any of its subcontractors are suspended or debarred by the Commonwealth, the federal government, or any other state or governmental entity. Such notification shall be made within 15 days of the date of suspension· or debarment.

4. The failure of the Contractor to notify the Granter of its suspension or debarment by the Commonwealth, any other state, or the federal government shall constitute an event of default of the Grant with the Commonwealth.

5. The Contractor agrees to reimburse the Commonwealth for the reasonable costs of investigation incurred by the Office of State Inspector General for investigations of the Contractor's compliance with the terms of this or any other agreement between the Contractor and the Commonwealth, which results in the suspension or debarment of the Contractor. Such costs shall include, but shall not be limited to, salaries of investigators, including overtime; travel and lodging expenses; and expert witness and documentary fees. The Contractor shall not be responsible for investigative costs for investigations that do not result in the Contractor's suspension or debarment.

6. The Contractor may obtain a current list of suspended and debarred Commonwealth contractors by either searching the internet at https://www.dgs.internet.state.pa.us/debarment_list/ or contacting the: Department of General Services | Office of Chief Counsel | 603 North Office |Building |Harrisburg, PA 17125 | Telephone No: (717) 783-64 72 | FAX No: (717) 787-9138

Name: _____________________________________

Title: ______________________________________

Signed: _____________________________________

Date: ________________________________________ https://www.dgs.internet.state.pa.us/debarment_list/

Revised February 1, 2010

EXHIBIT G

Contract Provisions – Right to Know Law 8-K-1532

a. The Pennsylvania Right-to-Know Law. 65 P.S. §§ 67.101-3104, (“RTKL”) applies to this Contract. For the purpose of these provisions, the term “the Commonwealth” shall refer to the contracting Commonwealth agency.

b. If the Commonwealth needs the Contractor’s assistance in any matter arising out of the RTKL related to this Contract, it shall notify the Contractor using the legal contact information provided in this Contract.

The Contractor, at any time, may designate a different contact for such purpose upon reasonable prior written notice to the Commonwealth.

c. Upon written notification from the Commonwealth that it requires the Contractor’s assistance in responding to a request under the RTKL for information related to this Contract that may be in the Contractor’s possession, constituting, or alleged to constitute, a public record in accordance with the RTKL (“Requested Information”), the Contractor shall:

1. Provide the Commonwealth, within ten (10) calendar days after receipt of written notification, access to, and copies of, any document or information in the Contractor’s possession arising out of this Contract that the Commonwealth reasonably believes is Requested Information and may be a public record under the RTKL; and

2. Provide such other assistance as the Commonwealth may reasonably request, in order to comply with the RTKL with respect to this Contract.

d. If the Contractor considers the Requested Information to include a request for a Trade Secret or Confidential Proprietary Information, as those terms are defined by the RTKL, or other information that the Contractor considers exempt from production under the RTKL, the Contractor must notify the Commonwealth and provide, within seven (7) calendar days of receiving the written notification, a written statement signed by a representative of the Contractor explaining why the requested material is exempt from public disclosure under the RTKL.

e. The Commonwealth will rely upon the written statement from the Contractor in denying a RTKL request for the Requested Information unless the Commonwealth determines that the Requested Information is clearly not protected from disclosure under the RTKL. Should the Commonwealth determine that the Requested Information is clearly not exempt from disclosure, the Contractor shall provide the Requested Information within five (5) business days of receipt of written notification of the Commonwealth’s determination.

f. If the Contractor fails to provide the Requested Information within the time period required by these provisions, the Contractor shall indemnify and hold the Commonwealth harmless for any damages, penalties, costs, detriment or harm that the Commonwealth may incur as a result of the Contractor’s failure, including any statutory damages assessed against the Commonwealth.

g. The Commonwealth will reimburse the Contractor for any costs associated with complying with these provisions only to the extent allowed under the fee schedule established by the Office of Open Records or as otherwise provided by the RTKL if the fee schedule is inapplicable.

Revised February 1, 2010

EXHIBIT G

h. The Contractor may file a legal challenge to any Commonwealth decision to release a record to the public with the Office of Open Records, or in the Pennsylvania Courts, however, the Contractor shall indemnify the Commonwealth for any legal expenses incurred by the Commonwealth as a result of such a challenge and shall hold the Commonwealth harmless for any damages, penalties, costs, detriment or harm that the Commonwealth may incur as a result of the Contractor’s failure, including any statutory damages assessed against the Commonwealth, regardless of the outcome of such legal challenge. As between the parties, the Contractor agrees to waive all rights or remedies that may be available to it as a result of the Commonwealth’s disclosure of Requested Information pursuant to the RTKL.

i. The Contractor’s duties relating to the RTKL are continuing duties that survive the expiration of this Contract and shall continue as long as the Contractor has Requested Information in its possession.

Enclosure 1 to Management Directive 215.8 Amended Page 1 of 3

CONTRACTOR INTEGRITY PROVISIONS

It is essential that those who seek to contract with the Commonwealth of Pennsylvania (“Commonwealth”) observe high standards of honesty and integrity. They must conduct themselves in a manner that fosters public confidence in the integrity of the Commonwealth contracting and procurement process.

1. DEFINITIONS. For purposes of these Contractor Integrity Provisions, the following terms shall have the meanings found in this Section:

a. “Affiliate” means two or more entities where (a) a parent entity owns more than fifty percent of the voting stock of each of the entities; or (b) a common shareholder or group of shareholders owns more than fifty percent of the voting stock of each of the entities; or

(c) the entities have a common proprietor or general partner.

b. “Consent” means written permission signed by a duly authorized officer or employee of the Commonwealth, provided that where the material facts have been disclosed, in writing, by prequalification, bid, proposal, or contractual terms, the Commonwealth shall be deemed to have consented by virtue of the execution of this contract.

c. “Contractor” means the individual or entity, that has entered into this contract with the

Commonwealth.

d. “Contractor Related Parties” means any affiliates of the Contractor and the Contractor’s executive officers, Pennsylvania officers and directors, or owners of 5 percent or more interest in the Contractor.

e. “Financial Interest” means either:

(1) Ownership of more than a five percent interest in any business; or

(2) Holding a position as an officer, director, trustee, partner, employee, or holding any position of management.

f. “Gratuity” means tendering, giving, or providing anything of more than nominal monetary value including, but not limited to, cash, travel, entertainment, gifts, meals, lodging, loans, subscriptions, advances, deposits of money, services, employment, or contracts of any kind. The exceptions set forth in the Governor’s Code of Conduct, Executive Order 1980-18, the 4 Pa. Code §7.153(b), shall apply.

g. “Non-bid Basis” means a contract awarded or executed by the Commonwealth with

Contractor without seeking bids or proposals from any other potential bidder or offeror.

2. In furtherance of this policy, Contractor agrees to the following:

a. Contractor shall maintain the highest standards of honesty and integrity during the performance of this contract and shall take no action in violation of state or federal laws or regulations or any other applicable laws or regulations, or other requirements applicable to Contractor or that govern contracting or procurement with the Commonwealth.

b. Contractor shall establish and implement a written business integrity policy, which includes, at a minimum, the requirements of these provisions as they relate to the Contractor activity with the Commonwealth and Commonwealth employees and which is made known to all Contractor employees. Posting these Contractor Integrity Provisions conspicuously in easily-accessible and well-lighted places customarily frequented by employees and at or near where the contract services are performed shall satisfy this

Enclosure 1 to Management Directive 215.8 Amended Page 2 of 3 requirement.

c. Contractor, its…