1-IFB4354 - Bid Packet.docx

Section X

BID PACKET BID NO. IFB4354

ROOF REPLACEMENT

Ellis Porter Riverside Pool 320 Ellis Porter Drive

Pricing Form Anti-Collusion Statement Contractor’s Qualifications/References Individuals Assigned to the Project Federal Work Authorization Program Affidavit and MOU Compliance with Prevailing Wage Law Affidavit (Submit with invoices only if prevailing wage applies)

PRICING FORM

(Only use this form if submitting a hard-copy bid)

I have received the documents entitled Roof Replacement – Ellis Porter Riverside Pool House Building, along with addenda number ___ and have included their provisions in the bid. I have examined the documents and sites thoroughly and submit the following bid.

In submitting this bid, I agree (1) to hold my bid open for sixty (60) days; (2) to accept provisions of the specifications (3) to enter into and execute a contract, if awarded on the basis of this bid, and furnish guarantee bonds in accordance with specifications; (4) to complete the work in accordance with contract documents; and (5) to complete the work by the time stipulated in the supplementary conditions.

Item Description – as specified herein

Bid Amount

Type of System Est Start Date and # Days to Complete

1.1. EPDM Roof Replacement

The undersigned bidder represents to the City and to other bidders that his base bid and the estimates on which it is based have been carefully checked and contain no errors and nothing has been omitted in determining the amount of the bid.

This project shall be completed as quickly as possible. Work shall begin within 30 days of the final contract signature and be completed within 14 days of the start date unless other arrangements have been approved by the City.

Indicate the landfill for disposal of roofing and related materials. All related costs should be included with the roof costs.

Discount for prompt payment on invoices only % days. Discount will not be used for evaluation of bids.

Are the products bid manufactured, produced or assembled in the United States? YES NO

I/We, the undersigned do hereby certify that the information presented in this bid is true and accurate and agree to provide the specified products and services at the price and time in accordance with the terms and specifications stated herein if awarded the bid. I/We also certify that I am a duly authorized representative of the business entity below and that I possess the legal authority to sign on behalf of the business for which I am acting.

Name of Company

Agent & Title

Address

Telephone

Email Address

Signature & Date

Form of Business: __ Sole Proprietorship __ Partnership __Corporation __ Limited Liability Corporation

ANTI-COLLUSION STATEMENT

STATE OF ) COUNTY OF )

being first duly sworn

that all statements made and facts set out in the bid for the above project are true and correct; and that the bidder (the person, firm, association, or corporation making said bid) 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 bid of any contract which results from its acceptance.

Affiant further certifies that bidder is not financially interested in, or financially affiliated with, any other bidder for the above project.

(BY)

(BY)

Sworn to before me this day of , 2025.

Notary Public

My commission expires:

CONTRACTORS QUALIFICATIONS/REFERENCES

NAME OF COMPANY ADDRESS CONTACT PERSON TELEPHONE SERVICE DATE PROJECT NUMBER AND DESCRIPTION:

NAME OF COMPANY ADDRESS CONTACT PERSON TELEPHONE SERVICE DATE PROJECT NUMBER AND DESCRIPTION:

NAME OF COMPANY ADDRESS CONTACT PERSON TELEPHONE SERVICE DATE PROJECT NUMBER AND DESCRIPTION:

INDIVIDUALS ASSIGNED TO PROJECT

List key personnel to be assigned to this project and their qualifications.

SUBCONTRACTORS

If the Bidder intends to use any subcontractors in the course of the construction, he shall list them:

Federal Work Authorization Program

Contractors that meet the definition of a business entity as defined in section 285.525, RSMo, pertaining to section 285.530, RSMo, providing services exceeding $5,000, shall maintain enrollment and participation in a federal work authorization program with respect to the employees hired after enrollment in the program who are proposed to work in connection with the contracted services included herein. If the contractor’s business status changes during the life of the contract to become a business entity as defined in section 285.525, RSMo, pertaining to section 285.530, RSMo, then the contractor shall, prior to the performance of any services as a business entity under the contract enroll and participate in a federal work authorization program such as E-Verify.

Contractors must, by sworn affidavit and provision of documentation (copy of E-Verify Memo of Understanding Electronic Signature Page), affirm their enrollment and participation in a federal work authorization program. Contractors shall sign an affidavit affirming that it does not knowingly employ any person who is an unauthorized alien in connection with the contracted services. See Affidavit of Compliance with Section 285.525-285.550 RSMo in the Bid Submittal Packet.

For vendors that are not already enrolled and participating in a federal work authorization program, E-Verify is an example of this type of program. Information regarding E-Verify is available at https://www.e-verify.gov/.

Affidavit of Compliance with Section 285.525-285.550 RSMo For All Services in Excess of $5,000.00

State of ) County of )

) ss

I, , am an authorized agent of (Bidder). This business is enrolled and participates in a federal work authorization program for all employees working in connection with services provided to the City of Jefferson. This business does not knowingly employ any person that is an unauthorized alien in connection with the services being provided. Documentation of participation in a federal work authorization program (signature page of the MOU with Homeland Security) is attached to this affidavit.

Furthermore, all subcontractors working on this contract shall affirmatively state in writing in their contracts that they are not in violation of Section 285.530.1 RSMo, shall not thereafter be in violation and submit a sworn affidavit under penalty of perjury that all employees are lawfully present in the United States.

Affiant Date

Subscribed and sworn to before me this day of , .

My commission expires:

If bidder is an individual and does not have any employees of any sort, complete this section.

I, the undersigned, being at least eighteen years of age, swear upon my oath that I am either a United States citizen or am classified by the United States government as being lawfully admitted for permanent residence.

Date Signature

Subscribed and sworn to before me this day of , .

My commission expires:

Sample E-Verify Memo of Understanding – MOU Electronic Signature Page

Company ID Number: XXXXXXX

Approved by:

Employer Your Company Name

Name (Please Type or Print) John Doe Title

Signature Electronically Signed Date

05/27/2019

Department of Homeland Security – Verification Division

Name (Please Type or Print) USCIS Verification Division Title

Signature Electronically Signed Date 05/27/2019

Compliance with Prevailing Wage Law Affidavit. This form is to be completed by the awarded bidder and submitted with their invoice and certified payroll only if the amount of the contract exceeded $75,000 and prevailing wage applied.

AFFIDAVIT

COMPLIANCE WITH PREVAILING WAGE LAW

Before me, the undersigned Notary Public, in and for the County of , State of , personally came and appeared

, Name Position of the Name of Company

(A Corporation) and after being duly sworn did depose and say that all provisions and requirements set out in Chapter 290, Section 290.210 through and including 290.340, Missouri Revised Statutes, pertaining to the payment of wages to workmen employed on public works projects have been fully satisfied and there has been no exception to the full and complete compliance with said provisions and requirements and with Annual Wage Order No. 27 for Cole County as applicable, issued by the Division of Labor Standards of Missouri and as amended, in carrying out the contract and work in connection with the Roof Replacement at 427 Monroe Street project located in Jefferson City, Missouri in Cole county and completed on the Day of , 2026.

Signature Subscribed and sworn to me this Day of , 2026.

My commission expires:

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