1-IFB4356 - Bid Forms.docx

ATTACHMENT A – PRICING FORM

(Only use this form is submitting a hard copy bid. Electronic bids must submit pricing via Bonfire Pricing Form)

Bidders shall indicate firm, fixed pricing for the site below for demolition services as described herein.

Line #

Location

Lump Sum Cost

1.

812 Monroe Street

SUBCONTRACTORS

All subcontractors shall be listed if the bidder intends to use subcontractors.

Discount for prompt payment on invoices only ____%____ days. (Discount will not be evaluated.)

Are you a certified disadvantaged owned business? ___ Yes ___ No

Are you a certified woman-owned business? ___ Yes ___ No

I/We the undersigned do hereby certify that the information presented in this proposal is true and accurate and agree to provide the specified products and services at the price and time stated 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 AND TITLE _____________________________________________________________

ADDRESS _____________________________________________________________________

TELEPHONE ___________________ EMAIL ADDRESS _______________________________

SIGNATURE OF BIDDER ___________________________________ DATE _______________

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

ATTACHMENT B

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

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.

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.

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

ATTACHMENT C

ANTI-COLLUSION STATEMENT

STATE OF _____________________________)

COUNTY OF ___________________________)

__________________________________________________________________ being first

NAME OF PERSON SIGNING STATEMENT

duly sworn deposes and says that he is ______________________________________ of TITLE OF PERSON SIGNING _________________________________________________________________________

COMPANY NAME

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 ________________, 20___.

Notary Public

My commission expires: ____________________________________

ATTACHMENT D – DISADVANTAGED BUSINESS UTILIZATION AGREEMENT

A. The bidder agrees to attempt to expend at least ____% of the contract, if awarded, for Disadvantaged Business Enterprise (DBE) for purposes of this goal, the term “Disadvantaged Business Enterprise” shall mean a business:

1. Which is at least 51 percent owned by one or more minorities or women, or, in the case of a publicly owned business, at least 51 percent of the stock of which is owned by one or more minorities or women; and

2. Whose management and daily business operations are controlled by one or more such individuals.

“Disadvantaged Group Member” or “Disadvantaged” means a person who is a citizen or lawful permanent resident of the United States, and who is:

1. Black (a person having origins in any of the black racial groups of Africa);

2. Hispanic (a person of Spanish or Portuguese culture with origins in Mexico, South or Central America, or the Caribbean Island, regardless of race);

3. Asian American (a person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian sub-continent, or the Pacific Islands);

4. American Indians and Alaskan Native (a person having origins in any of the original peoples of North America);

5. Member of other groups, or other individuals, found to be economically and socially disadvantaged by the Small Business Administration under Section 8(a) of the Small Business Act, as amended [15 U.S.C. 637(a)].

6. A female person who requests to be considered as an DBE, and who “owns” and “controls” a business as defined herein.

Disadvantaged Business Enterprises may be employed as contractors, subcontractors, or suppliers.

B. The bidder must indicate the Disadvantaged Business Enterprise(s) proposed for utilization as part of this contract as follows:

Total Bid Amount: _________________ Total $ Participation: _____________

Percentage of Disadvantaged Business Enterprise Participation: __ %

C. The bidder agrees to certify that the disadvantaged business firm(s) engaged to provide materials or services in the completion of this project: (a) is a bona fide Disadvantaged Business Enterprise; and (b) has executed a binding contract to provide specific materials or services for a specific dollar amount.

Certification that the Disadvantaged Business Enterprise(s) has executed a binding contract with the bidder for materials or services should be provided to the DBE Coordinator at the time the bidder’s contract is submitted to the DBE Coordinator.

D. The undersigned hereby certifies that he or she has read the terms of this agreement and is authorized to bind the bidder to the agreement herein set forth.

Name of Authorized Officer

Date

Signature of Authorized Officer image1.png