1-Penn Forest Twp 2026 Line Painting BID DOCUMENT Revised 06-16-26 - PennBid.pdf

MS-944 03-07

DISTRICT 5-0

PROPOSAL & CONTRACT Revised on 06-16-26

(THIS PROPOSAL INCLUDES

(WHEN EXECUTED) INSTRUCTIONS TO BIDDERS)

A. DEPOSIT OF PROPOSALS.

All proposals must be submitted electronically Penn Forest Township___________________570-325-2768 via PennBid at https://pennbid.bonfirehub.com by Municipality Name and Type Telephone

August 3, 2026

Date Dana Vitale ___________________________________

Secretary

Sealed Proposals will be received on or before

3:00 p.m., on August 3, 2026 2010 State Route 903________________________________

Time and Date Address

Bids will be opened and read at approximately Jim Thorpe, PA 18229_______________________________

7:00 p.m., on August 3, 2026 Proposals must be submitted electronically

Time and Date via PennBid at https://pennbid.bonfirehub.com

1. The contractor proposes to furnish and deliver all materials (including Form CS-4171, Certificate of Compliance, TR-465 Daily Bituminous Mixture Certification or other forms pre-approved by PennDOT and to do and perform all work on the following project as more specifically set forth in the Schedule of Prices (Attachment), in accordance with drawings and specifications on file at PennBid at https://pennbid.bonfirehub.com As well as the supplements and special requirements contained herein and/or attached hereto and current PennDOT specifications (Publication 408), bidders need to be prequalified by PennDOT (Sec. 102.01).

2. If designated as the successful bidder, the contractor will 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 September 30, 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% 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 -https://protect.checkpoint.com/v2/r01/___https:/pennbid.bonfirehub.com___.YXAzOnBlbm5mb3Jlc3Q6YzpvZmZpY2UzNjVfZW1haWxzX2F0dGFjaG1lbnQ6YzI1ODk2ZDBmNTc1ZmFhYTY0OGZhYTgzM2I3M2NlMTQ6NzozODQ0OmY5ZWU3OWQwMTRlNDA2OWU5YWRkODBiZWE0NzdmOTUzMDMwZTZhNWJhYzkyMmUxODIyYWNiNmVhZGQzMmMyNmI6cDpUOk4 https://protect.checkpoint.com/v2/r01/___https:/pennbid.bonfirehub.com___.YXAzOnBlbm5mb3Jlc3Q6YzpvZmZpY2UzNjVfZW1haWxzX2F0dGFjaG1lbnQ6YzI1ODk2ZDBmNTc1ZmFhYTY0OGZhYTgzM2I3M2NlMTQ6NzozODQ0OmY5ZWU3OWQwMTRlNDA2OWU5YWRkODBiZWE0NzdmOTUzMDMwZTZhNWJhYzkyMmUxODIyYWNiNmVhZGQzMmMyNmI6cDpUOk4 https://protect.checkpoint.com/v2/r01/___https:/pennbid.bonfirehub.com___.YXAzOnBlbm5mb3Jlc3Q6YzpvZmZpY2UzNjVfZW1haWxzX2F0dGFjaG1lbnQ6YzI1ODk2ZDBmNTc1ZmFhYTY0OGZhYTgzM2I3M2NlMTQ6NzozODQ0OmY5ZWU3OWQwMTRlNDA2OWU5YWRkODBiZWE0NzdmOTUzMDMwZTZhNWJhYzkyMmUxODIyYWNiNmVhZGQzMmMyNmI6cDpUOk4

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; and an affidavit accepting the provisions of the Workmen’s Compensation Act of 1915, as amended.

7. “The parties agree that the relationship between the Contractor and the Municipality 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 the Municipality. Contractor hereby certifies, represents and warrants to the Municipality 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

SEAL

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County: Carbon Municipality: Penn Forest Township Project No.: 2026 Line Painting

ATTACHMENT #1

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LOCATION OF WORK:

Various Roads Located in Penn Forest Township, Carbon County

DESCRIPTION OF WORK:

As indicated below and in Attachment 1-A:

Contractor is to place either a 4” Double Yellow Center Line with Glass Beads or a 4” Single White Edge

Line with Glass Beads in conformance with the Current PennDOT Publication 408, Section 962 on various roads with in the Township.

ESCALATOR CLAUSE: (If adopted by the Municipality)

None

SCHEDULE OF PRICES

1.Item

No.

2. Approximate

Quantities

3. Units 4.*Description 5. Unit

Price

6. Total

1.

2.

138,864

277,728

LF

LF

4” Double Yellow Center Line with Glass Beads

4” Single White Edge Line with Glass Beads

*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.

SUBTOTAL

SUBTOTAL(S) FROM

OTHER ATTACHMENT(S)

TOTAL AMOUNT OF BID

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SPECIAL PROVISIONS TO CONTRACT MS-944 (Attachment 1-A)

CONTAINS IMPORTANT INFORMATION FOR THE CONTRACTOR

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

- Traffic Control and Safety Devices to be provided by the Contractor. (PA. DEPART. Of TRANS. Publication 212 and 213, WORKZONE TRAFFIC CONTROL, CURRENT EDITION.)

- Delivery tickets for all materials.

- CS-4171 Certificate of Compliance required for all materials.

- The Contractor shall notify the Municipality 5 calendar days prior to the start of the project.

- Work to be completed on or before September 30, 2026. After September 30, 2026, liquidated damages apply at the rate of

$885.00 per calendar day.

- Municipality reserves the right to limit work completed.

- Completion of NON-COLLUSION AFFIDAVIT required.

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

- Contractor should review the proposed project with the Municipality’s Representative prior to bidding. For further information contact Dana Vitale, Secretary at 570-325-2768 between the hours of 8:00 a.m. to 3:30 p.m. Monday through Friday.

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

- Contractor to supply proof of CDL Drug and Alcohol Compliance.

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

- Bidders can either be a PennDOT Pre-qualified Prime or PennDOT Pre-qualified Sub-Contractor and proof of

Pre-qualification is required. Bidders need to be PennDOT pre-qualified for Work Class Code “O3” Paint

Applications.

Line Painting

The scope of work is supply all materials and equipment to apply double 4” yellow center traffic lines with glass beads and 4” single white edge traffic lines with glass beads to roadways and all equipment and workers to properly control traffic and conform to PennDOT Publication 212 and 213.

- The Contractor shall obtain all materials from an approved PENNDOT Bulletin 15 supplier and provide

Certification as specified in PENNDOT Pub 408, Section 106.03(b) 3, that the paint and glass beads meet the following specifications:

Glass Beads; Conforming to Current PennDOT Publication 408, Section 1103.14 meeting “Type A” Gradation

Paint; Provide the correct color and type of waterborne paint from a source listed in Bulletin 15.

- The material and work shall conform to PENNDOT Pub. 408, Section 962.

Insurance Requirements

The awarded contractor shall purchase and maintain, at its expense, during the term of this contract and any renewals or extensions thereof, insurance issued by companies acceptable to the Municipalities. See the “Insurance

Requirement” Attachment. The Bidder will provide the Municipality named in this contract with a copy of the insurance binder. Penn Forest Township MUST be named as additional insured on the policy.

CDL Drug and Alcohol Testing Certificate The Contractor will be responsible for providing the Municipality with a completed “Contractor Statement of Compliance with

CDL Testing Program Requirements” Form on Page 13 or their own CDL Drug and Alcohol Testing Certificate for any

Contractor or Sub-Contractor working on the job performing work which requires a Commercial Driver’s License.

Instructions to Bidders regarding the bidding documents;

The Bidders are to thoroughly review the bid document before submitting their bids, the Newspaper Advertisement is part of the bid documents. Any questions regarding the bid documents are to be presented and received by the Municipal Secretary in writing either by mail or e-mail a minimum of 3 working days before the date that the Municipality sets to receive bids. A working day is Monday through Friday from 8:00 am to 3:00 pm, Saturday’s and Sundays are not considered working days in regard to the submittal of questions. Any verbal questions must be followed up with a written request.

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SPECIAL PROVISIONS TO CONTRACT MS-944 (Attachment 1-A)

All Bidders are to return the following documents as part of their bid submission (failure to provide the required documentation will result in the rejection of the bid):

- Bid Document pages 1 through 6 with bidder information completed on page 1, Unit Prices and Total Prices completed on Page 3 and signatures areas completed on pages 2 and 6.

- A Bid Bond in the amount of 10% of the total bid

- Anti-Collusion Affidavit, see page 11 of the bid package

Upon review of bids by the Municipality a notice of award will be issued and the successful bidder will be required to provide the following additions documentation within 20 calendar days and before any work can begin:

- Performance Bond in the amount of 100% of the amount of the awarded contract

- Payment Bond in the amount of 100% of the amount of the awarded contract

- Completed “Affidavit RE Accepting Provisions of the Workmen’s Compensation Act Form”, see page 10 of the bid package.

- Completed Commonwealth of Pennsylvania Public Works Employment Verification Form, see page 14 of the bid package.

- Certificate of Insurance naming the Municipality as an additionally insured party on the policy, see pages 4 and 12 of the bid package.

- Proof of Participation or a statement of participation, indicating the Testing Company, in a CDL Drug and Alcohol

Compliance testing program as outlined on page 4 or by completing the “Contractors Statement of Compliance with

CDL Testing Program Requirements” on page 13.

Public Works Employment Verification Act

General. In accordance with Act 127 of 2012, known as the Public Works Employment Verification Act (“the Act”), effective

January 1, 2013, 43 P.S. §§167.1-167.11, the Contractor shall use the Federal Government’s E-Verify system to ensure that all employees performing work on the project, including subcontractor’s employees, are authorized to work in the United States.

Verification Form. The Contractor shall verify the employment eligibility of each new employee hired after January 1, 2013 and submit the Commonwealth Public Works Employment Verification Form (“Form”) included in the bid package attachments to the Municipality.

Contractor. Mail the Form, signed by an authorized representative of the Contractor to the Municipality along with the

Performance and Payment Bonds as specified by the contract documents. Failure or refusal to provide the Form will be considered a refusal to comply with bidding requirements, will result in rejection of the bid, and may subject the Contractor to the enforcement activities, sanctions and civil penalties specified in the Act.

Subcontractor. The Prime Contractor will obtain a Form signed by an authorized representative of any subcontractor performing work on the project, possessing sufficient knowledge to make the representations and certifications on the Form.

The Prime Contractor shall submit the Form to the Municipality prior to requesting subcontractor approval and before the subcontractor performs any work. Failure or refusal to provide the Form will be considered a refusal to comply with subcontractor approval requirements, will result in rejection of the subcontractor request, and may subject the subcontractor to the enforcement activities, sanctions and civil penalties specified in the Act.

The Prime Contractor shall include information about the requirements of the Act in all subcontracts.

Department of General Services. The Department of General Services is the Commonwealth agency responsible for enforcement and administration of the Act. Please direct questions about the Act to:

Department of General Services Public Works

Employment Verification Compliance Office

Room 105 Tent Building

18th and Herr Streets

Harrisburg, PA 17125

Fax: 717-214-3669

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SPECIAL PROVISIONS TO CONTRACT MS-944 (Attachment 1-A - Continued)

Measurements and calculations of quantities are for bidding purposes only; if there are questions regarding the Linear Feet of line painting completed, final measurements will be conducted by a representative from the Contractor and a representative from the Municipality and final payment will be based on these mutually agreed to measurements and quantities.

The Contractor shall supply the Line Painter run sheets or invoice showing the Linear Feet of lines that were painted.

This item of work is to be paid for by Linear Foot based on these run sheets or line painting invoice following a review by the Municipality.

My signature signifies that I have read and understand the above 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

Company Municipality

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2026 LIST OF ROADS FOR LINE PAINTING

TOWNSHIP ROADS

YELLOW DBL

LINE YELLOW DBL LINE

SGL WHITE OUTER

LINE

SGL WHITE OUTER

LINE

MILES LINEAR FEET MILES LINEAR FEET

T-419 FOREST STREET 1.0 5280.0 2 10560.0

T-473 DANNER ROAD 0.9 4752.0 1.8 9504.0

T-474 STONY MTN ROAD 4.5 23760.0 9.0 47520.0

T-480 SMITH ROAD .7 3696.0 1.4 7392.0

T-481 DRAKES CREEK ROAD 2.3 12144.0 4.6 24288.0

T-506 BEHRENS ROAD 1.4 7392.0 2.8 14784.0

T-508 CHURCH ROAD 3.6 19008.0 7.2 38016.0

T-512 WEILER ROAD 0.8 4224.0 1.6 8448.0

T-513 HENNING ROAD 0.2 1056.0 0.4 2112.0

T-514 SCHOOL HOUSE ROAD 0.9 4752.0 1.8 9504.0

T-516 OLD STAGE ROAD 2.2 11616.0 4.4 23232.0

T-518 MECKESVILLE ROAD 2.2 11616.0 4.4 23232.0

T-519 STONY CREEK ROAD 0.7 3696.0 1.4 7392.0

T-520 WARGO ROAD 0.6 3168.0 1.2 6336.0

T-521 SHORT ROAD 0.3 1584.0 0.6 3168.0

TRANSFER STATION ROAD 0.4 2112.0 0.8 4224.0

TOTALS 26.3 138864.0 52.6 277728.0

MS-944

PROPOSAL AND CONTRACT INSTRUCTIONS – FORM 944

1. The proposal must be typewritten or printed.

2. If more than one proposal on any project is submitted by any individual, firm or partnership, corporation, or association under the same names, only one lowest proposal will be considered.

3. Description of work------

A. If additional space is needed; insert appropriately numbered attachment and note “Continued on

Attachment No. __________________________.”

B. Where Wearing Surfaces are a part of this Contract, Average Daily Traffic (ADT) Count or SRL determination must be included in the description.

4. Part A of Page 1 to be completed by municipality. Part B of Page 1 to be completed by contractor. Schedule of Prices –

Column #1 (Item), #2 (Approximate Quantities), #3 (Unit, i.e., ton, square yard, linear feet, etc.) and #4 (Description, i.e., bituminous materials – 9.5 mm S & L, 12.5 mm Wearing, 25.0 mm Base Course, etc.) must be filled in by the municipality to insure equitable bidding. Column #5 (Unit Price), #6 (Total), and total amount of bid must be filled in by the contractor. If more space is needed, add note at bottom of the page: Continued on Attachment No. 1-A,” and add additional sheet designated as Attachment No. 1-A, 1-B, etc. Repeat for each additional sheet required.

5. If liquidated damages are to be assessed, add the following sentence to Part A #2. “If all work is not completed on time, liquidated damages will be assessed at the rate of $ ______________________________per additional working day.”

(OR”…as set forth in the attached schedule.”)

6. Payment and Performance bonds are provided only by the successful bidder. Contracts from $4,000.00 up to $5,000.00 in Second Class Townships - performance bond must be not less than 10% or greater than 100% of amount of contract.

Contracts greater than $1,500.00 up to $10,000.00 in First Class Townships, Boroughs and Third-Class Cities - bonds must be between 50 % to 100% of the contract amount. Contracts in excess of $5,000.00 in Second Class Townships and in excess of $10,000.00 in First Class Townships, Boroughs and Third-Class Cities - bonds must be in 100% of the amount of the contract. Bond Forms MS-944 Attachments 2 and 3 and Workmen’s Compensation Affidavit -

Attachment 4 must be submitted by the successful bidder within 20 days of the contract award. Failure to submit the bonds shall constitute grounds to cancel the contract.

7. *Construction projects, where the estimated cost of the total project exceeds $25,000, are subject to the provisions of the

Pennsylvania Prevailing Wage Act 442. It is the responsibility of the municipality to obtain the Prevailing Wage Scale for the area and include it in the proposal. IF the Prevailing Wage Act applies, this fact shall be noted in the advertisement.

On projects utilizing Federal revenue Sharing Funds, if the project cost exceeds $2,000 and is financed with 25% or more Federal Revenue Sharing Funds, the Davis Bacon Act applies. Again, it is the responsibility of the municipality to obtain the Davis Bacon Wage Rates, include them in the proposal and note the fact in the advertisement. If both Acts are applicable, the Davis Bacon Act has preference over the Pennsylvania Prevailing Wage Act.

8. An ESCALATOR CLAUSE is optional; however, if used, it must be included in the proposal prepared by the municipality. An escalator clause may not be inserted by the contractor.

*(1961, Nov 14, P.L. 987; 43 P.S. 165)

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MS-944 (02-01) PERFORMANCE BOND Attachment 2 (REPRODUCE LOCALLY) (With Corporate Surety)

KNOW ALL MEN BY THESE PRESENTS, that we, _______________________________________________

(NAME AND ADDRESS OF CONTRACTOR)

as Principal and ____________________________________________________________________________________

(SURETY COMPANY)

a corporation incorporated under the laws of the State of _____________________________________________as Surety

(NAME OF STATE)

are held and firmly bound unto ____________________________________________________ . In the full and just sum of _________________________________________________________ ($ _____________________________) dollars lawful money of 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 bouden 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 obligations such that if the 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 contract 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 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)

SEAL Attest / Witness CONTRACTOR

_____________________________________ BY: ___________________________________________________

TITLE TITLE

SEAL Attest / Witness ___________________________________________________

SURETY COMPANY

____________________________________ BY: ____________________________________________________

TITLE TITLE

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MS-944 PAYMENT BOND Attachment 3

KNOW ALL MEN BY THESE PRESENTS, that we, _______________________________________________ of _____________________________________, as PRINCIPAL and ________________________________________ 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 true 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 to 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 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 therefore, may sue in assumpsit’s on this Payment bond in his, their, or it own name and may prosecute the same to final for such sum or sums as may be 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 or 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: _______________________________________________

TITLE TITLE

WITNESS:

SURETY COMPANY

______________________________________ BY: ______________________________________________

TITLE TITLE

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MS-944 Attachment 4

AFFIDAVIT RE

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

Accepted the provisions of the Workmen’s Compensation Act of 1915 of the Commonwealth of Pennsylvania, with its supplements and amendments, and have insured their liability hereunder in it accordance with the terms of said

Act with _________________________________________________________________________________________

(SURETY COMPANY)

(TYPE OR PRINT) CONTRACTOR

BY: ______________________________________

SIGNATURE

Sworn to and subscribed before me this ________________________________________________________ day of

_______________________________________A.D. 20 ____________

My Commission Expires ___________________________

(DATE)

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D-7126 ( 6-99 )

ANTI-COLLUSION AFFIDAVIT

County Carbon

Municipality Penn Forest Township

Project Number 2026 Line Painting

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)

BY

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

Notary Public

My Commission expires

INSURANCE REQUIREMENTS

The awarded contractor shall purchase and maintain, at its expense, during the term of this contract and any renewals or extensions thereof, the following types of insurance issued by companies acceptable to the

Municipality.

1. Workmen’s compensation insurance sufficient to cover all of the employees of the contractor working to perform this contract, as required by the laws of the Commonwealth.

2. Comprehensive general liability insurance, property damage insurance, and where appropriate automobile liability insurance. The minimum amount of coverage shall be $250,000.00 per person and $1,000,000.00 per occurrence for bodily injury, including death and $250,000.00 per person and $1,000,000.00 per occurrence for property damage.

These coverages shall be occurrence-based. The policy shall name the Municipality as an additional insured and shall contain a provision that the coverage afforded thereunder shall not be cancelled or changed unless at least thirty (30) days prior written notice has been given to the Municipality.

Prior to the commencement of work, the contractor shall provide the Municipality with a current certificate(s) of insurance showing the required coverages and provisions.

3. Your attention is directed to the hold harmless and indemnification provision:

“The Contractor shall hold the Municipality harmless from any indemnify the Municipality against any and all claims, demands, and actions based upon or arising out of any activities performed by the Contractor and its employees and agents under this Contract and shall, at the request of the Municipality, defend any and all actions brought against the Municipality based upon any such claims or demands.”

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COMMONWEALTH OF PENNSYLVANIA

PUBLIC WORKS EMPLOYMENT VERIFICATION FORM

Date__________________

Business or Organization Name (Employer) _________________________________________________

Address ______________________________________________________________________________

City ___________________________________ State ___________________ Zip Code _____________

____ Contractor ____ Subcontractor (Check One)

Contracting Public Body: _______________________________________________________________

Contract/Project No.: __________________________________________________________________

Project Description: ___________________________________________________________________

Project Location: _____________________________________________________________________

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

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