10-BIDDERS AFFIDAVIT.pdf

PDF 12 KB Posted

Attached to
Southwest 96-inch Water Transmission Pipeline Project
Solicitation number
CIZ-DWU-26 003
Issued by
Dallas County, Texas

About this file

This is a Bidder's Affidavit form required by the City of Dallas, Texas for the Southwest 96-inch Water Transmission Pipeline Project. The project involves installation of approximately 14,300 linear feet of 96-inch steel water pipe, 570 linear feet of 78-inch steel water pipe, and 30 linear feet of 54-inch prestressed concrete cylinder water pipe using open cut and tunneling methods. The scope also includes cathodic protection, electrical systems, instrumentation and controls for electrically actuated valves, site restoration, and paving. Plans, specifications, and bid proposal spreadsheets are available on the Bonfire platform at https://dallascityhall.bonfirehub.com/ beginning Friday, March 13, 2026, prior to 4:00 p.m. The project manager is Tracey Long, PE.

The affidavit certifies that the bidding firm's safety records from the Dallas OSHA office or the local OSHA office in the firm's jurisdiction do not reflect six or more serious violations (including no repeat violations) or three or more willful violations (including no repeat violations) within the preceding three years. This certification is required by City Council Resolution #891132, and failure or refusal to complete the form may result in bid rejection. The affidavit must be signed by a corporate officer, sworn to, and notarized before submission.

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Text version

Date of Bid Opening

BIDDER'S AFFIDAVIT

The following information is required by City Council Resolution #891132.

Failure or refusal to complete this form may result in bid rejection.

The undersigned certifies that safety records from the Dallas OSHA office or the local OSHA office in which this firm does business does not reflect penalties for six (6) or more serious violations, none of which may be repeat violation, nor may it reflect three

(3) or more willful violations, none of which may be repeat violations, within the preceding three (3) years.

Name of Signatory Title Address

Corporate Authorized Title Address Signatory (Only) The above signature must be by a Corporate Officer.

Legal Name of Bidder Address

SWORN TO AND SUBSCRIBED BEFORE ME on this _____ day of ______________, 20______, to certify which witness my hand and seal of this office.

NOTARY PUBLIC, STATE OF ___________

Printed Name of Notary

File details come from the government source that posted it. Updated .