15-9.0 BID DOCUMENTS PAGES D-1 THRU D-9.pdf

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D. FORM OF GUARANTY:

Accompanying this Proposal is a in the amount of

Dollars $ as bid security.

LIST OF SUBCONTRACTORS

The Bidder further certifies that the following firms or businesses will be awarded subcontracts for the stated portions of the work in the event the Bidder is awarded the Contract. (Add additional pages as required)

Subcontractor Name & Address Specialty Area

1.

2.

3.

4.

ADDENDUMS:

The bidder acknowledges receipt of the hereinafter enumerated Addendums which have been issued during period of bidding and agrees that said Addendums shall become a part of this contract. The bidder shall list below the numbers and issuing dates of the bulletins.

Addendum No. Issuing Date

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The undersigned hereby certifies that this Proposal is genuine, and not sham or collusive, or submitted in the interest or on behalf of any person, firm or corporation not herein named, and has not, induced any other persons to refrain from biddings, and has not in any way sought by collusion to secure for himself an advantage over any other bidder.

FIRM NAME

ADDRESS

BUSINESS PHONE#

Official

By

TITLE

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Contractor Responsibility Certification

Firm Name: ________________________________________________

Firm Address: ______________________________________________

Contact Name: _____________________________________________

Telephone No.: _____________________________________________

Fax No.: ___________________________________________________

Email Address: _____________________________________________

Project Name: ______________________________________________

Project Number: ____________________________________________

I attest that I have read, and will comply with the Township of Upper Darby Model Responsible

Contractor Ordinance.

Signature: _____________________________ Date: ______________________

The submitting firm is required to certify compliance with the contractor responsibility standards set forth below by checking appropriate boxes. Specifically, to perform work for the

Borough of Jenkintown, submitting firms must answer “Yes” to Questions 1, 2 and 9, 10, 11, 12, 13 and 14 and answer “No” to Questions 3 through 8.

(1) Does the firm have or will it obtain all valid, effective licenses, registrations or certificates required by federal, state, county, or local law, including, but not limited to, licenses, registrations or certificates required to: (a) do business in the designated locale; and (b) perform the contract work it seeks to perform. These shall include, but not be limited to, licenses, registrations or certificates for any type of trade work or specialty work which the firm proposes to self-perform?

Yes No

TOWNSHIP OF UPPER DARBY

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(2) Does the firm meet the bonding requirements for the contract, as required by applicable law or contract specifications and any insurance requirements, as required by applicable law or contract specifications, including general liability insurance, workers compensation insurance and unemployment insurance requirements?

(3) Has the firm been debarred by any federal, state or local government agency or authority in the past three (3) years?

(4) Has the firm defaulted on any project in the past three (3) years?

(5) Has the firm had any type of business, contracting or trade license, registration, or other certification suspended or revoked in the past three (3) years?

(6) Has the firm been cited for a willful violation of federal or state safety laws as determined by a final decision of a court or government agency in the past three (3) years?

(7) Has the firm or its owners been convicted of any crime relating to the contracting business as determined by a final decision of a court or government agency in the past ten (10) years?

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(8) Has the firm, in the past three (3) years, been found by a final decision of a court or government agency in violation of any law applicable to its contracting business, including, but not limited to, licensing laws, tax laws, prompt payment laws, wage and hour laws, prevailing wage laws, environmental laws or others, where the result of such violation was the payment of a fine, back pay damages or any other type of penalty in the amount of $1,000.00 or more?

(9) Does the firm agree to pay all craft employees that it employs on the project the current wage rates and benefits as required under applicable federal or state wage laws for the duration of the referenced project?

(10) Does the firm participate in a Class A Apprenticeship Program for each separate trade or classification in which it employs craft employees and agree to continue to participate in such program or programs for the duration of the referenced project?

(A) For purposes of this section, a “Class A Apprenticeship Program” is an apprenticeship program that is currently registered with and approved by the

U.S. Department of Labor or a state apprenticeship agency and has graduated apprentices to journeyperson status for at least three (3) of the past five (5) years.

(B) If a firm is identified as the lowest responsible bidder or otherwise selected as the prospective awardee or as a subcontractor of an awardee, it shall provide appropriate documentation, as determined by the Central Purchasing

Department, to verify it meets the requirements of this section for each trade or classification of craft workers it will employ on the project. This verification shall be provided prior to performance of work by the firm and the documentation shall clearly indicate which crafts the firm employs and which crafts are covered by the identified apprenticeship programs.

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(11) Does the firm have all other technical qualifications and resources, including equipment, personnel and financial resources, to perform the referenced contract, or agree that it will obtain same through the use of qualified, responsible subcontractors?

(12) Does the firm agree to notify the Central Purchasing Department of any material changes to any matters attested to in this certification within seven (7) days?

(13) Does the firm understand and agree that, if it is a general contractor, construction manager or other prime contract and it receives a Notice of Intent to Award

Contract, it shall provide the Central Purchasing Department within seven (7) days a Subcontractor List that identifies any subcontractors it will use in connection with the project and furnish Contractor Responsibility Certifications for all identified subcontractors with all required supporting documentation.

(14) Does the firm understand and agree that this certification must be completed by an authorized representative of the firm that that sufficient knowledge and information to address all matter addressed herein.

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In executing this Responsibility Certification, the submitting firm understands and agrees that if the Central Purchasing Department determines that this certification contains false or misleading material information that was provided knowingly or with reckless disregard for the truth or omits material information knowingly or with reckless disregard of the truth, the firm may be prohibited from performing work for the Township of Upper Darby for a period of three (3) years. Such circumstances shall also subject the firm to any other penalties and sanctions, including contract termination, available to the Township of Upper Darby under law. A contract terminated under these circumstances shall further entitle the Township of Upper Darby to withhold payment of any monies due to the firm as damages.

I certify that the foregoing representations regarding the past performance and present qualifications of the undersigned firm are true and correct.

Print and Sign Name

Title

Name of Firm

Date

Subscribed and sworn to before me this _____ day of _____________, 2017

Notary Public

My Commission Expires:___________

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EXPERIENCE QUESTIONNAIRE

CONTRACT IDENTIFICATION

ROOF REPLACEMENT – PUBLIC WORKS BUILDING (RE-BID)

SUBMITTED TO THE TOWNSHIP OF UPPER DARBY

(-Corporation

BY (-Partnership

(-An Individual

PRINCIPAL OFFICE ADDRESS .

(The signer of this questionnaire guarantees the truth and accuracy of all statements and of all answers to interrogatories hereinafter made.)

1. What type of business is Bidder's organization?

2. How many years has Bidder's organization been performing work, as a contractor or subcontractor, of the type required for this Project?

3. Provide information on all projects currently in progress.

Contract Amount Type of

Work

When

Completed

Name and Address of

Owner Engineer/Architect

2026 RESURFACING OF VARIOUS STREETS IN UPPER DARBY

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4. Has Bidder's organization ever defaulted on any contract or failed to complete any contract?

If so, where and why?

5. List names, addresses, and phone numbers of individuals or organizations that can be contacted by

Borough or Engineer to obtain references.

6. What is the construction experience of the principal individuals of Bidder's organization?

Individual's Name Present Position or Office Magnitude and Type of Work In What Capacity?

STATE OF

COUNTY OF

being duly sworn deposes and says that he is of

Title Name of Organization and that the answers to the foregoing questions and all statements therein are true and correct.

Signature ________________________________________

Sworn to before me this Day of , 2018

My commission expires

Signature of Notary Public

*Type or print name below each signature.

Municipality