19-Doc 00 45 13.1 - CONTRACTOR RESPONSIBILITY CERTIFICATION.pdf

CONTRACTOR RESPONSIBLITY CERTIFICATION

00 45 13.1-1

DOCUMENT 00 45 13.1

PROJECT IDENTIFICATION: 2026 Road Paving, Inlet Replacement, and Curb Ramp Program

CONTRACT IDENTIFICATION AND NUMBER: #2025-01237

This Certification is submitted by (Name of Firm)

CONTRACTOR ADDRESS:

CONTACT NAME:

PHONE NO: FAX NO:

1. Has the firm been debarred by any federal, state or local government agency or authority in the past three

(3) years.

YES NO

2. Has the firm defaulted on any project in the past three (3) years.

3. Has the firm had any type of business, contracting or trade license revoked or suspended by any governmental agency or authority in the past three (3) years.

4. Has the firm committed a serious or willful violation of federal or state safety laws as determined by a final decision of a court or government agency authority in the past three (3) years.

5. Has the firm been found in violation of any other law relating to its contracting business, including but limited to wage or hour laws, environmental laws, antitrust laws, licensing laws or tax laws, by a final decision of a court or government agency authority in the past three (3) years.

6. The firm has all technical qualifications and resources including equipment, personnel and financial resources, to perform the referenced contract, or will obtain same through the use of qualified, responsible subcontractors.

7. Proof of participation in a Class A Apprenticeship Program must be attached.

The Township of Bristol may require any other additional information it deems necessary to evaluate a prospective contractor’s technical qualifications, resources and performance capabilities, as well as the type of impact its operations will have on a local community impacted by the project. The Township of Bristol may require that such information be included in a Statement of Qualifications and Experience as an attachment to the Contractors Responsibility Certification.

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(I / We) stipulate that if awarded a contract the firm will provide a subcontractors list and subcontractors information as specified.

If submitting firm is, or was in the past five years, related to any other company or business entity that provided or provides contractual services in the construction, maintenance, service or repair industries, whether as a parent company, subsidiary or any other business relationship, it shall submit a Contractor Responsibility Certification that explains in detail the nature of any such relationship, if requested.

If any person or entity that is a shareholder, owner or partner of the submitting firm owns an interest of 20% or more in another entity or previously owned such an interest in another entity that provides or has provided contractual services in the construction, maintenance, service or repair industries, it shall attach a separate statement to its Contractor Responsibility Certification that explains in detail the nature of any such relationship.

The Township of Bristol may require that Contractor Responsibility Certifications and other information required by this act be submitted electronically.

Signature

Name

Title

END OF DOCUMENT