ATTACHMENT A – PRICING FORM

All bids must be as specified or equal. Bidder must complete, sign, and return this document stating the firm fixed hourly rates for the period specified in the specifications.

The fixed hourly rates are fully loaded and include wages, benefits, overhead, general and administrative expenses and profit. Guaranteed not-to-exceed quotes will be based on these hourly rates.

Discount for prompt payment on invoices only ___%___ days. Discount will not be evaluated on bid.

The prices contained in this bid are firm for _____ days prior to award.

SUBCONTRACTORS

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

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 & Title

Address

Telephone

Email Address

Signature & 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.

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 – ANIT-COLLUSION STATEMENT

ANTI-COLLUSION STATEMENT

STATE OF _____________________________)

COUNTY OF ___________________________)

___________________________________________________________________ being first duly sworn deposes and says that he is _______________________ of _____________________________________

TITLE OF PERSON SIGNING NAME OF PROPOSER

that all statements made and facts set out in the bid for the above project are true and correct; and that the Proposer (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 Proposer is not financially interested in, or financially affiliated with, any other Proposer for the above project.

(BY) _________________________________________

(BY) _________________________________________

Sworn to before me this ________ day of ________________, 2025.

Notary Public

My commission expires: ____________________________________ image1.png