2-Bidder Contractor Reponsibility Form (revised 1-17-25) (1).pdf

Revised 01/17/2025

TO:

FROM: Cheri Estrada, NIPG-CPP, CPPO, CPPB Director of Purchasing, Tacoma Public Schools

The following items are contract requirements which must be executed prior to receiving your purchase order.

PREVAILING WAGES: In compliance with the Department of Labor & Industries, prior to the start of work, you are to submit a Statement of Intent to Pay Prevailing Wages online at: lni.wa.gov. Based on the contract amount, you must submit a COMBO form online (under $5000) or Statement of Intent to Pay Prevailing Wages for all trades in your employ and any subcontractors. The Affidavit of Prevailing Wages Paid (approved by the Department of labor and Industries) is required prior to final payment.

RETAINAGE: Select a retainage option from the following page. All projects over $150,000 require a performance bond and 5% retainage will be held. Projects under $150,000 Contractors can choose to obtain a performance bond and have 5% withheld or have 10% withheld with no bond.

*Note that before retainage can be released for all projects exceeding $35,000 the District is required to submit a Notice of Completion. Payment of retainage shall only be made upon receipt of Letters of Release from the Department of Revenue, L&I, and Employment Security.

CERTIFICATE OF INSURANCE: The contractor shall provide proof that the required insurance has been obtained and the certificate of insurance or the certified copy of the insurance policy has been filed with the Owner prior to commencement of work. The Tacoma School District #10 shall be named as additional insured for liability arising out of work under this contract as the result of the negligence, real or alleged, on the part of the contractor, his subcontractors, and their subcontractors. Each insurance policy shall have a clause providing that it shall not be canceled by the insurance company without twenty (20) days written notice to the Owner of intention to cancel. The amount of such insurance shall be no less than $1,000,000 each occurrence.

In addition, you must sign and return the attached certification form to the district prior to issuance of a purchase order. Your purchase order will be your Notice to Proceed with the work of this contract.

https://www.lni.wa.gov/

Revised 01/17/2025

BIDDER/CONTRACTOR RESPONSIBILITY

AS A CONDITION OF PERFORMING THE WORK, THE CONTRACTOR CERTIFIES THAT:

It will comply with the current prevailing wages pursuant to

RCW 39.12 and/or the Davis-Bacon Act(40 U.S.C 3141-3144, and 3146-3148) and the requirements of 29 C.F.R pt 5 as may be applicable. See Washington State Prevailing Wage Rates and Benefit Code Key. LINK: WA L&I Wages

It is a registered contractor with RCW 18.27. LINK: WA L&I Verify

It will comply with RCW 70.92, Aged and Physically Handicapped.

It will comply with RCW 28A.400.330, Crimes Against Children, and SHALL NOT have employees in areas where students are unsupervised at any time. Request to obtain written approval after appropriate background check.

It has a current state unified business identifier number. LINK:

SOS Business Search

It has industrial insurance coverage for its employees working in Washington as required in Title 51 RCW.

It has an employment security department number as required in Title 50 RCW.

It has a state excise tax registration number as required in Title 82 RCW. LINK: DOR Business Lookup

It is not disqualified from bidding on any public works contract under RCW 39.06.010 (unregistered or unlicensed contractors) or RCW 39.12.065(3) (prevailing wage violations). LINK: L&I Debarred Contractors

For all federally funded work, it will comply with Federal Executive order 12549 “Debarment and Suspension” and the origination certifies it and all subcontractors and their principals are not debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department or agency from doing business with the Federal Government.

Pursuant to RCW 39.04.350, within the three-year period immediately preceding the Bid Date, the Bidder has not been determined by a final and binding citation and notice of assessment issued by the Department of Labor and Industries or through a civil judgment entered by a court of limited or general jurisdiction to have willfully violated, as defined in RCW 49.48.082, any provisions in RCW 49.46, 49.48, or 49.52.

For public works projects subject to the apprenticeship utilization requirements in RCW 39.04.320, have not been found out of compliance by the Washington State Apprenticeship and Training Council for working apprentices our of ratio, without appropriate supervision, or outside their approved work processes as outlined in their standards or apprenticeship under chapter RCW 49.04 for the one-year period immediately preceding the date of the bid solicitation.

If this project is over $1,000,000, the Contractor will comply with RCW 39.04.320.

CHECK ONE OR BOTH OF THE BOXES BELOW TO MEET COMPLIANCE PER RCW 39.04.350 AND RCW 39.06.020 ☐ Received training provided by the Department of Labor & Industries on requirements related to public works and prevailing wage under RCW 39.12

☐ Have completed three or more public works projects and have a valid business license in Washington State for three or more years.

SELECT ONE OF THE RETAINAGE OPTIONS BELOW

For all projects below $150,000.00 (including tax) For all projects exceeding $150,000.00 (including tax)

☐ 10% retainage will be held by the District

A payment and performance bond is required (to be received within 10-20 days after contract award and before first payment is issued).

☐ 5% retainage will be withheld by the District and the contractor submits a performance bond (at the contractor’s expense, not the Districts)

☐ 5% will be withheld by the District

☐ For projects under $5000, the contract dollar amount indicated shall only be for a single payment in full upon completion of the L&I COMBO form

☐ Retainage investment Option selected, see completed form attached

The undersigned certifies under penalty of perjury under the laws of the State of Washington that the foregoing representations are true and correct.

Project Name Number(s): Bid/Quote/Contract

Business Name E-Mail

UBI # Address, City, State, Zip

Print Name Phone

Signature (signature options: RCW 9A.72.085) Date https://app.leg.wa.gov/rcw/default.aspx?cite=39.12 https://secure.lni.wa.gov/wagelookup/ https://app.leg.wa.gov/rcw/default.aspx?cite=18.27 https://secure.lni.wa.gov/verify/ https://secure.lni.wa.gov/verify/ https://app.leg.wa.gov/rcw/default.aspx?cite=70.92 https://app.leg.wa.gov/rcw/default.aspx?cite=28A.400.330 https://ccfs.sos.wa.gov/#/ https://app.leg.wa.gov/rcw/default.aspx?cite=51 https://app.leg.wa.gov/rcw/default.aspx?cite=50 https://app.leg.wa.gov/rcw/default.aspx?cite=82 https://secure.dor.wa.gov/gteunauth/_/ https://app.leg.wa.gov/rcw/default.aspx?cite=39.06.010 https://app.leg.wa.gov/rcw/default.aspx?cite=39.12.065 https://secure.lni.wa.gov/debarandstrike/ContractorDebarList.aspx https://app.leg.wa.gov/rcw/default.aspx?cite=39.04.350 https://app.leg.wa.gov/rcw/default.aspx?cite=49.48.082 https://app.leg.wa.gov/rcw/default.aspx?cite=49.46 https://app.leg.wa.gov/rcw/default.aspx?cite=49.48 https://app.leg.wa.gov/rcw/default.aspx?cite=49.52 https://app.leg.wa.gov/rcw/default.aspx?cite=39.04.320 https://app.leg.wa.gov/rcw/default.aspx?cite=49.04 https://app.leg.wa.gov/rcw/default.aspx?cite=39.04.320 https://app.leg.wa.gov/rcw/default.aspx?cite=39.04.350 https://app.leg.wa.gov/rcw/default.aspx?cite=39.06.020 https://app.leg.wa.gov/rcw/default.aspx?cite=39.12