2-CDBG Procurement Packet.pdf

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SPECIFICATIONS

Project Name:

Project Number:

Agency:

Project Manager:

Project Location:

Allegheny County Economic Development Federally-Funded Projects

Procurement Compliance Package Checklist

PROCUREMENT DOCUMENTS TO BE SUBMITTED BY THE PRIME CONTRACTOR/SUBCONTRACTOR/SUPPLIER

The documents listed on this checklist must be included in your bid submission, unless otherwise noted below. These documents are to be submitted to the Agency by all contractors and forwarded to the ACED Project Manager for final approval. The documents pertaining to Subcontractors must be provided within 10 days of the project award letter, if not included with the Prime Contractor’s original bid proposal.

INITIAL TO INDICATE THE DOCUMENTS HAVE BEEN PROVIDED

Agency / Project Manager

Revised October 2025

Notice to Prime Contractors/Subcontractors This document must be included in the bid package and completed by the Prime Contractor/Subcontractor as part of the original bid proposal.

Award Verification for Prime/ Subcontractors (Form-PL3/PL4) This document must be included in the bid package and completed by the Agency/Prime Contractor/Subcontractor as part of the original bid proposal.

Schedule of Subcontractors This document must be included in the bid package and submitted no more than 10 days after contract is awarded.

Agency Prime Contractor/Subcontractor Verification This document must be included in the bid package and submitted no more than 10 days after contract is awarded.

Fringe Benefit Letter This document must be included in the bid package and completed by the Prime Contractor/Subcontractor as part of the original bid proposal.

U.S. Department of Labor Certified Payrolls/ Apprentice Registrations Upon being awarded the contract, all contractors must submit a weekly certified payroll sheet to the Project Manager. This document is two (2) pages. Provide valid apprenticeship program documents for all apprentices.

Construction Stoppage Statement This document is provided to the Project Manager if the project requires a delay of work for six weeks or more.

Section 3 - Contractor’s Compliance Certification (see separate Section 3 Packet) For housing construction, rehabilitation, or other public construction: Agencies that receive assistance that exceeds $200,000, contractors/ subcontractors are required to comply with Section 3 requirements.

Section 3 Monthly Employment and Business Utilization Reports (Due Monthly)

Final Schedule of Subcontractors This document ensures that all subcontractors who worked on the project are recorded

Award Verification for Suppliers / Professional Services -PL5 This document is to be submitted for all suppliers or professional services receiving $1,000 or more.

Agency/Prime Contractor/SubcontractorSupplier / Professional Services Verification This document must be included in the bid package and submitted no more than 10 days after contract is awarded.

Allegheny County Economic Development Federally-Funded Projects

Procurement Compliance / Bid Package Documents

NOTICE TO PRIME CONTRACTORS/SUBCONTRACTORS

PROJECT NAME__________________________________________ Project #_______________________

PROJECT LOCATION_____________________________________________________________________

Agency_______________________________________________________________________________

All contractors for the above-named project understand that any payment requests for the project will not be processed by Allegheny County Economic Development until all requirements are met. It is the responsibility of the Agency to make sure that all the paperwork is submitted by everyone on the project before request for payments are submitted.

It is further understood that the Prime Contractor is responsible for collecting all paperwork for each Subcontractor hired and must submit it to the Agency, along with a signed agreement between the Prime and Subcontractor(s. Both Prime and Subcontractors are required to retain copies of all paperwork for this Federally-funded project for a period of three (3) years after completion of the project.

By signing this form, you have acknowledged that you did receive a copy of the U.S. Department of Housing and Urban Development’s Federal Labor Standards Provision and that you understand all the requirements.

The Prime Contractor was given: U.S. Department of Labor publication WH 1321, “Notice to All Employees”; U.S.

Occupational Safety and Health Administration publication 3165, “Job Safety & Health Protection Poster”; and U.S.

Department of Housing and Urban Development publication 901, “Equal Employment Opportunity.” These posters, along with a copy of the issued U.S. Department of Labor Wage Decision, are to be displayed in a prominent place at the work site.

The contractor understands that no basic wage can be lower than the wage issued: if fringe benefits are not paid into a special fund, the fringe benefits listed for any particular trade in the wage decision is added to, and becomes part of, the basic hourly wage for the employee performing the work.

All payrolls must be forwarded within seven days after the pay period. Payrolls must be certified on the reverse side and Legally valid electronic signatures are acceptable. A legally valid electronic signature includes any electronic process that indicates acceptance of the certified payroll record, and includes an electronic method of verifying the signer’s identity. The electronic signature must show a dated time stamp. It should include the physical date, time and persons name. Note: Photocopies, stamps, or non-dated timestamps of signatures do not satisfy this requirement.

Acknowledgment by Prime Contractor____ Subcontractor____

Company Name_________________________________________________________________________

Authorized Official:______________________________________________________________________

Signature:__________________________________________________________Date:______________

This form must be signed by the Prime Contractor or Subcontractor

Revised October 2025

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SPECIFICATIONS

Project #

Project Name:

Date Contract Awarded to Contractor Above:

Agency Signature

Print Name

Date:Company Signature:

Title:

THIS PORTION IS TO BE COMPLETED BY OPERATING AGENCY ONLY:

Total Project Contract Award Amount $

Project Location:

Date

Title

Revised October 2025

State:

Email Address:

IRS ID Number:

Zip Code:

CAGE Number: CAGE Expiration Date:

Print Name:

Allegheny County Economic Development Federally-Funded Projects Procurement Compliance / Bid Package Documents

Above Contractor Contract Amount: $

Above Contractor CDBG Contract Amount $___________________

Above Contractor HOME Contract Amount $___________________

Above Contractor HARP Contract Amount $_________________

AWARD VERIFICATION FOR PRIME/ SUBCONTRACTORS- PL3/PL4

THIS FORM MUST BE COMPLETED, SIGNED, AND SUBMITTED FOR ALL CONTRACTORS USED ON THE JOB.

ALL INFORMATION MUST BE FILLED IN COMPLETELY OR FORM MUST BE RESUBMITTED.

(Check One)

PL3- Award Notice for Prime Contractor PL4- Award Notice for Subcontractor

To be filled out by Prime/ Subcontractor:

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SPECIFICATIONS

DUNS Number:

Company Name:

Address:

City:

Telephone Number:

SCHEDULE OF SUBCONTRACTORS

PRIME CONTRACTORS: This form must be submitted to the Agency no more than ten days after you have received a bid award letter notifying you that you have been awarded the contract. Failure to submit this form could disqualify your bid.

SUB CONTRACTORS: This form must be completed and submitted to the prime contractor

PROJECT NAME

PROJECT LOCATION PROJECT #

CONTRACTOR’S NAME

IRS ID#_ DATE

STATE:

IRS ID#:

Revised October 2025

ZIP:

Check here if no sub contractors will be utilized by the above contractor

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SPECIFICATIONS

COMPANY NAME:

ADDRESS:

CITY:

TELEPHONE #:

Type of Work:

ZIP:

COMPANY NAME:

ADDRESS:

CITY:

STATE:

TELEPHONE #:

IRS ID#:

Type of Work:

ZIP:

COMPANY NAME:

ADDRESS:

CITY:

STATE:

TELEPHONE #:

IRS ID#:

Type of Work:

ZIP:

COMPANY NAME:

ADDRESS:

CITY:

STATE:

TELEPHONE #:

IRS ID#:

Type of Work:

AGENCY > PRIME CONTRACTOR / SUBCONTRACTOR VERIFICATION

(Agency/Prime/Subcontractor Legal Name) has an agreement with

(Prime/Subcontractor Legal Name) to work on the

(Project Name)_ located in the area of , PA.

If awarded the contract, the above Agency/Prime Contractor/Subcontractor intends to have a written, binding contract with the above Prime Contractor or Subcontractor to perform the following work:

(Provide Brief Description of the Type of Work Agreed Upon)

Agency’s Authorized Signature:_____________________________________________ Date:

Agency’s Printed Name:___________________________________________________ Title:

Prime Contractor’s Authorized Signature:_____________________________________ Date:

Prime Contractor’s Printed Name: __________________________________________ Title:

Subcontractor’s Authorized Signature:_______________________________________ Date:

Subcontractor’s Printed Name: _____________________________________________ Title

Revised October 2025

The contract dollar amount as specified in the written agreement is $

The portion of the above to be reimbursed/paid with Federal funds is $

THIS FORM MUST BE SUBMITTED FOR EVERY PRIME / SUBCONTRACTOR HIRED FOR THIS FEDERALLY-FUNDED PROJECT AND SUBMITTED TO THE AGENCY. THIS FORM IS TO BE SUBMITTED 10 DAYS AFTER CONTRACT IS AWARDED.

Project #:

ADD DOCUMENT

FRINGE BENEFIT LETTER

Wage Decision Serial #

IRS ID#

City State

Project Name_

Project #

Contract Amount $

Prime/Subcontractor Company Name (Circle One)_

Address:

FRINGE BENEFITS:

All Fringe Benefits will be paid as follows:

_Fringes will be included in the basic hourly wage rates.

_Fringes will be paid into the following Benefit Plans: (List Hourly Fringe Benefit Rate)

Name of Plan:

Address:

City:

Classification: Hourly Fringe Benefit Rate

Name of Plan:

Address:

City:

Classification: Hourly Fringe Benefit Rate

Name of Plan:

Address:

City:

Classification: Hourly Fringe Benefit Rate

Prime/ Subcontractor’s Signature

Printed Name: Date:

Revised October 2025

Zip Code

State: Zip Code:

State: Zip Code:

State: Zip Code:

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CONSTRUCTION STOPPAGE STATEMENT

State Zip Code

If there is no work performed on the project for SIX WEEKS or MORE, this form must be completed and submitted to the Agency by the Contractor.

Company Name

Company Address

City

Telephone Number

Project #

Project Name

Project Address City Zip Code

I certify that work on this project will be delayed for a period of six (6) weeks or more effective as of . this date _. The work on this project will resume on (date)_

The payroll number which was last submitted to the AGENCY was payroll number .

Therefore when the work resumes, the payrolls will be numbered starting with the next sequential number from the last payroll submitted.

Authorized Signature: Prime Contractor_ Date Print Name Prime Contractor

Authorized Signature: Subcontractor_ Date Print Name Subcontractor

This form must be submitted to the AGENCY to be forwarded to the Project Manager at Allegheny County Economic Development.

Date

Received by (Agenc Name)

Authorized Signature

Received by ACED Project Manager_

Signature Date

Revised October 2025

State

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Revised October 2025

Allegheny County Economic Development Federally-Funded Projects Procurement Compliance / Bid Package Documents

FINAL SCHEDULE OF SUBCONTRACTORS

PRIME CONTRACTORS: This form must be submitted to the Agency after you have completed all the work on the project. Failure to submit this form could delay final grant disbursement.

SUBCONTRACTORS: This form must be completed and submitted to the prime contractor

PROJECT NAME

PROJECT LOCATION PROJECT #

CONTRACTOR’S NAME

IRS ID#_ DATE

Check here if no sub-contractors were utilized by the above contractor

COMPANY NAME

ADDRESS_______________________________________________CITY_____________________________

STATE ____ ZIP________

TELEPHONE: ___________________ IRS ID: _____________

Type of Work: __________________________________________

First Day on Jobsite: _____________________

Final Day on Jobsite: ____________________

Amount reimbursed with grant funds: $__________________

COMPANY NAME

ADDRESS_______________________________________________CITY_____________________________

STATE ____ ZIP________

TELEPHONE: ___________________ IRS ID: _____________

Type of Work: __________________________________________

First Day on Jobsite: _____________________

Final Day on Jobsite: ____________________

Amount reimbursed with grant funds: $__________________

COMPANY NAME

ADDRESS_______________________________________________CITY_____________________________

STATE ____ ZIP________

TELEPHONE: ___________________ IRS ID: _____________

Type of Work: __________________________________________

First Day on Jobsite: _____________________

Final Day on Jobsite: ____________________

Amount reimbursed with grant funds: $__________________

ADD DOCUMENT

Project #

Project Name:

Date Contract Awarded to Contractor Above:

Agency Signature

Print Name

Date:Company Signature:

Title:

THIS PORTION IS TO BE COMPLETED BY OPERATING AGENCY ONLY:

Total Project Contract Award Amount $

Project Location:

Date

Title

Revised October 2025

State:

Email Address:

IRS ID Number:

Zip Code:

CAGE Number: CAGE Expiration Date:

Print Name:

Allegheny County Economic Development Federally-Funded Projects Procurement Compliance / Bid Package Documents

Above Contractor Contract Amount: $

Above Contractor CDBG Contract Amount $___________________

Above Contractor HOME Contract Amount $___________________

Above Contractor HARP Contract Amount $_________________

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SPECIFICATIONS

DUNS Number:

Company Name:

Address:

City:

Telephone Number:

AWARD VERIFICATION FOR SUPPLIERS AND PROFESSIONAL SERVICES–PL5

THIS FORM MUST BE COMPLETED, SIGNED, AND SUBMITTED FOR SUPPLIERS ($1,000 or more) AND ALL PROFESSIONAL SERVICES USED ON THE JOB. ALL INFORMATION MUST BE FILLED IN COMPLETELY OR FORM MUST BE RESUBMITTED.

PL5—Award Notice for Suppliers and Professional Services

This portion to be completed by Supplier / Professional Service Provider:

Allegheny County Economic Development Federally-Funded Projects Procurement Compliance / Bid Package Documents

AGENCY / PRIME CONTRACTOR / SUBCONTRACTOR > SUPPLIER/

PROFESSIONAL SERVICES VERIFICATION FORM

(Agency/Prime/Subcontractor Legal Name) has an agreement with

(Supplier/ Professional Service Legal Name/ Address) to work on the

(Project Name) _ located in the area of _, PA.

If awarded the contract, the above Agency/Prime Contractor/Subcontractor intends to have a binding contract with the above supplier or professional service to provide the following materials or services:

(Provide a Brief Description of the Supplies or Professional Services Agreed Upon)

Agency Authorized Signature: ______________________________________________Date: ______________________

Agency’s Printed Name: _____________________________________________Title: _____________________________

Prime Contractor’s Authorized Signature: ______________________________________Date: ______________________

Prime Contractor’s Printed Name: ______________________________________ Title: ____________________________

Subcontractor’s Authorized Signature: ________________________________________ Date: ______________________

Subcontractor’s Printed Name: _________________________________________ Title: ____________________________

Supplier / Service Authorized Signature: _______________________________________Date: ______________________

Supplier / Service Printed Name: ________________________________________Title: ____________________________

THIS FORM MUST BE SUBMITTED FOR EVERY SUPPLIER ($1,000 or more) and ALL PROFESSIONAL

SERVICES HIRED FOR THIS FEDERALLY-FUNDED PROJECT AND SUBMITTED TO THE AGENCY.

Project #:

. . The contract dollar amount as specified in the written agreement is $

The portion of the above to be reimbursed/paid with Federal funds is $ . .

Revised October 2025

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13 - CONTRACTOR - SUPPLIER-CHECKLIST 6-2020.pdf

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