2-Docs. to be Submitted with Bid.pdf

BARC Roof Recovery Applications BARC Developmental Services

CAI 70725.07

PR - 1

Bidder's Name __________________________

PROPOSAL (BID FORM)

PROJECT IDENTIFICATION: BARC ROOF RECOVERY APPLICATIONS

BARC DEVELOPMENTAL SERVICES

CONTRACT IDENTIFICATION NUMBER: 70725.07

THIS BID IS SUBMITTED TO: BARC Developmental Services Executive Offices 4950 York Road Holicong, PA 18928

1. The undersigned BIDDER proposes and agrees, if this Bid is accepted, to enter into an

Agreement with OWNER in the form included in the Contract Documents to complete all Work as specified or indicated in the Contract Documents, with bid issue date of June 15, 2026, for the contract price and within the Contract Time indicated in this Bid and in accordance with the Contract Documents.

2. BIDDER accepts all of the terms and conditions of the Instructions to Bidders, including without limitation those dealing with the disposition of Bid Security. This Bid will remain open for ninety (60) days after the day of Bid Opening. BIDDER will sign the Agreement and submit the Contract Security and other documents required by the Contract Documents within fifteen (15) days after the date of OWNER'S Notice of Award.

3. In submitting this Bid, BIDDER represents, as more fully set forth in the Agreement, that:

a. BIDDER has examined copies of all the Contract Documents and of the following addenda:

Date Number

(Receipt of all of which is hereby acknowledged) and copies of the Instructions to

Bidders.

b. BIDDER has examined the site and locality where the Work is to be performed, the legal requirements, (federal, state, and local laws, ordinances, rules, and regulations), and the conditions affecting cost, progress, or performance of the Work and has made such independent investigations as BIDDER deems necessary.

c. This Bid is genuine and not made in the interest of or on behalf of any undisclosed person, firm, or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization or corporation; BIDDER has not directly or indirectly induced or solicited any other BIDDER to submit a false or sham bid;

BIDDER has not solicited or induced any person, firm, or corporation to refrain from bidding; and BIDDER has not sought by collusion to obtain for himself any advantage over any other BIDDER or over OWNER.

4. Bidder will complete the work for the following price(s):

CAI 70725.07

PR - 2

Bidder's Name __________________________

SCHEDULE OF PRICES

Item No.

Description Unit Approx.

Quantit y

Unit Price

Total Cost

BASE BID

1 Mobilization/Demobilization/Bonds/Insurance Lump Sum 1 2 Protection and Restoration of Project Site Lump Sum 1

A. Cafeteria/Office Roof 3 Demolition and Disposal of Existing Coping, Surface Mounted Counter Flashing and Termination Bar, EDPM Pipe Boots, EPDM Wraps, Condensing Lines, Counter Flashing, EPDM Membrane, and Insulation

Lump Sum 1

4 Slice Existing Field Membrane in 10’ x 10’ Grid System for Existing Roofing Ventilation

Lump Sum 1

5 Provide and Install Versico’s Tapered Polyisocyanurate Insulation ½” per 1’ at New Cricket locations Between the Two (2) Existing Scupper Discharge Locations Extending 8’ Out at Center Point Tapering Back into Discharge Locations (Or Approved Equal)

Lump Sum 1

6 Provide and install Versico’s Mechanically Attached 060 reinforced White TPO Roof System - Complete (Or Approved Equal)

Lump Sum 1

7 Provide and install Versico’s 30” wide TPO Walk Roll at Ladder Access Location to Upper Roof as well as at the Access Point to the Roof Top Units heat welded to the new field membrane (Or Approved Equal)

Lump Sum 1

8 Supply and install new shop fabricated 24-gauge steel coping in standard Kynar color selection with continuous front cleat and rear mechanical attachment including all required accessories

Lump Sum 1

9 Allowance for Unforeseen Repairs Lump Sum 1 $7,500 $7,500 B. Upper Roof

10 Demolition and Disposal of Existing Coping, EDPM Pipe Boots, Vent Stacks, Existing Wall Downspout Scuppers

Lump Sum 1

11 Slice Existing Field Membrane in 10’ x 10’ Grid System

Lump Sum 1

12 Provide and install Versico’s tapered polyisocyanurate insulation ½” per 1’ at new cricket locations between the two (2) existing scupper discharge locations extending 8’ out at center point tapering back into discharge locations to provide directional slope as well as high side of roof top units and makeup air unit only (Or Approved Equal)

Lump Sum 1

13 Provide and install Versico’s mechanically attached 060 reinforced white TPO roof

Lump Sum 1

CAI 70725.07

PR - 3

system -Complete (Or Approved Equal) 14 Provide and Install Versico’s 30” Wide TPO

Walk Roll at Roof Access Location Only (Or Approved Equal)

Lump Sum 1

15 Provide and install shop fabricated 24 gauge 12” x 7” Through Wall scuppers at existing discharge locations in standard Kynar color selection to match existing attached to existing in place downspouts

Lump Sum 1

16 Supply and install new shop fabricated 24-gauge steel coping in standard Kynar color selection with continuous front cleat and rear mechanical attachment including all required accessories

Lump Sum 1

17 Allowance for Unforeseen Repairs Lump Sum 1 $7,500 $7,500

TOTAL BASE BID

STIPULATED UNIT PRICES

The following unit prices for items of work will be used in making minor additions (or deductions) in the project. The Contractor stipulates in submitting his bid that he will perform this additional work or provide credit to the Owner for such work not performed at the following stipulated unit prices:

Item Description Unit Unit Price 101 Full Depth Replacement of Insulation as Deemed

Necessary by Owner/Owners Engineer S.F.

BIDDER agrees and understands that:

(a) Estimated quantities of the various Unit Price Items listed in the Proposal are only approximate and are so listed only as a basis upon which to evaluate bids.

(b) If final quantities of the Unit Price Items tabulated in the Schedule of Prices are greater or less than those indicated by the Contract Documents, BIDDER will accept additions to, or deductions from the item, applying the unit prices shown in the BID SCHEDULE OF PRICES.

(c) Unit prices left blank will result in the rejection of the bid.

(d) Bid prices submitted in "Stipulated Unit Prices" will be determined fair and reasonable by comparing BIDDER's unit price with the average unit price bid by all bidders for the same item, and a BIDDER’s unit price greater than 100% of the average unit price of any item will be cause for rejection of the bid.

5. Contract Schedules

a. BIDDER (Contractor) agrees that work will begin within fifteen (15) days of Notice to Proceed.

CAI 70725.07

PR - 4

b. BIDDER (Contractor) agrees that work will be completed as follows after the Contract Time commences to run:

Substantial Completion 90 days/Final Completion 120 days

c. BIDDER (Contractor) agrees that should the work not be completed within the allotted time, BIDDER (Contractor) will pay to the Owner Liquidated Damages per calendar day for each day that work is not completed in accordance with the Supplementary Conditions, Section 12.06(C).

d. BIDDER (Contractor) accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the work on time.

6. The following documents are attached to and made a condition of this Bid:

a. Required Bid Security in the amount of 10% of Base Bid.

b. A tabulation of Subcontractors and other persons and organizations required to be identified in this Bid.

c. Disclosure Form, if bidder a corporation or partnership, listing ownership names and addresses.

d. Certificate of Non-Segregated Facilities.

e. Verification of Contractor Eligibility.

f. Non-Collusion Affidavit.

g. Bidders Qualification Form.

h. Title 49 Code of Federal Regulations, Part 29 Debarment and Suspension

Certificate (Found in Appendix)

I. Contractor’s Certification on Federal Contract Requirements (Found in Appendix)

j. Anti-Lobbying Certification (Found in Appendix)

k. False Claims Act 31, USC §3729-3733 (Found in Appendix)

l. Contractor Questionnaire (Found in Appendix)

m. Affirmative Action Plan (Found in Appendix)

n. Build America, Buy America Act (BABAA) Self-Certification (Found in Appendix)

o. Bidders Certification Form (Found in Appendix)

9. Communications concerning this Bid shall be addressed to the following address:

CAI 70725.07

PR - 5

10. The terms used in this Bid which are defined in the General Conditions of the Construction Contract included as part of the Contract Documents have the meanings assigned to them in the General Conditions and Supplementary Conditions.

SUBMITTED ON ____________________, 20_____.

CAI 70725.07

PR - 6

If Bidder is:

An Individual:

By_____________________________________________________________(SEAL)

(Individual's Name) doing business as ______________________________________________________

Business address: ______________________________________________________

Phone No. ____________________________________________________________

A Partnership:

By___________________________________________________________________

(Firm Name)

(General Partner)

Business address:______________________________________________________________

Phone No. ____________________________________________________________

A Corporation:

By___________________________________________________________________

(Corporation Name)

(State of Incorporation)

By___________________________________________________________________

(Name of Person Authorized to Sign)

(Title)

(Corporate Seal)

Attest________________________________________________________________

(Secretary)

Business address: _____________________________________________________

Phone No. ____________________________________________________________

CAI 70725.07

PR - 7

A Joint Venture

By___________________________________________________________________

(Name)

(Address)

By____________________________________________________________________

(Name)

(Address)

(Each joint venturer must sign. The manner of signing for each individual, partnership, and corporation that is a party to the joint venture should be in the manner indicated above.)

BID BOND

Bond No. _________________

KNOW ALL MEN BY THESE PRESENTS, that we, the undersigned, ________________

_____________________________________ as Principal, and __________________________

_____________________________________ as Surety, are hereby held and firmly bound unto

_____________________________________ as Owner in the penal sum of ________________

_____________________________________ for the payment of which, well and truly to be made, we hereby jointly and severally bind ourselves, our heirs, executors, administrators, successors and assigns. Signed, this ____________________ day of_____________________, 20 ______.

The condition of the above obligation is such that whereas the Principal has submitted to

__________________________________________ a certain bid, attached hereto and hereby made a part hereof to enter into a contract in writing, for the _____________________________

NOW, THEREFORE,

(a) If said Bid shall be rejected, or in the alternate,

(b) If said Bid shall be accepted and the Principal shall execute and deliver a contract in the Form of Contract attached hereto (properly completed in accordance with said Bid) and shall furnish a bond for his faithful performance of said Contract, and for the payment of all persons performing labor or furnishing materials in connection therewith, and shall in all other respects perform the agreement created by the acceptance of said Bid, then this obligation shall be void, otherwise the same shall remain in force and effect, it being expressly understood and agreed that the liability of the Surety for any and all claims hereunder shall in no event, exceed the penal amount of this obligation as herein stated.

The Surety, for value received hereby, stipulates and agrees that the obligations of said

Surety and its bond shall be in no way impaired or affected by any extension of the time within which the Owner may accept such Bid; and said Surety does hereby waive notice of any such extension.

IN WITNESS WHEREOF, the Principal and the Surety have hereunto set their hands and seals, and such of them as are corporations have caused their corporate seals to be hereto affixed and these presents to be signed by their proper officers, the day and year first set forth above.

Principal

Surety

By:_____________________________

SEAL

AGREEMENT OF SURETY

Regarding Bid Bond

KNOW ALL MEN BY THESE PRESENTS, that we, ____________________________________ (Surety Company) _______________________________, as Surety, a corporation existing under the laws of the State of

___________________________, and authorized to transact business in the Commonwealth of

Pennsylvania, hereby agrees, intending to be legally bound hereby, to execute and deliver to

_______________________________________________________________ within the (Owner) time limit specified in the Contract Documents, the Performance Bond and Payment Bond in the forms included in the Contract Documents, each in amount of 100% of the Contract Sum, in favor of the

____________________________________________________, as required for the faithful performance (Owner) and proper fulfillment of the __________________________________________ contract for the (Project Name)

____________________________________________ Project, located in ________________________ (Municipality)

_______________________ County, Pennsylvania, on behalf of________________________________ (Contractor) (hereinafter called the Bidder) provided that the above contract be awarded to the bidder within sixty (60) days after the date of opening of the bids or otherwise set forth in the Instructions to Bidders and Invitation to Bidders.

Surety further agrees that should the Surety, after modification of intent to make such award, omit or refuse to execute the required bonds and agreement, then the Surety shall pay to the

_____________________________________________________, hereinafter called the Obligee, any (Owner) difference between the total amount specified in said bidder's proposal for the required work and the amount of which said Obligee may procedure the same work, if the latter amount be in excess of the former, plus any advertising, architectural, legal and other expenses incurred by Obligee; provided, however, that the obligations of Surety hereunder shall not exceed the amount of bid security provided by the Bidder together with interest.

Dated ______________________, 20_____ _________________________________________ (Corporate Surety)

Witness or Attest:

____________________________________ By:_______________________________________ Attorney-in-Fact*

Name:_____________________________________ (Please Type)

*Attach an appropriate Power of Attorney, dated as of the same date as this Agreement, evidencing the authority of the Attorney-in-Fact to act on behalf of the corporation.

V:\jle\SPECLEGAL\revagreesurety.doc

CERTIFICATE AS TO CORPORATE PRINCIPAL

I,________________________________________________________, certify that I am the

__________________________________________________, of the Corporation named as

Principal in the within bond; that ___________________________________ who signed the said bond on behalf of the Principal was then of said Corporation; that I know his signature, and his signature thereto is genuine; and that said bond was duly signed, sealed, and attested to for and in behalf of said Corporation by authority of this governing body.

_____________________________ (Corporate

Seal)

_____________________________ Title

Public Disclosure Information

In order to conform to Chapter 33 of the Public Laws of 1977, all corporations or partnerships must provide the following information:

1. Name of Firm:________________________________________________

2. Is Firm a Corporation: Yes_______________ No______________

3. Name of State in Which Incorporated:_____________________________

4. Is Firm a Partnership: Yes_______________ No______________

The following individuals own ten (10) percent or more of any class stock in the corporation or are a ten (10) percent or more partner in the firm:

NAME ADDRESS TITLE PERCENT

IF ANY OF THE AFOREMENTIONED STOCKHOLDERS BE A CORPORATION, WHEREBY

THEY HOLD TEN (10) PERCENT OR MORE OF ANY CLASS STOCK IN BIDDING

CORPORATION, THEY MUST ALSO PROVIDE THE INFORMATION REQUESTED ABOVE.

Sworn to and The above information is true and Subscribed before me this____________ correct to the best of my knowledge.

day of ______________, ____________.

(Signature)

(Corporate Seal) ________________________________ (Name)

(Address)

(Title)

CERTIFICATION OF NON-SEGREGATED FACILITIES

The Bidder certifies that he/she does not maintain or provide for his/her employees any segregated facilities at any of his/her establishments, and that he/she does not permit his employees to perform their services at any location, under his/her control, where segregated facilities are maintained. The Bidder certifies further that he/she will not maintain or provide for his/her employees any segregated facilities at any of his/her establishments, and that he/she will not permit his/her employees to perform their services at any location under his/her control where segregated facilities are maintained. The Bidder agrees that a breach of this certification will be a violation of the Equal Opportunity clause in any contract resulting from acceptance of this bid. As used in this certification, the term "segregated facilities" means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, timeclocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are, in fact, segregated on the basis of race, color, religion, or national origin, because of habit, local custom, or otherwise. The Bidder agrees that (except where he/she has obtained identical certification from proposed subcontractors for specific time periods) he/she will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the

Equal Opportunity clause, and that he/she will retain such certifications in his/her files.

Note: The penalty for making false statements in offers is prescribed in 18 U.S.C.}1001.

Date: ____________________, 20_____ _____________________________ (Name of Bidder)

Official Address (including ZIP CODE): By:___________________________

Title

VERIFICATION OF CONTRACTOR ELIGIBILITY AND

TERMINATION OF INELIGIBLE CONTRACTOR

CONTRACTOR CERTIFICATION

I hereby certify that I/we am/are not currently under suspension or debarment by the Commonwealth, any other state, or the federal government.

In the event I/we am/are found ineligible after an award of Contract, said Contract shall be terminated and the matter will be referred to the Department of Labor for its action.

If I/we enter into subcontracts or employ under this contract any subcontractors or individuals who are currently suspended or debarred by the Commonwealth or federal government or who become suspended or debarred by the Commonwealth or federal government during the term of this contract or any extension or renewals thereof, the Owner shall have the right to require the termination of such subcontracts or employment, at no cost to the Owner. I/We agree to reimburse the Owner for costs and expenses incurred due to my/our non-compliance with terms of this certification requirement.

Contractor Signature Name of Firm Date

Subcontractor Signature Name of Firm Date

The contractor may obtain the current list of contractors suspended or debarred by the Commonwealth of Pennsylvania by contacting:

Department of General Services Office of Chief Counsel 603 North Office Building Harrisburg, PA 17125 Telephone No. (717)783-6472 Fax No. (717)787-9138

If any contractor cannot so certify, the contractor must submit along with the bid/proposal a written explanation of why such certification cannot be made.

NON-COLLUSION AFFIDAVIT OF PRIME BIDDER

State of __________________________) County of ________________________ ) ss.

__________________________________, being first duly sworn, deposes and says that:

(1) He/She is __________________________________________________________ (Owner, partner, officer, representative or agent) of/to _______________________________________________, the Bidder that has submitted the attached Bid;

(2) He/She is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid;

(3) Such Bid is genuine and is not a collusive or sham Bid;

(4) Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly, with any other Bidder, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other Bidder, firm or person to fix the price or prices in the attached Bid or of any other Bidder, or to fix any overhead, profit or cost element for the Bid prices or the Bid price of any Bidder, or to secure through any collusion, conspiracy, connivance or unlawful agreement, any advantage against the County or any person interested in the proposed Contract; and

(5) The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, representatives, owners, employees, or parties in interest, including this affidavit.

Signed:___________________________

(Title)

Subscribed and sworn to before me this __________________ day of _________________________________, 20____.

Title _____________________________

My Commission expires _______________________________________________________

BIDDERS QUALIFICATION FORM

1. NAME_________________________________________________________________

PRINCIPAL OFFICE ADDRESS____________________________________________

TELEPHONE_____________________________________________

If a Corporation, answer these: If a Co-Partnership, answer these:

Capital paid in cash $__________________ Date of Organization__________________

When Incorporated ___________________ State whether partnership is general or

In what state ________________________ limited _____________________________

President's Name ____________________ Name, address, and age of partners:

Vice-Pres. Name _____________________ ___________________________________

Secretary's Name ____________________ ___________________________________

Treasurer's Name ____________________ ___________________________________

2. How many years has your organization been in business as a contractor under present business name?_________________________________________________________

3. How many years experience in this type of work has your organization had:

(a) As a contractor __________ (b) As a sub-contractor _____________

4. List the construction experience in this type of work of the officers and management personnel, including superintendents of your organization.

Individual's Name

Present Office or

Position

Years of Construction

Experience

Magnitude and Type of

Work

In What Capacity

5. What are the largest projects your organization has completed?

Contract Amount Class of Work When Completed For Whom

a. ______________________________________________________________________

b. ______________________________________________________________________

c. ______________________________________________________________________

d. ______________________________________________________________________

e. ______________________________________________________________________

Name and address of references for items listed above:

a. ______________________________________________________________________

b. ______________________________________________________________________

c. ______________________________________________________________________

d. ______________________________________________________________________

e. ______________________________________________________________________

Any other references:

6. List Contracts (next page)

A. INCLUDE A COPY OF YOUR FINANCIAL STATEMENTS INCLUDING

BALANCE SHEET AND INCOME AND LOSS STATEMENT.

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7. Have you ever failed to complete any work awarded to you? ______________________

If so, where and why?_____________________________________________________

8. Have you ever been debarred by Pennsylvania Labor and Industry for violating the

Prevailing Wage Act? ______________ If so, state date and describe violation.

9. Have you or has any officer or partner of your organization ever been an officer or partner of some other contracting organization that failed to complete a construction contract?_______________________________________________________________

If so, state name of individual, position, and the name of the other organization, dates, project, and reasons therefore. _____________________________________________

10. Has your organization ever been denied state funded prequalification in this state or any other state under this name or any other name? ____________________________

If so, please indicate state(s), and explain reasons for denial._____________________

11. If you are prequalified by any states, list states and categories of prequalified construction work._______________________________________________________

12. If you intend to sublet any part of the work, will you require a bond from the subcontractor? __________________________________________________________

13. Give a list of uncompleted contracts as presently held by you.

Contract Amount

14. What equipment do you own that is available for the proposed work?

15. State approximately the largest amount of work you have done in any one year.

Remarks:______________________________________________________________

16. Name one bank reference.

Name_________________________________________________________________

Address_______________________________________________________________

Low bidder shall provide a letter of authorization, addressed to above bank reference, naming the Engineer to make necessary inquiries.

17. Name two (2) credit references:

a) Name___________________________________________________________

Address__________________________________________________________

b) Name___________________________________________________________

Address__________________________________________________________

Signed____________________

Title______________________

Date_____________________

Board of Commissioners Robert J. Harvie Jr., Chair

Diane M. Ellis-Marseglia, LCSW, Vice Chair Gene D. DiGirolamo, Secretary

DEPARTMENT OF HOUSING & COMMUNITY DEVELOPMENT

Neshaminy Manor Center, 1260 Almshouse Road, Doylestown, PA 18901 Telephone: (215) 345-3845 fax: (267) 885-1376 www.buckscounty.gov

BUILD AMERICA, BUY AMERICA ACT (BABAA) SELF-CERTIFICATION

Timer period/Invoicing Period: _________________________________

For CDBG financial assistance programs subject to BABA, contractors and subcontractors must sign and submit the following certification to the next tier (e.g., subcontractors submit to the contractor; contractors submit to the non-federal entity) each bid or offer for an infrastructure project that has not been waived by a BABA waiver:

The undersigned certifies, to the best of their knowledge and belief, that:

The Build America, Buy America Act (BABA) requires that no federal financial assistance for “infrastructure” projects is provided “unless all of the iron, steel, manufactured products, and construction materials used in the project are produced in the United States.” Section 70914 of Public Law No. 117-58, §§ 70901-52.

The undersigned certifies that for the (Project Name and Location) that the iron, steel, manufactured products, and construction materials used in this contract are in full compliance with the BABA requirements including:

1. All iron and steel used in the project are produced in the United States. This means all manufacturing processes, from the initial melting stage through the application of coatings, occurred in the United States.

2. All manufactured products purchased with CDBG financial assistance must be produced in the United

States. For a manufactured product to be considered produced in the United States, the cost of the components of the manufactured product that are mined, produced, or manufactured in the United States is greater than 55% of the total cost of all components of the manufactured product, unless another standard for determining the minimum amount of domestic content of the manufactured product has been established under applicable law or regulation.

3. All construction materials are manufactured in the United States. This means that all manufacturing processes for the construction material occurred in the United States.

MATERIALS/MANUFACTURED GOOD(S) BEING USED FOR PROJECT (PLEASE LIST)

Type of Good Make & Model Manufacturing Location

I hereby certify that all of the iron, steel and manufactured goods supplied or provided by our company for use on this project was produced in the United State of America, unless an applicable waiver applies.

Or

I am relying on the following Buy America waiver(s) (check all that apply):

De Minimis Waiver Iron, steel and manufactured goods supplied/provided by our company equal no more than 5 percent of the total cost of the iron, steel and manufactured goods used in and incorporated into this project.

Small Grants Waiver

The total cost of the award/subaward is less than $250,000 and is not subject to the provisions of Buy America.

“The [Contractor or Subcontractor], __________________________, certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the [Contractor or Subcontractor] understands and agrees that the provisions of 31U.S.C. Chap. 38, Administrative Remedies for False Claims and Statements, apply to this certification and disclosure, if any.”

Representative Name Title

Representative Signature Date

Signature of [Contractor’s or Subcontractor’s] Authorized Official

Printed Name and Title of [Contractor’s or Subcontractor’s] Authorized Official

Name of Contracting Firm (please print)

Signature Date

MANUFACTURER CERTIFICATIONS

As an additional step to ensure compliance when purchasing products for the project, CDBG award recipients or subrecipients may request a certification letter from the product manufacturer to demonstrate compliance with BABA requirements. Although requesting manufacturer certifications is not required, HCD recommends this step as a best practice for documenting compliance with BABA. HCD recommends that certification letters contain five essential elements, which include:

• A reference to the project;

• Specific product information;

• Compliance with BABA reference;

• Location of manufacturer (country); and

• A company representative signature.

The certification letter should be maintained as part of the project record to be made available to HCD if requested.

BIDDER CERTIFICATION FORM

Attach this form to all Bids for qualifying CDBG Funded Projects PURPOSE: This “Bidder Certification Form” is used to certify that, as required by federal law, materials listed in the bid(s) and below meet the requirements of the Build America, Buy America Act, AKA the Buy America Program

(BAP).

REQUIREMENTS BASED ON CDBG FISCAL YEAR (FY) FUNDING: BAP requirements for qualifying CDBG funded projects are phased in by the CDBG fiscal year by which the project is funded.

1. FY2023 funded projects: All iron and steel used in the project are produced in the United States. This means all manufacturing processes, from the initial melting stage through the application of coatings, occurred in the United States.

2. FY2024 funded projects: All iron and steel, and all listed manufactured products used in the project are produced in the United States. This means the manufactured product was manufactured in the United States, and the cost of the components of the manufactured product that are mined, produced, or manufactured in the United States is greater than 55 percent of the total cost of all components of the manufactured product, unless another standard for determining the minimum amount of domestic content of the manufactured product has been established under applicable law or regulation; and, for FY2025 funded projects forward;

3. FY2025 funded projects: All iron and steel, and all listed manufactured products, and all construction materials (listed and non-listed) are manufactured in the United States. This means that all manufacturing processes for the construction material occurred in the United States.

CERTIFICATION:

I hereby certify the materials in the attached Bid meet the requirements of the Build America, Buy America Act and accompanying guidance. Responsible Contractors, manufacturers, suppliers, and any other person or entity signing this certification agree to provide documentation verifying the material meets all requirements upon demand of the CDBG Grantee, Subgrantee, or the Federal Government. Signing this document does not prevent the signee of providing evidence of such a request.

Bid Number/Identifier (Bid to be attached):

Type of materials to be supplied including model, make & manufacturing location):

Other Exceptions to be requested: _____________________________________________________________________

CDBG Fiscal Year (FY) that applies: 2024

Company Name: Representing (Contractor, supplier, manufacturer, etc.): Phone Number: Email: Authorized Representative Name (Print): Signature:

Title 49, Code of Federal Regulation, Part 29 Debarment and Suspension Certification

(see: http://www.sam.gov/portal/SAM/#1 )

The bidder, under penalty of perjury, certifies that, except as noted below, he/she or any person associated therewith in the capacity of owner, partner, director, officer, manager:

o is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal agency;

o has not been suspended, debarred, voluntarily excluded or determined ineligible by any federal agency within the past three years;

o does not have a proposed debarment pending; and has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past three years;

If there are any exceptions to this certification, insert the exceptions in the following space:

Exceptions will not necessarily result in denial of award, but will be considered in determining bidder's responsibility. For any exception noted above, indicate below to whom it applies, initialing agency, and dates of action.

The penalty for making false statements is prescribed in the U.S. Criminal Code, 18 U.S.C. 1001.

Signature Date

Type or Print Name and Title of Signer

NOTE: Each member of a Joint Venture must submit this form. Additionally, previous certifications under the present Joint Venture shall be submitted upon request.

Contractor’s Certification on Federal Contract Requirements

(To Be Executed by Bidder and Submitted with Bid)

I hereby certify that I have reviewed the federal construction contract-related requirements imposed on the Contractor(s) of Grant -funded construction projects and fully understand all my obligations if the project is awarded to me.

Project Name:

Location:

Amount of Bid: $

Name of Bidder: _____________________________________

Authorized Applicant Name

(Print Full Name)

Street Address

City, State Zip Code

Authorized Applicant Signature

Anti-Lobbying Amendment Certification

For all orders above the limit prescribed in 2 CFR 200 - Appendix II (currently $100,000), the Offeror must complete and sign the following:

The following certification and disclosure regarding payments to influence certain federal transactions are made per the provisions contained in 2 CFR 200 - Appendix II and 31 U.S.C.

1352, the "Byrd Anti-Lobbying Amendment."

(a ) 2 CFR 200 - Appendix II, "Contract Provisions for Non-Federal Entity Contracts Under Federal Awards" is hereby incorporated by reference into this certification

(b) The offeror, by signing its offer, hereby certifies to the best of his or her knowledge and belief that:

(1) No Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of

Congress on his or her behalf in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment or modification of any Federal contract, grant, loan, or cooperative agreement;

(2) If any funds other than Federal appropriated funds (including profit or fee received under a covered Federal transaction) have been paid, or will be paid, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress on his or her behalf in connection with this solicitation, the offeror shall complete and submit, with its offer, 0MB standard form LLL, Disclosure of Lobbying

Activities, to the Contracting Officer; and

(3) He or she will include the language of this certification in all subcontract awards at any tier and require that all recipients of subcontract awards in excess of $150,000 shall certify and disclose accordingly.

(c ) This certification is a material representation of fact upon which reliance is placed when this transaction was made or entered into. Submission of this certification and disclosure is a prerequisite for making or entering into this contract imposed by section 1352, title 31, United States Code. Any person making an expenditure prohibited under this provision or who fails to file or amend the disclosure form to be filed or amended by this provision, shall be subject to a civil penalty of not less than $10,000, and not more than $100,000, for each such failure.

Authorized Applicant Name (Print Full Name)

Authorized Applicant Signature Date

False Claims Act, 31 U.S.C. §3729-3733

(To Be Executed by Bidder and Submitted with Bid)

False Claims Statement: U.S. Code, Title 31, Section 3729, False Claims, provides a civil penalty of not less than $5,000 and not more than $10,000, plus 3 times the amount of damages for any person who knowingly presents, or causes to be presented, a false or fraudulent claim; or who knowingly makes, or caused to be used, a false record or statement; or conspires to defraud the Government by getting a false or fraudulent claim allowed or paid.

Conviction of false claims and statements may result in criminal and/or civil penalties. (18

U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)

User Acknowledgement and Certification:

I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate.

Authorized Applicant Name (Print Full Name)

Authorized Applicant Signature Date

Contractor’s and Subcontractor’s Questionnaire

All Contractors and Subcontractor’s must complete and return this form to:

BUCKS COUNTY

DEPARTMENT OF HOUSING & COMMUNITY DEVELOPMENT

NESHAMINY MANOR CENTER

1260 ALMSHOUSE ROAD

DOYLESTOWN, PA 18901

Attach a separate copy of this questionnaire for each subcontractor.

1. Name, Address, Telephone, e-mail address, Home Improvement Contractor Registration Number, and Employer Identification Number:

(Sole proprietors who do not have an EIN number, please provide Social-Security number)

2. Project Name, Location and Contract Number:

3. Type of Work to be Undertaken:

4. Amount of Contract: $________________

5. How Many Subcontractors will be Employed on this project:____________

6. Estimate Completion Date: ______________

7. The below information is used by HUD to monitor and evaluate awarded contracts against the total program activity and the designated as mandated by the Small Business Act (SBA).

The Department requires the information to provide guidance and oversight of programs for the development of small business, minority firms, businesses owned by disadvantaged persons, and women-owned firms.

Are any of the Principal Owners of the Contracting Firm:

a) A Resident of Bucks County: _________

b) Female: _________

c) Section 3: _________

d) A Member of a Minority Group: _________

If yes, please select the appropriate code below: ___________

Below are the Racial/Ethnic codes that are offered on HUD’s report.

1 = White Americans 2 = Black Americans

3 = Native Americans 4 = Hispanic Americans 5 = Asian/Pacific Americans 6 = Hasidic Jews

All Contractors and subcontractors undertaking projects funded through HCD will indicate the number of their employees, by race and sex, on this form. Include all employees of the firm, not just those working on the Community Development project.

SECTION 3 DEFINITIONS

Pursuant to 24 CFR 75.5, a Section 3 business concern, must meet at least one of the criteria set forth below which has been documented within a last six-month period:

(i) It is at least 51 percent owned and controlled by low- or very low-income persons;

(ii) Over 75 percent of the labor hours performed for the business over the prior three-month period are performed by Section 3 workers; or

(iii) It is a business at least 51 percent owned and controlled by current public housing residents or residents who currently live in Section 8-assisted housing.

A Section 3 Resident is defined as a public housing resident or an individual who resides in the metropolitan area or non-metropolitan county in which the Section 3 covered assistance is expended and who is considered to be a low-to very low-income person.

QUALIFYING AS A SECTION 3 BUSINESS

8. Does your business qualify as a Section 3 business concern?

RACIAL GROUP

# OF MALE

EMPLOYEES

# OF

HISPANIC

MALE

EMPLOYEES

# OF

FEMALE

EMPLOYEES

# OF

HISPANIC

FEMALE

EMPLOYEES

White

Black/African American

Asian

Other Race

More than One Race

Yes: Complete the chart below for all owners of the business (attach pages if needed).

No

Owner’s Name Home Address Household Size Household Income Percent Ownership

9. Does your business employ Section 3 or Targeted Section 3 workers?

Yes: Complete the chart below on employees qualifying as Section 3 or Targeted Section

3 Workers.

E Employee Name H Home Address Hou Household Size Hou Household Income D Date of Hire

10. Will your business sub-contract this contract with any business that has any of the characteristics noted in Questions 1 or 2?

Yes: Complete Chart C contracts with Section 3 qualifying businesses.

No

Section 3

SubContractor

Sub-Contractor

Business Address

Con Contact Person Percent of Contract awarded to Sub- Contractor

By signing below, I certify all information in this form is true and correct to the best of my knowledge.

Authorized Representative Signature and Title

Affirmative Action Plan

TO ENSURE EQUAL OPPORTUNITY IN HIRING AND EMPLOYMENT FOR ALL WORK

FUNDED THROUGH THE BUCKS CONTY HOUSING & COMMUNITY DEVELOPMENT

DEPARTMENT.

All contractors and sub-contractors agree to take the following actions:

1. Endorse the following statement: The undersigned contractor has agreed that it will not discriminate against any employee or applicant for employment because of race, color, religion, sex or national origin and will take affirmative action to insure that applicants are employed and that employees are treated during employment without regard to their race, color, religion, sex or national origin.

2. When hiring any subcontractors, to provide an opportunity for any minority businesses and women's business enterprises located within Bucks County to bid for the job. This includes:

a Placing qualified small and minority businesses and women's business enterprises on solicitation lists.

b Dividing total requirements, when economically feasible, into smaller tasks or quantities to permit maximum participation by small and minority businesses, and women's business enterprises;

c Establishing delivery schedules, where the requirement permits, which encourage participation by small and minority businesses, and women's business enterprises;

d Using the services and assistance, as appropriate, of such organizations as the Small

Business Administration and the Minority Business Development Agency of the Department of Commerce; and

3. Report to the Department of Housing & Community Development on the firm’s total employees, by race and sex.

4. Send a copy of this Affirmative Action Plan to any collective bargaining organization with which the contractor has an agreement.

5. Post the Equal Opportunity Poster and this Affirmative Action Plan in conspicuous location available to employees.

(Name of Firm) _____________________________ hereby agrees to abide by the provisions of this Affirmative Action Plan.

Authorized Representative Signature and Title