2-Documents to be completed by each bidder.pdf

QUALIFICATIONS OF BIDDER QUESTIONNAIRE

BOROUGH OF DEER LAKE

SCHUYLKILL COUNTY, PENNSYLVANIA

DEER LAKE DAM D54-112 – DAM SPILLWAY REPAIRS

1. Company Name:

Address:

Phone: Contact Person:

2. Do you have the necessary facilities, experience and financial resources to perform the work in a satisfactory manner and within the time stipulated? Circle One:

Yes No

3. What is the longest delivery date of any equipment and/or materials?

4. Do you maintain a permanent place of business? Circle One:

Address: (if same as above, write same)

5. Do you have adequate plant equipment to do the work properly and expeditiously?

Circle One:

List major pieces of equipment to be used on this project:

List number of crews to be assigned on this project and the number of men in each crew.

6. Do you have suitable financial status to meet obligations incident to the work? Attach latest financial statement. Do not prepare a new one. Circle One:

Yes No

Name of Banker:

Phone Number:

7. Have you ever failed to complete any work awarded to you? Circle One:

If yes, describe the work and provide the reason for not completing the work:

8. Have you ever defaulted on a Contract? Circle One:

If yes, describe the work and provide the reason for defaulting:

9. Within the past two years have you not been paid in full for work performed?

Circle One:

If yes, describe the work and provide name, address and phone number of Municipality/Agency that refused payment to your firm:

10. List present contracts and the approximate bid amount that you have bid this year, along with the status of each bid, i.e. bid not yet opened, apparent low bidder, awarded the contract, not awarded the contract, etc. If necessary, provide the list on a separate sheet(s) of paper.

Project Name Bid Amount Status of Bid

11. Do you have appropriate technical experience? Circle One:

Give brief statement:

Name of Superintendent to be assigned to this project:

Name:

Years & type of experience:

Name(s) of foremen to be assigned to this project:

Years & type of experience:

12. Name, address, phone number, contact person, type of construction, and dollar amount of most recent, previously performed contracts of similar nature.

Name of Contract:

Contact Person: (Owner or Engineer)

Phone Number: ( )

Type of Construction Work:

Contract Amount:

Date Completed:

Name of Contract:

Contact Person: (Owner or Engineer)

Phone Number: ( )

Type of Construction Work:

Contract Amount:

Name of Contract:

Contact Person: (Owner or Engineer)

Phone Number: ( )

Type of Construction Work:

Contract Amount:

13. Have you ever been a party to, or otherwise been involved in any action or legal proceeding involving matters related to race, color, nationality, or religion? Circle One:

If yes, give full details:

14. Have you ever been accused of discrimination based upon race, color, nationality, or religion in any action of legal proceeding, including any proceeding related to any Federal Agency? Circle One:

If yes, give full details:

NOTE: BIDDER shall attach a list of similar projects completed, per Qualifications of Contractor requirements in various sections of the Technical Specifications and/or the Instructions to Bidders.

This Questionnaire to be signed by an authorized representative of Bidder:

Title:

Date:

Notarization

State of _________________________________, County of _______________________, being duly sworn, deposes and says that he is ____________________________ of (Title)

______________________________________, and that the answers to the foregoing questions

(Name of Organization) and all statements therein contained are true and correct.

Sworn to and subscribed before me this _____ day of ________________________, 20____.

Notary Public

My Commission Expires __________________________

BID FORM

ARTICLE 10 – BID SUBMITTAL

10.01 This Bid is submitted by:

Contact Information of Individual Preparing Bid

Contact Person Name:

Contact Person Title:

Business Address:

Federal Tax ID No.:

Telephone No.:

Fax No.:

E-mail Address:

SUBMITTED on , 20 .

State Contractor License No. . [If applicable]

If Bidder is:

An Individual

Name (typed or printed):

By:

(Individual’s signature)

Doing business as:

A Partnership

Partnership Name:

By:

(Signature of general partner -- attach evidence of authority to sign)

Name (typed or printed):

A Corporation

Corporation Name:

State of Incorporation:

Type (General Business, Professional, Service, Limited Liability):

By:

(Signature -- * see note below)

(CORPORATE SEAL)

Attest (* see note below)

Date of Qualification to do business in Pennsylvania is / / .

* The President’s or Vice-President’s signature must be attested by the Corporate Secretary or

Treasurer. If any employee other than the President or Vice-President signs on behalf of the Corporation, or if the President’s or Vice-President’s signature is not attested to by the Secretary or Treasurer, a copy of the corporate resolution authorizing said signature must be attached to this Bid.

Failure to attach a copy of the appropriate authorization, if required, may result in rejection of the Bid.

A Joint Venture

Name of Joint Venture:

First Joint Venturer Name: (SEAL)

(Signature of first joint venture partner -- attach evidence of authority to sign)

Second Joint Venturer Name: (SEAL)

(Signature of second joint venture partner -- attach evidence of authority to sign)

(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.)

LIST OF SUBCONTRACTORS

Subcontractor's Name & Address Portion of Work Assigned

Firm's Name:

Signature: Title:

(Authorized Representative)

S E A L

LIST OF SUPPLIERS

Supplier’s Name & Address Materials Supplied

Firm's Name:

Signature: Title:

(Authorized Representative)

REFERENCE FORM

Note: This reference form shall be completed and submitted by the Bidder and all subcontractors.

Name of Bidder or Subcontractor:

1. Company Name:

Contact Person:

Telephone: FAX:

Email Address:

2. Company Name:

3. Company Name:

INSTRUCTIONS FOR NON-COLLUSION AFFIDAVIT

1. This Non-Collusion Affidavit is material to any contract awarded pursuant to this bid. According to the

Pennsylvania Antibid-Rigging Act, 73 P.S. 1611 et seq., governmental agencies may require Non- Collusion Affidavits to be submitted together with bids.

2. This Non-Collusion affidavit must be executed by the member, officer, or employee of the bidder who makes the final decision on prices and the amount quoted in the bid.

3. Bid rigging and other efforts to restrain competition, and the making of false sworn statements in connection with the submission of bids are unlawful and may be subject to criminal prosecution. The person who signs the Affidavit should examine it carefully before signing and assure himself or herself that each statement is true and accurate, making diligent inquiry, as necessary, of all other persons employed by or associated with the bidder with responsibilities for the preparation, approval, or submission of the bid.

4. In the case of a bid submitted by a joint venture, each party to the venture must be identified in the bid documents, and an Affidavit must be submitted separately on behalf of each party.

5. The term "complementary bid" as used in the Affidavit has the meaning commonly associated with that term in the bidding process, and includes the knowing submission of bids higher than the bid of another firm, any intentionally high or noncompetitive bid, and any other form of bid submitted for the purpose of giving a false appearance of competition.

6. Failure to file an Affidavit in compliance with these instructions will result in disqualification of the bid.

NON-COLLUSION AFFIDAVIT

Contract/Bid No.

State of Pennsylvania :

: s.s

County of :

I state that I am of

(Title) (Name of Firm) and that I am authorized to make this affidavit on behalf of my firm, and its owners, directors, and officers. I am the person responsible in my firm for the price(s) and the amount of this bid.

I state that:

(1) The price(s) and amount of this bid have been arrived at independently and without consultation, communication, or agreement with any other contractor, bidder, or potential bidder.

(2) Neither the price(s) nor the amount of this bid, and neither the approximate price(s) nor approximate amount of this bid, have been disclosed to any other firm or person who is a bidder or potential bidder, and they will not be disclosed before bid opening.

(3) No attempt has been made or will be made to induce any firm or person to refrain from bidding on this contract, or to submit a bid higher than this bid, or to submit any intentionally high or noncompetitive bid.

(4) The bid of my firm is made in good faith and not pursuant to any agreement or discussion with, or inducement from, any firm or person to submit a complementary or other noncompetitive bid.

(5) , its affiliates, (Name of Firm) subsidiaries, officers, directors, and employees are not currently under investigation by any governmental agency and have not in the last four (4) years been convicted or found liable for any act prohibited by State or Federal law in any jurisdiction, involving conspiracy or collusion with respect to bedding on any public contract, except as follows:

NON-COLLUSION AFFIDAVIT

I state that understands

(Name of Firm) and acknowledges that the above representations are material and important, and will be relied on by the Borough of Deer Lake in awarding the contract(s) for which this bid is submitted. I understand and my firm understands that any misstatement in this affidavit is and shall be treated as fraudulent concealment from the Borough of Deer Lake of the true facts relating to the submission of bids for this contract.

(Name and Company Position)

SWORN TO AND SUBSCRIBED

BEFORE ME THIS

DAY OF , 20

My Commission Expires

Notary Public

PENAL SUM FORM

EJCDC® C-430, Bid Bond (Penal Sum Form). Published 2013.

Prepared by the Engineers Joint Contract Documents Committee.

BID BOND

Any singular reference to Bidder, Surety, Owner or other party shall be considered plural where applicable.

BIDDER (Name and Address):

SURETY (Name, and Address of Principal Place of Business):

OWNER (Name and Address):

Borough of Deer Lake

Deer Lake Borough Municipal Building

238 Lake Front Drive

Orwigsburg, Pennsylvania 17961

BID

Bid Due Date: November 11, 2025

Description (Project Name— Include Location): Deer Lake Dam D54-112 – Dam Spillway Repairs, Borough of Deer Lake, Schuylkill County, Pennsylvania

BOND (Ten Percent (10%) of Total Bid Submitted)

Bond Number:

Date:

Penal sum $

(Words) (Figures)

Surety and Bidder, intending to be legally bound hereby, subject to the terms set forth below, do each cause this Bid Bond to be duly executed by an authorized officer, agent, or representative.

BIDDER SURETY

(Seal) (Seal)

Bidder’s Name and Corporate Seal Surety’s Name and Corporate Seal

By: By:

Signature Signature (Attach Power of Attorney)

Print Name Print Name

Title Title

Attest: Attest:

Signature Signature

Title Title

Note: Addresses are to be used for giving any required notice.

Provide execution by any additional parties, such as joint venturers, if necessary.

PENAL SUM FORM

EJCDC® C-430, Bid Bond (Penal Sum Form). Published 2013.

Prepared by the Engineers Joint Contract Documents Committee.

1. Bidder and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors, and assigns to pay to Owner upon default of Bidder the penal sum set forth on the face of this Bond. Payment of the penal sum is the extent of Bidder’s and Surety’s liability. Recovery of such penal sum under the terms of this Bond shall be Owner’s sole and exclusive remedy upon default of Bidder.

2. Default of Bidder shall occur upon the failure of Bidder to deliver within the time required by the Bidding Documents (or any extension thereof agreed to in writing by Owner) the executed Agreement required by the Bidding Documents and any performance and payment bonds required by the Bidding Documents.

3. This obligation shall be null and void if:

3.1 Owner accepts Bidder’s Bid and Bidder delivers within the time required by the Bidding Documents (or any extension thereof agreed to in writing by Owner) the executed Agreement required by the Bidding Documents and any performance and payment bonds required by the Bidding Documents, or

3.2 All Bids are rejected by Owner, or

3.3 Owner fails to issue a Notice of Award to Bidder within the time specified in the Bidding Documents (or any extension thereof agreed to in writing by Bidder and, if applicable, consented to by Surety when required by

Paragraph 5 hereof).

4. Payment under this Bond will be due and payable upon default of Bidder and within 30 calendar days after receipt by

Bidder and Surety of written notice of default from Owner, which notice will be given with reasonable promptness, identifying this Bond and the Project and including a statement of the amount due.

5. Surety waives notice of any and all defenses based on or arising out of any time extension to issue Notice of Award agreed to in writing by Owner and Bidder, provided that the total time for issuing Notice of Award including extensions shall not in the aggregate exceed 120 days from the Bid due date without Surety’s written consent.

6. No suit or action shall be commenced under this Bond prior to 30 calendar days after the notice of default required in

Paragraph 4 above is received by Bidder and Surety and in no case later than one year after the Bid due date.

7. Any suit or action under this Bond shall be commenced only in a court of competent jurisdiction located in the state in which the Project is located.

8. Notices required hereunder shall be in writing and sent to Bidder and Surety at their respective addresses shown on the face of this Bond. Such notices may be sent by personal delivery, commercial courier, or by United States Registered or

Certified Mail, return receipt requested, postage pre-paid, and shall be deemed to be effective upon receipt by the party concerned.

9. Surety shall cause to be attached to this Bond a current and effective Power of Attorney evidencing the authority of the officer, agent, or representative who executed this Bond on behalf of Surety to execute, seal, and deliver such Bond and bind the Surety thereby.

10. This Bond is intended to conform to all applicable statutory requirements. Any applicable requirement of any applicable statute that has been omitted from this Bond shall be deemed to be included herein as if set forth at length. If any provision of this Bond conflicts with any applicable statute, then the provision of said statute shall govern and the remainder of this Bond that is not in conflict therewith shall continue in full force and effect.

11. The term “Bid” as used herein includes a Bid, offer, or proposal as applicable.

COMMONWEALTH OF PENNSYLVANIA

PUBLIC WORKS EMPLOYMENT VERIFICATION FORM

Date _______________________

Business or Organization Name (Employer)_________________________________________________

Address _____________________________________________________________________________

City _____________________________________ State_____________ Zip Code ________________

Contractor {dzōŎƻƴǘNJŀŎǘƻNJ όŎƘŜŎƪ ƻƴŜύ

Contracting Public Body _______________________________________________________________

Contract/Project No ___________________________________________________________________

Project Description ____________________________________________________________________

Project Location ______________________________________________________________________

As a contractor/subcontractor for the above referenced public works contract, I hereby affirm that as of the above date, our company is in compliance with the Public Works Employment Verification Act

(‘the Act’) through utilization of the federal E‐Verify Program (EVP) operated by the United States

Department of Homeland Security. To the best of my/our knowledge, all employees hired post

January 1, 2013 are authorized to work in the United States.

It is also agreed to that all public works contractors/subcontractors will utilize the federal EVP to verify the employment eligibility of each new hire within five (5) business days of the employee start date throughout the duration of the public works contract. Documentation confirming the use of the federal EVP upon each new hire shall be maintained in the event of an investigation or audit.

I, _________________________, authorized representative of the company above, attest that the information contained in this verification form is true and correct and understand that the submission of false or misleading information in connection with the above verification shall be subject to sanctions provided by law.

Authorized Representative Signature

1. NONDISCRIMINATION/SEXUAL HARASSMENT

a. Representations. The Grantee represents that it is presently in compliance with and will remain in compliance with all applicable federal, state, and local laws, regulations, and policies relating to nondiscrimination and sexual harassment for the term of the agreement. The Grantee shall, upon request and within the time periods requested by the Commonwealth, furnish all necessary employment documents and records, including EEO-1 reports, and permit access to its books, records, and accounts by the Commonwealth for the purpose of ascertaining compliance with provisions of this Nondiscrimination/Sexual Harassment Clause.

b. Nondiscrimination/Sexual Harassment Obligations. The Grantee shall not:

i. in any manner discriminate in the hiring of any employee(s) for the performance of the activities required under this agreement or any subgrant agreement, contract, or subcontract, by reason of race, gender, creed, color, sexual orientation, gender identity or expression, or in violation of the Pennsylvania Human Relations Act (“PHRA”) and applicable federal laws, against any citizen of this Commonwealth who is qualified and available to perform the work to which the employment relates.

ii. in any manner discriminate by reason of race, gender, creed, color, sexual orientation, gender identity or expression, or in violation of the PHRA and applicable federal laws, against or intimidate any of its employees.

iii. in any manner discriminate by reason of race, gender, creed, color, sexual orientation, gender identity or expression, or in violation of the PHRA and applicable federal laws, in the provision of services under this agreement or any subgrant agreement, contract, or subcontract.

iv. in any manner discriminate by reason of race, gender, creed, color, sexual orientation, gender identity or expression, or in violation of PHRA and applicable federal laws, against any subgrantee, contractor, subcontractor, or supplier who is qualified to perform the work to which this agreement relates.

v. in any manner discriminate against employees by reason of participation in or decision to refrain from participating in labor activities protected under the Public Employee Relations Act, Pennsylvania Labor Relations Act, or National Labor Relations Act, as applicable, and to the extent determined by entities charged with the Acts’ enforcement and shall comply with any provision of law establishing organizations as employees’ exclusive representatives.

c. Establishment of Grantee Policy. The Grantee shall establish and maintain a written nondiscrimination and sexual harassment policy that complies with the applicable law and these Nondiscrimination/Sexual Harassment provisions and shall inform its employees in writing of the policy. The policy must contain a provision that states that sexual harassment will not be tolerated and employees who practice it will be disciplined.

For the entire period of this agreement, the Grantee shall: (1) post its written nondiscrimination and sexual harassment policy or these Nondiscrimination/Sexual Harassment provisions conspicuously in easily accessible and well-lighted places customarily frequented by employees at or near where the grant activities are performed;

or (2) provide electronic notice of the policy or this clause to its employees not less than annually.

d. Notification of Violations. The Grantee’s obligations pursuant to these provisions are ongoing from the effective date and through the termination date of the agreement.

Accordingly, the Grantee shall notify the Commonwealth if, at any time during the term of this agreement, it becomes aware of any actions or occurrences that would result in violation of these provisions.

e. Cancellation or Termination of Agreement. The Commonwealth may cancel or terminate this agreement and all money due or to become due under this agreement may be forfeited for a violation of the terms and conditions of these Nondiscrimination/Sexual Harassment provisions. In addition, the granting agency may proceed with debarment or suspension and may place the Grantee in the Contractor Responsibility File.

f. Subgrant Agreements, Contracts, and Subcontracts. The Grantee shall include these Nondiscrimination/Sexual Harassment provisions in its subgrant agreements, contracts, and subcontracts with all subgrantees, contractors, and subcontractors providing goods or services under this agreement. The incorporation of these provisions in the Grantor’s subgrants, contracts, or subcontracts does not create privity of contract between the Commonwealth and any subgrantee, contractor, or subcontractor, and no third-party beneficiaries are created by those provisions. If the Grantee becomes aware of a subgrantee’s, contractor’s, or subcontractor’s violation of these provisions, the Grantee shall use its best efforts to ensure the subgrantee’s, contractor’s, or subcontractor’s compliance with these provisions.

Signature Date

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