2-MS-944 Documents - Oak Street.xls
XLS spreadsheet 446 KB Posted
- Attached to
- Oak Street
- Solicitation number
- Not on record
- Issued by
- Dauphin County, Pennsylvania
About this file
This file is a Project Instructions document and associated contract forms issued by Pennsylvania's Municipal Services for the Borough of Millersburg in Dauphin County for the Oak Street repaving project. The project involves the repaving of Oak Street from Church Street to Blosser, including milling, base repair, overlay work, and the installation of rolled curbs on both sides of the street. Sealed bids must be submitted electronically via PennBid at https://pennbid.bonfirehub.com by 3:00 PM on July 22, 2026, with bids to be opened and read at approximately 6:00 PM on the same date. The project is located at Oak Street, Millersburg, PA 17061, and the work scope includes approximately 734 square yards of pavement excavation and 92 tons of 1.5" Superpave 9.5mm PG64-22 material. The contract completion timeline is specified in Attachment 1-A, with an expected project conclusion by October 31, 2026.
The Borough of Millersburg is funded through State Liquid Fuels Funds for this project. Bidders must submit proposals using the municipality-furnished Form MS-944, accompanied by a certified check or bid bond as a proposal guarantee, with specific bid security amounts to be determined by the municipality based on municipal classification. The successful bidder must provide a performance bond and payment bond equal to 100 percent of the contract value within 20 days of award, along with an affidavit accepting the provisions of the Workmen's Compensation Act. Liquidated damages are assessed at $500.00 per calendar day for non-compliance. All bidders must submit a completed Form 7126 Anti-Collusion Affidavit with their bid proposal as required by Publication 408. The municipality reserves the right to reject any or all proposals and to waive any informalities in the bidding process.
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|---|---|---|
| 1-Oak Street 2026.pdf |
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Text version
PROJECT INSTRUCTIONS
| (Rev.1-14) |
| DIRECTIONS FOR BIDDING, ADVERTISING, EXECUTION AND COMPLETION OF |
| CONTRACTS USING STATE LIQUID FUELS FUNDS. |
| Attached for your convenience in advertising, awarding and completing a contract for the proposed project in your municipality are the following forms: |
| Step 1. (1) Copy of MS-329, Project Approval form, issued by Municipal Representative during initial appointment to set-up project. |
| Step 2. (2) Copies of the - Form of Advertisement, on which it will be necessary to insert the actual time and date that bids are to be opened. |
| ADVERTISING REQUIREMENTS - Recent amendments to the various municipal codes, relating to bidding and advertising requirements, necessitate a constant review by respective municipalities to insure compliance. |
| Step 3. (2) Copies of MS-981. Attach to each, a copy of the newspaper advertisement; record the name and address of each bidder and the amount of their bid. Record to whom the contract was awarded, their address, and the dollar amount. |
| Please have the proper officials and yourself sign the resolution at the bottom of the MS-981. Place your municipal seal where designated and forward one (1) copy to this office as soon as possible after bid opening. An acceptance resolution must be part of your municipality’s minutes. |
| Step 4. (3) Copies of MS-339 Application for County Aid (for municipalities who are eligible for county aid). First - Municipal Secretary to complete Section 1 and forward all copies to the County, Next - County to complete Section 2 and immediately return all copies to Municipal Services for approval. |
| Step 5. (2) Copies of Form MS - 944 Proposal and Contract, Proposal and Contract Instructions - Form 944, Attachment 1- Schedule of Prices, Special Provisions to Contract MS-944 (Attachment “1-A”). One copy of each will be furnished to each prospective bidder to be used as a proposal, when completed by the municipality. As required by Publication 408, Section 102.06(e),each bidder must submit a completed Form 7126 - Anti-Collusion Affidavit with its bid proposal. |
| Step 6. (2) Copies of Attachment 2 - Performance Bond, Attachment 3 – Payment Bond, Attachment 4 – Affidavit RE Accepting Provisions of the Workmen’s Compensation Act, and Form MS – NCP - Notice of Completion. One copy of each will be completed by the successful bidder and returned to the municipality. Return an executed copy of the MS-944 Proposal and Contract, and Bonds to the contractor. |
| At this point return one (1)-completed copy of all the above documents to this office, and keep a completed copy for your files. |
| Upon project completion, an itemized final invoice and completed NCP Form are required to be supplied to the municipality from the contractor. Send a copy to the Municipal Services Unit and call us for a final inspection. A representative will set up a final inspection appointment. After the final inspection and approval of the project, an MS-999 Final Completion Report will be issued the municipality for signature and seal. Return all completed copies of MS-999 to Municipal Services for signature. An approved copy will be returned for your records. |
ADVERTISEMENT
FORM OF
ADVERTISEMENT
| Sealed proposals will be received by the: | |||||||
| Borough of Millersburg | of | Dauphin County | |||||
| (City, Borough, Twp.: 1st. Cl. or 2nd Cl.) | (County) | ||||||
| at | 101 West Street, Millersburg, PA 17061 | Millersburg, PA 17061 | |||||
| (Address) | |||||||
| until | 3:00 PM | ,on | July 22, 2026 | , for the following: | |||
| (Time) | (Month-Day-Year) | ||||||
| Options | Item Number | Quantity | Unit | Description | |||
| (NOTICE TO ADVERTISER, #N/A Indicates there is no information on that line.) | |||||||
| Liquidated damages apply at the rate of $ | 500.00 | per calendar day. | |||||
| Proposals must be upon the forms furnished by the Municipality. | |||||||
| For third class cities the bid must be accompanied by a certified check or bid bond in the amount of 10 % of the | |||||||
| bid, made payable to the municipality. For other municipal types it is the discretion of the municipality. | |||||||
| A performance bond or certified check in the amount of 100% of the contract shall be furnished by the | |||||||
| successful bidder within 20 days after the contract is awarded. | |||||||
| The Municipality reserves the right to reject any or all proposals. | |||||||
| (City, Borough, Twp: 1st. Cl. Or 2nd Cl. | |||||||
| BY: | |||||||
| (Name) | |||||||
| (Title) | |||||||
| (Date) | |||||||
| THIS ADVERTISEMENT ENDS HERE | |||||||
| FOR DEPARTMENT USE ONLY | |||||||
| This advertisement meets the requirements of regulation 1300. |
MS-981
| MS-981 (7-09) | |||||||||
| First Edition | |||||||||
| County: | Dauphin County | Bids Open: | 6:00 PM | ||||||
| Municipality: | Borough of Millersburg | Date: | July 22, 2026 | ||||||
| ATTACH | |||||||||
| NEWSPAPER | Project Advertised | Newspaper | |||||||
| CLIPPING | 1 st Date | Daily | |||||||
| 2nd Date | Weekly | ||||||||
| HERE | |||||||||
| AND RETURN TO | |||||||||
| One Bidder Only | |||||||||
| BIDDER | ADDRESS | AMOUNT | |||||||
| CONTRACT AWARDED TO: | |||||||||
| Remarks: | |||||||||
| DATE | : | ||||||||
| Resolution: The Officials of | Borough of Millersburg | by majority action have accepted the Low bid and awarded | |||||||
| the contract as indicated above. | |||||||||
| Chairman-President of Council-Mayor | |||||||||
| Supervisor-Other Official | |||||||||
| Supervisor- Other Official | |||||||||
| Secretary-Seal |
PROPOSAL & CONTRACT PG. 1
| MS-944 (7-09) | ||||||||
| PROPOSAL AND CONTRACT | ||||||||
| ( WHEN EXECUTED ) | THIS PROPOSAL INCLUDES | |||||||
| INSTRUCTIONS TO BIDDERS | ||||||||
| INSTRUCTIONS ON PAGE 4 | ||||||||
| A. DEPOSIT OF PROPOSALS. | ||||||||
| All proposals must be submitted electronically | Borough of Millersburg | |||||||
| via PennBid at https://pennbid.bonfirehub.com by | MUNICIPALITY (NAME & TYPE) | |||||||
| July 22, 2026 | ." | |||||||
| . | DATE | James Whitall | ||||||
| SECRETARY | ||||||||
| Sealed Proposals will be received on or before | ||||||||
| 3:00 PM | on the above Letting Date. | 101 West Street | ||||||
| TIME | Millersburg, PA 17061 | |||||||
| ADDRESS | ||||||||
| Bids will be opened and read at approximately | ||||||||
| 6:00 PM | , on the above Letting Date. | PROPOSALS MUST BE submitted electronically | ||||||
| TIME | via PennBid at https://pennbid.bonfirehub.com | |||||||
| 1 | The contractor proposes to furnish and deliver all materials ( including Form CS-4171, CERTIFICATE OF COMPLIANCE and/ or TR-465 DAILY BITUMINOUS MIXTURE CERTIFICATION ) and to do and perform all work on the following project as more specifically set forth in the Schedule of Prices (Attachment), in accordance with drawings | |||||||
| and specifications on file at | PennBid at https://pennbid.bonfirehub.com | as well as the supplements | ||||||
| and special requirements contained herein and/ or attached hereto and current PennDOT Specifications (Publication 408), except (a) bidders need not be prequalified by PennDOT (Sec.102.01), and (b) Volumetric testing of bituminous paving materials is not required (Sec. 409). | ||||||||
| 2 | If designated as the successful bidder, the contractor will begin work on the date specified in the notice to proceed, or as otherwise provided in the special requirements, and will | |||||||
| complete all work within | see attachment 1-A | calendar days. | ||||||
| 3 | Accompanying this proposal is a certified check or bid bond in the amount of | N/A | ||||||
| made payable to the municipality as a proposal guarantee which, it is understood, will be | ||||||||
| forfeited in case the contractor fails to comply with the requirements of the proposal. | ||||||||
| B. PROPOSAL OF: | ||||||||
| NAME / ADDRESS OF CONTRACTOR | ||||||||
| CONTRACTORS CERTIFICATION | ||||||||
| It is hereby certified as follows: | ||||||||
| 1 | The only person interested in the proposal as principal (s) is (are): | |||||||
| 2 | None of the above persons are employees of the municipality. | |||||||
| 3 | This proposal is made without collusion with any other person, firm or corporation. | |||||||
| 4 | All plans and specifications referred to above and the site of the work have been examined by the contractor. The contractor understands that the quantities indicated herein are approximate and are subject to change as may be required; and that all work is payable on the basis of the unit price listed on the Schedule of Prices. (Attachment 1). | |||||||
| -1- |
PennBid at https://pennbid.bonfirehub.com
PROPOSAL & CONTRACT PG. 2
| 5 | The contractor will comply with all requirements of the laws and implementing regulations of the Commonwealth of Pennsylvania and the United States relating to human relations, equal opportunity and non-discrimination in employment, and will pay to workmen employed in the performance of the contract the wages to which they may be entitled. | ||||
| 6 | The contractor will provide the municipality with a performance bond, conditioned upon the faithful performance of the contract in accordance with the plans, specifications and conditions thereof, and a payment bond, conditioned on the prompt payment of all material furnished and labor supplied or performed in the prosecution of the work, in accordance with the Public Works Contractors’ Bond Law of 1967; and an affidavit accepting the provisions of the Workmen’s Compensation Act of 1915, as amended. | ||||
| 0 | |||||
| 0 | |||||
| CONTRACTOR | |||||
| BY: | DATE: | ||||
| TITLE: | |||||
| WITNESSED OR ATTESTED BY: | DATE: | ||||
| TITLE: | |||||
| TO BE EXECUTED ONLY IN THE EVENT THE ABOVE PROPOSAL IS ACCEPTED | |||||
| ACCEPTED ON : | |||||
| DATE | |||||
| Borough of Millersburg | |||||
| MUNICIPALITY | |||||
| BY: | |||||
| TITLE: | |||||
| BY: | |||||
| TITLE: | |||||
| BY: | |||||
| TITLE: | |||||
| ATTESTED BY: | |||||
| TITLE: | |||||
| -2- |
SEAL
ATTACHMENT 1 PG. 3 (5)
| ATTACHMENT 1 | |||||||
| TO MS - 944 ( PROPOSAL AND CONTRACT MS - 944 ) | |||||||
| County: | Dauphin County | Municipality: | Borough of Millersburg | ||||
| Project Number: | 2026-02 | ||||||
| LOCATION OF WORK: | |||||||
| THIS PORTION TO BE COMPLETED | |||||||
| BY THE MUNICIPALITY | Oak Street, Millersburg, PA 17061 | ||||||
| DESCRIPTION OF WORK: | |||||||
| Repaving of Oak Street in Millersburg Borough from Church Street to Blosser. Includes milling, base reapir, and overlay. Rolled curbs on both sides of the street. | |||||||
| ESCALATOR CLAUSE:( if adopted by Municipality.) | |||||||
| SCHEDULE OF PRICES | |||||||
| Item | |||||||
| 1 No. | Approximate | ||||||
| 2 Quantities | Unit | ||||||
| 3 | *Description | ||||||
| 4 | Unit | ||||||
| 5 Price | Total |
| 1 | Paving | ||
| 1.A | 734 | SY | Pavement Excavation |
| 1.B | 92 | Ton | 1.5" Superpave 9.5mm PG64-22 <0.3M ESALS |
| 1.C | 70 | Ton | 4" Superpave 25mm, PG 64-22 <0.3M ESALS |
| 1.D | 20 | Ton | 2A Stone -Base Repair |
| 1.E | 400 | LF | Rolled Curb |
| * DESCRIPTION: |
Must include ADT on wearing surfaces
USE OF CUTBACK ASPHALT IS PROHIBITED
BETWEEN MAY 1st AND OCTOBER 31st, EXCEPT
AS NOTED IN BULLETIN NO. 25.
FOR OPTION OR PHASE BIDS THE TOTALS FOR
| EACH MUST BE INCLUDED. | TOTAL | ||
| SUBTOTAL FROM OTHER ATTACHMENTS | |||
| BID TOTAL FOR A NON OPTION / PHASE BID | |||
| OPTION 1 OR PHASE 1 BID TOTAL | |||
| OPTION 2 OR PHASE 2 BID TOTAL | |||
| EACH MUST BE INCLUDED. | OPTION 3 OR PHASE 3 BID TOTAL | ||
| - 3 - |
ATTACHMENT 1-A
| (5-06) | SPECIAL PROVISIONS TO CONTRACT MS-944 ( Attachment 1-A ) | ||||||||
| CONTAINS IMPORTANT INFORMATION FOR THE CONTRACTOR | |||||||||
| The Prime Contractor and subcontractors must comply with all of the following provisions | |||||||||
| that are marked with an "X". | |||||||||
| x | Traffic Control and Safety Devices to be provided by the Contractor. | ||||||||
| ( Maintenance and Protection of Traffic to comply with current MUTCD, Publication 212 and Publication 213.) | |||||||||
| x | Delivery tickets for all materials. | ||||||||
| x | CS-4171 Certificate of Compliance and/ or TR-465 Daily Bituminous Mixture Certification required for all materials. | ||||||||
| x | Notify the Municipality | four | working days prior to start of project. | ||||||
| x | Work to be completed on or before | 12/31/26 | . After | 1/1/27 | Liquidated damages apply at | ||||
| the rate of $ | 500.00 | per calendar day. | |||||||
| x | Roadway to be power broomed by | (contractor | x | municipality | )prior to start of project. | ||||
| x | Excess material to be removed by | (contractor | x | municipality | .) | ||||
| x | Municipality to inspect project. | ||||||||
| x | Need Bill of Lading for each shipment of bituminous material per Section 702.1(c) of Specifications 408. | ||||||||
| Tack Coat required per Section 460, or 409 for superpave, of Specifications 408 and is incidental to | |||||||||
| paving item unless noted otherwise. | |||||||||
| Prime Coat required per Section 461 of Specifications 408. | |||||||||
| Bituminous Seal on all abutting pavement and curbs required. | |||||||||
| x | Saw cut or Milled Paving Notch required and incidental to paving item unless noted otherwise. | ||||||||
| Scratch/ Leveling Courses to be placed at the discretion of appointed inspector(s). | |||||||||
| Full width pavement with one pass required. | . | ||||||||
| x | Municipality reserves the right to limit work completed. | ||||||||
| Taper pavement the last 3 feet to curb. | |||||||||
| For FOB Source bids, hauling distance will determine selection of bid award. | |||||||||
| Municipality reserves the right to procure material which best suits their requirements after all bids and | |||||||||
| items are reviewed. | |||||||||
| x | Incidental Preparation and clean up required. ( Project Construction Materials ) | ||||||||
| The municipality reserves the right to make an award on the basis of the aggregate total for all like | |||||||||
| items on which quotations are received. | |||||||||
| x | Provide design, which meets Specifications Form 408 to the municipality 5 days prior to start of work. | ||||||||
| x | Contractor responsible for defects that occur within one year of applications. | ||||||||
| Contractor required to review proposed project with Municipality’s Representative prior to bidding. | |||||||||
| x | Oil Samples required from each distributor truck by contractor (1) one quart : A.M. & P.M. and | ||||||||
| witnessed by municipality and retained by municipality. (Oil samples must be placed in an | |||||||||
| approved type container that is compatible with oil sample.) | |||||||||
| At least three random stone samples to be taken by contractor on project site witnessed by | |||||||||
| municipality and retained by municipality. | |||||||||
| Complete all testing in accordance with Specification Form 408 Section 409 except for superpave | |||||||||
| volumetric testing. | |||||||||
| Notice to Proceed will be the date of Contract acceptance. | |||||||||
| x | Final Completion Certificate & Notice of Completion required. | ||||||||
| x | Future award of Contract will be based on quality of work as determined by the municipality. | ||||||||
| Contractor, notify all residents of pending work to be performed. | |||||||||
| My signature signifies that I have read and understand the above special provisions to this | |||||||||
| contract, and by being authorized by this company to act as their authorized representative, and | |||||||||
| on their behalf hereby agree to adhere to any and all of the provisions pertaining to this contract. | |||||||||
| Contractor's Representative | Date | Municipality's Representative Date | |||||||
| Borough of Millersburg | |||||||||
| Company | Municipality |
PERFORMANCE BOND PG. 1
| MS-944-S (7-09) | PERFORMANCE BOND | |||||||
| Attachment 2 | (With Corporate Surety) | |||||||
| KNOW ALL MEN BY THESE PRESENTS, That we, | ||||||||
| 0 | ||||||||
| (NAME AND ADDRESS OF CONTRACTOR) | ||||||||
| as Principal and | ||||||||
| (SURETY COMPANY) | ||||||||
| a corporation incorporated under the laws of the State of | as Surety | |||||||
| (NAME OF STATE) | ||||||||
| are held and firmly bound unto | in the full and just sum of | |||||||
| (NAME OF MUNICIPALITY) | ||||||||
| ($ | ) | dollars | ||||||
| lawful money to the United States of America, to be paid to the above Municipality or its assigns, to which payment well and truly to be | ||||||||
| made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. | ||||||||
| WHEREAS, the above bounden Principal has entered into a contract with the above Municipality, bearing even date herewith, for | ||||||||
| the undertaking of certain obligations as therein set forth. | ||||||||
| NOW, THEREFORE, the condition of this obligation is such that if the above bounden Principal, as Contractor, shall in all | ||||||||
| respects comply with and faithfully perform the terms and conditions of said Contract, including the Specifications and conditions referred | ||||||||
| to and made a part thereof, and such alterations as may be made in said Specifications as therein provided, and shall well and truly, and in | ||||||||
| a manner satisfactory to the municipality fulfill all obligations as therein set forth, then this Obligation shall be void, but otherwise the same | ||||||||
| shall be and remain in full force, virtue and effect. | ||||||||
| It is further provided that any alteration which may be made in the terms of the contractor or its specifications with the express | ||||||||
| approval of the Municipality or the Principal to the other, shall not in any way release the Principal and the Surety or either or any of them, | ||||||||
| their heirs, executors, administrators, successors or assigns from their liability hereunder, notice to the surety of any such alteration or | ||||||||
| forebearance being hereby waived. | ||||||||
| IN WITNESS WHEREOF, the said Principal and Surety have duly executed this Bond under Seal, pursuant to due and legal action | ||||||||
| authorizing the same to be done on | . | |||||||
| (DATE OF BOND) | ||||||||
| Attest / Witness: | ||||||||
| CONTRACTOR | ||||||||
| BY | ||||||||
| TITLE: | ||||||||
| TITLE: | ||||||||
| Attest / Witness: | 0 | |||||||
| SURETY COMPANY | ||||||||
| TITLE: | ||||||||
| TITLE: | ||||||||
| - 1 - |
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PAYMENT BOND PG. 2
| MS-944S | PAYMENT BOND | Attachment 3 | |||||||||||
| KNOW ALL MEN BY THESE PRESENTS, that we | 0 | ||||||||||||
| as PRINCIPAL and | |||||||||||||
| a corporation incorporated under the laws of the State of | as SURETY, are | ||||||||||||
| held and firmly bond unto the | 0 | , in the full and just sum of | |||||||||||
| ($ | )dollars, lawful money of the | ||||||||||||
| United States of America, to be paid to the said | 0 | or its assigns, to which | |||||||||||
| payment well and truly to be made, we bind ourselves, our heirs, executors, administrators, | |||||||||||||
| successors and assigns, | jointly and severally, firmly by these presents. | ||||||||||||
| WHEREAS, the above bounden Principal has entered into a contract with the above | |||||||||||||
| municipality hereinafter called Obligee, bearing even date herewith, for the improvement of a | |||||||||||||
| certain section of highway or bridge in said Municipality consisting of: | |||||||||||||
| for approximately the sum of: | ($ | ) dollars. | |||||||||||
| NOW, THEREFORE, the condition of this obligation is such that if the above bounden | |||||||||||||
| PRINCIPAL shall and will promptly pay or cause to be paid in full all sums of money which may be | |||||||||||||
| due by contract or otherwise, to any individual, firm, partnership, association or corporation, for all | |||||||||||||
| material furnished or labor supplied or performed in the prosecution of the work, whether or not the | |||||||||||||
| said for material or labor entered into and became component parts of the work and for rental of the | |||||||||||||
| equipment used and services rendered by public utilities in, or in connection with the prosecution of | |||||||||||||
| such work, then this obligation to be void, otherwise to remain in full force and effect. | |||||||||||||
| The PRINCIPAL and SURETY, hereby, jointly and severally, agree with the Obligee herein | |||||||||||||
| that any individual firm, partnership, association or corporation, which has performed labor or | |||||||||||||
| furnished material in the prosecution of the work as provided, and any public utility which has not | |||||||||||||
| been paid in full therefor, may sue in assumpsit on this Payment Bond in his, their, or its own name | |||||||||||||
| and may prosecute the same to final for such sum or sums as may be justly due him, them or it, and | |||||||||||||
| have execution thereon. Provided, however, that the Obligee shall not be liable for the payment of | |||||||||||||
| any costs of expenses of such suit. | |||||||||||||
| RECOVERY by any individual, firm, partnership, association or corporation hereunder shall | |||||||||||||
| be subject to the provisions of the “Public Works Contractors’ Bond Law of 1967", Act No. 385, | |||||||||||||
| approved December 20, 1967,P.L. 869, which Act shall be incorporated herein and made a part | |||||||||||||
| hereof, as fully and completely as though its provisions were fully and at length herein recited. | |||||||||||||
| It is further provided that any alterations which may be made in the terms of the contract or | |||||||||||||
| in the work to be done or materials to be furnished or labor to be supplied or performed under it or | |||||||||||||
| the giving by the Obligee of any extension of time for the performance of the contract or any other | |||||||||||||
| forebearance on the part of either the Obligee or the Principal to the other, shall not in any way | |||||||||||||
| release the PRINCIPAL and the SURETY or SURETIES of any such alteration, extension of | |||||||||||||
| forebearance being hereby waived. | |||||||||||||
| IN WITNESS WHEREOF, the said PRINCIPAL and SURETY have duly executed this Bond | |||||||||||||
| under seal this | day of | ,20 | . | ||||||||||
| WITNESS: | 0 | ||||||||||||
| CONTRACTOR | |||||||||||||
| BY: | |||||||||||||
| TITLE: | TITLE: | ||||||||||||
| WITNESS: | 0 | ||||||||||||
| SURETY COMPANY | |||||||||||||
| TITLE: | TITLE: | ||||||||||||
| - 2 - |
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WORKMANS COMP. PG. 3
| Attachment 4 | |||||||||
| AFFIDAVIT RE | |||||||||
| ACCEPTING PROVISIONS OF THE WORKMEN’S COMPENSATION ACT | |||||||||
| State of | ) | ||||||||
| ) | |||||||||
| ) ss: | |||||||||
| ) | |||||||||
| County of | ) | ||||||||
| he has | |||||||||
| being duly sworn according to law deposes and says that they have | |||||||||
| it has | |||||||||
| accepted the provisions of the Workmen’s Compensation Act of 1915 of the Commonwealth of Pennsylvania, with | |||||||||
| has | his | ||||||||
| its supplements and amendments, and have insured their liability thereunder in accordance with the terms of said | |||||||||
| its | |||||||||
| Act with | . | ||||||||
| (SURETY COMPANY) | |||||||||
| ( TYPE OR PRINT) | CONTRACTOR | ||||||||
| BY | |||||||||
| SIGNATURE | |||||||||
| Sworn to and subscribed before me this | day of | A.D. 20 | . | ||||||
| SIGNATURE | |||||||||
| My Commission Expires | ( DATE ) | ||||||||
| - 3 - |
ANTI-COLLUSION AFFIDAVIT
| D-7126 ( 7-09 ) | ||||||||
| ANTI-COLLUSION AFFIDAVIT | ||||||||
| County | Dauphin County | |||||||
| Municipality | Borough of Millersburg | |||||||
| Project Number | 2026-02 | |||||||
| State of | 0 | Fed. Project No. | ||||||
| ( If Applicable ) | ||||||||
| County of | 0 | |||||||
| The undersigned deponent deposes and says that he is the | ||||||||
| of the | 0 | Company; that he is authorized to make this | ||||||
| affidavit on behalf of said company in compliance with section 102.06 (e) of Department Specifications, | ||||||||
| Publication 408, as amended and that the said company has not, either directly or indirectly, entered | ||||||||
| into any agreement, participated in any collusion, or otherwise taken any action in restraint of free | ||||||||
| competitive bidding in connection with such contract. | ||||||||
| 0 | ||||||||
| (Contractor) | ||||||||
| BY | ||||||||
| Sworn to and subscribed before me the undersigned notary public this | ||||||||
| day of | , | . | ||||||
| Notary Public | ||||||||
| My Commission expires |
MS-NCP
| MS-NCP | ||||
| Borough of Millersburg | MUNICIPALITY | |||
| NOTICE OF COMPLETION | ||||
| IN REFERENCE TO PROJECT # | 2026-02 | |||
| Name of Contractor | ||||
| Performance of work as specified on the above numbered contract is completed and | ||||
| final pavement inspection has been made by the contractor and municipality in | ||||
| accordance with the terms of the contract awarded. | ||||
| DATE OF AWARD | December 31, 1899 | |||
| Signature of Municipality | ||||
| Signature of Contractor | ||||
| Both copies of this form to be filled by the Contractor-Municipality on completion of final | ||||
| pavement restoration. | ||||
| THIS PORTION TO BE COMPLETED BY MUNICIPALITY | ||||
| FINAL COMPLETION CERTIFICATE | ||||
| By the affixing of my signature I hereby certify that final | ||||
| inspection has been made and all work has been performed in | ||||
| accordance with the above contract # and is hereby accepted | ||||
| by the municipality as completed. | ||||
| Authorized Agent for the Municipality | ||||
| *DATE | ||||
| * The contractor is responsible for maintenance of permanent pavement repairs for a | ||||
| period of one year from this date. |
CS-4171
File details come from the government source that posted it. Updated .