2023R_ENG_122n Bid Documents.pdf

INVITATION TO BID (ITB)

*REBID

Construction of East Grady Street Sidewalk

The City of Statesboro, Georgia invites the submission of sealed bids for a construction project known as Bid Project #2023R-ENG-122n from qualified contractors for the construction of approximately 1,300 LF of sidewalk, two (2) storm structures, and roadway striping at intersection along Grady Street starting at 124 South Main Street and ending at Mulberry Street.

*NOTE: This is a rebid. All requirements and documents of the previous bid are invalid.

Pre-bid Conference

A mandatory pre-bid conference for Bid Project #2023R-ENG-122n project will be held on Tuesday, November 28, 2023 at 10:00 AM local time at the Statesboro Municipal Court Room, 22 W. Grady Street, Statesboro, Georgia. Bids will not be accepted from Bidders that do not attend the mandatory pre-bid conference.

Sealed bids for the construction project will be will be received in the office of Darren Prather, Director of Central Services (Issuing Office), 22 West Grady Street, Statesboro, GA 30458 until 10:00 AM local time on Thursday, December 14, 2023 at which time they will be publicly opened and read aloud in the Statesboro Municipal Court Room.

Obtaining the Bidding Documents

All questions and requests for electronic bid documents should be sent via email to darren.prather@statesboroga.gov. The City of Statesboro and its representatives will not be responsible for bidding documents, including addenda, if any, obtained from sources other than the issuing office.

mailto:darren.prather@statesboroga.gov

BID CHECKLIST

Bid Project Number: 2023R-ENG-122n Bid Title: East Grady Street Sidewalk Bid Deadline: Thursday, October 14, 2023 at 10:00 A.M. EST

Company Name: __________________________________________________

BASE BID TOTAL: __________________________________________________

Contact Information: __________________________________________________

Email address: __________________________________________________

Signature of Authorized Representative: ____________________________________ Date: ______________

Number of Bid Addendums Received: _______

Checklist of item(s) needed to accompany bid forms:

1. ☐ Two (2) Copies of Bid Submissions 7. ☐ Bid Bond

2. ☐ Georgia Security and Immigration Compliance Act

8. ☐ Non-Collusion Affidavit of Prime Bidder/Subcontractor

3. ☐ Affidavit Verifying Status for City Public Benefit Application

9. ☐ Certification Regarding Debarment Suspension, and other Responsibility Matters

4. ☐ Contractor Affidavit (E-Verify) 10. ☐ Minority Female Business Enterprise (MFBE) Affidavit

5. ☐ Bid Form 11. ☐ Minority Female Business Enterprise (MFBE) Grid Form

6. ☐ Bid Table 12. ☐ Receipt of Addenda (if any)

GENERAL REQUIREMENTS, SPECIFICATIONS, AND NOTES

1) Any Requests for Information (RFIs) concerning this bid request shall be made in writing to Darren Prather, Director of the Department of Central Services, via email at darren.prather@statesboroga.gov by 3:00 PM EST on Monday, December 4, 2023.

2) It is the bidders’ responsibility to ensure that all attachments are included in the bid package received. For this bid package the following attachments apply:

a) Georgia Security And Immigration Compliance Act

b) Affidavit Verifying Status For City Public Benefit Application

c) E-Verify (Contractor Affidavit)

d) Bid Form

e) Bid Table

f) Bid Bond

g) Non-Collusion Affidavit Of Prime Bidder/Subcontractor

h) Certification Regarding Debarment Suspension, And Other Responsibility Matters – Primary Covered

Transactions

i) Minority/Female Business Enterprise (MFBE) Affidavit

j) Minority/Female Business Enterprise (MFBE) Grid Form

3) All bids shall be accompanied by a bid bond in an amount not less than five percent (5%) of the base bid (no personal or company checks are accepted). A performance bond and a payment bond equal to 100 percent (100%) of the awarded bid price must be provided at the time the contract is awarded. All bonds must meet qualifications acceptable to the City of Statesboro, and shall be secured from bonding companies licensed to do business in the State of Georgia.

4) Contractor and all subcontractors must obtain a business license in Georgia, be fully insured, and be a licensed contractor in the State of Georgia.

5) Contractor shall maintain the following insurance:

(a) comprehensive general liability, including blanket contractual, covering bodily injuries with limits of no less than $1,000,000 per o ccurrence, and property damage with limits of no less than $1,000,000 per occurrence

(b) commercial automobile liability, including blanket contractual, covering bodily injuries with limits of no less than $1,000,000 per occurrence, and property damage with limits of no less than $1,000,000 per accident

(c) statutory worker’s compensation insurance, including $1,000,000 employer’s liability insurance

(d) employee dishonesty and/or crimes coverage with respect to personnel of Contractor having access to City buildings, with limits of no less than $50,000 per occurrence. All insurance shall be provided by an insurer(s) acceptable to the City and shall provide for thirty (30) days prior notice of cancellation to the City. Upon request, Contractor shall deliver to the City a certificate or policy of insurance evidencing Contractor’s compliance with this paragraph. Contractor shall abide by all terms and conditions of the insurance and shall do nothing to impair of invalidate the coverage.

6) The successful bidder shall secure and pay for all permits, assessments, charges or fees required in mailto:darren.prather@statesboroga.gov connection with the proposed construction.

7) It is the intent of the City of Statesboro to encourage participation by minority and female owned business enterprises (MFBE) for all procurement processes. The construction phase of this project shall include a minimum 20% minority or female business enterprise participation of total construction cost. All submittals for this ITB must include a statement acknowledging compliance with 20% MFBE requirement at time for submittal of sealed bids. Upon submittal of sealed bids pre-qualified contractors will be required to provide proof of MFBE certification if general/prime contractor is a certified MFBE or provide list of MFBE sub-contractors, identify % of participation by each sub-contractor and proof of minority or female owned business certification for proof of compliance with this section requirement.

8) All bids must be submitted on the “Bid Form” provided herein. The Contractor E-Verify Affidavit and Non-collusion affidavit must also be completed and submitted with the bid. All sheets must be fully completed. All bids shall be sealed and clearly marked on the outside of submitted envelope: “City of Statesboro Bid Project #2023-ENG-122n – East Grady Street Sidewalk”. All bid packages shall be submitted to the attention of Darren Prather, Director of Central Services, 22 West Grady Street, Statesboro, GA 30458 by 10:00 AM EST on Thursday, December 14, 2023. For additional information on the bid package, please contact Darren Prather via email.

9) Bidders will be fully responsible for the delivery of their bids in a timely manner. Reliance upon the US Postal

Service or other carriers shall be at the bidder’s risk. Late bids will not be considered.

10) All prices and notations must be in ink or typewritten. Mistakes may be crossed out and corrections typed or printed adjacent to the mistake and initialed in ink by the person who signs the bid. Prices shall be stated in units and quotations made separately on each item. Mathematical calculations on all bid submittals will be checked by the City and any mistakes corrected. The City of Statesboro will not post the bid submittal results until after the mathematical verification process has been completed. In case of conflict, unit prices will govern. Where there is a conflict between words and figures, words will govern.

11) The City of Statesboro reserves the right to reject any or all bids, to accept bids in whole or part, and to waive technicalities and informalities.

12) Before City executes contract, contractor shall provide the following:

a) Proof of proper Workers Compensation Insurance as required per State Law.

13) Proof of General Liability Insurance of $1 million per incident and $2 million aggregate.

14) City may at its discretion before executing contract, request proof of automobile insurance for all company vehicles used on this project.

15) Upon approval of the bid by the City, the Notice to Proceed shall be issued in a timely manner following the execution of the contract documents.

16) Contractor will need to coordinate with the City prior to scheduled work to ensure access or electrical outages.

17) All work shall be substantially completed within 120 calendar days (ninety (90) calendar days plus an additional thirty (30) calendar days to complete punch list items) of being given the “Notice to Proceed”.

Failure to complete the work within the number of days stipulated in the signed Contract Form, including extensions granted thereto, shall entitle the City of Statesboro to retain from compensation otherwise due to be paid to the Contractor, or otherwise recover by all remedies of law an amount equal to that listed in the Schedule of Deductions for Each Day of Overrun in Contract Time Table, Section 108.08 of the Georgia Department of Transportation’s Standard Specifications Construction of Transportation Systems, 2013 Edition. It is agreed by and between the City of Statesboro and the Contractor that this sum has been established, not as a penalty, but as liquidated damages and that it is reasonable and acceptable, as the City provides services necessary for the health and welfare of the public and due to the impracticability and extreme difficulty of fixing and ascertaining the actual damages assessed for each consecutive calendar day of delay in the completion date.

18) All construction work shall be performed in accordance with the most recent Building Codes and Standards.

19) All proposed materials must be submitted to and approved by the City of Statesboro prior to installation.

20) The City reserves the right to reject any defective material on-site. All materials shall be installed in accordance with the most current Building Codes and Specifications.

21) The City reserves the right to add, modify, or delete quantities. Contractor will be paid for actual in-place quantities completed and accepted for pay items listed in the scope of work schedule. Contractor will not be entitled to an adjustment of unit price on an item which increased or decreased from the original plan quantity.

22) Contractors shall bid on only those items provided in the scope of work. No alternative material types submitted by the contractor will be considered during the bidding phase.

23) The Contractor is responsible for coordinating work with the owner to ensure access to properties is adequately maintained. The contractor will be responsible for any damage on these properties due to construction.

24) The contractor shall exercise caution, as to not damage any infrastructure, either private or public, not related to this project (e.g. overhead utilities, sidewalks, asphalt, mailboxes, landscaping, etc.). Repairs for all damages will be the responsibility of the contractor.

25) For bid items quantified by units other than lump sum, the contractor will only be compensated for the actual quantity of material installed/placed.

26) The quantities shown on the Bid Schedule and Bid Table are estimated for bidding purposes only. Exact quantities are to be verified before ordering. Any overages will not be paid unless prior approval is obtained by the City Engineer or their representative.

27) It is the contractor’s responsibility to visit the site and verify the nature of required work including required quantities.

28) The City will pay the contractor upon receipt of properly prepared invoices, sent to the City of Statesboro

Engineering Department. Contractor should include “City of Statesboro ENG-122n: East Grady Street Sidewalk” on the invoice.

29) The construction site shall be cleaned from construction debris and equipment before payment of retainage will be made.

INFORMATION TO BIDDERS

The OWNER may waive any informalities or minor defects or reject any and all BIDS. Any BID may be withdrawn prior to the above scheduled time for the opening of BIDS or authorized postponement thereof. Any BID received after the time and date specified shall not be considered. No BIDDER may withdraw a BID within 60 days after the actual date of the opening thereof. Should there be reasons why the contract cannot be awarded within the specified period the time may be extended by mutual agreement between the OWNER and the BIDDER.

Georgia Department of Transportation Standard Specifications for Construction of Transportation Systems, 2013 Edition, to include most recent revisions, are the governing standards for this project. All striping shall be in accordance with current MUTCD Standards.

BIDDERS must satisfy themselves of the accuracy of the estimated quantities in the BID Schedule by examination of the site and a review of the drawings and specifications including ADDENDA. After BIDS have been submitted, the BIDDER shall not assert that there was a misunderstanding concerning the quantities of WORK or of the nature of the WORK to be done.

The OWNER shall provide to BIDDERS prior to BIDDING, all information that is pertinent to, and delineates and describes, the land owned, and rights-of-way acquired or to be acquired.

The CONTRACT DOCUMENTS contain the provisions required for the construction of the PROJECT. Information obtained from an officer, agent, or employee of the OWNER or any other person shall not affect the risks or obligations assumed by the CONTRACTOR or relieve him from fulfilling any of the conditions of the contract.

Attorneys-in-fact who sign BID BONDS or payment BONDS and performance BONDS must file with each BOND a certified and effective dated copy of their power of attorney.

The party to whom the contract is awarded will be required to execute the Agreement within ten (10) Calendar days from the date when NOTICE OF AWARD is delivered to the BIDDER. The NOTICE OF AWARD shall be accompanied by the necessary Agreement form. In case of failure of the BIDDER to execute the Agreement, the OWNER may at his option consider the BIDDER in default.

The OWNER within ten (10) days of receipt of acceptable Agreement signed by the party to whom the Agreement was awarded shall sign the Agreement and return to such party an executed duplicate of the Agreement. Should the OWNER not execute the Agreement within such period, the BIDDER may by WRITTEN NOTICE withdraw his signed Agreement. Such notice of withdrawal shall be effective upon receipt of the notice by the OWNER.

The NOTICE TO PROCEED shall be issued within ten (10) days of the execution of the Agreement by the OWNER.

Should there be reasons why the NOTICE TO PROCEED cannot be issued within the ten (10) day period or within the period mutually agreed upon, the CONTRACTOR may terminate the Agreement without further liability on the part of either party.

The OWNER may make such investigations as he deems necessary to determine the ability of the BIDDER to perform the WORK, and the BIDDER shall furnish to the OWNER all such information and data for this purposed as the OWNER may request. The OWNER reserves the right to reject any BID if the evidence submitted by, or investigation of, such BIDDER fails to satisfy the OWNER that such BIDDER is properly qualified to carry out the obligations of the Agreement and to complete the WORK contemplated therein.

A conditional or qualified BID will not be accepted. Award will be made to the most responsible BIDDER.

OWNER reserves the right to award project based on base bid only or any combination of alternates, if applicable, at their sole discretion.

All applicable laws, ordinances, and the rules and regulations of all authorities having jurisdiction over construction of the PROJECT shall apply to the contract throughout.

Each BIDDER is responsible for inspecting the site and for reading and being thoroughly familiar with the CONTRACT DOCUMENTS. The failure or omission of any BIDDER to do any of the foregoing shall in no way relieve any BIDDER from any obligation in respect to his BID.

The low BIDDER shall supply the names and addresses of major material SUPPLIERS and SUBCONTRACTORS when requested to do so by the OWNER. All bidders must have a State of Georgia Contractors License.

GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT

CONTRACTOR must execute an affidavit verifying that CONTRACTOR has registered and participates in the federal work authorization program to verify information of all new employees, per O.C.G.A. 13-10-90, et. seq., and Georgia Department of Labor Regulations Rule 300-10-1-02, and must execute an affidavit verifying residency status per O.C.G.A. 50- 36-1, et. seq. The appropriate affidavits are attached to these contract documents and are incorporated herein by reference and made a part of this contract.

The CONTRACTOR further certifies that any SUBCONTRACTOR employed by CONTRACTOR for the performance of this agreement has executed appropriate SUBCONTRACTOR affidavits verifying its registration and participation in the federal work authorization program and compliance with O.C.G.A. 13-10-90, et. seq., and Georgia Department of Labor Regulations Rule 300-10-1-02, and verifying residency status per O.C.G.A. 50-36-1, et. seq, and that all such affidavits are incorporated into and made a part of every contract between the CONTRACTOR and each SUBCONTRACTOR.

CONTRACTOR’S compliance with O.C.G.A. 13-10-90, et. seq. Georgia Department of Labor Regulations Rule 300- 10-1-02, and O.C.G.A. 50-36-1 et. seq is a material condition of this agreement and Contractor’s failure to comply with said provisions shall constitute a material breach of this agreement.

AFFIDAVIT VERIFYING STATUS

FOR CITY PUBLIC BENEFIT APPLICATION

By executing this affidavit under oath, as an applicant for the award of a contract with The City of Statesboro, Georgia, I, _________________________________, [Name of natural person applying on behalf of individual, business, corporation, partnership, or other private entity] am stating the following as required by O.C.G.A.

Section 50-36-1:

1) _____I am a United States citizen

OR

2) _____I am a legal permanent resident 18 years of age or older or I am an otherwise qualified alien or non-immigrant under the Federal Immigration and Nationality Act 18 years of age or older and lawfully present in the United States. *

In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of Code Section 16-10-20 of the Official Code of Georgia.

Signature of Applicant: Date

Printed Name:

*Alien Registration number for non-citizens

SUBSCRIBED AND SWORN BEFORE ME ON THIS THE_____DAY OF _____________________, 2023

Notary Public

My commission Expires:

*Note: O.C.G.A. § 50-36-1(e)(2) requires that aliens under the federal Immigration and Nationality Act, Title 8 U.S.C., as amended, provide their registration number. Because legal permanent residents are included in the federal definition of “alien”, legal permanent residents must also provide their alien registration number.

Qualified aliens that do not have an alien registration number may supply another identifying number below.

Contractor Affidavit Under O.C.G.A. § 13-10-91{b){l)

By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13- 10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services on behalf of City of Statesboro has registered with, is authorized to use and uses the federal work authorization program commonly known as E- Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-91. Furthermore, the undersigned contractor will continue to use the federal work authorization program throughout the contract period and the undersigned contractor will for the physical performance of services in satisfaction of such contract only with subcontractors who present an affidavit to the contractor with the information required by O.C.G.A. § 13-10-91(b). Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:

Federal Work Authorization User Identification Number Date of Authorization

Name of Contractor

2023R-ENG-122n – East Grady Street Sidewalk Name of Project

City of Statesboro Name of Public Employer

I hereby declare under penalty of perjury that the foregoing is true and correct.

Executed on _____________________, 20____, ______________________ (city), _________ (state).

Signature of Authorized Officer or Agent

Printed Name and title of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME ON THIS _____ DAY OF _______________________, 2023.

Notary Public My Commission Expires

BID FORM

Proposal by _____________________________________________________ (hereinafter called "BIDDER"), organized and existing under the laws of the State of _________________________ Doing business as*

______________________________________________________________ To the City of Statesboro

(hereinafter called "OWNER").

In compliance with your Advertisement for Bids, BIDDER hereby proposes to perform all WORK for the construction of City of Statesboro ENG-122n: East Grady Street Sidewalk in strict accordance with the CONTRACT

DOCUMENTS, within the time set forth therein, and at the prices stated below.

By submission of this BID, each BIDDER certifies, and in the case of a joint BID each party thereto certifies as to his own organization, that this BID has been arrived at independently, without consultation, communication, or agreement as to any matter relating to this BID with any other BIDDER or with any competitor.

BIDDER hereby agrees to commence WORK under this contract on or before a date to be specified in the NOTICE

TO PROCEED and to fully complete the PROJECT within 120 consecutive calendar days thereafter.

BIDDER acknowledges receipt of the following ADDENDUM (if any):

*Insert “a corporation", "a partnership", or "an individual" as applicable.

ENG-122N E. GRADY STREET SIDEWALK BID TAB

QUANTITY COST

ITEM DESCRIPTION

NUMBER

OF

UNITS

UNIT

MEASURE PER UNIT TOTAL COST

GRADING AND DRAINAGE

1 DEMOLITION 1 SUM

2 SITE GRADING 1 SUM

3 FLARED END SECTION :18” 1 EA

4 18" RCP DRAINAGE PIPE 40 LF

5 DROP INLET, 1019A TOP 1 EA

6 RIP RAP: TYP 3 20 SY

GRADING AND DRAINAGE SUBTOTAL $ -

ROADWAY

8 6”x24" CURB AND GUTTER 450 LF

9 CLASS B CONCRETE FILLER STRIP 6" 50 SY

10 6" CONCRETE DRIVEWAY 75 SY

11 CONCRETE SIDEWALKS 4” THICK 550 SY

12 PEDESTRIAN CROSSING DYED CONCRETE 55 SY

13 REMOVE AND REPLACE EXISTING SIDEWALK 10 SY

14 HANDRAILS 40 LF

HANDICAP RAMPS W/ DETECTABLE WARNING

SURFACE 18 EA

16 STRUCTURE RELOCATION (SIGNS) 8 EA

ROADWAY SUBTOTAL $ -

WATER DISTRIBUTION SYSTEM

17 WATER METER RELOCATION 8 EA

WATER DISTRIBUTION SYSTEM SUBTOTAL $ -

EROSION CONTROL

18 CONSTRUCTION EXIT 1 EA

19 CONCRETE WASHOUT 1 EA

20 SILT FENCE TYPE NS 1100 LF

21 SILT FENCE TYPE S 250 LF

22 TEMPORARY GRASSING Ds2 1 AC 23 PERMANENT GRASSING Ds3 1 AC 24 MULCHING Ds1 1 AC 25 INLET PROTECTION Sd2-F 2 EA 26 INLET PROTECTION Sd2-P 8 EA

EROSION CONTROL SUBTOTAL $ -

27 TRAFFIC CONTROL 1 SUM

28 MOBILIZATION 1 SUM

BASE BID TOTAL:

BID BOND

KNOW ALL MEN BY THESE PRESENTS, that we, the undersigned, (herein called the “Principal”), and , as Surety, are held firmly bound unto The

City of Statesboro (herein called the “OWNER”), in the sum of:

DOLLARS ($ lawful money of the United States of America, for the payment of which, will and truly be made, we bind ourselves, our heirs, executors, administrators, successors and assignees, jointly and severally, firmly by these presents, SIGNED, SEALED, AND DATED this day of

_______________________________, 2023.

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

The City of Statesboro 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

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 extensions.

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.

ATTEST:

(Principle) Secretary

Principal

BY

(SEAL)

(Witness as to Principal) (Address)

(Address)

ATTEST:

Surety

(Surety) Secretary

(SEAL)

(Witness as to Surety) (Attorney-in-Fact)

(Address) (Address)

IMPORTANT – Surety companies executing BONDS must appear on the Treasury Department's most current list (Circular 570 as amended) and be authorized to transact business in the state where the project is located.

NON-COLLUSION AFFIDAVIT OF PRIME BIDDER/SUBCONTRACTOR

State of Georgia County of Bulloch

___________________________, being first duly sworn, deposes and says that he or she is Owner of ___________________________ the party making the foregoing bid that the bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation; that the bid is genuine and not collusive or sham; that the Bidder has not directly or indirectly induced or solicited any other Bidder to put in a false or sham bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any Bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding; that the Bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the Bidder or any other Bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other Bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract; that all statements contained in the bid are true; and further, that the Bidder has not , directly or indirectly, submitted his or her bid price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid."

(Date) (Signed)

Bidder Name Authorized Representative (Person, Firm, Corp.)

Address Representative's Name

City, State, Zip Representative's Title

Vendor Name: __________________________________

Representative: _________________________________ Title: ______________________________

Signature: _____________________________________ Date: ______________________________

*By signing this form, I agree to the terms and conditions contained in this bid package and if my company is awarded the contract, I agree that this signed bid response shall serve as the legal binding document concerning this contract.

SUBSCRIBED AND SWORN BEFORE ME ON THIS _____ DAY OF _________________, 20______.

Notary Public My Commission Expires

CERTIFICATION REGARDING DEBARMENT SUSPENSION, AND OTHER

RESPONSIBILITY MATTERS - PRIMARY COVERED TRANSACTIONS

INSTRUCTIONS FOR CERTIFICATION

1. By signing and submitting this proposal, the prospective primary participant is providing the certification set out below.

2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation could disqualify such person from participation in this transaction.

3. The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available, the City may terminate this transaction for cause or default.

4. The prospective primary participant shall provide immediate written notice to the department or agency to which this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

5. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the department to which this proposal is being submitted for assistance in obtaining a copy of those regulations.

6. The prospective primary participant agrees by submitting this proposal that should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is proposed for debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction.

7. The prospective primary participant further agrees by submitting this proposal that it will include the clause titled ''Certification

Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion- Lower Tier Covered Transaction,'' provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

8. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not proposed for debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the list of Parties Excluded from Federal Procurement and Non-procurement Programs.

9. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

10. Except for transactions authorized under paragraph 6 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under 49 CFR pan 9, subpart 9.4, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default.

CERTIFICATION

1) The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals:

a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department or agency;

b) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification;

and

d) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default.

2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.

Organization Name PR/Award or Project Name

Name and Title

Signature Date

MINORITY/FEMALE OWNED BUSINESS ENTERPRISE (MFBE)

AFFIDAVIT

Section 1: Business ID

I attest that I am a majority minority or female owned business enterprise: YES NO

Employer Identification Number State of Incorporation

MFBE (Disadvantaged/Woman) Ownership: Minority Female

MFBE (Disadvantaged/Woman) Owned Certification Number

Section 2: Business Information

Business Name DBA Name

Company Corporation Type Company Ownership Ethnicity

Company Ownership Gender

Section 3: Business Contact Information

Company Address City State Zip

Company Phone # Company Website

Section 4: Business Principal Information

Principal Contact Name Principal Contact Title

Principal Contact Cell # Principal Contact Email

Section 5: Project Participation Information

Project Name ___________Project Participation by Business

% Business Project Participation as: General Contractor Subcontractor

Disclaimer and Signature I certify that my answers are true and complete to the best of my knowledge.

Print, Signature, and Title: Date

Notary Signature and Seal Date

MINORITY/FEMALE OWNED BUSINESS ENTERPRISE (MFBE) AFFIDAVIT