C i t y F o r m s

Page 1 of 3 6-5-2008 RCK

Purchasing and Contracting Revised 11/2021

Bond No.

PAYMENT AND PERFORMANCE BOND

THE CITY OF SEATTLE

We, (“Principal”), and

[Insert full legal name of Vendor / Contractor] a corporation [Insert legal name of Surety and its state of incorporation] authorized to transact surety business in the State of Washington, (“Surety”), are held and firmly bound unto The City of Seattle (“City”), as Obligee, in an amount equal to the total compensation and expense reimbursement payable to Principal for satisfactory completion of Principal’s work under Contract No. between Principal and City, which total is initially Dollars ($ ), lawful money of the United States of America, for the payment of which sum Principal and Surety bind themselves, their heirs, legal representatives, successors and assigns, jointly and severally, firmly by these presents. Said contract (hereinafter referred to as "the Contract") is for and is made a part hereof by this reference. The Contract includes the original agreement as well as all documents attached thereto or made a part thereof and all addenda, amendments, change orders, and any other document modifying, adding to or deleting from said Contract any portion thereof.

This Bond is executed in accordance with the laws of the State of Washington and is subject to all provisions thereof and the Charter and ordinances of City insofar as they are not in conflict therewith, and is entered into for the use and benefit of City, and all laborers, mechanics, subcontractors, and materialmen, and all persons who supply such person or persons, or subcontractors, with provisions or supplies for the carrying on of the work covered by the Contract.

THE CONDITION OF THIS OBLIGATION is such that if Principal faithfully performs all the provisions of the Contract and pays all laborers, mechanics, and subcontractors and materialmen, and all persons who supply such person or persons, or subcontractors, with provisions and supplies for the carrying on of such work; and pays all other just debts incurred in the performance of such work (provided, however, that the conditions of this obligation shall not apply to any money loaned or advanced to any such contractor or subcontractor or other person in the performance of such work); and to the extent permitted by law indemnifies, defends, and holds City harmless from all cost and damage by reason of Principal’s default, then this obligation shall be null and void; otherwise it shall remain in full force and effect.

THE PARTIES FURTHER ACKNOWLEDGE AND AGREE AS FOLLOWS:

(1) Surety hereby consents to, and waives notice of, any alteration, change order, or other modification of the Contract and any extension of time made by City, except that any single or cumulative change order amounting to more than twenty-five percent (25%) of the penal sum of this bond shall require Surety's written consent.

(2) Surety recognizes that the Contract includes provisions for additions, deletions, and modifications to the work or Contract Time and the amounts payable to Principal (i.e., Vendor/Contractor). No such change or any combination thereof shall void or impair Surety's obligation hereunder.

(3) Whenever City has declared Principal (i.e., Vendor/Contractor) to be in default and City has given Surety written notice of such declaration, Surety shall promptly (in no event more than thirty [30] days following receipt of such notice) specify, in written notice to City, which of the following actions Surety intends to take to remedy such default, and thereafter shall:

(a) Remedy the default within fifteen (15) days after its notice to City; or

(b) Assume within fifteen (15) days following its notice to City, full responsibility for the completion of the Contract in accordance with all of its provisions, and become entitled to payment of the balance of the Contract sum as provided in the Contract; or

(c) Pay City upon completion of the Contract, in cash, the cost of completion together with all other reasonable costs and expenses incurred by City as a result of Principal’s (i.e.,Vendor/Contractor's) default, including but not limited to those incurred by City to mitigate its losses, which may include but are not limited to attorneys' fees and the cost of efforts to complete the work prior to Surety's exercising any option available to it under this Bond; or

(d) Obtain a bid or bids for completing the Contract in accordance with its terms and conditions, and upon a

6-5-2008 RCK Page 2 of 3

SURETY’S QUALIFICATIONS: Every Surety named on this bond must either appear on the United States Treasury Department's most current list (Circular 570 as amended or superseded) or have a current rating of at least A-:VII in A. M. Best’s Key Rating Guide. Additionally, every Surety named on this bond must be authorized by the Washington State Insurance Commissioner to transact business as a surety in the State of Washington.

INSTRUCTIONS FOR SIGNATURES: This bond must be signed by the president or a vice-president of a corporation; the managing general partner of a partnership; managing joint venturer of a joint venture; manager of a limited liability company (“LLC”) or, if no manager has been designated, a member of such entity; a general partner of a limited liability partnership (“LLP”); or the owner(s) of a sole proprietorship. If the bond is signed by any other representative, the Principal must attach written proof of that signer’s authority to bind the Principal, identifying and quoting the provision in the corporate articles of incorporation, bylaws, Board resolution, partnership agreement, certificate of formation, power of attorney, or other document authorizing delegation of signature authority to such signer, and confirmation acceptable to the Seattle City Attorney’s Office that such delegation was in effect on the date the bond was signed.

A NOTARY PUBLIC MUST ACKNOWLEDGE EACH SIGNATURE ON THIS BOND.

determination by City and Surety jointly of the lowest responsible bidder, arrange for one or more agreements between such bidder and City, and make available as work progresses (even though there is a default or a succession of defaults under such agreement(s) for completion arranged for under this paragraph) sufficient funds to pay the cost of completion of the Contract less the balance of the Contract price, but not exceeding, including other costs and damages for which Surety may be liable hereunder, the penal sum of this Bond. The term "balance of the Contract price," as used in this paragraph, shall mean the total amount payable by City to Principal (i.e., Vendor/Contractor) under the Contract, less the amount properly paid by City to Principal (i.e., Vendor/Contractor).

In addition to (a) through (d) above, Surety shall pay City all other reasonable costs and expenses incurred by City as a result of Principal’s (i.e. Vendor/Contractor’s) default, and prior to Surety’s exercising any option available to Surety under this bond.

(4) The venue for any action arising out of or in connection with this bond shall be in King County, Washington.

(5) No right or action shall accrue on this Bond to or for the use of any person or corporation other than The City of Seattle and, to the extent required under RCW Chapter 39, all laborers, mechanics, subcontractors, and materialmen, and all persons who supply such person or persons, or subcontractors, with provisions or supplies for the carrying on of the work covered by the Contract.

(6) Nothing of whatever kind or nature whatsoever that will not discharge the Principal shall operate as a discharge or a release of liability of the Surety, any law, rule of equity, or usage relating to the liability of sureties to the contrary notwithstanding.

(7) No rider, amendment, or other document modifies this Bond unless made in writing and accepted by Principal, Surety and the City.

(8) Surety shall give to Principal and to City not less than sixty (60) days’ prior written notice by certified mail, return receipt requested, of the effective date of the expiration or cancellation of this bond. Notice to City shall be mailed to: FAS, P. O.

Box 94669, Seattle, WA 98124-4669 or delivered to FAS at 700 5th Av., Ste. 4350, Seattle, WA 98104-5008.

(9) Principal must provide City with a replacement bond, acceptable to City, not less than thirty (30) days before the effective date of this bond’s expiration or cancellation as specified in the Surety’s notice provided pursuant to Condition (8) above.

(10) If Principal fails to provide the replacement bond not less than thirty (30) days before the effective date of this bond’s expiration or cancellation as specified in the Surety’s notice provided pursuant to Condition (8) above, such failure shall constitute a default under this bond, for which City may make a claim, and Surety shall be obligated to make immediate payment under this bond of all sums.

6-5-2008 RCK Page 3 of 3

STATE OF )

) ss: ACKNOWLEDGMENT FOR PRINCIPAL

COUNTY OF )

I certify that I know or have satisfactory evidence that is the person who appeared before me, said person acknowledged that he/she signed this bond, and on oath stated that he/she was authorized to execute the bond on behalf of the Principal as the Principal’s free and voluntary act for the uses and purposes mentioned therein.

WITNESS my hand and official seal hereto affixed this day of , .

(Signature of Notary Public) (Print or type name of Notary Public)

Notary Public in and for the state of residing at My commission expires . SEAL

STATE OF )

) ss: ACKNOWLEDGMENT FOR SURETY

COUNTY OF )

I certify that I know or have satisfactory evidence that is the person who appeared before me as the Attorney-in-Fact for the Surety that executed the foregoing bond, acknowledged said bond to be the free and voluntary act and deed of the Surety for the uses and purposes therein mentioned, and on oath stated that he/she is authorized to execute said bond on behalf of the Surety, and that the seal affixed on said bond or the annexed Power of Attorney is the corporate seal of said Surety.

WITNESS my hand and official seal hereto affixed this day of , .

(Signature of Notary Public) (Print or type name of Notary Public)

Notary Public in and for the state of residing at My commission expires . SEAL

FOR THE SURETY: FOR THE PRINCIPAL:

By By: _

(Signature of Attorney-in-Fact) (Signature of authorized signer for Principal)

(Type or print name of Attorney-in-Fact) (Type or print NAME of signer for Principal)

(Type or print telephone number for Attorney-in-Fact) (Type or print TITLE of signer for Principal)

SK rev Page 1 of 2

BOND IN LIEU OF RETAINED FUNDS

Revised

Bond No._______________

I. [Insert Principal’s legal name and check appropriate box below] , an individual OR a husband and wife, a partnership organized under the laws of the State of , the General or Managing Partner for which is , a limited liability corporation organized under the laws of the State of , the Manager (or Member) for which is [specify applicable status], a corporation organized and existing under the laws of the State of and authorized to do business in the State of Washington, as Principal (hereinafter "Principal"), has been awarded a contract with The City of Seattle (hereinafter "Seattle") for or relating to , (Contract No. , which contract is incorporated herein by this reference);

II. The Contract and Ch. 60.28 of the Revised Code of Washington (hereinafter "RCW") require Seattle to withhold from Principal a sum (hereinafter "the retainage") in an amount not to exceed five percent (5%) of all monies earned by Principal on estimates during the progress of work under the Contract, but in the initial sum of

Dollars ($ ) as a trust fund for the protection and payment of (a) the claims of any person arising under the Contract, and (b) the State of Washington with respect to taxes imposed pursuant to RCW Title 82 that may be due from Principal; and

III. Principal has requested that Seattle not withhold the retainage, or that Seattle release all or a portion of the retainage currently withheld, as allowed under RCW 60.28.011(6) in exchange for this Bond; Now, Therefore, THE CONDITIONS OF THIS OBLIGATION ARE AS FOLLOWS:

1. Principal and , a corporation organized and existing under the laws of the State of and authorized to transact business in the State of Washington as Surety (hereinafter "Surety"), are jointly and severally held and bound unto Seattle and all other beneficiaries of the trust fund created by RCW 60.28.011(1), as Obligees, in a penal sum equal to five percent (5%) of all monies earned by the Principal on estimates during the progress of work under said Contract (which sum includes and is not limited to increases due to change orders, increases in the quantity of work, and the addition of new items of work), lawful money of the United States of America, for the payment of which Principal and Surety bind themselves and their heirs, executors, administrators, successors, and assigns, jointly and severally, as provided herein.

2. This Bond, including any proceeds therefrom, is subject to all claims and liens arising out of the work performed under said Contract, in the same manner and priority as set forth for the retainage under RCW Ch.

60.28. Any amount(s) determined by Seattle to be due and payable from the retainage in accordance with the provisions of RCW Ch. 60.28 shall be paid by Surety not later than thirty (30) days from and after Surety's receipt of Seattle's written identification of the appropriate payee and amount payable.

3. Surety waives notice of any extension of time or other modification of the Contract. Surety agrees to and is bound by the laws and subject to the jurisdiction of the courts of the State of Washington with respect to this Bond. The venue for any action hereunder shall be in King County, Washington.

4. This Bond shall remain in full force and effect until Surety is notified by Seattle that (a) all necessary affidavits have been provided by Principal; (b) Seattle has received the Washington State Department of Revenue's certification that all taxes, increases and penalties due and to become due from Principal with respect to such Contract or otherwise have been paid in full or are readily collectible without recourse to the State's lien on this Bond; (c) Seattle is satisfied that the claims of materialmen and laborers who have filed claims against such bond, Bond No. _______________________

SK rev Page 2 of 2 together with sums sufficient to defray the cost of foreclosing the liens of such claims and to pay attorneys' fees associated therewith, have been paid; (d) any sums due to Seattle from the Principal have been paid; (e) Seattle is satisfied that all other taxes, increases, and penalties due and owing from the Contractor have been paid; and

(f) the obligation is duly released by Seattle.

For Surety: For Principal:

By: By:

(Signature) Attorney-in-Fact (Signature)

(Print or type name of Attorney-in-Fact) (Print or type name of signer for Principal)

Print or type address of Attorney-in-Fact for Surety:

(Print or type title of signer for Principal)

STATE OF )

) ss: (PRINCIPAL’S ACKNOWLEDGMENT)

COUNTY OF )

On this day of , __

WITNESS my hand and official seal hereto affixed the day and year in this certificate first above written.

, before me a notary public in and for the State of , duly commissioned and sworn, personally appeared

, the person(s) described in and who executed the foregoing Bond, and acknowledged to me that signed and sealed said Bond as a free and voluntary act and deed for the Principal so identified in foregoing Bond for the uses and purposes therein mentioned, and on oath stated that is/are authorized to execute said Bond for the principal named therein.

(Signature of Notary Public) (Print or type name of Notary Public)

Notary Public in and for the State of residing at My commission expires . [SEAL]

STATE OF )

) ss: (SURETY’S ACKNOWLEDGMENT)

COUNTY OF )

On this day of , __

WITNESS my hand and official seal hereto affixed the day and year in this certificate first above written.

, before me a notary public in and for the State of , duly commissioned and sworn, personally appeared

, the person described in and who executed the foregoing Bond, and acknowledged to me that signed and sealed said Bond as a free and voluntary act and deed for the Surety so identified in foregoing Bond for the uses and purposes therein mentioned, and on oath stated that is authorized to execute said Bond for the Surety named therein.

(Signature of Notary Public) (Print or type name of Notary Public)

Notary Public in and for the State of residing at My commission expires . [SEAL]

City of Seattle Revision: 05/2026

SUBCONTRACTOR APPROVAL APPLICATION

INSTRUCTIONS: Before a classified subcontractor, service provider, or supplier of any tier may begin Work, all sections of this form must be completed (including all necessary attachments), signed by the Prime Contractor, and submitted for approval by the owner’s representative (i.e., Engineer or Project Manager). “Classified” means all those who employ work categories that are covered by prevailing wage.

1. Business name and address must be the same as shown on the State License.

2. Fill in first four columns using the Bid Form in the Contract. For Lump Sum contracts use the Schedule of Values and Unit Price items. Use column headed “Amount Sublet” for the subcontractor’s cost for that item. When splitting bid item work, including a specialty item, a description of the portion of the work being performed by this subcontractor must be clarified in the column headed “Bid Item Description.” For example, if the Bid Item is “Handhole Type 2”, but subcontractor is only performing saw-cutting, then indicate “Handhole Type 2 saw-cutting only” in this column.

3. All dollar values shall include cents.

4. If the Contractor is requesting to self-perform, check the box next to “Subcontractor.”

5. If the Subcontractor is requesting to Subcontract, check the box next to “Lower Tier Subcontractor.”

SECTION A – PROJECT AND BUSINESS INFORMATION

Project Name PW# Spec. No (if applicable)

Contractor Business Name (Prime) Telephone Number

Address City State Zip

Approval is requested to sublet the Work described below to:

Business Name (Select one: Subcontractor or Lower Tier Contractor or Supplier or Service Provider)

Telephone Number/E-mail

Address City State Zip

Federal Tax ID # State UBI # Seattle Business License # Contractor’s License # (when applicable)

Exp. Exp.

Employment Security (ES)#

Subcontracted to (name of higher-tiered business)

Subcontractor’s Estimated Start Date

Subcontractor’s Estimated Number of Working Days

TOTAL SUBCONTRACT AWARD

AMOUNT (i.e., Total Amount Sublet per table below)

Check indicating the subcontractor/supplier/service provider has a signed written agreement on file with the Prime Contractor:

Is this an FHWA project?

Yes, complete and attach WSDOT Form 420-004 with this application.

No, no additional form required.

Work to be sublet:

Bid Item # Quantity Bid Item Description

Unit Price Extension or Lump Sum Price

Amount of Extension or Lump Sum Sublet

Partial Amount of Bid Item (Y/N)

Total Amount Sublet:

SECTION B – PREVAILING WAGE INTENT

LNI approved Intent to Pay Prevailing Wages for subcontractor/supplier/service provider attached? Yes ( Intent# )

No(Attach receipt of Intent filing)

SECTION C - RESPONSIBILITY

In accordance with Section 1-02.1 of the Contract, the following responsibility verifications must be met for a subcontractor/supplier/service provider to be considered responsible and approved to the Site. To verify responsibility for each subcontractor/supplier/service provider, go to each listed link below, and print and attach evidence of the following:

1. If required by the business and scope type, certificate of registration in compliance with Chapter 18.27 RCW (https://secure.lni.wa.gov/verify/)

2. If required by the business type, industrial insurance coverage for the firm’s employees working in Washington as required by Title 51 RCW. (http://www.lni.wa.gov/IPUB/101-002-000.pdf)

3. Employment security number as appropriate under Title 50 RCW (supplied by the subcontractor)

4. State excise tax registration number as provided under Title 82 RCW (https://secure.dor.wa.gov/gteunauth)

5. Not disqualified from bidding on any public works contracts provided in RCW 39.06.010, 39.12.065, 49.46.005, 49.52

(https://secure.lni.wa.gov/debarandstrike/ContractorDebarList.aspx)

6. A current Seattle Business License with current Business and Occupancy Taxes pursuant to SMC 5.55.030

(http://www.seattle.gov/licenses/find-a-business)

7. Not owe any monetary disincentive assessments or penalties regarding Apprentice Utilization on prior projects.

8. Registered on the City of Seattle’s Procurement Portal, powered by OpenGov. https://procurement.opengov.com/portal/seattle

9. Have received training on requirements related to public works and prevailing wage by Labor and Industries or approved training provider under RCW 39.04.350, and chapter 39.12 or are exempted by Labor and Industries (https://secure.lni.wa.gov/verify)

10. If this is a federally funded project, the company is registered with the federal System of Award Management.

(https://www.SAM.gov/SAM/)

Does this Work require trade/scope specific qualifications or experience?

Yes? Please attach the copy of the specification and the required experience evidence (e.g. certification, etc.)

No

SECTION D – SOCIAL EQUITY

Does the total sublet dollar amount of the Work, as listed in Section A, match the dollar amount listed in the WMBE Guarantee section of the Inclusion Plan?

Not applicable Yes No (If no, please contact Miguel Beltran, Contract Compliance Manager in Purchasing and Contracting (PC), to reconcile the amount sublet and the amount listed as the WMBE Guarantee. Attach Miguel’s written confirmation to this form to be approved to work on site. (206) 684-4525.)

By signing this form, I certify that I have verified the subcontractor/supplier/service provider listed above is compliant with the requirements listed on this application. I understand and will require that the subcontractor/supplier/service provider comply fully with the Contract under which this Work is being performed.

Prime Contractor's Signature Date

Consent for City of Seattle Administering Department Only

Authorized CITY OF SEATTLE Signature Date:

Printed Name of Signature Title:

Approved Rejected, Reason:

Relative

Weight

(Percent)

Score

(0-100) Points

1 9.5% 0 0

3.5% 0 0

3 4.3% 0 0

2.8% 0 0

5 3.0% 0 0

5.8% 0 0

6.8% 0 0

7.5% 0 0

5.2% 0 0

7.7% 0 0

8.7% 0 0

12 6.2% 0 0

13 8.2% 0 0

14 7.0% 0 0

8.8% 0 0

Contract Change Orders have been submitted on time, on approved forms, and with appropriate documentation

CONTRACTOR PERFORMANCE EVALUATION

PW CONTRACT NO.:

REVIEW DATE:

COS DEPARTMENT PROJECT MANAGER: COMPLIANCE REPRESENTATIVE: LABOR EQUITY REPRESENTATIVE:

CATEGORY #1 - CONSTRUCTION WORK

All work has been done as specified in the Contract Specifications and Plans

(including workmanship)

The Contractor is continuously represented by a duly authorized representative at the project site during progress of the Work.

Contractor’s supervision is on-site and knowledgeable on contract specifications and plans. Keeps Owner up to date

Construction Work Criteria

SCORING CRITERIA: Deficient: 0-59, Subject to Improvement: 60-69, Standard: 70-79, Good: 80-89, Superior: 90-100

RFI’s have been submitted using provided format within the specifications and submitted with appropriate information.

Submittals have been prepared and submitted per the project manual

Contractor keeps at the project site for review by the Engineer shop drawings and other drawings accurately detailing deviations from original drawings per the project manual.

Critical Path (CPM) Schedule and Look Ahead Schedule has been prepared, submitted, and updated per the project manual.

Equipment and machinery are adequate for the purposes used, kept in good working condition, and operated by competent operators per the project manual.

Relations and coordination with the general public, other agencies and adjacent contractors per the project manual.

Compliance with environmental laws, ordinances, & regulations

Contractor maintains Safety Standards and Responsibilities to the Public per the project manual.

Project site kept clean

Payments submitted accurate and on time with supporting documentation

CONTRACTOR CONTRACTOR REPRESENTATIVE:

PROJECT NAME

PROJECT DESCRIPTION:

CONTRACT AWARD SUM: FINAL CONTRACT SUM: CWA (Yes or No): REVIEW TYPE (Mid or Final):

Contractor has effectively coordinated work between subcontractors and suppliers.

Rev: September 2023 Page 1 of 3

5.0% 0 0

100% 0

Relative

Weight

(Percent)

Score

(0-100) Points

17 20.0% 0 0

18 20.0% 0 0

19 20.0% 0 0

20.0% 0 0

21 20.0% 0 0

100% 0

Relative

Weight

(Percent)

Score

(0-100) Points

10% 0 0

60% 0 0

24 10% 0 0

25 10% 0 0

26 10% 0 0

COMMENTS:

SCORING CRITERIA: Deficient: 0-59, Subject to Improvement: 60-69, Standard: 70-79, Good: 80-89, Superior: 90-100

All on-line reports are accurate and up to date each month (LCPtracker and

B2Gnow

Eligible subcontractors are receiving prompt payments (30 days after invoice).

Contractor is on-track for achieving their goals (WMBE goal /Apprentice

Utilization goal/DBE goal). Contractor makes good faith efforts to achieve

Prevailing Wage Compliance. Contractor complies with prevailing wage law and resolves issues in a timely manner.

Compliance Criteria

Worksite is free from harassment, bullying or hazing conduct, and meets the

Acceptable Work Site standards.

Contractor has submitted a feasible Social Equity Plan for Priority Hire projections and Apprenticeship utilization. Projections were feasible at the start of construction and were updated if/when requested.

NOTE: All scoring criteria receiving a "Deficient" score (0-59) will require an explanation justifying the rating in the Comment Box.

CATERGORY #2: CONTRACT COMPLIANCE- CATEGORY SCORE

Labor Equity Criteria

Contractor attends the Joint Administrative Committee (JAC) and discusses project progress and workforce performance.

Contractor and all subcontractors submit pre-job paperwork at least two weeks prior to beginning work and attend pre-job conferences

Contractor has demonstrated compliance with articles II, III, IV, VI, VII, X of the

CWA

Contractor exceeds, meets or provides evidence of good faith efforts towards the project workforce requirements for Priority Hire Apprentices, Priority Hire

Journey-Level workers, and Preferred Entry Apprentices.

CATEGORY #2 - CONTRACT COMPLIANCE

Diligence in completing final (punch list) work within scheduled timeframe

( Mid-point Review will result in a score of 100 )

CATEGORY #1: CONSTRUCTION WORK - CATEGORY SCORE

NOTE: All scoring criteria receiving a "Deficient" score (0-59) will require an explanation justifying the rating in the Comment Box.

SCORING CRITERIA: Deficient: 0-59, Subject to Improvement: 60-69, Standard: 70-79, Good: 80-89, Superior: 90-100

COMMENTS:

NOTE: All scoring criteria receiving a "Deficient" score (0-59) will require an explanation justifying the rating in the Comment Box.

COMMENTS:

CATERGORY #3 - LABOR EQUITY (For Projects with a Community Workforce Agreement (CWA))

Rev: September 2023 Page 2 of 3

100% 0

OVERALL PEFORMANCE EVALUATION SCORE 0

P.O. Box 94669

Seattle, WA

98124-4669

FAS_PW_Admin@Seattle.gov

CONTRACTOR COMMENT/CONTRACTOR FEEDBACK:

Note: A Contractor may contest any final score or comment by submitting a protest in writing. Protests must submitted to the FAS-Purchasing and Contracting Director within five (5) business days after receiving the Final

Contractor Perfromance Evaluation. Submit Final Contractor Peformance Evaluation scoring protests to FAS-

Purchasing and Contracting at:

By mail: By email:

CATERGORY #3: LABOR EQUITY - Point Allocation

50% w/out CWA, 25% w/CWA

0% w/out CWA, 25% w/CWA

50%

OVERALL PERFORMANCE EVALUATION

FAS - PC Div. Director/Dep Div. Director DateContractor Representative Signature Date

Capital Department - Project Manager Date

FAS - Purchasing and Contracting Date FAS - Labor Equity Signature Date

FAS - Contract Compliance Signature Date

CATERGORY #3: LABOR EQUITY - CATEGORY SCORE

SCORING CRITERIA: Deficient: 0-59, Subject to Improvement: 60-69, Standard: 70-79, Good: 80-89, Superior: 90-100

CATERGORY #1: CONSTRUCTION WORK - Point Allocation

CATERGORY #2: CONRACT COMPLIANCE - Point Allocation

Rev: September 2023 Page 3 of 3

City of Seattle

Department of Finance and Administrative Services Purchasing and Contracting

Revised 11/2024 Page 1 of 8

Supplemental Bidder Responsibility Criteria Form (SBRC)

INTENT

As required under RCW 39.04.350, the Owner will make a responsibility determination of the lowest responsive bidder. Responsibility is evidenced by the Bidder’s performance history free from non-compliance and legal issues and by the Bidder’s project experience, if specified. Responsibility is not a qualifications determination.

Financial responsibility will be determined by a Bidder’s ability to provide a Payment and Performance Bond.

Per the Bid Documents, the Owner may take whatever action is necessary to establish the ability of the Bidder to perform the Work to the Owner’s satisfaction, and it is the sole opinion of the Owner if the Bidder is considered responsible.

INSTRUCTIONS

Upon Purchasing and Contracting (PC) request to complete this SBRC, the Bidder must return the SBRC within three (3) Business Days or as otherwise allowed by PC.

Bidder responses to the SBRC shall be in the context of the project staff associated with the performance of this project.

Return completed SBRC via either:

o Email: FAS_PW_Admin@seattle.gov o US Mail: City of Seattle, Seattle Municipal Tower, P.O. Box 94669, Seattle, WA 98124-4669 o By Delivery: (Street Address): 700 5th Ave, Suite 4350, Seattle, WA 98104-5008

Please clearly mark the package/email with the Public Works Number (PW#), Project Name and title of “Supplemental Bidder Criteria Form.”

Questions? Please contact Purchasing and Contracting (PC) at FAS_PW_Admin@seattle.gov or (206) 684-0444.

PROJECT BID

PW# Project Name

Your Contact Name and Title

Your Contact Phone Number

Contact Email

Company Legal Name

DBA (if any)

If applicable, list any former company names under which the Bidder, its Owners, and/or its principals has operated in the past three (3) years. (Mark NA if Not Applicable)

Signature:

By signing, you are attesting that all the information submitted in the SBRC is accurate and complete.

Signature of Authorized Representative Date

Print Name and Title: _____________________________________________________________

Supplemental Bidder Responsibility Criteria Form

Revised 11/2024 Page 2 of 8

PART 1 – Compliance History

The City will use the following responses to evaluate a Bidder’s responsibility.

A “YES” response on one question may, or may not, be evidence of not being responsible. The City will use a preponderance of evidence through “YES” responses and any repeat offenses when making a determination that a Bidder is not responsible. Per the Bid Documents, the City reserves the right to reject

Bid based on a responsibility determination or to require a corrective action plan around any of the following performance topics.

1. Performance Evaluation: Within the last 3 years, has your firm, under present or past business name, received one or more “deficient,” category rating from a City of Seattle Contractor Performance Evaluation.

No Yes (if yes, please attach a detailed explanation of the circumstances and any resolutions)

2. Anti-discrimination: Within the last 10 years, has your firm been found to have violated any local, state, or federal anti-discrimination laws or regulations?

No Yes (if yes, please attach a detailed explanation of the circumstances)

3. WMBE Inclusion: If your firm has done business previously with the City of Seattle, have you received one or more “deficient” evaluation scores on your WMBE Inclusion aspirational goals within the last 3 years?

4. Prevailing Wage: Within the last 3 years, has your firm been found by the City, or any government agency, to have underpaid your employees regarding prevailing wages when applicable and/or has your firm ever been required to provide restitution and pay back wages?

5. Minimum Wage. Within the last 5 years has your firm ever been found by the City, or any government agency, to have not paid the required minimum wage to an employee? (SMC 14.19, RCW 49.46)

6. Wage Theft: Within the last 5 years has your firm ever been found to have improperly managed employee wages, tips or payment documentation as required by SMC 14.20?

Revised 11/2024 Page 3 of 8

7. Apprenticeship: Within the last 3 years, has your firm had unresolved citations or liens issued by

Washington Department of Labor and Industries regarding apprenticeship?

Has your firm failed to meet the required apprenticeship/training goals on previous projects?

8. Labor Equity/Priority Hire: Within the last 5 years, has your firm violated any collective bargaining, project labor or community workforce agreement?

No Yes (if yes, please attach a detailed explanation and outline corrective action you have taken to ensure similar incidents do not occur in the future.)

Within the last 5 years, has your firm failed to meet any goals and requirements of a project labor or community workforce agreement?

No Yes (if yes, please attach a detailed explanation and outline corrective action you have taken to ensure similar incidents do not occur in the future.)

9. Acceptable Work Site: Within the last 3 years, has your firm or an employee of your firm, been involved or accused of inappropriate work place behavior including, but not limited to, harassment, bullying, racist or sexual misconduct, hazing, or similar?

10. Termination: Within the last 3 years, has your firm, under present or past business name, been terminated for “default or cause” on any public construction project?

11. Debarment: Within the last 3 years, has your firm or any firm with which any of your firm’s owners, officers or partners was associated, been debarred, disqualified, removed or otherwise prevented from bidding on, or completing any public construction project for any reason? Note: “associated with” refers to another construction firm in which an owner, partner or officer of your firm held a similar position.

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12. Paid Sick and Safe Time (PSST): Has your firm ever failed to comply with the PSST requirements (SMC 14.16 and RCW 49.46) to eligible employees?

No Yes (if yes, please attach a detailed explanation of the circumstances)

Note: Paid Sick and Safe Time is required beyond that which you might pay employees as part of prevailing wage compensation and benefits.

______ (initials) I am aware of the requirements of SMC Chapter 14.16 and RCW 49.46.

13. Safety: Within the past 3 years, has the Washington State Department of Labor and Industries, federal

OSHA, or any other state’s occupational safety and health agency cited your (local) firm for any “serious,”

“willful” or “repeat” violations of its safety or health regulations?

14. WA State L&I Experience Factor: Is your firm’s current Experience Factor greater than 1 for the current calendar year?

No Yes (if yes, please attach an explanation of the circumstances causing the rating over 1 and steps taken to reduce the experience factor)

List the Experience Factor (Washington workers’ compensation insurance) of your firm for each of the past 3 years.

Current Year: Previous Year: Year to previous year:

Note: An Experience Factor is calculated annually by the Washington Department of Labor and Industries. More information can be found here: http://www.lni.wa.gov/ClaimsIns/Insurance/RatesRisk/How/ExpFactor/ExpModFactor/

If your firm is Self-Insured: 1.) attach your OSHA 300 logs for the last 3 years; 2.) calculate your incident rate for the current calendar year using the following website: https://www.safetyinfo.com/calculator-osha-incident-rate-free-index/; 3.) print out your rating and submit as an attachment to the SBRC. A rating of 3.0 or above may require additional documentation explaining circumstances causing the rating and steps your firm has taken to reduce incident rates.

15. Environmental: Within the past 3 years, has the Environmental Protection Agency (EPA), Washington

Department of Ecology (Ecology), any Regional Clean Air Agency, or any other state’s equivalent environmental enforcement agency cited either your firm, or the owner of a project on which your firm was the contractor?

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16. Fair Chance Employment: Within the last 3 years, has your firm been found to be out of compliance with the requirements of SMC 14.17 and the use of conviction and arrest records in your hiring practices?

Equal Benefits: Please declare one (1) option from the list below that describes the Contractor’s compliance status with Seattle Municipal Code Chapter 20.45 and related rules. For additional information or explanations regarding the Equal Benefits Program with the City please visit our website at http://www.seattle.gov/city-purchasing-and-contracting/social-equity/equal-benefits

Option A: The Contractor makes, or intends to make by the contract award date, all benefits available on an equal basis to its employees with spouses and its employees with domestic partners, and to the spouses and the domestic partners of employees, in every location within the United States where substantial work on contract will be performed.

Option B: The Contractor does not make benefits available to either the spouses or the domestic partners of its employees.

Option C: The Contractor has no employees.

Option D: Collective Bargaining Delay. Benefits are available on an equal basis to non-union workers, but union workers are subject to a collective bargaining agreement that does not provide equal benefits.

Option E: Open Enrollment Delay. The first open enrollment period for implementing Equal Benefits is not available until after contract execution

Option F: Cash Equivalent Payment. The Contractor intends to provide a cash equivalent payment to eligible employees in lieu of making benefits available.

No United States Presence: The Contractor does not perform substantial work for the contract in any United State location.

Non-Compliant: The Contractor does not comply and does not intend to comply, and refuses all options provided above.

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PART 2 – Personnel

Key Personnel: List the Superintendent and Project Manager who will be assigned to this project.

Superintendent Project Manager

Attach detailed resumes, updated within the last year, for each named individual with a list of all projects supervised or managed within the past three (3) years (or longer if required in the Bid Documents), with references and contact information for each project.

The Owner may check other owner references for previous projects and use the other owner’s assessment of the personnel’s performance in determining responsibility.

Note: The Bidder may not subsequently replace or substitute a different Superintendent or Project Manager without the Owner reviewing and approving the qualifications of the new Superintendent or Project Manager.

PART 3 – Work Experience

Work Experience: The Bidder and Bidder’s personnel or Subcontractor’s personnel (if permissible by the Bid

Documents) must meet the specified work experience requirements if specified in the Bid Documents.

A Work Experience Form is included for the Bidder (Attachment A). A Work Experience Form

Subcontractors (Attachment B) is also included IF the Bid Documents allow for the past experience of a subcontractor to satisfy work experience requirements.

Please complete one (1) Work Experience Form for each reference project satisfying specified work experience requirements. Unless otherwise stated in the Bid Documents, include projects substantially completed by your firm in the last 5 years.

The Owner may check references on the projects provided to confirm the other owner’s assessment of the Bidder’s performance. The Owner may inquire about topics, including but not limited to, the following:

Quality control;

Safety record;

Ability to develop, track and meet project schedules;

Use of skilled personnel;

Management of subcontractors;

Compliance with contract documents;

Management of submittals process, change orders and close out; and

Any other criteria required for the project being bid.

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Work Experience Form: Bidder Attachment A

The City will evaluate the submitted information to determine whether a Bidder has the work experience necessary for this project, if specified in the Bid Documents.

Please complete one form per reference project for the number of projects as required in the Bid Documents.

Please demonstrate on this form how the reference project meets the specified work experience requirements defined in the Bid Documents.

Please mark “NA” in all boxes that don’t apply to the reference project.

PAST PROJECT EXPERIENCE DETAILS

BIDDER’S COMPANY NAME:

BIDDER CONTACT NAME & PHONE NUMBER:

PROJECT NAME:

PROJECT CONTRACT NUMBER:

PROJECT OWNER:

PROJECT LOCATION:

PROJECT OWNER CONTACT NAME & TITLE:

OWNER’S TELEPHONE NUMBER:

NOTICE TO PROCEED DATE: COMPLETION DATE: AWARDED CONTRACT

VALUE:

FINAL CONTRACT VALUE:

PRIME CONTRACTOR NAME (If not bidder):

CONTRACTOR CONTACT NAME & PHONE NUMBER (If not bidder):

BRIEF PROJECT DESCRIPTION:

LIST TECHNICAL SCOPES OF WORK PERFORMED BY THE BIDDER, INCLUDING ANY RELEVANT DETAILS TO DEMONSTRATE SIMILAR EXPERIENCE AND ANY REQUIRED EXPERIENCE DETAILED IN THE SPEC. (e.g., demolition, specialty construction, electrical, mechanical, paving, etc.)

SPECIALTY TRADES/OTHER SUBCONTRACTED SCOPES PERFORMED:

List other scopes of work performed by other subcontractors with relevant work experience. Indicate if your company managed this work or if the work was managed by another firm on the reference project.

WMBE/DBE UTILIZATION RATES: STATE THE MINORITY AND WOMAN UTILIZATION ON THIS PROJECT, REGARDLESS OF WHETHER THE OWNER SOUGHT OR REQUIRED SUCH UTILIZATION. (State in a percentage of the Final Contract Value.)

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Work Experience Form: Subcontractor Attachment B

USE THIS FORM ONLY IF THE BID DOCUMENTS ALLOW FOR THE USE OF A SUBCONTRACTOR’ PAST EXPERIENCE TO SATISFY THE

PROJECT’S WORK EXPERIENCE REQUIREMENTS.

If the Bid Documents allow for the use of subcontractor experience, the City will evaluate the submitted information to determine whether a Subcontractor has the experience necessary for this project.

Please complete one form per reference project for the number of projects as required in the Bid Documents.

Please demonstrate on this form how the reference project meets the specified work experience requirements defined in the Bid Documents.

Please mark “NA” in all boxes that don’t apply to the reference project.

SCOPE(S) of WORK to be performed by Subcontractor (e.g., electrical, concrete, plumbing): _____________________________________________________

PAST PROJECT EXPERIENCE DETAILS

SUBCONTRACTOR COMPANY NAME:

UBI No: ____ - ____ - _____

SUBCONTRACTOR CONTACT NAME & PHONE NUMBER:

PROJECT NAME:

PROJECT CONTRACT NUMBER:

PROJECT OWNER:

PROJECT LOCATION:

PROJECT OWNER CONTACT NAME & TITLE:

PROJECT OWNER’S TELEPHONE NUMBER:

NOTICE TO PROCEED DATE: COMPLETION DATE: AWARDED CONTRACT

VALUE:

FINAL CONTRACT VALUE:

PRIME CONTRACTOR NAME:

CONTRACTOR CONTACT NAME & PHONE NUMBER:

BRIEF PROJECT DESCRIPTION:

LIST TECHNICAL SCOPES OF WORK PERFORMED BY THE SUBCONTRACTOR, INCLUDING ANY RELEVANT DETAILS TO DEMONSTRATE SIMILAR EXPERIENCE AND ANY REQUIRED EXPERIENCE DETAILED IN THE SPEC. (e.g., demolition, specialty construction, electrical, mechanical, paving, etc.)

PW#: Date:

Project Name:

Award Amount

(No tax ):

Prime:

Contact Name:

Phone Number: City Staff approval:

Date:

Return the completed plan to PC for approval.

PC Contract Analyst: PC Labor Equity Staff (If Applicable):

Phone: 206- Phone: 206- Email: @seattle.gov Email: @seattle.gov Mailing Address: PO Box 94669, Seattle WA 98124-4669 Physical Address: Seattle Municipal Tower, 700 5th Avenue, Seattle WA 98104, Suite 4350

PC will discuss the social equity requirements and workforce projections prior to approving and completing award. PC may require improvements to your proposed plan before approving.

Social Equity Plan This Plan compiles all the Social Equity components of the project. The Social Equity Plan is updated as the project progresses. The first version of this Plan is due after you receive your Intent to Award. This Plan is a condition of award, and must be delivered prior to award. Additional updates as the project progresses shall be requested as needed by Purchasing and Contracting (PC). You will first incorporate your Inclusion Plan (which was submitted within your bid) and provide any other decisions or subcontract awards that have been made. The following sections apply to this project:

WMBE Inclusion Plan Supplement Apprenticeship Utilization Plan Priority Hire Projections

The City will not award until an approved Social Equity Plan is received. Undue delay may result in rejection of the bid.

PC reserves the right to request updates and to set a deadline for re-submittal. Failure to meet the deadline for the updated submittal may result in withholding of remaining payments until the Social Equity Plan is received and accepted.

Title your email with the name of your project and please include the PW# so it can be easily identified by the Contract Analyst.

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$0.00

PRIME:

Is this a Guaranteed

WMBE?

Is the Subcontract Executed?

Is the sub/supplier registered in

OBD?

II. WMBE UTILIZATION NOT YET DETERMINED OR COMMITTED

Do you anticipate using a

WMBE?

Can only a Sole Source do the work?

Approximate Subcontract $

Amount

#DIV/0!Total WMBE (intended and not yet commited) #DIV/0!

Scopes of Work that you Intend to Award to WMBEs

PW#:

PROJECT NAME:

Contract WMBE Goal (percent):

Note: After contract award, the prime contractor can seek a change to the WMBE Inclusion Plan by informing the PC/Contract Analyst, making a request to the Project manager through a Change Order and demonstrating “G ood C ause.” Include an updated version of this Plan to show how such a change impacts the goals and guarantees. PC will evaluate the request, and if appropriate, a Change Order will be prepared by the Project Engineer. If PC determines that the change to the WMBE Inclusion Plan is not justified, PC will inform the Prime Contractor. Requests without the WMBE inclusion plan supplement form will not be accepted.

Complete the folowing section if the percentage of Award Amount provided above remains less than the aspirational goal given within your original Inclusion Plan that you submitted at time of bid.

Total amount Intended to be performed by WMBEs to Date + Total Amount Not Yet Committed to a WMBE Sub/Supplier = >Total Contract amount WMBE Goal (must meet or exceed the Aspirational Goal).

Total Amount Not Yet Committed to a Sub/Supplier:

Total Amount Intended to be Performed by WMBEs to Date:

Scopes where the sub/supplier is not yet determined or committed When do you anticipate making a selection?

Award Amount (No tax):

Approximate Subcontract $

Amount Intended WMBE Name

For non-federal projects with a base-bid Engineers Estimate of $300,000 or more.

WMBE Inclusion Plan Supplement

Y/N

I. WMBE SUBCONTRACTOR/SUPPLIERS INTEND TO AWARD: A WMBE Guarantee does not require a signed contract with the WMBE at bid time, however utilization of the WMBE Guarantee firm is mandatory when the contract is awarded. The work performed must be a commercially useful function in the amount equal or greater than the minimum guaranteed in the Inclusion Plan

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Date

PW#: PRIME:

PROJECT NAME:

Prime Contractor and all Subcontractors

Trade/Craft/Job Classification

Journey Labor Hours

Apprentice Labor Hours

Total Labor Hours for

Project

Apprentice Percentage

Number of Apprentices

0 0 0 0.00% 0

For projects $1 million or more, the prime contractor shall ensure that ___% of the total contract labor hours utilized on the Project are performed by apprentices registered with the Washington State Apprenticeship and Training Council (WSATC). The prime contractor should explore different avenues to meet the apprenticeship requirement and should include the apprentice utilization requirements in all subcontracts as a flowdown provision to ensure that all subcontractors working on the project contribute to attaining the apprentice utilization requirements. The prime contractor remains responsible for meeting the apprentice utilization requirements of the contract, including overall compliance on all contract labor hours worked by subcontractors. For assistance with available resources for apprenticeship programs, contact the Contract Analyst assigned to the project.

List the prime and all subcontractors scheduled to work on this project, and indicate trade craft or classification and the estimated number of hours to be performed by journey level and apprentice workers for each.

Note : To change the apprentice utilization requirement after contract award, the prime contractor must fill out the Apprentice Utilization Proposal Plan and make a written request to PC to reduce the required apprentice utilization percentage. The request must include documentation of the contractor's good faith efforts to hire apprentices with WSATC-approved programs.

Documents shall demonstrate that an inadequate number of apprentices are available to meet the required apprentice utilization percentage or that there is a disproportionately high ratio of material costs to labor hours, which does not make the required minimum levels of apprentice participation feasible for this contract, and that the contractor has made good faith efforts to comply with the requirement. Requests without the Apprentice Utilization Proposal Plan form will not be accepted. PC will evaluate the request, and if appropriate, a Change Order will be prepared by the Project Engineer. If PC determines that a reduction in the required utilization percentage is not justified, PC will communicate the decision in writing to the prime contractor.

Apprentice Utilization Proposal Plan

Estimated information

Fo…