Funded by: Federal Highway Administration, Seattle Transportation Plan Levy

Bids Open: November 4, 2026

CITY OF SEATTLE

Improvement of

Roosevelt Way Preservation

NHPP-1611(005)

FEDERALLY FUNDED PROJECTS: This project is federally funded; therefore, the Contractor must comply with the Federal Regulations and complete all data required in the “Bidder’s Checklist”.

PW#: 2025-074

BID FORMS

ADDENDUM 1

Roosevelt Way Preservation Page 6 Bid Form NHPP-1611(005)

Version: 1/01/26-FHWA

B. BID PROPOSAL FORMS

BID FORM

TO THE DIRECTOR OF FINANCE AND ADMINISTRATIVE SERVICES OF THE CITY OF SEATTLE:

A. The undersigned Bidder hereby certifies to have personally and carefully examined the Bid Documents issued for: Roosevelt Way Preservation , as authorized under Ordinance Number(s) 127362.

B. The Bidder has examined the Project Site where the Work is to be performed and the conditions affecting the Work;

C. Understanding that the quantities shown in the Bid are estimates only, being given for the purposes of comparing Bids, the Bidder hereby proposes to furnish all Material and labor and to perform all Work which may be required, and to complete the Work within the time fixed and upon the terms and conditions provided in the Bid Documents for the following prices:

D. The Bidder has attached a Bid Guaranty in the amount of five percent (5%) of the Total Bid including retail sales tax in the form of cashier’s check, certified check, or Bid bond;

(NOTE: The letters “SP” whenever appearing in the SP column of the Bid Form indicate that additions or revisions to the Standard Specifications applicable to that Bid item are included in the project manual.

The Contractor is advised to review those requirements regarding Bid items so designated.)

The number to the left of the Bid item description denotes the “Bid item code” for that particular Bid item.

If it is a six digit number, the first three digits indicate the associated Specification division and section number. If it is a seven digit number, the first digit denotes the schedule number and the next three digits indicate the associated Specification division and section number. The last three digits comprise the identification number for that item within the particular Section.

A separate schedule will be issued for those items in which the Owner will pay retail sales tax in accordance with the excise tax Rule 170 (refer to Section 1-07.2(2) of the Specifications). For all other Bid items, the Contractor shall include retail sales tax in accordance with the excise tax Rule 171 (refer to Section 1-07.2(1) of the Specifications)

NOTE TO BIDDERS:

Bidders submitting Bids electronically must enter bid item prices on OpenGov.

Bidders submitting a hard copy Bid via United States Postal Service (USPS) must complete the Bid Form.

Roosevelt Way Preservation Page 7-1

Bid Item Code

Bid Item Description

Estimated Quantity

Units Unit Price Unit Price Extension

SP 1 104001 MINOR CHANGE 65,000 CALC $1.00 $65,000.00

SP 2 105005 CONSTRUCTION SURVEYING 1 LS ________________ __________________

SP 3 108005 CRITICAL PATH SCHEDULE UPDATE, MIN. BID =

$1500 per EA

13 EA ________________ __________________

SP 4 109005 MOBILIZATION 1 LS ________________ __________________

SP 5 110020 TRAFFIC CONTROL PEACE OFFICERS 1,800 HR ________________ __________________

SP 6 110025 PORTABLE CHANGEABLE MESSAGE SIGN 34 WK ________________ __________________

SP 7 110030 TRAFFIC CONTROL SUPERVISOR 1 LS ________________ __________________

SP 8 110035 PEDESTRIAN TRAFFIC CONTROL 1 LS ________________ __________________

SP 9 110040 FLAGGERS 2,500 HR ________________ __________________

SP 10 110050 OTHER TEMPORARY TRAFFIC CONTROL

DEVICES

1 LS ________________ __________________

11 110051 NOT USED 0 NA ________________ __________________

SP 12 110055 OTHER TRAFFIC CONTROL LABOR 2,000 HR ________________ __________________

SP 13 110065 WORK ZONE SAFETY CONTINGENCY 75,000 FA $1.00 $75,000.00

14 201005 CLEARING & GRUBBING 1,548 SF ________________ __________________

15 202030 REMOVE ASPHALT PAVEMENT 320 SY ________________ __________________

16 202035 REMOVE CEM CONC SIDEWALK 4,719 SY ________________ __________________

Bidder:_____________________________________ Page Subtotal:________________________

BID FORM 2025-074

Bid Item

SCHEDULE: BASE BID

Roosevelt Way Preservation Page 7-2

Code

Bid Item Description

Estimated Quantity

Units Unit Price Unit Price Extension

17 202045 REMOVE PAVEMENT 6,651 SY ________________ __________________

18 202145 REMOVE CURB 4,882 LF ________________ __________________

19 202270 REMOVE CATCH BASIN OR SAND BOX 2 EA ________________ __________________

20 202305 REMOVE FOUNDATION, METAL STRAIN POLE 1 EA ________________ __________________

21 202307 REMOVE FOUNDATION, METAL STRAIN POLE

(FULL DEPTH)

1 EA ________________ __________________

22 202310 REMOVE FOUNDATION, STREET LIGHT POLE 4 EA ________________ __________________

23 202330 REMOVE HANDHOLE 8 EA ________________ __________________

24 202340 REMOVE INLET 13 EA ________________ __________________

25 202350 REMOVE LUMINAIRE AND BRACKET ARM 3 EA ________________ __________________

26 202385 REMOVE POLE, METAL STRAIN 2 EA ________________ __________________

27 202390 REMOVE POLE, STREET LIGHT 2 EA ________________ __________________

28 202400 REMOVE POST, METAL 29 EA ________________ __________________

29 202420 REMOVE POST, WOOD 2 EA ________________ __________________

30 202430 REMOVE SIGN 51 EA ________________ __________________

31 202480 REMOVE TREE 5 EA ________________ __________________

32 202650 REMOVE VEHICLE SIGNAL HEAD 13 EA ________________ __________________

Bidder:_____________________________________ Page Subtotal:________________________

BID FORM 2025-074

Bid Item

Roosevelt Way Preservation Page 7-3

Code

Bid Item Description

Estimated Quantity

Units Unit Price Unit Price Extension

33 202655 REMOVE PEDESTRIAN SIGNAL HEAD 4 EA ________________ __________________

34 202685 REMOVE WIRING, STREET LIGHTING 1 LS ________________ __________________

SP 35 202750 SAWCUT ASPHALT CONCRETE, FULL DEPTH 205 LF ________________ __________________

SP 36 202767 SAWCUT CEMENT CONCRETE SIDEWALK, FULL

DEPTH

1,647 LF ________________ __________________

SP 37 202770 SAWCUT RIGID PAVEMENT, FULL DEPTH 7,262 LF ________________ __________________

38 202850 ABANDON AND FILL PIPE 77 LF ________________ __________________

39 202s02 REMOVE HANDRAIL 163 LF ________________ __________________

SP 40 202s03 REMOVE, STORE, AND REINSTALL HANDRAIL 412 LF ________________ __________________

41 204005 COMMON EXCAVATION 1,386 CY ________________ __________________

SP 42 204301 UTILITY VERIFICATION EXCAVATION, FULL

DEPTH, (STRAIN POLE FOUNDATION)

1 EA ________________ __________________

43 207010 SAFETY SYSTEMS IN TRENCH EXCAVATION,

MIN. BID =$0.80 per SF

856 SF ________________ __________________

SP 44 207040 UTILITY SUPPORT SYSTEM 240 LF ________________ __________________

45 401002 MINERAL AGGREGATE, TYPE 2 1,949 TN ________________ __________________

46 401017 MINERAL AGGREGATE, TYPE 17 117 TN ________________ __________________

47 504020 SURFACE PREP, PRELEVEL 120 TN ________________ __________________

48 504025 SURFACE PREP, PLANE BITUMINOUS

PAVEMENT

44,360 SY ________________ __________________

Bidder:_____________________________________ Page Subtotal:________________________

BID FORM 2025-074

Bid Item

Roosevelt Way Preservation Page 7-4

Code

Bid Item Description

Estimated Quantity

Units Unit Price Unit Price Extension

49 504055 PAVEMENT, HMA (CL 1 IN) 147 TN ________________ __________________

50 504145 PAVEMENT, WMA (CL 1/2 IN) 4,958 TN ________________ __________________

51 504260 PAVEMENT PATCH, TEMPORARY 300 TN ________________ __________________

52 504300 CEMENT CONCRETE GRINDING FOR BUTT

JOINT, 0-2" DEPTH

29 SY ________________ __________________

53 504310 CRACK SEALING 8,500 LF ________________ __________________

54 505132 ROADWAY CEM CONC, HES (24 HR), 8 IN 30 SY ________________ __________________

55 505136 ROADWAY CEM CONC, HES (24 HR), 12 IN 61 SY ________________ __________________

56 505289 ROADWAY CEM CONC BASE, HES (24 HR), 12 IN 4,462 SY ________________ __________________

57 705356 CATCH BASIN, TYPE 242B 3 EA ________________ __________________

58 705357 CATCH BASIN, TYPE 240C 4 EA ________________ __________________

59 705358 CATCH BASIN, TYPE 240D 11 EA ________________ __________________

60 705450 INLET, TYPE 250A 1 EA ________________ __________________

61 705451 INLET, TYPE 250B 7 EA ________________ __________________

62 705452 INLET, TYPE 252 5 EA ________________ __________________

SP 63 708058 PIPE, CB CONN, D.I., CL 50, 8 IN 428 LF ________________ __________________

64 708258 PIPE, INLET CONN, D.I., CL 50, 8 IN 299 LF ________________ __________________

Bidder:_____________________________________ Page Subtotal:________________________

BID FORM 2025-074

Bid Item

Roosevelt Way Preservation Page 7-5

Code

Bid Item Description

Estimated Quantity

Units Unit Price Unit Price Extension

65 708s01 VERTICAL CONNECTION, 8 IN 25 VF ________________ __________________

SP 66 713s01 SUPPORT FOR SPU CREW WORK 10,000 FA $1.00 $10,000.00

67 714015 ASSIST SPU WITH RESETTING EXISTING

HYDRANT

10 EA ________________ __________________

68 714020 ASSIST SPU WITH RELOCATING EXISTING

HYDRANT

3 EA ________________ __________________

69 717008 BEDDING, CL B, 8 IN PIPE 727 LF ________________ __________________

70 717s90 TELEVISION INSPECTION 428 LF ________________ __________________

71 720005 ADJUST EXISTING MH, CB, OR VC 14 EA ________________ __________________

72 720020 ADJUST EXISTING VALVE BOX 2 EA ________________ __________________

73 720045 ADJUST EXISTING HANDHOLE 9 EA ________________ __________________

SP 74 720050 ADJUST EXISTING ELECTRICAL VAULT 5 EA ________________ __________________

75 720231 UTILITY CASTING, TYPE 231, COVER 21 EA ________________ __________________

76 720235 UTILITY CASTING, TYPE 230L 8 EA ________________ __________________

77 720265 UTILITY CASTING, TYPE 265, VANED GRATE 13 EA ________________ __________________

78 720266 UTILITY CASTING, TYPE 266, VANED GRATE 0 EA ________________ __________________

79 720s01 UTILITY CASTING, TYPE 263 2 EA ________________ __________________

80 721004 FULL CIPP LINER, 8 IN 473 LF ________________ __________________

Bidder:_____________________________________ Page Subtotal:________________________

BID FORM 2025-074

Bid Item

Roosevelt Way Preservation Page 7-6

Code

Bid Item Description

Estimated Quantity

Units Unit Price Unit Price Extension

81 801001 CONSTRUCTION STORMWATER & EROSION

CONTROL PLAN (CSECP)

1 LS ________________ __________________

82 801002 TREE, VEGETATION & SOIL PROTECTION PLAN

(TVSPP)

1 LS ________________ __________________

SP 83 801003 SPILL PREVENTION, CONTROL &

COUNTERMEASURES PLAN (SPCCP)

1 LS ________________ __________________

84 802026 TREE, CONIFEROUS EVERGREEN, 5 FT TO 6 FT 2 EA ________________ __________________

85 802070 TREE, DECIDUOUS, 2 IN TO 2-1/2 IN CAL 19 EA ________________ __________________

86 802214 PLANTING SOIL 263 CY ________________ __________________

87 802235 MULCH, ARBORIST WOOD CHIP 17 CY ________________ __________________

88 802360 TREE ROOT BARRIER 180 LF ________________ __________________

89 802610 SEEDED LAWN INSTALLATION 6,407 SF ________________ __________________

90 802700 LANDSCAPE ESTABLISHMENT, MIN. BID =

$13,000

1 LS ________________ __________________

91 802710 LAWN ESTABLISHMENT, MIN. BID = $2,200 1 LS ________________ __________________

92 802720 ROCK MULCH 4 CY ________________ __________________

SP 93 802730 PRUNING 42,251 FA $1.00 $42,251.00

SP 94 802s01 INVERTED-U BIKE RACK 6 EA ________________ __________________

SP 95 802s02 BIKE RACK BASE 4 EA ________________ __________________

SP 96 802s03 BOULDER - TYPE 1 5 EA ________________ __________________

Bidder:_____________________________________ Page Subtotal:________________________

BID FORM 2025-074

Bid Item

Roosevelt Way Preservation Page 7-7

Code

Bid Item Description

Estimated Quantity

Units Unit Price Unit Price Extension

SP 97 802s04 BOULDER - TYPE 2 2 EA ________________ __________________

98 804025 CURB, CEM CONC W/ 25% POZZOLANS 7,273 LF ________________ __________________

99 804035 CURB AND GUTTER, CEM CONC W/ 25%

POZZOLANS

648 LF ________________ __________________

SP 100 804040 CURB, CEM CONC, PBL BUFFER W/ 25%

POZZOLANS

1,600 SY ________________ __________________

101 807005 CURB, TRAFFIC, PRECAST 515 LF ________________ __________________

SP 102 807s01 WHEEL STOP 4 EA ________________ __________________

SP 103 807s02 RUBBER MOUNTABLE HARDENED LINE 330 LF ________________ __________________

104 808002 LANE MARKER, TYPE 2 1,000 EA ________________ __________________

105 810011 FLEXIBLE DELINEATOR POST (28" HIGH) 210 EA ________________ __________________

106 810012 FLEXIBLE DELINEATOR POST (48" HIGH) 19 EA ________________ __________________

107 810013 FLEXIBLE DELINEATOR POST (66" HIGH) 1 EA ________________ __________________

108 813030 RELOCATE OR RESET MONUMENT AND

MONUMENT FRAME AND COVER

7 EA ________________ __________________

109 814026 CURB RAMP W/ 25% POZZOLANS 782 SY ________________ __________________

110 814030 DETECTABLE WARNING PLATE 1,830 SF ________________ __________________

111 814035 TACTILE DIRECTIONAL INDICATOR, CAST-IN-

PLACE

322 LF ________________ __________________

112 814130 BUS SHELTER FOOTING W/ 25% POZZOLANS 14 SY ________________ __________________

Bidder:_____________________________________ Page Subtotal:________________________

BID FORM 2025-074

Bid Item

Roosevelt Way Preservation Page 7-8

Code

Bid Item Description

Estimated Quantity

Units Unit Price Unit Price Extension

113 814205 SIDEWALK, CEM CONC W/ 25% POZZOLANS 5,593 SY ________________ __________________

114 814210 SIDEWALK, THICKENED EDGE W/ 25%

POZZOLANS

5,543 LF ________________ __________________

115 818142 HANDRAIL, TYPE 442 163 LF ________________ __________________

SP 116 818s01 REINFORCING U-BAR 55 EA ________________ __________________

117 819006 DRIVEWAY, CEM CONC, 6 IN 47 SY ________________ __________________

118 819018 DRIVEWAY, CEM CONC, HES (24 HRS), 8 IN 152 SY ________________ __________________

119 821002 SIGN, TRAFFIC, POLE MOUNTED 31 EA ________________ __________________

120 821003 SIGN, TRAFFIC, SPAN WIRE MOUNTED 7 EA ________________ __________________

121 821004 SIGN, TRAFFIC, POST MOUNTED 119 EA ________________ __________________

122 821030 POST, SIGN 54 EA ________________ __________________

123 821050 RELOCATE SIGN, TRAFFIC 27 EA ________________ __________________

124 821055 RELOCATE SIGN, STREET NAME 17 EA ________________ __________________

125 821s01 REFLECTIVE POST SLEEVE, RED 9 EA ________________ __________________

126 822006 PAVEMENT MARKING, PAINT, 6 IN STRIPE 670 LF ________________ __________________

127 822018 PAVEMENT MARKING, THERMOPLASTIC, 8 IN

STRIPE

7,500 LF ________________ __________________

128 822020 PAVEMENT MARKING, THERMOPLASTIC,

LEGEND/SYMBOL

199 EA ________________ __________________

Bidder:_____________________________________ Page Subtotal:________________________

BID FORM 2025-074

Bid Item

Roosevelt Way Preservation Page 7-9

Code

Bid Item Description

Estimated Quantity

Units Unit Price Unit Price Extension

129 822204 PAVEMENT MARKING, MMA, 4 IN STRIPE 16,700 LF ________________ __________________

130 822206 PAVEMENT MARKING, MMA, 6 IN STRIPE 14,250 LF ________________ __________________

131 822208 PAVEMENT MARKING, MMA, 8 IN STRIPE 870 LF ________________ __________________

132 822225 PAVEMENT MARKING AREA, MMA, GREEN 8,300 SF ________________ __________________

133 830052 LUMINAIRE, LED, PRINCIPAL ARTERIAL 5 EA ________________ __________________

134 830600 WIRING, STREET LIGHTING 1 LS ________________ __________________

135 830s00 RELOCATE ACCESS POINT 1 EA ________________ __________________

136 830s01 RELOCATE VEHICLE PREEMPTION DETECTOR 2 EA ________________ __________________

137 831131 SIGNAL HEAD, VEHICLE, 3 SECTION 1-WAY 13 EA ________________ __________________

138 831160 SIGNAL HEAD, PEDESTRIAN COUNTDOWN, LED 4 EA ________________ __________________

139 831180 APS PEDESTRIAN PUSHBUTTON ASSEMBLY 6 EA ________________ __________________

140 831200 BOOM TRUCK AND OPERATOR FOR INSPECTOR 4 HR ________________ __________________

141 831306 DETECTOR LOOP, 6 FT DIA. 75 EA ________________ __________________

142 831308 DETECTOR LOOP, PARALLELOGRAM 23 EA ________________ __________________

143 831450 TERMINAL CABINET 2 EA ________________ __________________

144 831480 SPAN WIRE 265 LF ________________ __________________

Bidder:_____________________________________ Page Subtotal:________________________

BID FORM 2025-074

Bid Item

Roosevelt Way Preservation Page 7-10

Code

Bid Item Description

Estimated Quantity

Units Unit Price Unit Price Extension

SP 145 831574 SIGNAL WIRING (NE NORTHGATE WAY) 1 LS ________________ __________________

SP 146 831575 SIGNAL WIRING (NE 112TH ST) 1 LS ________________ __________________

147 831583 RAPID FLASHING BEACON SYSTEM, SOLAR

(ROOSEVELT)

1 LS ________________ __________________

SP 148 831700 TEMPORARY SIGNAL (NE NORTHGATE WAY) 1 LS ________________ __________________

SP 149 831701 TEMPORARY SIGNAL (NE 112TH ST) 1 LS ________________ __________________

SP 150 831s08 BIKE INDICATOR SYSTEM 2 EA ________________ __________________

SP 151 831s09 THERMAL TRAFFIC DETECTION SYSTEM (NE

95TH ST)

1 LS ________________ __________________

152 832015 POLE, STEEL STRAIN, TYPE X 1 EA ________________ __________________

153 832285 POLE, ALUMINUM LIGHTING, 25 FT TO 35 FT 4 EA ________________ __________________

154 832422 PEDESTAL, ALUMINUM, 12 FT 1 EA ________________ __________________

155 832500 PEDESTRIAN PUSH-BUTTON POST 7 EA ________________ __________________

156 832535 FOUNDATION, POLE TYPE X 1 EA ________________ __________________

157 832545 FOUNDATION, STREET LIGHT POLE 4 EA ________________ __________________

158 832550 FOUNDATION, PEDESTAL 1 EA ________________ __________________

159 832551 FOUNDATION, RRFB PEDESTAL 3 EA ________________ __________________

160 832555 FOUNDATION, PEDESTRIAN PUSH BUTTON

POST

7 EA ________________ __________________

Bidder:_____________________________________ Page Subtotal:________________________

BID FORM 2025-074

Bid Item

Roosevelt Way Preservation Page 7-11

Code

Bid Item Description

Estimated Quantity

Units Unit Price Unit Price Extension

161 832810 BRACKET ARM, 10 FT 5 EA ________________ __________________

162 832815 BRACKET ARM, 15 FT 1 EA ________________ __________________

163 833023 CONDUIT, PVC, 2 IN 270 LF ________________ __________________

164 833034 CONDUIT, PVC, 3 IN 850 LF ________________ __________________

SP 165 833204 TRENCHING, CONDUIT 450 LF ________________ __________________

166 833332 HANDHOLE, TYPE 2 14 EA ________________ __________________

167 833333 HANDHOLE, TYPE 3 5 EA ________________ __________________

Bidder:_____________________________________ Page Subtotal:________________________

BID FORM 2025-074

Bid Item

Roosevelt Way Preservation Page 7-12

State Sales Tax (10.55% ) N/A

$_________________ Total BASE BID including tax

BID FORM SUMMATION 2025-074

BASE BID (items 1 through 167 inclusive)

Roosevelt Way Preservation Page 8 Declaration NHPP-1611(005)

Version: 1/01/26-FHWA

DECLARATION

I declare, under penalty of perjury under the Laws of the State of Washington, as follows:

A. BID: I agree to perform the Work in compliance with the Bid Documents, for the prices stated in the Bid Form.

B. NON-DISCRIMINATION: I agree to ensure equal opportunity for employment and to engage in Affirmative Efforts in the solicitation of women and minorities and WMBE firms for participation on this Contract in accordance with SMC Ch. 20.42 and RCW 35.22.650.

C. My bid takes into account the requirements imposed by Section 1-07.14, which waives, with respect to the Owner only, the Contractor’s immunity under RCW Title 51, (Industrial Insurance) of the Revised Code of Washington.

D. I agree to comply with the requirements regarding subcontracting, and the purchase of supplies or materials from firms that are not disqualified or otherwise debarred from doing business with the City under the provisions of SMC Ch. 20.42 or SMC Ch. 20.70.

E. Responsible Bidder Requirements: My bid acknowledges that I am in compliance with all of the responsible bidder requirements under RCW 39.04.350, including: having a certificate of registration under RCW 18.27 prior to bidding; a UBI number; industrial insurance coverage if required under Title 51 RCW; an employment security number under Title 50; and a state excise tax registration number under Title 82. I affirm I am not disqualified from bidding on any public works contract under RCW 39.06 or RCW 39.12.065(3) or on the System for Award Management (sam.gov). I will provide proof of these requirements if requested.

F. My bid acknowledges that I have or will have prior to Award a current Seattle Business License and current on all Business and Occupancy Taxes pursuant to SMC5.55.030A; registered on the City of Seattle’s Procurement Portal, powered by OpenGov https://procurement.opengov.com/portal/seattle; demonstrate compliance with Equal Benefits (SMC20.45) and Labor Standards (SMC 14.16, 14.17, 14.19, 14.20) through the SBRC compliance Part 1; and not in violation of Campaign Contributions (SMC 2.04).

G. FEDERAL REQUIREMENTS:

1. Required Contract Provisions of FHWA Form 1273: The Bidder, by signing agrees to comply with all of the requirements of FHWA Form 1273, “Required Contract Provisions Federal-Aid Construction Contracts” (included in the Appendix of this Project Manual), and certifies to the following specific requirements therein:

III. Certification of Nonsegregated Facilities.

X. Implementation of Clean Air Act and Federal Water Pollution Control Act.

XI. Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion.

XII. Certification Regarding Use of Contract Funds For Lobbying.

The Bidder shall check the box at left if there are any exceptions to the certification required by XI above and attach an explanation to the Bid.

2. Equal Employment Opportunity: As required by 41 CFR 60-1.7(b)(1), the Bidder, by signing the Bid Form, certifies that if the Bidder or proposed subcontractor has participated in a previous contract or subcontract subject to the Equal Opportunity clause, as required by Executive Orders 10925, 11114, or 11246, the Bidder or proposed subcontractor has filed with the Joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President’s Committee on Equal Employment Opportunity, all reports due under the applicable filing requirements (Standard Form 100 (EEO-1)).

https://procurement.opengov.com/portal/seattle

Roosevelt Way Preservation Page 9

Version: 1/01/26-FHWA

3. Non-Collusion: The Bidder, by signing the Bid Form, swears, deposes and says that the undersigned person(s) firm, association, or corporation has (have) 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 the preparation and submission of a Bid to the Owner for consideration in the award of a contract on the improvement described in the Bid Documents and to have agreed to the provisions of this declaration.

4. Buy America Certificate: The Bidder hereby certifies that it will comply with the requirements of Section 1048 of Intermodal Surface Transportation Act of 1991 and Regulations in 23 CFR 635, and the Infrastructure Investment and Jobs Act (117th Congress 2021-2022) Section 70914 and

2 CFR 184.

The Bidder hereby certifies that it cannot comply with the requirements of Section 1048 of the Intermodal Surface Transportation Efficiency Act of 1991 the Infrastructure Investment and Jobs Act (117th Congress 2021-2022) Section 70914 , but it may qualify for an exception to the requirements pursuant to Section 1048 of the Intermodal Surface Transportation Efficiency Act and regulations in 23 CFR 635.410 and the Infrastructure Investment and Jobs Act (117th Congress 2021-2022) Section 70914.

5. Bid Rigging: NOTICE TO ALL BIDDERS. To report Bid Rigging activities call: 1-800-424-9071

The U.S. Department of Transportation (USDOT) operates the above toll-free hotline Monday through Friday, 8:00 am to 5:00 pm, eastern time. Anyone with knowledge of possible Bid Rigging, Bidder Collusion, or other fraudulent activities should use the hotline to report such activities.

The hotline is part of USDOT’s continuing effort to identify and investigate highway construction contracts fraud and abuser and is operated under the direction of the USDOT Inspector General. All information will be treated confidentially and caller anonymity will be respected.

6. FSBE: The Bidder agrees to make every effort to meet the FSBE requirements set forth in Section 1-07.11(11).

Roosevelt Way Preservation Page 10

Version: 1/01/26-FHWA

GENERAL BUSINESS INFORMATION

Business Name:

Business Street Address:

Business Mailing Address:

Business Phone, general: Business Fax:

If the above address is not in the State of Washington please fill in the following:

Washington State Office Address:

State in which the Company is formed:

Continue Information here:

State of WA UBI No.:

State of WA Contractor Registration No.:

Employment Security Department No.

City of Seattle Business License No.:

CONTACT INFORMATION

Primary Contact for Award (Name and Title):

Primary Contact Phone: Email:

Administration Contact (Name and Title):

Administration Contact Phone: Email:

Social Equity Contact (Name and Title):

Social Equity Phone: Email:

INSURANCE INFORMATION

Name of Insurance Company:

Name of Insurance Contact:

Insurance Contact Phone: Email:

Receipt is hereby acknowledged of Addenda No(s).:

OFFICIAL AUTHORIZED TO SIGN FOR BIDDER:

I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct:

Location or Place Executed (City, State): Print Name and Title:

Date:

Signature:

Roosevelt Way Preservation Page 11 Disadvantaged Business Enterprise Utilization NHPP-1611(005)

Version: 1/01/26-FHWA

DISADVANTAGED BUSINESS ENTERPRISE UTILIZATION

FSBE GOAL REQUIREMENTS

1. In compliance with the requirements of 49 CFR Part 26 and the Contract Documents the Bidder shall make every good faith effort, through negotiations or written solicitations, to meet the FSBE participation goal established for this project. The FSBE goal shall be the dollar amount which equals the following percentage of the total bid (exclusive of retail sales tax collected separately by the Contractor from the City in accordance with the existing laws of the State of Washington and rulings of the Tax Commission,):

13%

If the Bidder is a certified FSBE and will perform with the Bidder’s own forces a percentage of the contract equal to or exceeding the required FSBE goal percentage, the Bidder will have met FSBE goal requirements.

2. Certification: It is the Bidder’s responsibility to ensure that all FSBEs projected for use have been certified by the State of Washington Office of Minority and Women’s Business Enterprises (OMWBE) prior to bid opening. Verification of a FSBEs certification status may be done directly by telephoning OMWBE at (360) 753-9693 or by referencing the OMWBE web page at:

https://omwbe.wa.gov/certified-businesses-directory

3. Submittals: A copy of the joint venture or partnership agreement shall be submitted with the Bid Form if the FSBE requirements are to be satisfied through such an agreement.

Bidder Questionnaire Agency Name Federal Aid Number

Prime Contractor Name Contract Number

Contract Name

Firm/Subcontractor Name Address (incl. ZIP Code)

DBE

Status

NAICS

Codes Scope of Work Firm Age Firm Gross Receipts

If you have additional Firms or Subcontractors that submitted Bids, please complete additional forms.

All bidders listed on any other forms, including the Subcontractor List, must appear on this form.

Prime Contractor Representative Date

DOT Form 272-022 Revised 4/2026

● Previous Versions Obsolete ●

DOT Form 272-022 Revised 12/2025

● Previous Versions Obsolete ●

Form Instructions

The following information for each firm that submitted a bid is required as part of 49 CFR 26.11(c)(2):

Firm/Subcontractor Name: Enter the name of each firm or subcontractor who submitted a quote or a bid on the contract.

Address: Enter the main address of the firm/subcontractor. Include the ZIP code.

DBE Status: Enter the DBE status. Options are DBE and Non-DBE.

NAICS Codes: Enter the appropriate NAICS Codes for the work the bid was submitted for.

Scope of Work: Enter the scope of the work the bid was submitted for.

Firm Age: Enter the age of the firm.

Firm Gross Receipts: Enter the annual gross receipts. Options are “Less than $1 million”, “$1-$3 million”, “$3-$6 million”, “$6-$10 million”, “$10-$20 million ”, “$20-$30.72 million ”, “Greater than $30.72 million ”.

https://20-$30.72

Roosevelt Way Preservation Page 16 Bidder / Subcontractor List

Rev FHWA 07/2020 Final Circulation

BIDDER / SUBCONTRACTOR LIST

As required in RCW 39.30.060, all Bidders for projects estimated to cost $1,000,000 or more shall identify Subcontractors that the Bidder will subcontract for the performance of rebar and structural steel installation, HVAC, plumbing as described in RCW 18.106 and electrical as described in RCW 19.28, or indicate that the Bidder intends to self-perform the work. If the Trade is left blank (either the name of a subcontractor is blank or a checkbox is not checked), the City shall accept the blank as “self performance.” If left blank, the City shall determine through clarification whether rebar and structural steel installation, HVAC, plumbing and electrical work is required to execute the project. The Bidder shall be bound to self-performance of that specialty for the duration of the Project. The Bidder may contract with more than one Subcontractor in each of these trades, but may not list more than one Subcontractor for each category of work. If Subcontractors vary with Bid Alternates, Additives, or Deductives, the Bidder must indicate on a separate Bidder/Subcontractor List which Subcontractor(s) will be used for which Alternate, Additive, or Deductive.

The Bidder/Subcontractor List must be submitted to Purchasing and Contracting (PC) with the Bid Forms as described in RCW 39.30.060 per Section 1-02.6. Failure to complete and submit the Bidder/Subcontractor List by the required time will result in the Bid being declared non-responsive and rejected. The Bidder is responsible for the timely delivery of the Bidder Subcontractor List. If awarded the contract, the Bidder agrees to utilize the subcontractors identified on the Bidder/Subcontractor List unless the City agrees to a substitution.

Trade You must check one box for each trade. If subcontracting, you must name the subcontractor(s) you will use and the category of work.

Heating, Ventilation & Air Conditioning (HVAC)

Name of Sub: ___________________________UBI#___________

Category of Work: ___________________________

Bidder will self-perform this work

N/A (this project does not include this work)

Plumbing Name of Sub: ___________________________UBI#___________

Category of Work: ___________________________

Bidder will self-perform this work

N/A (this project does not include this work)

Electrical Name of Sub: ___________________________UBI#___________

Category of Work: ___________________________

Bidder will self-perform this work

N/A (this project does not include this work)

Structural Steel Installation

Name of Sub: ___________________________UBI#___________

Category of Work: ___________________________

Bidder will self-perform this work

N/A (this project does not include this work)

Rebar Installation Name of Sub: ___________________________UBI#___________

Category of Work: ___________________________

Bidder will self-perform this work

N/A (this project does not include this work)

PW# Bidder’s Business Name

Name of Bidder’s Representative Signature of Bidder’s Representative

Title of Bidder’s Representative

Contractor Certification Wage Law Compliance - Responsibility Criteria

Washington State Public Works Contracts

FAILURE TO RETURN THIS CERTIFICATION AS PART OF THE BID PROPOSAL PACKAGE WILL

MAKE THIS BID NONRESPONSIVE AND INELIGIBLE FOR AWARD

I hereby certify, under penalty of perjury under the laws of the State of Washington, on behalf of the firm identified below that, to the best of my knowledge and belief, this firm has NOT been determined by a final and binding citation and notice of assessment issued by the Washington State Department of Labor and Industries or through a civil judgment entered by a court of limited or general jurisdiction to have willfully violated, as defined in RCW 49.48.082, any provision of RCW chapters 49.46, 49.48, or 49.52 within three

(3) years prior to the date of the Call for Bids.

Bidder Name:

Name of Contractor/Bidder - Print full legal entity name of firm

By:

Signature of authorized person Print Name of person making certifications for firm

Title:

Title of person signing certificate

Place:

Print city and state where signed

Date:

Form 272-009 08/2017

APWA-WA Division 1 Committee rev. 1/8/2016

Proposal for Incorporating Recycled Materials into the Project

In compliance with a new law that went into effect January 1, 2016 (SHB1695), the Bidder shall propose below, the total percent of construction aggregate and concrete materials to be incorporated into the Project that are recycled materials. Calculated percentages must be within the amounts allowed in COS Section 9-03.16(1)E, Table on Maximum Allowable Percent (By Weight) of Recycled Material, of the Standard Specifications.

Proposed total percentage: _____________________________ percent.

Note: Use of recycled materials is highly encouraged within the limits shown above, but does not constitute a Bidder Preference, and will not affect the determination of award, unless two or more lowest responsive Bid totals are exactly equal, in which case proposed recycling percentages will be used as a tie-breaker, per the APWA GSP in Section 1-03.1 of the Special Provisions. Regardless, the Bidder’s stated proposed percentages will become a goal the Contractor should do its best to accomplish. Bidders will be required to report on recycled materials actually incorporated into the Project, in accordance with the APWA GSP in Section 1-06.6 of the Special Provisions.

Bidder:

Signature of Authorized Official:

Date: