20250402 Cripple Creek Skate Park Part III CDOT Forms.pdf

Colorado Department of Transportation Contractors Performance Capability Statement – Form 605 Instructions: Form to be completed by an authorized agent or Officer of the successful bidder/Contractor selected for award in accordance with the Colorado Department of Transportation’s Bid Rules. Attach additional pages as needed if more space is required to complete the form.

Project Number: ______________________________

Partnerships or Joint Ventures: List the names of any partnerships or joint ventures in the area below or put a check mark in the box for none.

None

Performance Capability: For each item below identify decreases in the Contractor’s fiscal or workmanship qualifications compared to the last prequalification application submitted to the Colorado Department of Transportation. If there are no changes/decreases, put a check mark in each box for none as applicable.

Key Personnel Changes - None

Key Equipment Changes - None

Fiscal Capability Changes - None

Other Changes Affecting Ability to Perform Work - None

Signature Declaration: I declare under penalty of perjury in the second degree, and any other applicable State or Federal laws, that the statements made on this document are true and correct to the best of my knowledge.

Contractor Company Name

By

Title

Date

Second Company Name if Joint Venture

By

Title

Date

Form Number 605 – April 2024

Colorado Department of Transportation Anti Collusion Affidavit – Form 606 Instructions: Form to be completed by an authorized agent or Officer for the bidder/Contractor submitting a bid for the Colorado Department of Transportation Project identified below.

Project Number: ______________________________

I hereby attest that I am the person responsible within my firm for the final decision as to the price(s) and amount of this bid or, if not, that I have written authorization, enclosed herewith, from that person to make the statements set out below on their behalf and on behalf of my firm. I further attest that:

1. The price(s) and amount of this bid have been arrived at independently, without consultation, communication, or agreement for the purpose or with the effect of restricting competition with any other firm or person who is a bidder or potential prime bidder.

2. Neither the price(s) nor the amount of this bid have been disclosed to any other firm or person who is a bidder or potential prime bidder on this project and will not be so disclosed prior to bid opening.

3. Neither the prices nor the amount of the bid of any other firm or person who is a bidder or potential prime bidder on this project have been disclosed to me or my firm.

4. No attempt has been made to solicit, cause, or induce any firm or person who is a bidder or potential prime bidder to refrain from bidding on this project, or to submit a bid higher than the bid of this firm, or any intentionally high or noncompetitive bid or other form of complementary bid.

5. No agreement has been promised or solicited for any other firm or person who is a bidder or potential prime bidder on this project to submit an intentionally high, noncompetitive, or other form of complementary bid on this project.

6. The bid of my firm is made in good faith and not pursuant to any consultation, communication, agreement or discussion with, or inducement or solicitation by or from any firm or person to submit any intentionally high, noncompetitive, or other form of complementary bid.

7. My firm has not offered or entered into a subcontract or agreement regarding the purchase or sale of materials or services from any firm or person, or offered, promised or paid cash or anything of value to any firm or person, whether in connection with this or any other project, in consideration for an agreement or promise by any firm or person to refrain from bidding or to submit any intentionally high, noncompetitive or other form of complementary bid or agreeing or promising to do so on this project.

8. My firm has not accepted or been promised any subcontract or agreement regarding the sale of materials or services to any firm or person and has not been promised or paid cash or anything of value by any firm or person, whether in connection with this or any other project, in consideration for my firm's submitting any intentionally high, noncompetitive, or other form of complementary bid, or agreeing or promising to do so, on this project.

9. I have made a diligent inquiry of all members, officers, employees, and agents of my firm with responsibilities relating to the preparation, approval or submission of my firm's bid on this project and have been advised by each of them that he or she has not participated in any communication, consultation, discussion, agreement, collusion, or other conduct inconsistent with any of the statements and representations made in this affidavit.

10. I understand and my firm understands that any misstatement in this affidavit is and shall be treated as a fraudulent concealment from the Colorado Department of Transportation, of the true facts relating to submission of bids for this contract.

Signature Declaration: I declare under penalty of perjury in the second degree, and any other applicable state or federal laws, that the statements made on this document are true and complete to the best of my knowledge.

Contractor Company Name

By

Title

Date

Second Company Name if Joint Venture

By

Title

Form Number 606 – April 2024

Colorado Department of Transportation Assignment of Antitrust Claims – Form 621 Instructions: Form to be completed by an authorized agent or Officer of the successful bidder/Contractor selected for award of the Colorado Department of Transportation (CDOT) Project identified below.

Project Number: ______________________________

Contractor and CDOT recognize that in actual economic practice antitrust violations ultimately impact on CDOT.

Contractor hereby agrees to the following assignment of antitrust claim provisions for the executed construction Contract for the project:

1. Contractor hereby irrevocably assigns to CDOT all claims it may now have or which may hereafter accrue to it under federal or state antitrust laws in connection with the project, goods or services purchased or acquired by CDOT pursuant to the executed construction Contract.

2. Contractor hereby expressly agrees:

A. Upon becoming aware that a third party has commenced a civil action asserting on Contractor’s behalf and antitrust claim which has been assigned to CDOT hereunder, Contractor shall immediately advise in writing:

i. Such third party that the antitrust claim has been assigned to CDOT, and

ii. CDOT that such civil action is pending and of the date on which, in accordance with subparagraph A.(i) above, Contractor notified such third party that the antitrust claim had been assigned to CDOT.

B. To take no action which will in any way diminish the value of the claims or rights assigned or dedicated to CDOT hereunder.

C. Promptly to pay over to CDOT its proper share of any payment under an antitrust claim brought on Contractor’s behalf by any third party and which claim has been assigned to CDOT hereunder.

3. Further, Contractor agrees that in the event it hires one or more subcontractors to perform any of its duties under the executed construction Contract, Contractor shall require that each subcontractor do the following:

A. Irrevocably assign to CDOT as a third party beneficiary all claims that such subcontractor may have or which may thereafter accrue to the subcontractor under federal and state antitrust laws in connection with any goods or services provided by the subcontractor in carrying out the subcontractor’s obligations to the Contractor.

B. Upon becoming aware that a third party has commenced a civil action asserting on subcontractor’s behalf and antitrust claim which has been assigned to CDOT hereunder, Contractor shall immediately advise in writing:

i. Such third party that the antitrust claim has been assigned to CDOT, and

ii. Contractor and CDOT that such civil action is pending and of the date on which, in accordance with subparagraph B(i) above, subcontractor notified such third party that the antitrust claim had been assigned to

CDOT.

C. Take no action which will in any way diminish the value of the claims or rights assigned or dedicated to CDOT hereunder.

D. Promptly to pay over to CDOT its proper share of any payment under an antitrust claim brought on subcontractor’s behalf by any third party and which claim has been assigned or dedicated to CDOT pursuant hereto.

Signature Declaration: Acting in my capacity as an authorized agent or Officer for the Contractor do hereby agree to the above assignment of antitrust claim provisions.

Contractor Company Name

By

Title

Date

Second Company Name if Joint Venture

By

Title

Form Number 621 – April 2024

COLORADO DEPARTMENT OF TRANSPORTATION

COMMITMENT CONFIRMATION (CDOT Form 1415) Section A. Bidder/Prime Contractor and DBE Information. This section must be completed by the Bidder/Prime Contractor.

1. Project S/A No. or PCN Number (5 digit #):

2. FHWA Project #, Subaward Agreement # from

COTRAMS (FTA

contracts), or PO # (for CM/GC-CM contracts):

3. Project Name:

4. Name of Bidder/Prime Contractor:

5. Bidder/Prime Contractor's Contact Name:

6. Bidder/Prime Contractor's Contact Title:

7. Bidder/Prime Contractor's Contact Phone Number:

8. Bidder/Prime Contractor's Contact Email Address:

9. Name of DBE Firm:

10. DBE Firm Physical Address:

11. DBE Contact Name:

12. DBE Contact Email Address:

13. DBE Contact Phone Number:

14. Subcontracted to Whom: if Prime

15. Is the DBE part of a Joint Venture?

(if Yes, attach joint venture agreement) Yes No 16. Anticipated Work

Start Date:

17. Applicable Small Business Goals (To be completed ONLY for FHWA-funded Design-Build contracts)

DBE Design Goal

DBE Construction Goal

Applicable Contract Year: (July 1, - June 30, )

Section B. Commitment Details

18. DBE Commitment Details

a. Work Category c. DBE Work Code(s) (NAICS + Descriptor)

Construction

Trucking

Supplies

Services

Other

Design Services (for FHWA-funded Design- Build contracts and FTA Consultant Contracts only)

b. Work to be Performed d. Commitment Amount

e. Amount Eligible for DBE Participation

Total:

19. Bidder/Prime Contractor Representative:

This section must be signed by an individual with the authority to contractually bind the Bidder/Prime Contractor to the DBE commitment listed on this form. You declare under penalty of perjury in the second degree and any other applicable state or federal laws that the statements made in this document are complete, true, and accurate to the best of your knowledge. If a DBE commitment is being made and the subcontract is between a lower-tier subcontractor and a DBE firm (not the Prime Contractor), the Prime Contractor shall provide this signed CDOT Form 1415 to that lower-tier subcontractor and the DBE Standard Specification shall be followed.

a. Name b. Title c. Signature d. Date

"Previous editions are obsolete and may not be used." CDOT Form No. 1415 [09/23] Page 1

COMMITMENT CONFIRMATION (CDOT Form 1415) Section C. DBE Questionnaire. This section must be completed by the DBE firm. (Attach additional pages if necessary.)

This document is not a contract with the Bidder/Contractor; it is an acknowledgement of the obligation that the Bidder/Contractor is making to CDOT. The amounts listed above may be less than the subcontract or purchase order amount, but can never be more, and shall not reflect any mark up by the Bidder/Contractor. All questions must be answered.

20. Will the DBE firm be purchasing supplies or materials, or will the DBE firm be leasing or renting equipment from the Prime Contractor or its subcontractors? If so, explain.

21. Does the DBE firm intend to subcontract any portion of the work listed in Section B of this form? If yes, state to whom the DBE firm intends to sublet, what work is to be performed by said subcontractor, and the approximate written agreed upon dollar amount.

Include trucking subcontractors and owner-operators.

22. Will the DBE firm provide trucking services on this project? If yes, state how many trucks are owned by the DBE firm and employees that will work on this project.

23. Within the DBE firm, who will be supervising the work on this project?

24. Will the DBE firm be acting as a broker on this project? If yes, state what the DBE firm will be brokering and the approximate brokerage fee.

25. Will the DBE firm be acting as a supplier on this project? If yes, please state what the DBE firm will be supplying and whether or not they will manufacture the items.

This section must be signed by an individual with the authority to verify the DBE's anticipated participation on the contract as listed on this form. You, the DBE Representative, declare under penalty of perjury in the second degree and any other applicable state or federal laws that the statements made in this document are complete, true and to the best of your knowledge. You attest that you are eligible to participate as a DBE on this contract for the work listed above and have the capacity to perform the work as stated.

26. DBE Representative b. Title c. Signature d. Date

SECTION D. Determination. This section must be completed by the CDOT Region Civil Rights Office or the CDOT Civil Rights Business Resource Center staff member.

27. Review of Request Approved Denied

28. Comments

29. CDOT Representative

a. Name b. Title c. Signature d. Date of Decision

"Previous editions are obsolete and may not be used." CDOT Form No. 1415 [09/23] Page 2

GOOD FAITH EFFORT REPORT (CDOT Form 1416) Section A. Bidder/Prime Contractor and Project Information

1. Project (S/A) No.

or PCN Number (5 digit #):

2. FHWA Project #, Subaward Agreement # from

COTRAMS (FTA

projects), or PO # (for CM/GC-CM contracts):

3. Project Name:

4. Name of Bidder/Prime Contractor:

5. Bidder/Prime Contractor's Contact Name:

6. Bidder/Prime Contractor's Contact Title:

7. Bidder/Prime Contractor's Contact Phone #:

8. Bidder/Prime Contractor's Contact Email Address

Section B. Bid/Proposal Information (to be completed ONLY if submitted at bid time)

9. Bid/Proposal $Amount:

10. Contract Goal %Percentage

11. Contract Goal Dollar $Value:

Section C. Contract Summary to Date (not including this request) (to be completed after project is awarded)

12. Original Contract Amount:

13. Total Change $Orders (to date):

14. Total Other Adjustments $(to date):

15. Adjusted Contract Amount (applicable to $the DBE goal):

16. Contract DBE Goal (to $ %date):

17. Commitment (to date): $ % 18. Participation (to date): $ %

19. Applicable Small Business Goals DBE Design Goal DBE Construction Goal (To be completed ONLY for FHWA-funded Design-Build contracts) Applicable Contract Year: (July 1, - June 30, )

Section D. Efforts to Achieve DBE Participation. Complete the questions below and provide any supporting documentation which demonstrates the Bidder/Prime Contractor's good faith efforts. Attach additional page(s) as necessary.

20. Describe the overall plan or approach to meet the contract goal.

21. List the amount and the type of work the Bidder/Prime Contractor intends to self-perform on the contract.

22. List the amount and the type of work the Bidder/Prime Contractor intends to subcontract.

23. List the amount and type of work for all subcontracting opportunities for DBEs. Using the DBE Directory, include the number of DBEs that are certified in the specific NAICS codes for each contracting area.

"Previous editions are obsolute and may not be used." CDOT Form No. 1416 [09/23] Page 1

Section D. Efforts to Achieve DBE Participation (continued...) Describe the efforts to obtain DBE participation (i.e. how the Bidder/Contractor attempted to execute the plan or approach to meeting the contract goal). Cost alone shall not be a reason to reject a DBE and will be considered in the evaluation. Attach additional page(s) if necessary.

24. List the direct outreach conducted (state the name of the DBE solicited, date(s) and method of outreach - phone, email, or fax) (attach all supporting documentation for the direct outreach conducted).

25. List the indirect outreach conducted to contact DBEs such as events, publications, and/or communication with minority and other organizations. Include date(s), location, and audience of each event, and attach all supporting documentation for the indirect outreach conducted.

26. List other efforts made to assist DBEs in competing for or obtaining contracts (accepting quotes from DBEs that may be higher than other subcontractors, modifications to contract scopes, unbundling, mentoring, etc.).

27. List and describe any obstacles encountered in assisting or contracting with DBEs.

"Previous editions are obsolute and may not be used." CDOT Form No. 1416 [09/23] Page 2

28. Include any other efforts made by the Contractor to obtain DBE participation.

29. If the eligible participation submitted on the Form 1414 was miscalculated, determined to be invalid, or otherwise did not meet the contract goal, provide the justification for such deficiencies and the remedies that were taken to avoid the issue in the future. If the Bidder has obtained any additional commitments since submission of the bid, attach the Form 1415(s) and the reason why such commitments were not obtained prior to the proposal due date. (To be completed ONLY if submitted at proposal time)

Section E. Affidavit of Good Faith Efforts The Bidder/Contractor must show that it took all necessary and reasonable steps to achieve the DBE contract goal, which by their scope, intensity, and appropriateness to the objective could reasonably be expected to obtain sufficient DBE participation, even if not fully successful. 49 CFR Part 26, Appendix A sets forth examples and guidance for good faith efforts. The Bidder/Contractor is not limited to the examples provided in 49 CFR Part 26, Appendix A and may provide any documentation that demonstrates good faith efforts to obtain DBE participation on this contract.

If, at any time, CDOT has reason to believe that any person or firm has willfully and knowingly provided incorrect information or made false statements, CDOT may initiate suspension or debarment proceedings against the person or firm under 49 CFR Part 26, take enforcement action under 49 CFR Part 31, Program Fraud and Civil Remedies, and/or refer the matter to the Department of Justice or Office of the Inspector General for criminal prosecution under 18 U.S.C. 1001, which prohibits false statements in Federal programs.

By signing below, the Bidder/Contractor hereby affirms that it has made good faith efforts and has documented all such efforts on this form and through the attached supporting documentation.

30. Bidder/Prime Contractor Signature: 31. Date:

Section F. Determination

32. Project Owner Representatives (CDOT or Subrecipient/Local Agency)

Pre-Award ONLY CDOT Civil Rights Business Resource Center (CRBRC):

Approve

Reject

b. First & Last Name

Recommend for Approval

Recommend for Rejection

Approve

Reject

a. Title

Post- Award ONLY CDOT Region Civil

Rights Specialist (for post-award):

Post-Award ONLY Project

Engineer/Manager:

c. Signature d. Date e. Determination

33. Comments:

"Previous editions are obsolute and may not be used." CDOT Form No. 1416 [09/23] Page 3