24-05 - Electronic Bid Submission Form.pdf

CITY OF TROY VENDOR CERTIFICATION

CHARNWOOD CHIP SEAL 1/1

CITY OF TROY ENG. DEPT.

CONTRACT 24-05

VENDOR CERTIFICATION

THAT IT IS NOT AN

“IRAN LINKED BUSINESS”

Pursuant to Michigan law, (the Iran Economic Sanctions Act, 2012 PA 517, MCL 129.311 et seq.), before accepting any bid or proposal, or entering into any contract for goods or services with any prospective Vendor, the Vendor must first certify that it is not an “IRAN LINKED BUSINESS”, as defined by law.

Vendor

Legal Name

Street Address

City

State, Zip

Corporate I.D. Number/State

Taxpayer I.D. #

The undersigned, with: 1) full knowledge of all of Vendors business activities, 2) full knowledge of the requirements and possible penalties under the law MCL 129.311 et seq. and 3) the full and complete authority to make this certification on behalf of the Vendor, by his/her signature below, certifies that: the Vendor is NOT an “IRAN LINKED BUSINESS” as require by MCL 129.311 et seq., and as such that Vendor is legally eligible to submit a bid and be considered for a possible contract to supply goods and/or services to the City of Troy.

Signature of Vendor’s Authorized Agent:

Printed Name of Vendor’s Authorized Agent:

Witness Signature:

Printed Name of Witness:

CITY OF TROY CERTIFICATION REGARDING DEBARMENT,

CHARNWOOD CHIP SEAL SUSPENSION, AND OTHER

RESPONSIBILITY MATTERS

1 / 1

CITY OF TROY ENG. DEPT.

CERTIFICATION REGARDING

DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS

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

(1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in transactions under any non-procurement programs by any federal, state or local agency.

(2) Have not, within the three-year period preceding, had one or more public transactions (federal, state, or local) terminated for cause or default; and

(3) Are not presently indicted or otherwise criminally or civilly charged by a government entity

(federal, state, or local) and have not, within the three-year period preceding the proposal, been convicted of or had a civil judgment rendered against it:

a) For the commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public transaction (federal, state, or local), or a procurement contract under such a public transaction;

b) For the violation of federal, or state antitrust statutes, including those proscribing price fixing between competitors, the allocation of customers between competitors, or bid rigging; or

c) For the commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property.

I understand that a false statement on this certification may be grounds for the rejection of this proposal or the termination of the award. In addition, the general grant of this authority exists within the City’s Charter, Chapter 12, Section 12.2- Contracts.

[ ] I am able to certify to the above statements.

Name of Agency/Company/Firm (Please Print)

Name and title of authorized representative (Please Print)

Signature of authorized representative Date

[ ] I am unable to certify to the above statements. Attached is my explanation.

CITY OF TROY PROPOSAL

CHARNWOOD CHIP SEAL 1 / 5

CITY OF TROY

PLACE: CITY OF TROY

DATE: May 22, 2024, 10:00 AM

PROJECT: CHARNWOOD CHIP SEAL

The proposal of (hereinafter called “Bidder”) to the City of Troy, Oakland County, Michigan

The Bidder, in compliance with the Advertisement for Bid for the “CHARNWOOD CHIP SEAL”, having examined the plans and specifications with related documents and the sites of the proposed work, and being familiar with all of the conditions surrounding the construction of the proposed project, including the availability of materials and labor, hereby proposes to furnish all labor, materials and supplies, and to construct the project in accordance with the contract documents, within the time set forth therein, and at the prices stated below. These prices are to cover all expenses incurred in performing the work required under the contract documents, of which this proposal is part.

The Bidder affirms that in making such Proposal, neither he nor any company that he may represent nor anyone on behalf of him or the company directly has entered into any combination or collusion, undertaking or agreement with any bidder or bidders to maintain that the prices of said work, or any attempt to prevent any other bidder or bidders from bidding on said contract or work, and further affirms that such proposal is made without regard or reference to any other bidder or proposal and without any agreement or understanding or combination either directly or indirectly with any other person or persons with reference to such bidding in any way or manner whatsoever.

The Bidder agrees that this bid shall be good and may not be withdrawn for a period of sixty - (60) calendar days after the scheduled closing time for receiving bids.

The Bidder hereby agrees to commence work under this contract on or before the date to be specified in the written “Notice to Proceed”.

The Bidder acknowledges receipt of the following addenda:

No. DATED:

City of Troy Bids Due: Wednesday, May 22, 2024 500 W. Big Beaver 10:00 A.M., Local Time Troy, Michigan 48084 Contract: 24-05

CHARNWOOD CHIP SEAL 2 / 5

The undersigned, as Bidder, declares that he has familiarized himself with the location of the proposed project in the City of Troy. Bidder acknowledges that he has carefully examined the Plans, Specifications, and Contract Documents which he understands and accepts as sufficient for the purpose of constructing the work, and agrees that he will contract with the City of Troy, Oakland County, Michigan to furnish all labor, materials, and equipment necessary to do all the work specified and prescribed, and that he will accept in full payment therefore the sum of:

CITY OF TROY CONTRACT NO. 24-05

CHARNWOOD CHIP SEAL

Line Pay Item Description Quantity Units Unit Price Total

001 1100001 Mobilization, Max $20,000 1 LSUM

002 2047051 Audio-Video Route Survey, Max $5,000 1 LSUM

003 2050041 Subgrade Undercutting, Type II 100 Cyd

004 2057011 Excavation, 2 inches 6,270 Syd

005 4037001 DPW Structure Cover, Adj, Add Depth 5 Ft

006 4037050 DPW Structure Cover, Adj, Case 1 12 Ea

007 4037050 Sanitary Manhole Sealing 5 Ea

008 5012024 HMA, 4EL, PG 64-22, Leveling 500 Ton

009 5050002 Seal, Double Chip 62,700 Syd

010 5057011 Seal, Fog 62,700 Syd

011 8127051 Maintaining Traffic 1 LSUM

012 8507041 Inspection Crew Day Cday $800

TOTAL BID AMOUNT:

CHARNWOOD CHIP SEAL 3 / 5

The City reserves the right to accept any bid, or to reject any or all bids, to waive any and all informalities not involving price, time, or changes in the Work and to negotiate contract terms with the Successful Bidder, and the right to disregard all nonconforming, nonresponsive, unbalanced or conditional Bids. Also, the City reserves the right to reject the Bid of any Bidder if the City believes that it would not be in the best interest of the Project to make an award to that Bidder, whether because the Bid is not responsive or the Bidder is unqualified or of doubtful financial ability or fails to meet any other pertinent standard or criteria established by the City.

The undersigned agrees to furnish the required bonds and insurance certificates within seven (7) days after the acceptance of this proposal and further agrees to start construction within ten (10) days after being notified that work can begin.

The company representative does warrant that by signing the bid documents, the additional insured endorsement will be included in the insurance coverage supplied to the City as part of the specified requirements. All construction including restoration shall be completed by December 5, 2024.

Company: Address:

Signed: County:

By: Telephone:

Title: FAX:

CHARNWOOD CHIP SEAL 4 / 5

LEGAL STATUS OF BIDDER

(The Bidder shall fill out the appropriate form and strike out the other two).

A corporation duly organized and doing business under the laws of the State of Michigan for whom whose signature is affixed to the Proposal, is duly authorized to execute contracts.

A Partnership, all members of which, with addresses, are:

An Individual, whose signature is affixed to the Proposal.

CHARNWOOD CHIP SEAL 5 / 5

Please give the following information regarding your Proposal for this bid:

1. Number of years of experience in this work:

2. List the number and types of equipment to be used if awarded this bid:

3. List the municipalities you have contracted with during the past three years for this type of work:

4. Name of your bank and other financial reference:

5. Name of your insurance carrier:

6. PL/PD/BI Insurance carrier:

Workman’s Compensation:

Amount of Insurance Coverage:

6. Comments:

Signed:

Title:

Name & Address of Firm:

Date:

CITY OF TROY NON COLLUSION AFFIDAVIT

CHARNWOOD CHIP SEAL 1 / 1

CITY OF TROY ENG.DEPT.

TO WHOM IT MAY CONCERN:

, being duly sworn deposed, says that he (Print Full Name) is . The party making the foregoing proposal or bid, (State Official Capacity in Firm) that such bid is genuine and not collusion or sham; that said bidder has not colluded, conspired, connived, or agree, directly or indirectly, with any bidder or person, to put in a sham bid or to refrain from bidding and has not in any manner directly or indirectly sought by agreement or collusion, or communication or conference, with any person to fix the bid price or affiant or any other bidder, or to fix any overhead, profit, or cost element of said bid price, or that of any other bidder, or to secure the advantage against the City of Troy or any person interested in the proposed contract; and that all statements contained in said proposal or bid are true.

SIGNATURE OF PERSON SUBMITTING BID

NOTARY’S SIGNATURE

Subscribed and sworn to before me this day of, , 20____ in and for

County.

My commission expires: