26-026-ITB_Certification_Forms_-_Attachment_2.pdf

26-026-ITB TWO (2) DIGESTER TANKS AERATION

EQUIPMENT REPLACEMENT

ATTACHMENT 1

CERTIFICATION DOCUMENTS

Table of Contents

NON-DEBARMENT OR SUSPENSION CERTIFICATION

BUY AMERICAN CERTIFICATION – EQUIPMENT/BUILDING PROJECTS

DISCLOSURE OF LOBBYING ACTIVITIES CERTIFICATION

AFFIDAVIT REGARDING WORKER'S COMPENSATION

CERTIFICATION OF OFFEROR/BIDDER REGARDING TAX DELINQUENCY AND FELONY CONVICTIONS . 7

CERTIFICATION REGARDING DOMESTIC PREFERENCES FOR PROCUREMENTS

NON-DEBARMENT OR SUSPENSION CERTIFICATION

In accordance with the CODE OF FEDERAL REGULATIONS, Part 49, CFR Section 29.510, the Bidder, being duly sworn (or under penalty of perjury under the laws of the United States), certifies to best of his/her knowledge and belief, that its principals:

1. are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency;

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

3. are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in the above paragraph of this certification; and

4. have not within a three-year period preceding this proposal had one or more public transactions (federal, state, or local) terminated for cause or default.

Where the Bidder is unable to certify to any of the statements in this certification, such Bidder shall list exceptions below. Exceptions will not necessarily result in denial of award, but will be considered in determining contractor responsibility. For any exception noted, indicate below to whom it applies, the initiating agency, and the dates of the action. Providing false information may result in criminal prosecution or administrative sanction. If an exception is noted, the Bidder must contact the Sponsor to discuss the exception prior to award of the Contract.

The Bidder certifies under penalty of perjury under the laws of the Commonwealth of Kentucky that the foregoing is correct and true.

Name: Bidding contractor ___________________________________________________

By _________________________________Date:_______________

(SIGNATURE)

Name and Title ____________________________________________________

(PRINT OR TYPE)

Subscribed and sworn before me this date: Month _________ Day ______ Year __________

Notary Public's signature: ____________________________________________________

Commission expires: _________________________________________________________

END OF SECTION

BUY AMERICAN CERTIFICATION –

EQUIPMENT/BUILDING PROJECTS

As a matter of bid responsiveness, the bidder or offeror must complete, sign, date, and submit this certification statement with their proposal. The bidder or offeror must indicate how they intend to comply with 49 U.S.C. § 50101, and other Made in America Laws, U.S. statutes, guidance, and FAA policies by selecting one on the following certification statements. These statements are mutually exclusive. Bidder must select one or the other (not both) by inserting a checkmark (ü) or the letter “X”.

Bidder or offeror hereby certifies that it will comply with 49 U.S.C. § 50101, BABA and other related

U.S. statutes, guidance, and policies of the FAA by:

a) Only installing steel and manufactured products produced in the United States;

b) Only installing construction materials defined as: an article, material, or supply – other than an item of primarily iron or steel; a manufactured product; cement and cementitious materials; aggregates such as stone, sand, or gravel; or aggregate binding agents or additives that are or consist primarily of non-ferrous metals; plastic and polymer-based products (including polyvinylchloride, composite building materials, and polymers used in fiber optic cables); glass (including optic glass); lumber or drywall that have been manufactured in the United States.

c) Installing manufactured products for which the Federal Aviation Administration (FAA) has issued a waiver as indicated by inclusion on the current FAA Nationwide Buy American Waivers Issued listing; or

d) Installing products listed as an Excepted Article, Material or Supply in Federal Acquisition Regulation Subpart 25.108.

By selecting this certification statement, the bidder or offeror agrees:

a) To provide to the Airport Sponsor or FAA evidence that documents the source and origin of the steel and manufactured product.

b) To faithfully comply with providing U.S. domestic product.

c) To furnish U.S. domestic product for any waiver request that the FAA rejects.

d) To refrain from seeking a waiver request after establishment of the contract, unless extenuating circumstances emerge that the FAA determines justified.

The bidder or offeror hereby certifies it cannot comply with the 100 percent Buy American Preferences of 49 U.S.C. § 50101(a) but may qualify for a Type 3 waiver under 49 U.S.C. § 50101(b). By selecting this certification statement, the apparent bidder or offeror with the apparent low bid agrees:

a) To submit to the Airport Sponsor or FAA within 15 calendar days of being selected as the responsive bidder, a formal waiver request and required documentation that supports the type of waiver being requested.

b) That failure to submit the required documentation within the specified timeframe is cause for a non-responsive determination that may result in rejection of the proposal.

c) To faithfully comply with providing U.S. domestic products at or above the approved U.S.

domestic content percentage as approved by the FAA.

d) To refrain from seeking a waiver request after establishment of the contract, unless extenuating circumstances emerge that the FAA determines justified.

Required Documentation

Type 2 Waiver (Nonavailability) - The iron, steel, manufactured goods or construction materials are not available in sufficient quantity or quality in the United States. The required documentation for the Nonavailability waiver is:

a) Completed Content Percentage Worksheet and Final Assembly Questionnaire

b) Record of thorough market research, consideration where appropriate of qualifying alternate items, products, or materials including;

c) A description of the market research activities and methods used to identify domestically manufactured items capable of satisfying the requirement, including the timing of the research and conclusions reached on the availability of sources.

Type 3 Waiver – The cost of the item components and subcomponents produced in the United States is more that 60 percent of the cost of all components and subcomponents of the “item”. The required documentation for a Type 3 waiver is:

a) Completed Content Percentage Worksheet and Final Assembly Questionnaire including;

b) Listing of all product components and subcomponents that are not comprised of 100 percent

U.S. domestic content (Excludes products listed on the FAA Nationwide Buy American Waivers Issued listing and products excluded by Federal Acquisition Regulation Subpart 25.108 (products of unknown origin must be considered as non-domestic products in their entirety).

c) Cost of non-domestic components and subcomponents, excluding labor costs associated with final assembly at place of manufacture.

d) Percentage of non-domestic component and subcomponent cost as compared to total “item” component and subcomponent costs, excluding labor costs associated with final assembly at place of manufacture.

Type 4 Waiver (Unreasonable Costs) - Applying this provision for iron, steel, manufactured goods or construction materials, would increase the cost of the overall project by more than 25 percent. The required documentation for this waiver is:

a) Completed Content Percentage Worksheet and Final Assembly Questionnaire from

b) At minimum two comparable equal bidders and/or offerors;

c) Receipt or record that demonstrates that supplier scouting called for in Executive Order

14005, indicates that no domestic source exists for the project and/or component;

d) Completed waiver applications for each comparable bid and/or offer.

False Statements: Per 49 U.S.C. § 47126, this certification concerns a matter within the jurisdiction of the Federal Aviation Administration and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under Title 18, United States Code.

Date Signature

Company Name Title

DISCLOSURE OF LOBBYING ACTIVITIES CERTIFICATION

Certification for Federal-Aid Construction Services. In accordance with Public Law 101-1210, Section 319, by signing and submitting this bid, the Bidder certifies to the best of Bidder’s knowledge and belief:

1. that no federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement; and

2. that if any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence and officer or employee of any federal agency, a Member of Congress, and officer or employee of Congress, or an employee of a Member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.

This certification is a material representation of fact upon which reliance will be placed when a transaction is made or entered into. Submission of this Certification is a prerequisite for making or entering into a transaction imposed by Section 1352, Title 31, United States Code. Any person who fails to file the required Certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

The Bidder also agrees by submitting its bid that Bidder shall require the language of this Certification be included in all lower tier subcontracts, which exceed $100,000 and all subrecipients shall certify and disclose accordingly.

The Bidder certifies under penalty of perjury under the laws of the Commonwealth of Kentucky that the foregoing is correct and true.

Name: Bidding contractor ________________________________________________________

By __________________________________________Date:__________

(SIGNATURE)

Name and Title ________________________________________________________

(PRINT OR TYPE)

Subscribed and sworn before me this date: Month _____________________ Day ______ Year _____

Notary Public's signature: ______________________________________________

Commission expires: ______________________________________________

AFFIDAVIT REGARDING WORKER'S COMPENSATION

The undersigned Contractor, being awarded a Contract by the Kenton County Airport Board, operator of the Cincinnati/Northern Kentucky International Airport, identified as:

________________________________ hereby assures that all Contractors and subcontractors employed, or that will be employed, under the provisions of the foregoing identified contract shall be in compliance with Kentucky requirements for Worker's Compensation Insurance according to KRS Chapter 342 and unemployment insurance according to KRS Chapter 341.

DATED this day of , 20____.

Signature: ___________________________________________________

Name and Title (Printed):

STATE OF

COUNTY OF

Subscribed and sworn to before me, a Notary Public, by ________ , on behalf of the foregoing identified Contractor this day of ____ 20 .

Notary Public

My Jurisdiction is:

My Commission Expires:

CERTIFICATION OF OFFEROR/BIDDER REGARDING TAX DELINQUENCY AND FELONY

CONVICTIONS

The applicant must complete the following two certification statements. The applicant must indicate its current status as it relates to tax delinquency and felony conviction by inserting a checkmark () in the space following the applicable response. The applicant agrees that, if awarded a contract resulting from this solicitation, it will incorporate this provision for certification in all lower tier subcontracts.

Certifications

1) The applicant represents that it is (____) is not (____) a corporation that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability.

2) The applicant represents that it is (____) is not (____) a corporation that was convicted of a criminal violation under any Federal law within the preceding 24 months.

Note

If an applicant responds in the affirmative to either of the above representations, the applicant is ineligible to receive an award unless the sponsor has received notification from the agency suspension and debarment official (SDO) that the SDO has considered suspension or debarment and determined that further action is not required to protect the Government’s interests. The applicant therefore must provide information to the Owner about its tax liability or conviction, who will then notify the FAA Airports District Office, which will then notify the agency’s SDO to facilitate completion of the required considerations before award decisions are made.

Term Definitions

Felony conviction: Felony conviction means a conviction within the preceding twenty-four (24) months of a felony criminal violation under any Federal law and includes conviction of an offense defined in a section of the U.S. code that specifically classifies the offense as a felony and conviction of an offense that is classified as a felony under 18 U.S.C. § 3559.

Tax Delinquency: A tax delinquency is any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted, or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability.

CERTIFICATION REGARDING DOMESTIC PREFERENCES FOR PROCUREMENTS

The Bidder or Offeror certifies by signing and submitting this bid or proposal that, to the greatest extent practicable, the Bidder or Offeror has provided a preference for the purchase, acquisition, or use of goods, products, or materials produced in the United States (including, but not limited to, iron, aluminum, steel, cement, and other manufactured products) in compliance with 2 CFR § 200.322.