26-58_Attachment_1_Required_Forms.pdf

ATTACHMENT 1

REQUIRED FORMS

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BID FORM

ITB NO: 26-58

This proposal of , hereinafter called “BIDDER,” organized and existing under the laws of the State of doing business as (Insert “a corporation”, “a partnership” or “an individual” as applicable), is hereby submitted to the Board of County Commissioners, Bay County, hereinafter called “OWNER.”

In compliance with the Advertisement for Bids, BIDDER hereby proposes to perform all work, as detailed in this bid.

By submission of this BID, each Bidder certifies, and in the case of a joint BID each party thereto certifies as to its own organization, that this BID has been arrived at independently, without consultation, communication or agreement as to any matter relating to this BID with any other BIDDER or with any other competitor.

Vendor agrees to perform the entire work as indicated on the drawings and in compliance with the Contract Documents and Specifications, complete in every detail.

The Total Price is:

(Words)

Submitted By:

Name of Firm/Vendor Submitting This Bid

Bid Prepared By:

Name of Individual Who Prepared This Bid

Contact Email:

Address:

Phone:

Contractor’s License No.(if applicable)

Signature of Authorized Representative of Firm/Vendor Date

SEAL: (If bid is by Corporation)

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BID FORM (Con’t)

ITB NO: 26-58

Bidder agrees to perform all the work described in the Contract Documents for the following Unit Prices and Lump Sum Prices.

Item Description Unit of Issue

Qty Unit Price Total Price

1 Mobilization LS 1 $ $

2 Maintenance of Traffic LS 1 $ $

3 Erosion Control LS $ $

4 Site Restoration LS $ $

Asphalt Pavement Patching

LS $ $

Ductile Iron Mechanical Joint Fittings

LS $ $

24” Connection to Existing System

LS $ $

36” Connection to Existing System

LS $ $

C900 DR 25 PC 165

PVC Water Main

LS $ $

Manual Air Release Value (2” or Smaller)

LS $ $

Water Sampling Station

LS $ $

TOTAL PRICE $

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Pay Item 1 (Mobilization) lump sum price includes project layout, obtaining and complying with FDEP NPDES construction permit per FDOT special provisions section 104, detailed construction schedule, and notifications per FDOT special provisions section 102.

Pay Item 2 (Maintenance of Traffic) lump sum price includes all MOT signs, posts, barricades, connections, installation and removal. Includes maintenance of traffic and detours as required around the construction areas, removal and reinstallation of existing traffic signs, and maintenance of driveways during construction to allow access to property in accordance with FDOT standards and regulations.

Pay Item 3 (Erosion Control) lump sum price includes all work, materials, labor, and equipment required to complete the erosion control measures specified in the Contract Documents.

Pay Item 4 (Site Restoration) lump sum price includes landscaping installation and establishment as specified in the Contract Documents.

Pay Item 5 (Asphalt Pavement Patching) lump sum price includes all materials, equipment and labor required to replace asphalt per the Bay County details and specifications. Includes saw cutting and removal of existing surface, backfill with structural fill, spreading and compaction of Type B Stabilization (LBR 40), spreading and compaction of Limerock Base (LBR100), tack coat for asphalt, spreading and compaction of asphalt, cleanup and all related items for a complete job.

Pay Item 6 (Ductile Iron Mechanical Joint Fittings) includes all labor, material, and equipment associated with excavation, installation of ductile iron fittings, installation of transition fittings, “mega-lug” retainer glands, mechanical restraints, restrained coupling, concrete thrust blocks, backfill, compaction, testing, cleanup, and all related items for a complete job. Payment shall be made per pound of ductile iron mechanical joint fitting installed in accordance with Bay County Specification Section 02400 – Water Distribution System.

Pay Item 7 (24” Connection to Existing System) includes all labor, material, and equipment associated with excavation, wet connection, installation of tapping sleeve and tapping valve, tap of existing line, removal of coupon, installation of associated valve riser (valve box), concrete ring around top of valve box, valve marker, general fill, testing, cleanup and restoration, and all related items for a complete job. Payment shall be made per each connection installed as shown on plans in accordance with Bay County Specification Section 02400 – Water Distribution System.

Pay Item 8 (36” Connection to Existing System) includes all labor, material, and equipment associated with excavation, wet connection, installation of tapping sleeve and tapping valve, tap of existing line, removal of coupon, installation of associated valve riser (valve box), concrete ring around top of valve box, valve marker, general fill, testing, cleanup and restoration, and all related items for a complete job. Payment shall be made

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Pay Item 9 (C900 DR 25 PC 165 PVC Water Main) includes all labor and equipment associated with excavating, installation of water main of size and at locations shown on Plans, installation of detector wire and tape, bedding, backfill with excavated material, concrete for thrust blocks, concrete anchors, compaction, supply and installation of blue pipeline markers as requested by Engineer/Owner, disinfection and testing, cleanup, and all related items. Contractor is responsible for testing, disinfection, and de-chlorination in accordance with Bay County specifications and procedures. Sampling will be completed by Bay County. Payment shall be per linear foot of water main land, based on the size, material, and joint type shown on the Plans, reflected on the Bid Form, and in accordance with Bay County Specification Section 02400 –Water Distribution System.

Pay Item 10 (Manual Air Release Valve (2” or Smaller) includes all labor, material, and equipment associated with excavation, air valve assembly, connection to main, connecting internal piping, isolation valves and valves associated with accessories, drain piping as indicated in the Plans, fill as indicated in the plans, compaction, cleanup and restoration, testing, and all related items for a complete job. Payment shall be made per each assembly installed in accordance Bay County Standard Detail “Manual Air Release Valve (2” or Smaller)” shown on Sheet C-802.

Pay Item 11 (Water Sampling Station) includes all labor, material, and equipment associated with excavating, installation of water sample stations at location shown on Plans, bedding, backfill with excavated material, concrete for pad, compaction, disinfection and testing, clean up, and all related items for a complete job. Payment shall be made per each station installed in accordance with Bay County Standard Detail “Water Sampling Station” shown on Sheet C-801.

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ADDENDUM ACKNOWLEDGEMENT

I acknowledge receipt of the following addenda:

ADDENDUM NO. DATED

ADDENDUM NO. DATED

Name of Firm:

Authorized Signature:

Printed Name:

Title:

Date:

It is the responsibility of the firm to ensure that they have received addendums if issued.

Call (850) 248-8270 or email Purchasing@baycountyfl.gov prior to submitting your bid to ensure that you have received addendums.

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AFFIDAVIT OF COMPLIANCE WITH SECTION 287.138, FLORIDA STATUTES,

CONTRACTING WITH FOREIGN ENTITIES OF CONCERN

Before me, the undersigned authority, personally appeared (Name of Affiant)

_______________ ____________________, who, after being first duly sworn, deposes and says of his or her personal knowledge the following:

1. Affiant is the (Title) ___________________________ of (Business Name)

_________________________________ which does business in the State of Florida, hereinafter called the “Nongovernmental Entity.”

2. Nongovernmental Entity, pursuant to § 287.138, Florida Statues, certifies that (1)

Nongovernmental Entity is not owned by a government of a foreign country of concern; (2) a government of a foreign country of concern does not have a “controlling interest” in Nongovernmental Entity, as defined by Section 287.138(1)(a), Florida Statutes; and (3) Nongovernmental Entity is not organized under the law of nor has its principal place of business in a foreign country of concern. For the purposes of this affidavit, foreign country of concern means the People’s Republic of China, the Russian Federation, the Islamic Republic of Iran, the Democratic People’s Republic of Korea, the Republic of Cuba, the Venezuelan regime of Nicolás Maduro, or the Syrian Arab Republic, including any agency of or any other entity of significant control of such foreign country of concern, as defined in § 287.138(1)(c), Florida Statutes.

3. This Affidavit is executed by the Nongovernmental Entity accordance with § 287.138, Florida Statutes, for the purposes of preventing Bay County, Florida, from entering contracts with foreign entities of concern which would provide Nongovernmental Entity access to an individual’s personal identifying information.

Signed and Delivered on this _____ day of __________, 2025.

Signature of Affiant Printed Name of Affiant

STATE OF__________________

COUNTY OF________________________

Sworn to (or affirmed) and subscribed before me by means of □ physical presence or □ online notarization, this ______ day of _____________, 2025, by ___________________________.

Personally Known OR Produced Identification Type of Identification Produced________ __ ____________________________ (Notary Signature)

(SEAL)

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AFFIDAVIT OF COMPLIANCE WITH SECTION 787.06, FLORIDA STATUTES,

HUMAN TRAFFICKING ATTESTATION

Before me, the undersigned authority, personally appeared (Name of Affiant) _________________________________, who, after being first duly sworn, deposes and says of his or her personal knowledge the following:

1. Affiant is the (Title) ______________________________ of (Business Name) __________________________________ which does business in the State of Florida, hereinafter called the “Nongovernmental Entity.”

2. Nongovernmental Entity, pursuant to § 787.06(13), Florida Statues, certifies that 1) neither Nongovernmental Entity nor any of its subsidiaries or affiliates uses coercion for labor or services, as terms are defined in § 787.06, Fla. Stat., as may be amended from time to time; (2) Nongovernmental Entity will immediately notify Bay County, Florida, if, at any time in the future, Nongovernmental Entity does use coercion for labor or services, and understands that pursuant to such notification no contracts may be executed, renewed, or extended between the parties; and (3) Nongovernmental Entity has read the foregoing attestation, confirms the facts stated in it are true, ad are made for the benefit of, and reliance by, Bay County, Florida.

Signed and Delivered on this _____ day of __________, 2025.

Signature of Affiant Printed Name of Affiant

STATE OF ___________

COUNTY OF ______________

Sworn to (or affirmed) and subscribed before me by means of □ physical presence or □ online notarization, this ____ day of _____________, 2025, by ___________________.

Personally Known OR Produced Identification

Type of Identification Produced______ _______________________________ (Notary Signature)

(SEAL)

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ANTI-COLLUSION CLAUSE

Firm certifies that their response is made without prior understanding, agreement or connection with any Corporation, Firm or person submitting a response for the same services and is in all respects fair and without collusion or fraud.

Printed Name:

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CERTIFICATION REGARDING SCRUTINIZED COMPANIES LIST

Respondent Vendor Name:

Vendor FEIN:

Vendor's Authorized Representative Name and Title:

City: State: ZIP:

Phone Number:

Email Address:

Section 287.135, Florida Statutes prohibits agencies from contracting with companies, for goods or services over $1,000,000, that are participating in a boycott of Israel, are on the Scrutinized Companies that Boycott Israel list, the Scrutinized Companies with Activities in Sudan List, the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or has been engaged in business operations in Cuba or Syria.

Both lists are created pursuant to Section 215.473, Florida Statutes.

As the person authorized to sign on behalf of Respondent, I hereby certify that the company identified above in the sector entitled "Respondent Vendor Name" is not participating in a boycott of Israel, is not listed on the Scrutinized Companies that Boycott Israel List, the Scrutinized Companies with Activities in Sudan List, or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List and has not been engaged in business operations in Cuba or Syria. I understand that pursuant to Section 287.135, Florida Statutes, the submission of false certification may subject company to civil penalties, attorney's fees, and/or costs.

Certified By:

AUTHORIZED SIGNATURE

Print Name and Title:

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CONFLICT OF INTEREST DISCLOSURE FORM

For purposes of determining any possible conflict of interest, all firms, must disclose if any Bay County Board of County Commissioner(s), employee(s), elected officials(s), or any of its agencies is also an owner, corporate officer, agency, employee, etc., of their firm.

Indicate either “yes” (a county employee, elected official, or agency is also associated with your firm), or “no”. If yes, give person(s) name(s) and position(s) with your firm.

YES NO

NAME(S) POSITION(S)

Printed Name:

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DRUG FREE WORKPLACE

To have a drug-free workplace program, a business shall:

1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition.

2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations.

3. Give each employee engaged in providing the commodities or contractual services that are under Proposal a copy of the statement specified in subsection (1).

4. In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under Proposal, the employees will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction.

5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, by an employee who is so convicted.

6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section.

As the person authorized to sign the statement, I certify the following:

(Check one and sign in the space provided.)

This firm complies fully with the above requirements.

This firm does not have a drug free work place program at this time.

Printed Name:

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SUB-CONTRACTORS

As the bidder, I submit a listing of the Sub-Contractors which I shall use to accomplish the Work. Sub-Contractors are listed by name, address, amount of work and item of work. If none, please state so.

Subcontractor Name and Address:

Work to be performed and $ amount:

Printed Name:

Title:

Date:

*Complete additional forms if needed to list all subcontractors

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FLORIDA TRENCH SAFETY ACT CERTIFICATION AND DISCLOSURE

STATEMENT

SECTIONS 553.60-553.64, FLORIDA STATUTES

Trench Safety Act. The Contractor shall comply with all of the requirements of the Florida Trench Safety Act, Laws of Florida. Such assurance shall be legally binding on all persons employed by the Contractor and Subcontractors. The Contractor shall acknowledge that included in various items of the proposal and in the total bid price are costs for complying with the provisions of the Act.

Additionally, the Contractor is required to break out the costs for complying with the Florida Trench Safety Act.

The Contractor acknowledges that included in the various items of the proposal and in the Total Bid Price are costs for complying with the Florida Trench Safety Act and further identifies the costs to be summarized below:

Trench Safety Units of Unit Extended Measure Measure (Quantity) Cost (Description) (LF, SY)

A.

B.

C.

D.

TOTAL $

DATE , 20

Authorized Signature

Title

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BID BOND

BY THIS BOND, We, as Principal and , a corporation, as Surety, are bound to the Board of County Commissioners, Bay County, Florida, as County, in the sum of $ for the payment of which we bind ourselves, our heirs, personal representatives, successors, and assigns, jointly and severally. THE CONDITION of this bond is such that

1. The Principal has submitted to the County a certain Bid dated

2. If said Bid shall be rejected, or, if said Bid shall be accepted and the Principal shall execute and deliver a Contract, and furnish bonds for the faithful performances of work and for the payment of all persons performing labor and furnishing materials in connection therewith, and shall fulfill all other aspects created by the acceptance of said Bid, then this obligation shall be void. Otherwise, this bond shall remain in full force and effect with it being expressly understood and agreed that the liability of the Surety and for any and all claims hereunder shall, in no event, exceed the amount of this obligation.

This Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and this bond shall, in no way, be impaired or affected by any extension of time within which the County may accept such Bid; and Surety hereby waives notice of any such extension.

Signed, sealed and delivered in three (3) counterparts on

CORPORATE PRINCIPAL

By: Attest:

Its: Seal:

Acknowledged and subscribed on , before the undersigned authority by , as the of the Corporation named as Principal and with due authorization of the Corporation.

Notary Public

SURETY

By: Attest:

Seal:

Countersigned:

By:

Attorney-in-Fact, State of Florida

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