3-6-25-26 - Bid 2026-001 - Asphalt Seal Coat Bid Specs.Rev1.pdf

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Bid #2026-001

2026 Asphalt Sealcoat Program

West Rockhill Township

TABLE OF CONTENTS

Page

Proposal and Contract Form…………………………………………………

Attachment #1

Attachment #2

Proposal and Contract Instructions

Special Provisions

Liquidated Damages

Price Adjustment Clause

Insurance Requirements………………………………………………………….……9

Bid Bond

Performance Bond

Payment Bond

Anti-Collusion Affidavit

Public Works Employment Verification Form

Provisions of Workmen’s Compensation Act

Attachments (Fog Seal Specifications & Location Map)……………………attached g:\municipal\west rockhill\33 - file numbers\33-032 roads\road bids\2026\6-25-26 - bid #2026-001 - asphalt seal coat bid specs.rev1.doc

MS-944

PROPOSAL & CONTRACT

(WHEN EXECUTED)

Instructions on Page 3

(THIS PROPOSAL INCLUDES

INSTRUCTIONS TO BIDDERS)

A. DEPOSIT OF PROPOSALS.

All envelopes containing Bid proposals shall West Rockhill Township_______ be clearly marked “Bid Proposal for Letting of a MUNICIPALITY (NAME & TYPE) July 14, 2026 Bid for Asphalt Sealcoat Program (Bid 2026-001)”

DATE

Greg Lippincott______

TOWNSHIP MANAGER

Sealed Proposals will be received on or before 10:00 A.M. on July 14, 2026 1028 Ridge Road________

TIME ADDRESS

Bids will be opened and read at approximately Sellersville PA, 18960___ _ 10:00 A.M. on July 14, 2026

TIME

1. The contractor proposes to furnish all materials (including Form CS-4171, Certificate of Compliance and Form TR-465, Daily Asphalt Mixture Certification) and to do and perform all work on the following project as more specifically set forth in the Schedule of Prices (Proposal & Contract Attachment #1), as well as the supplements and technical specifications/special provisions contained herein and/or attached hereto and current PennDOT specifications (Publication 408), except Volumetric testing of asphalt paving materials is not required (Sec. 409).

2. If designated as the successful bidder, the contractor will begin work on the date specified in the Notice to

Proceed or otherwise provided in the General Specifications/Special Provisions, and will complete all work By September 30, 2025.

If all work is not completed by September 30, 2025, liquidated damages will be assessed as set forth in the PennDOT Publication 408, Section 108.07 (a). (Refer attached schedule)

3. Accompanying this proposal is a certified check or bid bond in the amount of 10% of the total bid made payable to the municipality as a proposal guarantee which, it is understood, will be forfeited in case the contractor fails to comply with the requirements of the proposal.

B. PROPOSAL OF: __________________________________________________________________________

NAME OF CONTRACTOR

ADDRESS

CONTRACTOR’S CERTIFICATION

It is hereby certified as follows:

1. The only person(s) interested in this proposal as principal(s) is (are):

2. None of the above persons are employees of the municipality.

3. This proposal is made without collusion with any other person, firm, or corporation.

4. All plans and specifications referred to above and the site work have been examined by the contractor.

The contractor understands that the quantities indicated herein are approximate and are subject to change g:\municipal\west rockhill\33 - file numbers\33-032 roads\road bids\2026\6-25-26 - bid #2026-001 - asphalt seal coat bid specs.rev1.doc as may be required; and that all work is payable on the basis of the unit prices listed on the Schedule of Prices (Attachment 1).

5. The contractor will comply with all requirements of the laws and implementing regulations of the

Commonwealth of Pennsylvania and the United States relating to human relations, equal opportunity and non-discrimination in employment, and will pay to workmen employed in the performance of the contract the wages to which they may be entitled.

6. The contractor will provide the municipality with a performance bond, conditions upon the faithful performance of the contract in accordance with the plans, specifications and conditions thereof, and a payment bond conditioned on the prompt payment of all material furnished and labor supplied or performed in the prosecution of the work, in accordance with the Public Works Contractor’s Bond Law of 1967; and an affidavit accepting the provisions of the Workmen’s Compensation Act of 1915, as amended.

CONTRACTOR

WITNESSED OR ATTESTED BY:

BY: ________________________________

TITLE

(SEAL)

TITLE:

TO BE EXECUTED ONLY IN THE EVENT THE ABOVE PROPOSAL IS ACCEPTED

ACCEPTED ON: _____________________

DATE

West Rockhill Township________

MUNICIPALITY

ATTESTED BY:

_____________________________________ BY: ________________________________

TITLE: TITLE:

Total Award g:\municipal\west rockhill\33 - file numbers\33-032 roads\road bids\2026\6-25-26 - bid #2026-001 - asphalt seal coat bid specs.rev1.doc

ATTACHMENT #1

MS-944

LOCATION OF WORK: Refer attachment #2

DESCRIPTION OF WORK: Contractor will provide labor and material necessary for application of

Polymer-Modified Cationic Emulsified Asphalt paving on Attachment #2 streets. Contractor is responsible for street sweeping roadway surface prior to installation of asphalt seal coat, and traffic control in accordance with PennDOT Publication 203 and Publication 213. Excess stone must be swept from the road surface within 30 days of application but not less than 14 days with a pick-up type sweeper. Work must be coordinated with the Township. (A minimum of 5 working days notice must be provided to West Rockhill Township prior to commencement of work.)

PRICE ADJUSTMENT CLAUSE: Refer page 8 of 15. Price Adjustment pursuant to PennDot Pub 408, Section 110.04

SCHEDULE OF PRICES

1.

Item No.

2.

Approximate

Quantities

3.

Unit

4. Description Base Bid

5.

Unit Price

6.

Total

1. 17,500 SY Single application of asphalt sealcoat with CRS-2PM (E- 3M) - per Section 470 of PennDOT Specifications, Form 408, with washed Type A, #8 aggregate, complete-in-place

– per PennDOT specifications, Form 408, Section 470 Plus Fog seal with CSS-1hPM with Type A Fine aggregate complete in place – per PennDot specifications Form 408, Section 472 (Old Bethlehem Pike)

2. 7,150 LF Supply and install 2-4” DYL (centerline) & 2-4” SWL (edge lines) pavement markings (waterborne pavement marking paint with glass beads)

TOTAL BASE BID:

Alternate Bid #1

3. 9,000 SY Single application of asphalt sealcoat with CRS-2PM (E- 3M) - per Section 470 of PennDOT Specifications, Form 408, with washed Type A, #8 aggregate, complete-in-place

– per PennDOT specifications, Form 408, Section 470 Plus Fog seal with CSS-1hPM with Type A Fine aggregate

Section 472 (Catch Basin Road)

Alternate Bid #2

4. 26,500 SY Single application of asphalt sealcoat with CRS-2PM (E- 3M) - per Section 470 of PennDOT Specifications, Form 408, with washed Type A, #8 aggregate, complete-in-place

– per PennDOT specifications, Form 408, Section 470 Plus Fog seal with CSS-1hPM with Type A Fine aggregate

Section 472 (Forrest Road)

5. 10,000 LF Supply and install 2-4” DYL (centerline) pavement marking (waterborne pavement marking paint with glass beads) (Ridge Valley Road to Bethlehem Pike)

TOTAL ALTERNATE #2 BID:

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Note: In addition to Payment and Performance Bonds in the amount of 100% of the contract price, successful bidder shall provide a one (1) year Maintenance Bond for 100% of the amount of the contract. The Maintenance Bond is to be security and guarantee to insure the integrity and quality of work performed.

Installation must be performed with a hydrostatic machine capable of a 20 feet wide asphalt seal coat application.

Width of asphalt seal coat application shall conform to existing cartway width and must be completed in a single pass.

Streets may be closed between the hours of 9:00AM and 4:00PM Monday thru Friday except for school buses. No work shall be performed on Saturday, Sunday or legal holiday unless approved in writing by the Township. A traffic control employee must be positioned at each end of the closure to assist motorists with access to dwellings within the work area.

Unit price for asphalt sealcoat includes street sweeping and removal of excess stone from the roadway and storm sewer inlets within thirty (30) days following installation. $2,500.00 of the contract total bid will be retained until street sweeping is completed.

The Township, at its sole discretion, reserves the right to reduce the amount of work (quantity) to be completed under this contract by up to 10%.

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ATTACHMENT #2

Refer Attached 2025 Street Program Location Map

(LAST PAGE)

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MS-944

PROPOSAL AND CONTRACT INSTRUCTIONS - FORM 944

1. The proposal must be typewritten or printed.

2. If more than one proposal on any project is submitted by any individual, firm or partnership, corporation or association under the same or different names, only one lowest proposal will be considered.

3. Description of Work:

Application of CRS-2PM (E-3M) Polymer-Modified Cationic Emulsified Asphalt with aggregate, plus fog seal.

A. If additional space is needed, insert appropriately numbered attachment and note “Continued on

Attachment No. ____________.”

B. Where Wearing Surfaces are a part of this Contract, Average Daily Traffic (ADT) Count must be included in the description.

4. Part A of Page 1 to be completed by municipality. Part B of Page 1 to be completed by contractor. Schedule of

Prices - Column #1 (Item), #2 (Approximate quantities), #3 (Unit, i.e., ton, square yard, linear feet, etc. and #4 (Description, i.e., asphalt materials – 9.5 mm S & L, 12.5 mm Wearing, 25.0 mm Base Course etc.) must be filled in by the municipality to insure equitable bidding. Columns #5 (Unit Price), #6 (Total), and total amount of bid, must be filled in by the contractor. If more space is needed, add note at the bottom of the page: “Continued on Attachment No. 1-A,” and add additional sheet designated as Attachment No. 1-A, 1-B, etc. Repeat for each additional sheet required.

5. If liquidated damages are to be assessed, add the following sentence to Part A #2. “If all work is not completed on time, liquidated damages will be assessed at the rate of $885.00 per additional working day.” (OR as set forth in the attached schedule.”)

6. Payment and Performance bonds are provided only by the successful bidder. Contracts under $5,000-bonds must be in 50% of the contract amount. Contracts in excess of $5,000 - bonds must be in 100% of the amount of contract. Bond Forms MS-944 Attachments 2 and 3 and Workmen’s Compensation Affidavit Attachment 4 must be submitted by the successful bidder within 20 days of the contract award. Failure to submit the bonds shall constitute grounds to cancel the contract.

7. An ESCALATOR CAUSE is optional; if used, it must be included in the proposal prepared by the municipality.

An escalator clause may not be inserted by the contractor.

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(8-05) SPECIAL PROVISIONS TO CONTRACT MS-944 (Attachment 1-A)

CONTAINS IMPORTANT INFORMATION FOR THE CONTRACTOR

The Prime Contractor and subcontractors must comply with all of the following provisions:

X Traffic Control and Safety Devices to be provided by the Contractor.

(PA DEPART. OF TRANS, Publication 203, WORK ZONE TRAFFIC CONTROL, CURRENT EDITION.)

X Delivery tickets for all materials.

CS-4171 Certificate of Compliance and/or TR-465 Daily Asphalt Mixture Certification required for all materials.

X Notify the Municipality five (5) working days prior to start of project.

X Work to be completed by 9/30/2025 . After 9/30/2025 Liquidated damages apply at the rate of $885.00 per calendar day.

X Roadway to be power broomed by contractor prior to start of project.

X Excess material to be removed contractor.

X Municipality to inspect project.

X Need Bill of Lading for each shipment of asphalt material per Section 702.1(c) of Specifications 408.

X Municipality reserves the right to limit work completed.

X Completion of NON-COLLUSION AFFIDAVIT required.

X Incidental Preparation and cleanup required. (Project Construction Materials) Provide design, which meets Specifications Form 408 to the Municipality 5 days prior to start of work.

X Contractor responsible for defects that occur within one year of applications.

X Oil samples required from each distributor truck by Contractor, one (1) quart AM & PM and witnessed by the

Township, and retained by the Township (Oil samples must be placed in approved type container that is compatible with the oil sample).

X At least three (3) random stone samples to be taken by the Contractor on the project site witnessed by the Township and retained by the Township.

X Notice to Proceed will be issued by the Township upon receipt of required bonds, insurance certificate, and contract documents.

X Final Completion Certificate & Notice of Completion required.

X Future award of Contract will be based on quality of work as determined by the municipality.

X Contractor shall notify all residents of pending work to be performed.

My signature signifies that I have read and understand the above provisions to this contract, and by being authorized by this company to act as their authorized representative, and on their behalf hereby agree to adhere to any and all of the provisions pertaining to this contract.

Contractor’s Representative Date Municipality’s Representative Date

___________________________________ West Rockhill Township Company Municipality g:\municipal\west rockhill\33 - file numbers\33-032 roads\road bids\2026\6-25-26 - bid #2026-001 - asphalt seal coat bid specs.rev1.doc

108.07 LIQUIDATED DAMAGES –

(a) Construction Engineering Liquidated Damages. For each day that any physical work remains uncompleted after the Required Completion Date, the sum per day specified in the following schedule, unless otherwise stated in the proposal, will be deducted from money due or to become due. This deduction will not be as a penalty, but as Construction Engineering Liquidated Damages.

Schedule of Daily Charges For Original Contract Amount Construction Engineering Liquidated Damages

From More Than To and Including Per Calendar Day

$ 0 $ 400,000 $ 975 400,000 1,000,000 1,845

1,000,000 5,000,000 2,685 5,000,000 10,000,000 4,125

10,000,000 15,000,000 5,755 15,000,000 6,805

If the Contractor is declared in default, as specified in Section 108.08. Construction Engineering Liquidation Damages will be charged as provided by this section. If the total amount chargeable as Construction Engineering Liquidated Damages exceeds the amount payable to the Contractor or the surety, the excess is to be paid to the State by the Contractor or surety.

(b) Road Users Liquidated Damages. When indicated in the proposal, Road Users Liquidated Damages will be charged for each day that the roadway is not opened to unrestricted traffic after the specified Milestone Date. The sum per day will be deducted from money due or to become due. This deduction will not be as a penalty, but as Road Users Liquidated Damages.

If the Contractor is declared in default, as specified in Section 108.08. Road Users Liquidated Damages will be charged in the amount indicated. If the total amount chargeable as Road Users Liquidated Damages exceeds the amount payable to the Contractor or the surety, the excess is to be paid to the State by the Contractor or surety.

(c) Work Zone Liquidated Damages. A sum of no less than $1,000 per 24-hour period will be charged as work zone liquidated damages for failure to comply with Maintenance and Protection of Traffic requirements and drawings or other contract traffic control requirements. This deduction will not be as a penalty, but as work zone liquidated damages.

(d) Erosion and Sedimentation Control (E&S) Noncompliance Liquidated Damages. Begin work to correct any noncompliance with Section 107.28 (Erosion and Sediment Pollution Control Plans and Permits) within 24 hours of notification by the Representative of the noncompliance. At the time of notification, the Representative will provide the Contractor with a copy of the visual site-inspection report or the report from DEP or their designee or other regulatory agency that identifies the noncompliance.

A sum of $1,500 per 24-hour period will be charged as E&S noncompliance liquidated damages for failure to begin work within 24 hours of notification of noncompliance and for each subsequent 24-hour period until E&S compliance is attained.

This deduction will not be as a penalty, but as E&S noncompliance liquidated damages.

The liquidated damages specified in this section are in addition to, and not in derogation of, the Contractor’s obligation set forth in Section 107.01 to indemnify the State and its representatives against any claim or liability arising from or based on the violation of any law, ordinance, regulation, order, or decree, including violations by Contractor employees, as well as any other obligation that the contractor may have to indemnify or hold the State and its representatives harmless.

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PRICE ADJUSTMENT CLAUSE

110.04 PRICE ADJUSTMENT OF ASPHALT MATERIALS – These requirements provide for a price adjustment, in the form of a payment to the Contractor or a rebate to the Department, for fluctuations in the cost of asphalt cement used in the asphalt materials placed as part of the construction work specified in the following Sections:

Applicable contract items include any modified standard or nonstandard item where the character of the work to be performed is considered placement of one or more of the asphalt materials specified in these Sections.

a Price adjustments, when applicable, will be computed based on the Asphalt Material item quantity (gallon) only, as paid on current estimates.

b When measured and paid for on a square yard basis, the tonnage of material placed will be determined from delivery tickets and the asphalt tonnage computed as specified Section 110.04(b)4.a. The tonnage of material wasted, if any, will be agreed upon with the Contractor and deducted.

c When measured and paid for on a Material Used Basis, price adjustments, when applicable, will be computed based on the Asphalt Material item quantity (gallon) only, as paid on current estimates.

d Price adjustments, when applicable, will be computed as specified for the type of asphalt material used in the type of paved shoulder placed, excludes shoulder backfill items.

e Price adjustments, when applicable, will be computed based on the tonnage of asphalt cement used in the ultra-thin bonded wearing course only (i.e., excluding the asphalt cement used in the emulsified asphalt membrane).

Amended 01.15.10

313 360 b 420 471 489e 656d

316 410 450 480 c 496 657d

341a 412 460 481 651d

342a 413 461 482 653d

344 b 419 470 c 483 654d

Publication 447 – Approved products for Lower Volume Local Roads

MS-0310-0010 b MS-0310-0031 b,c MS-0340-0005 a

MS-0310-0011 b MS-0310-0032 b,c MS-0350-0018 a

MS-0310-0021 b MS-0310-0051 b MS-0360-0019 b

MS-0310-0022 b MS-0311-0001 b MS-0370-0040 a g:\municipal\west rockhill\33 - file numbers\33-032 roads\road bids\2026\6-25-26 - bid #2026-001 - asphalt seal coat bid specs.rev1.doc

INSURANCE REQUIREMENTS

The contractor shall maintain, during the entire construction period, sufficient multi-peril liability insurance, workmen’s compensation insurance, and builder’s risk insurance to hold West Rockhill Township and its agents harmless from any liability or breach of contract, or other agreement, arising from the undertaking of the construction project.

A. West Rockhill Township must review all policies. All policies shall include a ten (10) day notice to West

Rockhill Township prior to cancellation or material damage.

B. Minimum Required Coverages:

1. Workmen’s Compensation.

2. Manufacturer’s and Contractor’s Public Liability with a limit of $1,000,000.00.

3. Property Damage with at least a $50,000.00 limit.

4. All Risk: The contractor will be responsible for any damage to the facility under construction, until it is turned over in its entirety to West Rockhill Township.

C. West Rockhill Township and its agents must be endorsed as additionally insured.

D. Copies of Insurance Certificates and endorsements to the contractor’s insurance policy(s) endorsing West Rockhill Township and its agents as additional insureds must be filed with West Rockhill Township.

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BID BOND

KNOW ALL MEN BY THESE PRESENTS, that we, the undersigned, ___________________________________

___________________________________ as Principal, and _______________________________________________ as Surety, are hereby held and firmly bound unto Bedminster Township as Township, in the penal sum of

____________________________________________________Dollars ($ ) for the payment of which, well and truly to be made, we hereby jointly and severally bind ourselves, our heirs, executors, administrators, successors and assigns.

Signed this _____ day of ____________________, 20___.

The Condition of the above obligation is such that whereas the Principal has submitted to ___________________ a certain Bid attached hereto and hereby made a part hereof, to enter into a contract in writing for:

NOW, THEREFORE,

a. If said Bid shall be rejected, or in the alternate.

b. If said Bid shall be accepted and the Principal shall execute and deliver a contract in the Form of

Contract attached hereto (properly completed in accordance with said bid), and shall furnish a bond for his faithful performance of said Contract, and for the payment of all persons performing labor or furnishing materials in connection therewith, and shall in all other respects perform the agreement created by the acceptance of said Bid, then this obligation shall be void, otherwise the same shall remain in force and effect; it being expressly understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed the penal amount of this obligation as herein stated.

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

IN WITNESS WHEREOF, the Principal and the Surety have hereunto set their hands and seals, and such of them as are corporations have caused their corporate seals to be hereto affixed and these presents to be signed by their proper officers, the day and year first set forth above.

____________________________________ (L.S.)

Principal

Surety

By: _____________________________________

IMPORTANT: Surety companies executing bonds must appear on the Treasury Department's most current list (Circular 570 as amended), and be authorized to transact business in the state where the project is located.

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MS-963

PERFORMANCE BOND

(With Corporate Surety)

KNOW ALL MEN BY THESE PRESENTS, That we, ______________________________________________________ as Principal and ___________________________________________________________________________________ a corporation incorporated under the laws of the State of ___________________________________________________ as Surety, are held and firmly bound unto _______________________________________________________________ in the full and just sum of ____________________________________________________________________________

($___________________) dollars lawful money of the United States of America, to be paid to the above Municipality or its assigns, to which payment well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.

WHEREAS, the above bounden Principal has entered into a contract with the above Municipality, bearing even date herewith, for the undertaking of certain obligations as therein set forth.

NOW, THEREFORE, the condition of this obligation is such that if the above bounden Principal, as Contractor, shall in all respects comply with and faithfully perform the terms and conditions of said Contract, including the Specifications and conditions referred to and made a part thereof, and such alterations as may be made in said Specifications as therein provided, and shall well and truly, and in a manner satisfactory to the Municipality fulfill all obligations as therein set forth, then this Obligation shall be void, but otherwise the same shall be and remain in full force, virtue and effect.

It is further provided that any alteration which may be made in the terms of the contract or its specifications with the express approval of the Municipality or the Principal to the other, shall not in any way release the Principal and the Surety or either or any of them, their heirs, executors, administrators, successors or assigns from their liability hereunder, notice to the Surety of any such alteration or forbearance being hereby waived.

IN WITNESS WHEREOF, the said Principal and Surety have duly executed this Bond under Seal, on (Date of Bond)

PLACE

SEAL

HERE Attest/Witness ________________________________________________________________

CONTRACTOR

____________________________________________________ BY: _____________________________________________________________

HERE Attest/Witness ________________________________________________________________

SURETY COMPANY

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MS-944S

PAYMENT BOND

KNOW ALL MEN BY THESE PRESENTS, that we, of , as PRINCIPAL and a corporation incorporated under the laws of the State of as SURETY, are held and firmly bond unto the ____________________________________________, in the full and just sum of ($ ) dollars, lawful money of the United States of America, to be paid to the said or its assigns, to which payment well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly, severally, firmly by these presents.

WHEREAS, the above bounden Principal has entered into a contract with the above municipality, hereinafter called Obligee, bearing even date herewith, for the improvement of a certain section of highway or bridge in said Municipality consisting of:

for approximately the sum of ($_______________) dollars.

NOW, THEREFORE, the condition of this obligation is such that if the above bounden PRINCIPAL shall and will promptly pay or cause to be paid in full all sums of money which may be due by contract or otherwise, to any individual, firm, partnership, association or corporation, for all material furnished or labor supplied or performed in the prosecution of the work, whether or not the said material or labor entered into and became component parts of the work and for rental of the equipment used and services rendered by the public utilities in, or in connection with the prosecution of such work, then this obligation to be void, otherwise to remain in full force and effect.

The PRINCIPAL and SURETY, hereby, jointly and severally, agree with the Obligee herein that any individual firm, partnership, association or corporation, which has performed labor or furnished material in the prosecution of the work as provided, and any public utility which has not been paid in full therefore, may sue in assumpsit on this Payment Bond in his, their, or its own name and may prosecute the same to final judgment for such sum or sums as may be justly due him, them or it, and have execution thereon. Provided, however, that the Obligee shall not be liable for the payment of any costs of expenses of such suit.

RECOVERY by any individual, firm, partnership, association or corporation hereunder shall be subject to the provisions of the “Public Works Contractors’ Bond Law of 1967”, Act No. 385 approved December 20, 1967, P.L. 869, which Act shall be incorporated herein and made a part hereof, as fully and completely as though its provisions were fully and at length recited.

It is further provided that any alterations which may be made in the terms of the contract or in the work to be done or materials to be furnished or labor to be supplied or performed under it or the giving by the Obligee of any extension of time for the performance of the contract or any other forbearance on the part of either the Obligee or the Principal to the other, shall not in any way release the PRINCIPAL and the SURETY or SURETIES of any such alteration, extension or forbearance being hereby waived.

IN WITNESS WHEREOF, the said PRINCIPAL and SURETY have duly executed this Bond under seal this day of , 20____.

WITNESS:

PLACE CONTRACTOR

SEAL

HERE

BY:

TITLE TITLE

WITNESS: SURETY COMPANY

HERE

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D-7126 ( 7-09 )

ANTI-COLLUSION AFFIDAVIT

County Bucks County

Municipality Bedminster Township

Project Number

State of Pennsylvania Fed. Project No.

( If Applicable )

County of Bucks

The undersigned deponent deposes and says that he is the of the Company: that he is authorized to make this affidavit on behalf of said company in compliance with section 102.06 (e) of Department Specifications, Publication 408, as amended and that the said company has 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 connection with such contract.

(Contractor)

BY

Sworn to and subscribed before me the undersigned notary public this day of , .

Notary Public

My Commission expires g:\municipal\west rockhill\33 - file numbers\33-032 roads\road bids\2026\6-25-26 - bid #2026-001 - asphalt seal coat bid specs.rev1.doc g:\municipal\west rockhill\33 - file numbers\33-032 roads\road bids\2026\6-25-26 - bid #2026-001 - asphalt seal coat bid specs.rev1.doc

AFFIDAVIT RE

ACCEPTING PROVISIONS OF THE WORKMEN’S COMPENSATION ACT

State of ) ) ss:

County of ) he has Being duly sworn according to law deposes and says that they have it has accepted the provisions of the Workmen’s Compensation Act of 1915 of the Commonwealth of Pennsylvania, with its supplements and amendments, and have insured their liability thereunder in accordance with the terms of said it

Act with _______________________________________.

(SURETY COMPANY)

(TYPE OR PRINT) CONTRACTOR

BY ___________________________________

SIGNATURE

Sworn to and subscribed before me this ______ day of _______________A.D. 20____.

SIGNATURE

My Commission Expires: ___________________

(DATE)

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