MS-944 (4-20)

TIME

, on April 22, 2026, at their meeting. PROPOSALS MUST BE MAILED OR OTHERWISE

TIME DELIVERED TO THE ABOVE ADDRESS.

and specifications on file at as well as the supplements complete all work within calendar days.

3 Accompanying this proposal is a certified check or bid bond in the amount of 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:

1 The only person interested in the 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.

THIS PROPOSAL INCLUDES

INSTRUCTIONS TO BIDDERS

ADDRESS

A. DEPOSIT OF PROPOSALS.

Sealed Proposals will be received on or before

All envelopes containing Bid proposals shall be clearly marked “Bid Proposal for letting of

PROPOSAL AND CONTRACT

( WHEN EXECUTED )

Joseph Ryan

MANAGER

DATE

on the above Letting Date.

100 E. MacDade Boulevard

-1-

It is hereby certified as follows:

NAME / ADDRESS OF CONTRACTOR

CONTRACTORS CERTIFICATION

All plans and specifications referred to above and the site of the work have been examined by the contractor. The contractor understands that the quantities indicated herein are approximate and are subject to change as may be required; and that all work is payable on the basis of the unit price listed on the Schedule of Prices. (Attachment 1).

If designated as the successful bidder, the contractor will begin work on the date specified in the notice to proceed, or as otherwise provided in the special requirements, and will

10% of Bid see attachment 1-A

Folsom, PA 19033

7:00 PM

The contractor proposes to furnish and deliver all materials ( including Form CS-4171, CERTIFICATE OF COMPLIANCE and/ or CS-4171B 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 (Attachment), in accordance with drawings and special requirements contained herein and/ or attached hereto and current PennDOT Specifications (Publication 408), except (a) bidders need not be prequalified by PennDOT (Sec.102.01), and (b) Volumetric testing of asphalt paving materials is not required (Sec. 413).

INSTRUCTIONS ON PAGE 4

Bids will be opened and read at approximately

April 16, 2026

10:00 AM

Ridley Township

MUNICIPALITY (NAME & TYPE)

BY: DATE:

TITLE:

WITNESSED OR ATTESTED BY: DATE:

TITLE:

BY:

TITLE:

BY:

TITLE:

BY:

TITLE:

ATTESTED BY:

TITLE:

MUNICIPALITY

RIDLEY TOWNSHIP

ACCEPTED ON:

DATE

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.

The contractor will provide the municipality with a performance bond, conditioned 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 Contractors’ Bond Law of 1967; and an affidavit accepting the provisions of the Workmen’s Compensation Act of 1915, as amended.

CONTRACTOR

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

SEAL

County:

SY -$

TN -$

SY Base & Trench Repair -$

A-1.1 SY -$

A-1.2 TN -$

A-1.3 SY Base & Trench Repair -$

TN -$

SUBTOTAL -$

EACH MUST BE INCLUDED.

* DESCRIPTION:

Must include ADT on wearing surfaces

USE OF CUTBACK ASPHALT IS PROHIBITED

BETWEEN MAY 1st AND OCTOBER 31st, EXCEPT

AS NOTED IN BULLETIN NO. 25.

FOR OPTION OR PHASE BIDS THE TOTALS FOR

ALTERNATE 1 PRICE TOTAL

ESTIMATE TOTAL

BASE BID PRICE TOTAL

ADDITIONAL STREETSALTERNATE 1:

4,610

Milling

Wearing Course: Fiber Modified, Superpave

9.5 mm PG64-22, ESL 0 to 0.3 mil

SEE ATTACHED STREETS LIST

Approximate 2 Quantities

ESCALATOR CLAUSE:( if adopted by Municipality.)

1,545

1 1/2" Superpave 9.5 mm Wearing Course 5" Superpave 25 mm Base/Trench Repair 1 1/2 - 3" Variable Depth Milling

Total

31,650

3,270 Wearing Course: Fiber Modified, Superpave

9.5 mm PG64-22, ESL 0 to 0.3 mil

Milling

Unit 5 Price

Item 1 No.

- 3 -

ATTACHMENT 1

TO MS - 944 ( PROPOSAL AND CONTRACT MS - 944 )

Delaware Municipality: Ridley Township

LOCATION OF WORK:

TH

IS

P O

R

TI

O N

T O

B E

C O

M

PL

ET

ED

BY

T

H E

M U

N

IC

IP

AL

IT

Y

Unit

SCHEDULE OF PRICES

*Description

Project Number: 26-23107-001CA

Not Adopted

DESCRIPTION OF WORK:

ALTERNATE 2 PRICE TOTAL

ALTERNATE 2: UNIT PRICING

A-2.1 1 Wearing Course: Superpave 9.5 mm PG64- 22, ESL 0 to 0.3 mil - WITHOUT FIBER

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

X Delivery tickets for all materials.

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

X five working days prior to start of project.

X . After the rate of $ 885.00 per calendar day.

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

X Excess material to be removed by (contractor municipality .)

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 Tack Coat required per Section 460, or 413 for superpave, of Specifications 408 and is incidental to paving item unless noted otherwise.

Prime Coat required per Section 461 of Specifications 408.

X Asphalt Seal on all abutting pavement and curbs required.

X Saw cut or Milled Paving Notch required and incidental to paving item unless noted otherwise.

X Scratch/ Leveling Courses to be placed at the discretion of appointed inspector(s).

X Municipality reserves the right to limit work completed.

X Taper pavement the last 3 feet to curb.

For FOB Source bids, hauling distance will determine selection of bid award.

Municipality reserves the right to procure material which best suits their requirements after all bids and items are reviewed.

X Incidental Preparation and clean up required. ( Project Construction Materials ) X The municipality reserves the right to make an award on the basis of the aggregate total for all like items on which quotations are received.

X 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.

Contractor required to review proposed project with Municipality’s Representative prior to bidding.

Oil Samples required from each distributor truck by contractor (1) one quart : A.M. & P.M. and witnessed by municipality and retained by municipality. (Oil samples must be placed in an approved type container that is compatible with oil sample.)

At least three random stone samples to be taken by contractor on project site witnessed by municipality and retained by municipality.

Complete all testing in accordance with Specification Form 408 Section 413 except for superpave volumetric testing.

Notice to Proceed will be the date of Contract acceptance.

X Final Completion Certificate & Notice of Completion required.

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

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

My signature signifies that I have read and understand the above special 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.

Date

Notify the Municipality

(4-20) 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 that are marked with an "X".

( Maintenance and Protection of Traffic to comply with current MUTCD, Publication 212 and Publication 213.)

Company Municipality

Contractor's Representative Municipality's Representative Date

Work to be completed on or before

RIDLEY TOWNSHIP

Liquidated damages apply at

Full width pavement with one pass required.

Attachment 2

($ ) dollars

WHEREAS, the above bounden Principal has entered into a contract with the above Municipality, bearing even date herewith, for

It is further provided that any alteration which may be made in the terms of the contractor or its specifications with the express authorizing the same to be done on .

BY

TITLE:

TITLE:

TITLE:

PERFORMANCE BONDMS-944-S (7-09)

(NAME OF MUNICIPALITY)

in the full and just sum of

(NAME OF STATE)

are held and firmly bound unto

KNOW ALL MEN BY THESE PRESENTS, That we, as Surety as Principal and a corporation incorporated under the laws of the State of

(SURETY COMPANY)

(NAME AND ADDRESS OF CONTRACTOR)

(With Corporate Surety)

Attest / Witness:

IN WITNESS WHEREOF, the said Principal and Surety have duly executed this Bond under Seal, pursuant to due and legal action

NOW, THEREFORE, the condition of this obligation is such that if the above bounden Principal, as Contractor, shall in all lawful money to 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.

forebearance being hereby waived.

shall be and remain in full force, virtue and effect.

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, 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 the undertaking of certain obligations as therein set forth.

respects comply with and faithfully perform the terms and conditions of said Contract, including the Specifications and conditions referred their heirs, executors, administrators, successors or assigns from their liability hereunder, notice to the surety of any such alteration or

(DATE OF BOND)

- 1 -

CONTRACTOR

SURETY COMPANY

Attest / Witness:

PLACE

SEAL

HERE

PLACE

HERE

MS-944S

KNOW ALL MEN BY THESE PRESENTS, that we 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 and 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 for material or labor entered into and became component parts of the work and for rental of the equipment used and services rendered by 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 therefor, may sue in assumpsit on this Payment Bond in his, their, or its own name and may prosecute the same to final 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 herein 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 forebearance 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 of forebearance being hereby waived.

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

WITNESS:

CONTRACTOR

BY:

SURETY COMPANY

TITLE: TITLE:

PAYMENT BOND Attachment 3 as PRINCIPAL and

- 2 -

WITNESS:

day of

TITLE:

PLACE

SEAL

HERE

PLACE

HERE

Attachment 4

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 has his its supplements and amendments, and have insured their liability thereunder in accordance with the terms of said its

Act with .

( TYPE OR PRINT)

BY

day of A.D. 20 .

My Commission Expires

(SURETY COMPANY)

AFFIDAVIT RE

ACCEPTING PROVISIONS OF THE WORKMEN’S COMPENSATION ACT

- 3 -

CONTRACTOR

SIGNATURE

Sworn to and subscribed before me this

( DATE )

SIGNATURE

D-7126 ( 7-09 )

County

Municipality

Project Number

State of Fed. Project No.

( If Applicable )

The undersigned deponent deposes and says that he is the of the

BY

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

County of

ANTI-COLLUSION AFFIDAVIT

26-23107-001CA

competitive bidding in connection with such contract.

into any agreement, participated in any collusion, or otherwise taken any action in restraint of free

Company; that he is authorized to make this

Publication 408, as amended and that the said company has not, either directly or indirectly, entered affidavit on behalf of said company in compliance with section 102.06 (e) of Department Specifications, Notary Public

My Commission expires

(Contractor)

006060-1

CONTRACTOR’S QUALIFICATION STATEMENT

All questions must be answered and the date given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate attached sheets. The Bidder may submit additional information if he so desires.

The Undersigned certifies under oath that the information provided herein is true and sufficiently complete so as not to be misleading.

Submitted to:

Address:

Submitted by:

Corporation:

Name:

Partnership:

Address:

Individual:

Principal Office:

Other:

Name of Project (if applicable)

Type of Work (file separate form for each Classification of Work):

General Construction

HVAC

Plumbing

Electrical

Other (please specify)

1. ORGANIZATION

1.1

How many years has your organization been in business as a Contractor?

1.2

How many years has your organization been in business under its present business name?

1.2.1 Under what other or former names has your organization operated?

1.3

If your organization is a corporation, answer the following:

1.3.1 Date of incorporation:

1.3.2 State of incorporation:

1.3.3 President's name:

1.3.4 Vice-president’s name:

1.3.5 Secretary’s name:

1.3.6 Treasurer’s name:

1.4

If your organization is a partnership, answer the following:

1.4.1 Date of organization:

1.4.2 Type of partnership (if applicable):

1.4.3 Name(s) of general partner(s):

1.5

If your organization is individually owned, answer the following:

1.5.1 Date of organization:

1.5.2 Name of owner:

1.6

If the form of your organization is other than those listed above, describe it and name the principals:

006060-2

2.

LICENSING

2.1

List jurisdictions and trade categories in which your organization is legally qualified to do business, and indicate registration or license numbers, if applicable.

2.2

List jurisdictions in which your organization’s partnership or trade name is filed.

3.

EXPERIENCE:

3.1

List the categories of work that your organization normally performs with its own forces.

3.2

Claims and Suits: (If the answer to any of the questions below is yes, please attach details).

3.2.1 Has you organization ever failed to complete any work awarded to it?

3.2.2 Are there any judgments, claims, arbitration proceedings or suits pending or outstanding against your organization or its officers?

3.2.3 Has your organization filed any law suits or requested arbitration with regard to construction contracts within the last five years?

3.3

Within the last five years, has any officer or principal of your organization ever been an officer or principal of another organization when it failed to complete a construction contract?

3.4

On a separate sheet, list major construction projects your organization has in progress, giving the name of project, owner, architect, contract amount, percent complete and scheduled completion date.

3.4.1 State total worth of work in progress and under contract:

3.5

On a separate sheet, list the major projects your organization has completed in the past five years, giving the name of project, owner, architect, contract amount, date of completion and percentage of the cost of the work performed with your own forces.

3.5.1 State average annual amount of construction work performed during the past five years:

3.6

On a separate sheet, list the construction experience and present commitments of the key individuals of your organization

4.

REFERENCES

4.1

Trade References:

4.2

Bank References:

4.3

Surety:

4.3.1 Name of bonding company:

4.3.2 Name and address of agent:

5.

FINANCING:

5.1

Financial Statement:

5.1.1 Attach a financial statement, preferably audited, including your organization’s latest balance sheet and income statement showing the following items:

Current Assets (e.g., cash, joint venture accounts, accounts receivable, notes receivable, accrued income, deposits, materials inventory and prepaid expenses);

Net Fixed Assets;

Other Assets:

Current Liabilities (e.g., accounts payable, notes payable, accrued expenses, provision for income taxes, advances, accrued salaries and accrued payroll taxes);

006060-3

Other liabilities (e.g. capital, capital stock, authorized and outstanding shares par values, earned surplus and retained earnings).

5.1.2 Name and address of firm preparing attached financial statement, and date thereof:

5.1.3 Is the attached financial statement for the identical organization named on page one?

5.1.4 If not, explain the relationship and financial responsibility of the organization whose financial statement is provided (e.g., parent-subsidiary).

5.2

Will the organization whose financial statement s attached act as guarantor of the contract for construction?

6.

AFFIRMATIVE ACTION PROGRAM

6.1

Each bidder must provide with his/her proposal a written statement describing the exact nature scope and history of their Affirmative Action Program in the interest of extending work opportunities to qualified minority workers.

6.2

Failure of a bidder to provide information as required under this paragraph may be cause for disqualification of the bidder’s proposal.

7.

APPRENTICESHIP TRAINING

7.1

A bidder shall be a participant in a state or federally approved Apprenticeship Training Program. Each bidder shall submit with his/her proposal a complete description of the Apprenticeship Training Program in which the bidder participates, including a list of the number of graduated apprentices every year for the past five years.

7.2

If requested by the Owner, the bidder shall submit within three days of the date of the request, the name, address, and telephone number of the state and federal agency which certifies the bidder’s Apprenticeship Training Program and the bidders identification number (if any) that would enable the Owner’s representative to verify the information provided by the bidder.

7.3

Failure of a bidder to provide information as required under this paragraph may be cause for disqualification of the bidders proposal.

8.

INSURANCE

Proof and submission of a description of any health care plans, worker’s compensation insurance and unemployment insurance maintained for the benefit of the contractor’s employees.

9.

Proof that the Contractor is not presently debarred by Federal, State or Local Authorities, and a history containing a full and complete description of events underlying any debarment with in the prior 10 year period.

10.

Proof that the Contractor has not defaulted on a project, trade or contracting license or been suspended or revoked and has not violated any prevailing wage laws.

11.

SIGNATURE

Dated at this ________ day of ____________________________________

Name of Organization: _____________________________________________

By: _____________________________________________________________

Title: ___________________________________________________________

____________________ being duly sworn deposes and says that the information provided herein is true and sufficiently complete so as not to be misleading

Subscribed and sworn before me this day of _____________________________________

My Commission Expires: ________________________

006070-1

SECTION 006070

MAINTENANCE BOND

KNOW ALL MEN BY THESE PRESENTS, that we as Principal, and a corporation, as Surety, are held firmly bound unto as Obligee, in the full and just sum of ($ ) for the payment of which sum, 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 said Principal entered into a contract with dated for

WHEREAS, said contract provides that the Principal will furnish a bond conditioned to guarantee for the period of one (1) year after approval of the final estimate on said job, by the Owner, against all defects in workmanship and materials which may become apparent during said period, and

WHEREAS, the said contract has been completed, and was approved on .

NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if within one (1) year from the date of approval of the said contract, the work done under the terms of said contract shall disclose poor workmanship in the execution of said work, and the carrying out of the terms of said contract, or it shall appear that defective materials were furnished thereunder, then this obligation shall remain in full force and virtue, otherwise this instrument shall be void.

Signed and sealed this day of , 20 .

Witness:

Principal

By:

Attorney-in-Fact

006080-1

RIDLEY TOWNSHIP

CONTRACTOR RESPONSIBILITY CERTIFICATION

Firm Name:

Firm Address:

Contact Name:

Telephone No.:

Fax No.:

Email Address:

Project Name:

The submitting firm is required to certify compliance with the contractor responsibility standards set forth below by checking appropriate boxes and providing the supplemental information at the time of submitting the bid.

(1) Does the firm have or will it obtain all valid, effective licenses, registrations or certificates required by federal, state, county, or local law, including, but not limited to, licenses, registrations or certificates required to: (a) do business in the designated locale; and (b) perform the contract work it seeks to perform. These shall include, but not be limited to, licenses, registrations or certificates for any type of trade work or specialty work which the firm proposes to self-perform?

Yes No

(2) Does the firm meet the bonding requirements for the contract as required by applicable law or contract specifications and any insurance requirements as required by applicable law or specifications, including general liability insurance, workers compensation insurance and unemployment insurance requirements?

(3) Has the firm been debarred by any federal, state or local government agency or authority in the past three (3) years?

(4) Has the firm defaulted on any project in the past three (3) years?

(5) Has the firm had any type of business, contracting or trade license, registration, or other certification suspended or revoked in the past three (3) years?

(6) Has the firm been cited for a willful violation of federal or state safety laws determined by a final decision of a court or government agency in the past three (3) years?

006080-2

(7) Has the firm or its owners been convicted of any crime relating to the contracting business as determined by a final decision of a court or government agency in the past ten (10) years?

(8) Has the firm, in the past three (3) years, been found by a final decision of a court or government agency in violation of any law applicable to its contracting business, including, but not limited to, licensing laws, tax laws, prompt payment laws, wage and hour laws, prevailing wage laws, environmental laws or other, where the result of such violation was the payment of a fine, back pay damages or any other type of penalty in the amount of $10,000 or more?

(9) Does the firm agree to pay all craft employees that it employs on the project the current wage rates and benefits as required under applicable federal or state wage laws for the duration of the referenced project?

(10) Does the firm participate in an Approved Registered Apprenticeship Program as defined in the

Ordinance for each separate trade or classification in which it employs craft employees and agree to continue to participate in such program or programs for the duration of the referenced project?

(A) attach list of all trades or classifications of craft workers to be used on the project

(B) attach copy of apprenticeship program registration certificate

(C) attach list of employees to be used on the project who have graduated from an Approved

Registered Apprenticeship Program

(D) attach copies of Employee Certification of Completion of Apprenticeship Program

(11) Does the firm have all other technical qualifications and resources, including equipment, personnel and financial resources, to perform the referenced contract, or agree that it will obtain some through the use of qualified, responsible subcontractors?

(12) Does the firm have at least the OSHA ten (10) hour training course for safety established by the

U.S. Department of Labor, Occupational Safety and Health Administration

(13) Does the firm agree to notify the Township Administration Office of any material changes to any matters attested to in this certification within seven (7) days?

(13) Does the firm understand and agree that it shall provide a Subcontractor List that identifies any subcontractors it will use in connection with the project and furnish Contractor Responsibility Certifications for all identified subcontractors with all required supporting documentation at the time of submitting the bid.

006080-3

(14) Does the firm understand and agree that this certification must be completed by an authorized representative of the firm that has sufficient knowledge and information to address all matters addressed here?

In executing this Responsibility Certification, the submitting firm understands and agrees that if the

Township determines that this certification contains false or misleading material information that was provided knowingly or with reckless disregard for the truth or omits material information knowingly or with reckless disregard of the truth, the firm may be prohibited from performing work for the Township for a period of three (3) years. Such circumstances shall also subject the firm to any other penalties and sanctions, including contract termination, available to the Township under law. A contract terminated under these circumstances shall further entitle the Township to withhold payment of any monies due to the firm as damages.

I certify that the foregoing representations regarding the past performance and present qualifications of the undersigned firm are true and correct.

Sign Name

Print Name

Title

Name of Firm

Date

Subscribed and sworn to before me this _____ day of , 20___.

Notary Public

My Commission Expires:

006090-1

SUBCONTRACTOR LIST

1.

Subcontractor

Responsibility Certification Attached

Phone:

Scope of Subcontract:

2.

3.

4.

006090-2

5.

6.

7.

006100-1

RIDLEY TOWNSHIP

SUBCONTRACTOR RESPONSIBILITY CERTIFICATION

Prime Contractor:

Subcontractor: _____________________________________________________________

Telephone No.:

Fax No.:

Email Address:

Project Name:

The submitting firm is required to certify compliance with the contractor responsibility standards set forth below by checking appropriate boxes and providing the supplemental information at the time of submitting the bid.

(1) Does the firm have or will it obtain all valid, effective licenses, registrations or certificates required by federal, state, county, or local law, including, but not limited to, licenses, registrations or certificates required to: (a) do business in the designated locale; and (b) perform the contract work it seeks to perform. These shall include, but not be limited to, licenses, registrations or certificates for any type of trade work or specialty work which the firm proposes to self-perform?

(2) Does the firm meet the bonding requirements for the contract as required by applicable law or contract specifications and any insurance requirements as required by applicable law or specifications, including general liability insurance, workers compensation insurance and unemployment insurance requirements?

(3) Has the firm been debarred by any federal, state or local government agency or authority in the past three (3) years?

(4) Has the firm defaulted on any project in the past three (3) years?

(5) Has the firm had any type of business, contracting or trade license, registration, or other certification suspended or revoked in the past three (3) years?

006100-2

(6) Has the firm been cited for a willful violation of federal or state safety laws determined by a final decision of a court or government agency in the past three (3) years?

(7) Has the firm or its owners been convicted of any crime relating to the contracting business as determined by a final decision of a court or government agency in the past ten (10) years?

(8) Has the firm, in the past three (3) years, been found by a final decision of a court or government agency in violation of any law applicable to its contracting business, including, but not limited to, licensing laws, tax laws, prompt payment laws, wage and hour laws, prevailing wage laws, environmental laws or other, where the result of such violation was the payment of a fine, back pay damages or any other type of penalty in the amount of $10,000 or more?

(9) Does the firm agree to pay all craft employees that it employs on the project the current wage rates and benefits as required under applicable federal or state wage laws for the duration of the referenced project?

(10) Does the firm participate in an Approved Registered Apprenticeship Program as defined in the

Ordinance for each separate trade or classification in which it employs craft employees and agree to continue to participate in such program or programs for the duration of the referenced project?

(A) attach list of all trades or classifications of craft workers to be used on the project

(B) attach copy of apprenticeship program registration certificate

(C) attach list of employees to be used on the project who have graduated from an Approved

Registered Apprenticeship Program

(D) attach copies of Employee Certification of Completion of Apprenticeship Program

(11) Does the firm have all other technical qualifications and resources, including equipment, personnel and financial resources, to perform the referenced contract, or agree that it will obtain some through the use of qualified, responsible subcontractors?

(12) Does the firm have at least the OSHA ten (10) hour training course for safety established by the

U.S. Department of Labor, Occupational Safety and Health Administration

(13) Does the firm agree to notify the Township Administration Office of any material changes to any matters attested to in this certification within seven (7) days?

006100-3

(13) Does the firm understand and agree that it shall provide a Subcontractor List that identifies any subcontractors it will use in connection with the project and furnish Contractor Responsibility Certifications for all identified subcontractors with all required supporting documentation at the time of submitting the bid.

(14) Does the firm understand and agree that this certification must be completed by an authorized representative of the firm that has sufficient knowledge and information to address all matters addressed here?

In executing this Responsibility Certification, the submitting firm understands and agrees that if the

Township determines that this certification contains false or misleading material information that was provided knowingly or with reckless disregard for the truth or omits material information knowingly or with reckless disregard of the truth, the firm may be prohibited from performing work for the Township for a period of three (3) years. Such circumstances shall also subject the firm to any other penalties and sanctions, including contract termination, available to the Township under law. A contract terminated under these circumstances shall further entitle the Township to withhold payment of any monies due to the firm as damages.

I certify that the foregoing representations regarding the past performance and present qualifications of the undersigned firm are true and correct.

Sign Name

Print Name

Title

Name of Firm

Subscribed and sworn to before me this _____ day of , 20___.

Notary Public

My Commission Expires:

006110-2

COMMONWEALTH OF PENNSYLVANIA

PUBLIC WORKS EMPLOYMENT VERIFICATION FORM

Business or Organization Name (Employer)

Address

City State_ Zip Code

Contractor Subcontractor ( c h e c k one)

Contracting Public Body

Contract/Project No

Project Description

Project Location

As a contractor/subcontractor for the above referenced public works contract, I hereby affirm that as of the above date, our company is in compliance with the Public Works Employment Verification Act ('the Act') through utilization of the federal E-Verify Program (EVP) operated by the United States Department of Homeland Security. To the best of my/our knowledge, all employees hired post January 1, 2013 are authorized to work in the United States.

It is also agreed to that all public works contractors/subcontractors will utilize the federal EVP to verify the employment eligibility of each new hire within five (5) business days of the employee start date throughout the duration of the public works contract. Documentation confirming the use of the federal EVP upon each new hire shall be maintained in the event of an investigation or audit.

I, , authorized representative of the company above, attest that the information contained in this verification form is true and correct and understand that the submission of false or misleading information in connection with the above verification shall be subject to sanctions provided by law.

Authorized Representative Signature