375541_R3_Project Manual_06-10-2024.pdf

PROJECT MANUAL

FOR

P.I.N. 3755.41

REPLACEMENT OF FRONTENAC ROAD BRIDGE OVER TRUMANSBURG CREEK

TOWN OF COVERT

SENECA COUNTY, NEW YORK

(LOCALLY ADMINISTERED FEDERAL AID PROJECT)

REPLACEMENT OF FRONTENAC ROAD BRIDGE OVER TRUMANSBURG CREEK

TOWN OF COVERT

SENECA COUNTY, NEW YORK

(LOCALLY ADMINISTERED FEDERAL AID PROJECT)

Submitted in accordance with the Standard Specifications adopted on May 1st, 2024, as posted on the Department’s website.

June 2024

P.I.N. 3755.41

CHA PROJECT #: 068763

Prepared for:

Seneca County Department of Public Works

2017 Prospect St., Romulus, NY 14541

Prepared by:

3 Winners Circle Albany, New York 12205

(518) 453-4500

TOC-1

TABLE OF CONTENTS

Notice to Bidders NTB-1 to NTB-4

Instructions to Bidders ITB-1 to ITB-6

Supplemental Information Available to Bidders CONR9

Bid Documents:

(Forms listed below are to be returned with bid) Bidder’s Checklist BC-1 Bid Form BF-1 to BF-4 Certified Copy of Resolution of Board of Directors BF-5 Bid Summary Forms BS-1 to BS-14 Bid Bond BB-1 to BB-3 Affidavit of Workers’ Compensation WC-1 Iran Divestment Act Certification ID-1 DBE Participation Goals DBE-1 to DBE-2 Non-Collusive Bidding Certification Bidder Information 12–1A.1

(Included in Appendix 12-1A below) Offerer Disclosure of Prior Non-Responsibility Determinations 12–1A.2

(Included in Appendix 12-1A below) Combined Certification Form (Included in Appendix 12-1A below) 12–1A.3 thru 12–1A.4 (Form listed below is to be returned after being announced the low bidder or when proposed for subcontract work) NYS Uniform Contracting Questionnaire (CCA-2) 19 pages

Agreement AG-1 to AG-7

Construction Payment Bond 3 pages

Construction Performance Bond 3 pages

Appendix 12-1 – Construction Contract Requirements 31 pages Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion Appendix 12-1.1

(FHWA Section 1273 X)

Certification Regarding Use of Contract Funds for Lobbying (FHWA 1273 Section XI) Appendix 12-1.1

False Claims Certification (31 USC §3729, NYS Finance Law Article 13) Appendix 12-1.2

Non-Collusive Bidding Certification (NYS Finance Law §139-d General and Appendix 12-1.3

Municipal Law §103-d)

Non-Collusive Bidding Certification (2CFR 1200) Appendix 12-1.4

Reporting Violations of Non-Collusive Bidding Procedures, Misconduct, Appendix 12-1.5 or Other Prohibited Contract Activities

Goals for Equal Employment Opportunity (EEO) Participation Appendix 12-1.6

Required Contract Provisions Federal-Aid Construction Contracts Appendix 12-1.7 to Appendix 12-1.22

Appendix 12-1A – Construction Contract Requirements Fillable Forms 7 pages Non-Collusive Biding Certification Bidder Information Appendix 12-1A.2

Offerer Disclosure of Prior Non-Responsibility Determinations Appendix 12-1A.3

Combined Certification Form Appendix 12-1A.4 to Appendix 12-1A.5

New York State DOL Prevailing Wage Rates 14 pages

United States DOL Davis-Bacon Wage Rates 9 pages

TOC-2

POST AWARD FORMS:

Notice of Award (NOA) 1 page

Notice to Proceed (NTP) 1 page

Sample Shop Drawing Transmittal Form 2 pages

Change Order Form 1 page

TECHNICAL INFORMATION

Special Notes:

General SN-1 to SN-5

Diesel Emission Reduction Act (DERA) Regulatory Compliance 1 page

Ultra Low Sulfur Diesel Fuel 1 page

Controlling Exposure to Diesel Exhaust 1 page

Dust Control 1 page

PG Binder and Mix Design Level 1 page

Special Specifications 7 pages

Material Inspection Table 2 pages

Earthwork Summary Sheets 2 pages

ENVIRONMENTAL PERMITS

USACE Nationwide Permit No. 3 – Maintenance 56 pages

ITB-1

INSTRUCTION TO BIDDERS

PROJECT IDENTIFICATION:

Project Title: PIN 3755.41

Replacement of Frontenac Road Bridge over Trumansburg Creek

Owner: Seneca County, New York

Engineer: CHA Consulting, Inc

3 Winners Circle

Albany, New York 12205

(518) 453-4500

1. INCORPORATION OF NEW YORK STATE STANDARD SPECIFICATIONS

This Contract shall be enforced by requirements stated in Section 100 of the New York State Department of Transportation Standard Specifications, Construction and Materials of May 1, 2024 and all

Addenda in effect on the date of advertising for bids shall apply, except where modified in these

Specifications. Although these Specifications were written with the New York State Department of

Transportation as the contract managing agency, it is the intent that these conditions and requirements be managed by the Owner. The Owner, or its representatives, will be responsible for all interpretations and decisions regarding these Specifications for this project. Therefore, the project Owner is to be substituted for any and all references to the Department and State officials. In addition, where the NYSDOT is mentioned in any capacity as an approving authority with regard to materials, shop drawings, or other approvals, the approving authority shall be changed to the Owner. Where reference is made to

“the proposal” in the New York State Standard Specifications and Construction Materials, “the proposal” shall be substituted with “the Contract Documents and Specifications”.

The Specifications, Plans, and Contract Documents provided by the Owner shall govern over those of other agencies but where the method of work, requirement of materials, and method of payment are not included in the Contract Documents provided by the Owner, the New York State Standard

Specifications and Construction Materials shall govern. The Specification Section of these Contract

Documents details the applicable item numbers of the Standard Specifications; however, the Contractor shall be aware that the Contract Drawings and Specifications contained herein may contain modifications which they are responsible for in the performance of the Contract.

The following changes are made to the subsections of the New York State Standard Specifications and Construction Materials:

§101 – ABBREVIATIONS AND DEFINITION OF TERMS – Modify the following:

§101-02 DEFINITIONS OF TERMS – Modify the following definitions:

Award - Delete the word “Department” and substitute “OWNER”.

Chief Engineer - Delete “The Chief Engineer of the New York State Department of Transportation” and substitute “OWNER”.

NTB-1

NOTICE TO BIDDERS

P.I.N. 3755.41

REPLACEMENT OF FRONTENAC ROAD BRIDGE OVER TRUMANSBURG CREEK

(LOCALLY ADMINISTERED FEDERAL AID PROJECT)

Town of Covert, Seneca County, New York

Notice is hereby given that the County of Seneca will accept sealed bids for:

Replacement of Frontenac Road Bridge over Trumansburg Creek Town of Covert, Seneca County, New York

PIN 3755.41

The Owner is the County of Seneca, and the work site is located in the Town of Covert, approximately 0.7 miles northeast of the intersection of NYS Route 89. The Total project length is 470 feet.

The work includes providing all labor, materials, machinery, tools, equipment, and other means of construction necessary and incidental to the completion of the work shown on the plans and described in these specifications including, but not necessarily limited to the following:

replacement of the Frontenac Road bridge over Trumansburg Creek (BIN 2209490) and full depth asphalt pavement reconstruction.

This is a Federal Aid Project and NYSDOT Standard Specifications, officially finalized and adopted on May 1st, 2024, as posted on the New York State Department of Transportation’s website must be followed by the successful bidder.

This project is a federal aid Group Type 4 – New or Replacement Bridge The DBE goal for this project is: 6.0% There are no M/WBE goals for this project.

The EEO Employment goals for this project are: 5.9% Minority Employment Goal

6.9% Women Employment Goal

The use of the NYSDOT approved civil rights reporting software, Equitable Business Opportunities (EBO), is required. Access authorization to EBO can be found at https://ebo.dot.ny.gov/.

No residential or geographical restrictions will be in effect for this project. Applicable Federal requirements take precedence over State and local requirements unless state and local requirements are deemed to be more stringent.

NTB-2

Copies of the Contract Plans and Documents may be examined at no expense or obtained at the following location:

CHA Consulting, Inc.

2200 Main Place Tower;

Buffalo, NY 14202 Tel: 716-847-6310

A Compact Disk containing the contract plans and documents may be obtained from CHA Consulting, Inc. by mailing a written request to the address above or by emailing Maristell Schlereth at mschlereth@chasolutions.com. If express mailing is desired the bidder must provide an account number with the request.

Plans will also be available for review only, at the office of the Seneca County Public Works Department, 1 Dipronio Drive, Waterloo, NY 13165.

No verbal interpretation of the intent of any of the Contract Documents will be made before receipt of Bids. Requests for interpretations prior to receipt of Bids must be presented in writing to the Engineer, CHA Consulting, Inc., iheadleykroll@chasolutions.com and to be given consideration must be received by the Engineer at least seven (7) days prior to the date set for the opening of Bids. Any interpretation, and any additional information or instruction will, if issued, be in the form of a written Addendum or Addenda sent by email to all holders of Contract Documents at the addresses furnished therefore, at least five (5) days prior to the date of the opening of Bids.

Failure of any Bidder to receive any such Addendum or interpretation shall not relieve such Bidder from any obligation under this Bid as submitted. All Addenda so issued shall become a part of the Contract Documents.

Questions regarding the Contract Documents should be directed to Iana Headley-Kroll, PE, CHA Consulting, Inc. through email at: iheadleykroll@chasolutions.com. Bidders shall promptly notify CHA Consulting, Inc. of any errors, omissions, conflicts, or ambiguity within the Contract Documents within 14 days of bid opening.

NTB-3

All bids must include the completed Bid Form, Non-Collusive Bidding and Disbarment Certifications, and Lobbying Certifications. This is a unit price bid as described in the Instructions to Bidders. No bidder may withdraw his/her bid within forty-five (45) calendar days after the actual date of the opening thereof.

Each bid must be accompanied by security in an amount not less than five percent (5%) of the amount of the bid in the form and subject to the conditions provided in the Instructions to Bidders.

Bids to be considered must be received in a sealed envelope by the County Manager Office at 1 DiPronio Drive, Waterloo, NY 13165 by 2:00 P.M., local time, on Thursday July 11, 2024 at which time they will be opened and read in the Board Room at 1 DiPronio Drive, 3rd Floor, Waterloo, NY 13165. Bids received after the above noted time will not be accepted. All sealed envelopes should be clearly labeled “BID: PIN 3755.41 – REPLACEMENT OF FRONTENAC ROAD BRIDGE OVER TRUMANSBURG CREEK” with the Bidders name and address, and the date and time of the bid opening.

The Bidder to whom the Contract is awarded will be required to furnish Performance, Payment and Guarantee Bonds from an acceptable Surety Company for an amount not less than 100% of the accepted bid. The successful Bidder and all subcontractors must have an approved CCA-2 on file with NYSDOT prior to being awarded a contract. If the successful Bidder does not currently have a CCA-2 on file with NYSDOT, the Bidder may find the CCA-2 forms and instruction for completion online at:

https://www.osc.state.ny.us/state-vendors/vendrep/vendor-responsibilityforms?redirect=legacy#Construction.

The successful Bidder will be required to comply with all provisions of the Federal Government Equal Employment Opportunity clauses issued by the Secretary of Labor on May 2, 1968 and published in the Federal Register (41 CFR Part 60-1, 33 F.2 7804). Successful bidders will be required to pay prevailing wage rates on this contract.

NOTICE: The County of Seneca shall not be held responsible for the completeness or accuracy of any bid documents received by a vendor that were not directly issued to that vendor directly by CHA Consulting, Inc.

Any vendor submitting a bid based on incomplete or inaccurate information resulting from documentation received from any third party, shall not have cause for relief from award or completion of a contract in accordance with the official documents on file with the Commissioner of Public Works.

It is HIGHLY suggested that all vendors interested in participating in this bid, contact the office of the Engineer directly at the above address or telephone number to assure they have received the most accurate and up-to-date material concerning this contract.

The County does not offer or supply anyone the list of people that have obtained a copy of these bid specifications or cost estimates for the project prior to the opening of the bid. NO EXCEPTIONS ARE MADE TO THIS POLICY.

NTB-4

The successful bidder will also be required to comply with all provisions of the environmental permits included at the end of this Project Manual.

The County of Seneca reserves the right to consider the bids for forty-five (45) days after receipt before awarding any Contract, and to waive any minor informalities in, and to reject, any and all bids. All bids are subject to final review and approval by the County of Seneca before any award of contract may be made. Receipt of bids by the County of Seneca shall not be construed as authority to bind the County of Seneca.

A Pre-Bid Conference will not be held for this project.

The work will be substantially completed on 10/17/2025 and completed and ready for final payment on 11/14/2025. The S Frontenac Point Road improvements for the detour including asphalt overlay and pull offs on S Frontenac Point Road shall be completed prior to the closure of BIN 220949 and prior to 10/31/2024. The closure of BIN 220949 shall not be allowed over the winter shutdown.

The New York State Department of Transportation, in accordance with Title VI of the Civil Rights Act of 1964, 78 Stat. 252, 42 U.S.C 2000d to 2000d-4 and Title 49 Code of Federal Regulations, Department of Transportation, Subtitle A, Office of the Secretary, Part 21, Nondiscrimination in Federally-assisted programs of the Department of Transportation and Title 23 Code of Federal Regulations, Part 200, Title VI Program and Related Statutes, as amended, issued pursuant to such Act, hereby notifies all who respond to the related solicitation, request for proposal or invitation to bid that it will affirmatively insure that in any contract entered into pursuant to this advertisement, disadvantaged business enterprises will be afforded full opportunity to submit bids in response to this invitation and will not be discriminated against on the grounds of race, color, national origin, sex, age, disability/handicap and income status in consideration for an award.

OWNERS CONTACT ENGINEER

Roy Gates Superintendent of Highways Seneca County 2017 Prospect St., Romulus, NY 14541 Ph: (607) 869-3325

Iana Headley-Kroll, P.E.

Project Manager CHA Consulting, Inc.

3 Winners Circle Albany, NY 12205 Ph: (518) 453-3961

ITB-2

Commissioner - Delete “The Commissioner of the New York State Department of Transportation” and substitute “OWNER”.

Comptroller - Delete “The head of the New York State Office of the State Comptroller” and substitute “OWNER”.

Contract - Delete the word “Department” and substitute “OWNER”.

Department - Delete entire definition and substitute “OWNER”.

Department Geotechnical Engineer - Delete entire definition and substitute “OWNER’S

ENGINEER”.

Department Engineering Geologist - Delete entire definition and substitute “OWNER’S

ENGINEER”.

Director, Construction Division - Delete entire definition and substitute “OWNER’S ENGINEER”

Engineer or Engineer in Charge - Delete entire definition and substitute “The Engineer representing the Owner having direct supervision of the execution of the Contract under direction of the engineering firm representing the Owner.”

Final Agreement - Delete “State of New York Department of Transportation” and substitute

“OWNER”.

Geotechnical Engineering Bureau - Delete. Inspector - Delete “The Department of Transportation” and substitute “The Owner”.

Material - Delete “Commissioner” and substitute “OWNER”.

Order on Contract - Delete “Commissioner” and substitute “OWNER”.

Proposal Form - Delete “Department” and substitute “OWNER”.

Subcontractor - Delete “Department” and substitute “OWNER”.

Test - Delete “Commissioner” and substitute “OWNER”.

§102 - BIDDING REQUIREMENTS AND CONDITIONS – Modify the following:

§102-02 - EXAMINING THE CONTRACT DOCUMENTS AND WORK SITE: Delete the first paragraph and substitute “Detailed plans of the work may be obtained through the Empire State Bidnet

System (www.EmpireStateBidSystem.com). Standard sheets are available on the Engineering > CADD Info > Drawings page of the New York State Department of Transportation’s Business

Center web site at: www.dot.ny.gov/business for free download.”

§102-06 - BID DEPOSIT: Delete this Section in its entirety and substitute with the requirements of Paragraph 3, BID SECURITY in these Information to Bidders.

http://www.empirestatebidsystem.com/ http://www.dot.ny.gov/business

ITB-3

§102-15 - SAMPLE FORM OF BID BOND: Delete this Section in its entirety.

§102-16 - SAMPLE CONTRACT PAY ITEM FORMAT: Delete this Section in its entirety.

§103 - CONTRACT AWARD AND EXECUTION– Modify the following:

§103-01 - CONTRACT AWARD: Delete this Section in its entirety and substitute with the following:

The Contract Award will be made only to the lowest responsible bidder as will best promote the public interest. The lowest bid will be determined by the Owner on the basis of gross sum for which the entire work will be performed, arrived at by a correct computation of all contract pay items specified in the bid documents, at the unit prices stated in the bid documents. If there is any discrepancy between the hard copy and electronic format of itemized proposals published by the Owner, in either the contract pay items or quantities, the Owner will evaluate the bids based only on that portion that is common to all formats. The Owner reserves the right to reject any or all bids.

The Owner reserves the right to reject any bid deemed non-responsive, or any contractor deemed non-responsible, and then, award to other than the low bidder, or waive minor informalities if, in its opinion, the best interest of the Owner will thereby be promoted. The Owner reserves the right to reject any proposal in which any of the bid prices are unbalanced to the potential detriment of the Owner. An unbalanced bid is considered to be one containing lump sum or unit bid prices which do not reflect reasonable actual costs plus a reasonable proportionate share of the bidder's anticipated profit, overhead costs, and other indirect costs which are anticipated for the performance of the work in question.

As a condition of Award, the Bidder shall submit a completed Form CCA-2, New York State Vendor

Responsibility Questionnaire - For Profit Construction. If requested by the Owner, the Bidder shall present additional evidence of ownership, corporate structure, ability and financial standing, as well as a statement as to equipment. Contracting corporations which are chartered in states other than

New York, as well as individuals or firms doing business under fictitious names, shall register with the NYS Department of State, authorizing them to conduct business in New York State prior to contract award. Contract award of a joint venture proposal will place upon the joint venture participants complete liability, jointly and individually, for contract performance.

§103-06 - SAMPLE FORM OF CONTRACT AGREEMENT: Delete this Section in its entirety with the following exceptions: Articles 3, 5, 8, 9, and 11 remain in effect as they are cross referenced in other sections of these Specifications.

§104 – SCOPE OF WORK– Modify the following:

§104-02 - CHANGES, CONTINGENCIES, EXTRA WORK AND DEDUCTIONS: Delete the first sentence and substitute “The provisions of Article 5, Alterations and Omissions of §103-06 of the Standard Specifications shall apply.”

§105 – CONTROL OF WORK – Modify the following:

§105-14-DISPUTED WORK AND DISPUTE RESOLUTION: Delete 105-14D in its entirety and substitute the following: “D. Review Time Periods for Disputes. After providing written notice the Contractor shall, as soon as the information is available or ascertainable, provide the Engineer with summary of its dispute contentions in accordance with Section 105-14E of the NYSDOT Standard Specifications. The Engineer will make an initial response, in writing, within 15 work

ITB-4

days after the Contractor provides the dispute submission. If a dispute is not resolved by the

Engineer to the satisfaction of the Contractor within 10 work days of receipt of the Engineer’s written decision, or the Engineer fails to reply within 15 days, the Contractor shall notify the Owner in writing, with copies to the Engineer, of its contentions relative to the dispute, indicating the substance of previous communications on the issue with the Engineer and its rebuttal of their previous findings.”

Delete 105.14H in its entirety and substitute the following: “H. Contract Closeout Process. A dispute, or a portion thereof, that has been previously submitted to the Owner or its representatives which remains unresolved to the satisfaction of the Contractor, may be submitted for the Owner’s review in connection with the closeout process.”

1. Contract Closeout Meeting. If requested by the Contractor, the Owner or its representatives will schedule a contract closeout meeting with the Owner at their office. The contract closeout meeting process involves meeting(s) with the Contractor and its representatives and the Owner’s personnel and representatives to amicably resolve all remaining disputes of the Contract.

2. Claims. If any dispute or portion thereof remains unresolved following the meeting(s) or conference(s) and the payment of the final agreement, the Contractor may file a claim in accordance with New York State Laws and the provisions of the Contract.”

2. BID ALTERNATES AND LOW BID DETERMINATION

If the contract is to be awarded, it will be awarded to the lowest responsible Bidder whose evaluation by

Owner indicates to Owner that the award will be in the best interests of the Project.

3. BID SECURITY

Each bid must be accompanied by cash in United States currency or a certified check of the Bidder in the amount not less than five percent (5%) of the bid. A Bid Bond fully executed by the Bidder as principal and having as surety thereon a surety company approved by the Owner and authorized to do business in

New York State will be accepted in lieu of cash or certified check. The Bid Bond shall be in the form of the sample shown in Section 103 of the New York State Standard Specifications and Construction Materials with all appropriate modifications, or in a form approved by the Owner. Checks should be made payable to the Owner.

Such Bid Security will be returned to all except the three lowest Bidders within three working days after the opening of Bids. The remaining deposits will be returned to the three lowest Bidders within three working days after execution of the Contract, or, if no Contract is executed within Sixty (60) calendar days after opening of Bids, upon demand of the Bidder at any time thereafter so long as he has not been notified of the acceptance of his Bid.

4. SALES AND USE TAX

OWNER is exempt from New York State Sales and Use Taxes on material and equipment to be incorporated in the Work (Exemption No. 14-600-2576). Said taxes should not be included in the Contract

Price.

ITB-5

5. SCHEDULE FOR BID AND AWARD OF CONTRACT

A schedule of the major events required for the Bid and the Award is shown below:

Notice of Award No later than 45 days following Bid

Opening

Signed Documents returned by

Contractor

No later than 15 days following Notice of Award

Signed Documents returned by Owner with Notice to Proceed

No later than 10 days following Signed

Documents returned by Contractor

Submittal of Bonds and Insurance No later than 15 days following Notice of Award

6. PREVAILING WAGES

This is a public works project NYSDOL Prevailing Wage Rates are in effect for this project and must be paid to the contractor and subcontractors.

7. BLANK

8. RESIDENCE OR GEOGRAPHICAL RESTRICTION

There are no residence or geographical restrictions placed on bidders of this project.

9. D/M/WBE/ BUSINESS

The Department has established the following utilization goal(s) for this contract, expressed as a percentage of the total contract bid price.

• Disadvantaged Business Enterprise (DBE) Utilization Goal 6.0 % (Federal Aid Only)

• Minority Business Enterprise (MBE) Utilization Goal N/A % (Non-Federal Aid Only)

• Women’s Business Enterprise (WBE) Utilization Goal N/A % (Non-Federal Aid Only)

• Service-Disabled Veteran-Owned Business (SDVOB) Goal N/A% (Non-Federal Aid Only)

10. EQUAL EMPLOYMENT OPPORTUNITY REQUIREMENTS

Work force minority participation goals for this project are 5.9%. Work force female participation goals for this project are 6.9%.

11. EQUITABLE BUSINESS OPPORTUNITIES (EBO)

The Contractor will be required to utilize NYSDOT’s civil right reporting EBO system. The

Contractor will be required to create an EBO account, if they do not already have one, before the project can be awarded.

12. LIST OF ADDITIONALLY INSURED

The following list supplements the required additional insured parties identified in §107-06A.4 -

ITB-6

Additional Insureds:

• The State of New York

• New York State Department of Transportation

• CHA Consulting, Inc.

• Any consultants working for or on the project, including their agents or employees

• Seneca County, New York

• Town of Covert, New York

Refer to Standard Specifications §107-06A.4 for requirements regarding these additional insured parties.

CONR9 (01/02/18)

SUPPLEMENTAL INFORMATION AVAILABLE TO BIDDERS

The bidder’s signature on this proposal certifies that they have made themselves aware of the availability of the information indicated below.

The information checked in the “Digital” column on this form is available via e-mail from CHA Consulting, Inc.

Requests for available information can be sent to IHeadleyKroll@chasolutions.com.

INFORMATION Digital1 Inspection Only

1. Unsealed Layered or 3D PDF Files

2. CADD Information

a. MicroStation DGN

b. InRoads DTM and XML format

c. InRoads ALG and XML format

3. Cross Sections in ADOBE PDF format

4. Quantity Work-ups2

5. Record Plans

6. Rock Cores (available for inspection only)

7. Sign Face Layouts in ADOBE PDF format

8. Stormwater Pollution Prevention Plan (SWPPP)

9. Subsurface Information

a. Subsurface Exploration Logs (In Plan Set)

b. Undisturbed Sample Logs

c. Laboratory Test Data from Soil Samples

d. Tabulated Results of Probing

e. Tabulated Depth to Bedrock

f. Rock Core Evaluation Logs

g. Compression Test Data from Rock Samples

h. Rock Outcrop Maps

i. Granular Materials Resource Survey Reports

j. Terrain Reconnaissance Reports

10. Subsurface Information - Other Information

a. Subsurface information from outside sources

b. Source Information - Granular Material and aggregates

c. Special Subsurface Reports

11. Anticipated Construction Schedule

12. Asbestos Information

a. Asbestos Blanket Variances

b. Asbestos Report

13. Special Reports or Other Information:

a. Permits (In Project Manual)

b. Design Approval Document

c. Survey Control Report

d. Wetland Compensation Report

1 – All digital material requested will be provided in ADOBE (PDF) format, unless noted above.

2 – Required for all projects.

mailto:IHeadleyKroll@chasolutions.com

BC-1

BIDDER’S CHECKLIST

In order to submit a complete bid, Bidders must submit the following documents:

Bid Form (BF-1 to BF-4)

Certified Copy of Resolution of Board of Directors (For Corporations) (BF-5)

Bid Summary Forms (BS-1 to BS-14)

Bid Bond or Certified Bank Check (BB-1 to BB-3)

Affidavit for Workers' Compensation (WC-1)

Certification of Compliance Iran Divestment Act (ID-1)

DBE Participation Goals (DBE-1)

Non-Collusive Bidding Certification Bidder Information (Appendix 12-1A.1)

Offerer Disclosure of Prior Non-Responsibility Determinations (12–1A.2)

Combined Certification Form (12–1A.3 thru 12–1A.4)

Also, the following forms are due from the apparent responsible low bidder no later than 10 days after the bid opening:

Proof of Ability to do Work in NYS or Covenant to Obtain

(obtained from NY Dept. of State)

NYS Uniform Contracting Questionnaire (CCA-2)

The low bidder must have an approved New York State Uniform Contracting Questionnaire

(CCA-2 Form) on file with NYSDOT prior to an award being made. The CCA-2 form is available online at https://www.dot.ny.gov/bids-and-lettings/construction-contractors/ general-info or by calling the NYSDOT Office of Contract Management at (518) 457-1564.

https://www.dot.ny.gov/bids-and-lettings/construction-contractors/%20general-info https://www.dot.ny.gov/bids-and-lettings/construction-contractors/%20general-info

BF-1

BID FORM

PROJECT IDENTIFICATION: PIN 3755.41

Replacement of Frontenac Road Bridge over

Trumansburg Creek Town of Covert, Seneca County, NY

THIS BID IS SUBMITTED TO: County Manager Office Seneca County

1 DiPronio Drive

Waterloo, NY 13165

1. The undersigned BIDDER proposes and agrees, if this bid is accepted, to enter into an agreement with OWNER in the form included in the Contract Documents to perform and furnish all work as specified or indicated in the Contract Documents for the Bid Price and Bid Times indicated in this Bid and in accordance with the other terms and conditions of the Contract Documents

2. Bidder accepts all the terms and conditions of the Advertisement or Notice to Bidders and Instructions to Bidders, including without limitation those dealing with the disposition of Bid security. This Bid will remain subject to acceptance for forty-five (45) days after the Bid opening.

Bidder will sign and deliver the required number of counterparts of the Agreement with the Bonds and other documents required by the Bidding Requirements within fifteen (15) days after the date of OWNER’s Notice of Award

3. In submitting this Bid, BIDDER represents as more fully set forth in the Agreement, that:

a. BIDDER has examined and carefully studied the Bidding Documents and the following

Addenda receipt of all which is hereby acknowledged: (List Addenda by Addendum Number and Date)

b. BIDDER has visited the site and become familiar with and is satisfied as to the general, local, and site conditions that may affect cost, progress, performance, and furnishing of the work.

c. BIDDER is familiar with and is satisfied as to all federal, state, and local Laws and Regulations that may affect cost, progress, performance, and furnishing of work.

d. BIDDER is aware of the general nature of work to be performed by OWNER and others at the site that relates to work for which this Bid is submitted as indicated in the Contract

Documents

e. BIDDER has correlated the information known to BIDDER, information and observations obtained from visits to the site, reports and drawings identified in the Contract Documents

BF-2

and all additional examinations, investigations, explorations, test, studies, and data with the Contract Documents

f. BIDDER has given ENGINEER written notice of all conflicts, errors, ambiguities or discrepancies that BIDDER has discovered in the Contract Documents and the written resolution thereof by ENGINEER is acceptable to BIDDER, and the Contract Documents are generally sufficient to indicate and convey understanding of all terms and conditions for performing and furnishing the Work for which this Bid is submitted.

g. This bid is genuine and not made in the interest of or on behalf of any undisclosed person, firm, or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization, or corporation; BIDDER has not directly or indirectly induced or solicited any other BIDDER to submit a false or sham Bid; BIDDER has not solicited or induced any person, firm or corporation to refrain from bidding; and BIDDER has not sought by collusion to obtain for itself any advantage over any other BIDDER or over

OWNER.

4. Bidder will complete the Work in accordance with the Contract Documents for the following price:

TOTAL BID FOR ALL UNIT PRICES

(use words) (figures)

BIDDER acknowledges that quantities are not guaranteed and final payment will be based on actual quantities determined as provided in the Contract Documents.

5. BIDDER agrees that the Work will be substantially completed and completed and ready for final payment on or before the dates or within the number of calendar days indicated in the Agreement.

BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work within the times specified in the Agreement.

6. The following documents are attached to and made a condition of this Bid:

a. All documents set forth in the Bidders Checklist.

7. Communications concerning this Bid shall be addressed in writing to:

County Manager Office

Seneca County

1 DiPronio Drive

Waterloo, NY 13165

ATTN: Kyle Lovell

8. Terms used in this Bid which are defined in the Instructions to Bidders will have the meanings indicated in the Instructions.

BF-3

SUBMITTED on __________________________________________________, 20___.

CONTRACTOR ___________________________________

(Signature of Authorized Representative)

(Print Name)

(Title)

BF-4

BIDDER INFORMATION SHEET

NAME OF BIDDER: *

ADDRESS:

PHONE NUMBER:

TYPE OF ENTITY: CORPORATION PARTNERSHIP INDIVIDUAL

IF A NON-PUBLICLY OWNED CORPORATION:

NAME OF CORPORATION:

LIST OF PRINCIPAL STOCKHOLDERS (HOLDING OVER 5% OF OUTSTANDING SHARES):

LIST OF OFFICERS:

LIST OF DIRECTORS:

DATE OF ORGANIZATION:

IF A PARTNERSHIP:

PARTNERS:

NAME OF PARTNERSHIP:

DATE OF ORGANIZATION:

* IF THE BUSINESS IS CONDUCTED UNDER AN ASSUMED NAME, A COPY OF THE

CERTIFICATE REQUIRED TO BE FILED UNDER THE NEW YORK GENERAL

BUSINESS LAW MUST BE ATTACHED.

BF-5

CERTIFIED COPY OF RESOLUTION OF

BOARD OF DIRECTORS

(NAME OF CORPORATION)

“Resolved that________________________________, __________________________________

(Person Authorized to Sign) (Title) of _______________________________ authorized to sign and submit Bid for this corporation for

(Name of Corporation) the following project:

and to include in such bid the certificate as to non collusion, and for any inaccuracies or misstatements in such certificate this corporate Bidder shall be liable under the penalties of perjury.

The foregoing is true and correct copy of resolution adopted by:

(NAME OF CORPORATION)

At meeting of its Board of Directors held on the _______day of _____________________20____

By_______________________________________

Title_____________________________________

(SEAL)

The above form must be completed if the Bidder is a corporation

REPLACEMENT OF FRONTENAC ROAD OVER TRUMANSBURG CREEK IN THE TOWN OF COVERT

PIN 3755.41

BROUGHT FORWARD

ESTIMATE OF

QUANTITIES DOLLARS CTS DOLLARS CTS

201.06 1

LUMP SUM

202.120001 1

LUMP SUM

202.19 112

CUBIC YARD

203.02 700

CUBIC YARD

203.03 700

CUBIC YARD

ITEM

EMBANKMENT IN PLACE

FOR

REMOVING EXISTING SUPERSTRUCTURES

FOR

REMOVAL OF SUBSTRUCTURES

ITEMS WITH UNIT BID PRICE WRITTEN IN WORDS UNIT BID PRICE AMOUNT BID

CLEARING AND GRUBBING

FOR

FOR

UNCLASSIFIED EXCAVATION AND DISPOSAL

FOR

CARRY FORWARD

BS - 1

PIN 3755.41

BROUGHT FORWARD

ESTIMATE OF

QUANTITIES DOLLARS CTS DOLLARS CTS

203.21 101

CUBIC YARD

206.01 581

CUBIC YARD

206.0201 82

CUBIC YARD

206.05 4

EACH

207.27 91

SQUARE YARD

AMOUNT BID

SELECT STRUCTURE FILL

FOR

ITEMS WITH UNIT BID PRICE WRITTEN IN WORDS UNIT BID PRICE

ITEM

STRUCTURE EXCAVATION

FOR

TRENCH AND CULVERT EXCAVATION

FOR

TEST PIT EXCAVATION

FOR

PREFABRICATED COMPOSITE INTEGRAL ABUTMENT DRAIN

FOR

BS - 2

PIN 3755.41

BROUGHT FORWARD

ESTIMATE OF

QUANTITIES DOLLARS CTS DOLLARS CTS

209.1003 565

SQUARE YARD

209.13 737

LINEAR FOOT

209.1901 565

SQUARE YARD

304.12 609

CUBIC YARD

404.0001 52

70$ 00 3,640$ 00

FIXED PRICE QUALITY UNIT

ITEMS WITH UNIT BID PRICE WRITTEN IN WORDS UNIT BID PRICE AMOUNT BID

ITEM

SEED AND MULCH TEMPORARY

FOR

SILT FENCE - TEMPORARY

FOR

ROLLED EROSION CONTROL PRODUCT, CLASS II TYPE A,

INTERMEDIATE

FOR

SUBBASE COURSE, TYPE 2

FOR

PLANT PRODUCTION QUALITY ADJUSTMENT TO ASPHALT ITEMS

FOR Seventy Dollars and No Cents

BS - 3

PIN 3755.41

BROUGHT FORWARD

ESTIMATE OF

QUANTITIES DOLLARS CTS DOLLARS CTS

404.0983 331

TON

404.1989 474

TON

404.3789 232

TON

407.0103 194

GALLON

418.7603 523

LINEAR FOOT

ITEMS WITH UNIT BID PRICE WRITTEN IN WORDS UNIT BID PRICE AMOUNT BID

ITEM

9.5 F3 TOP COURSE ASPHALT, 80 SERIES COMPACTION

FOR

19 F9 BINDER COURSE ASPHALT, 80 SERIES COMPACTION

FOR

37.5 F9 BASE COURSE ASPHALT, 80 SERIES COMPACTION

FOR

STRAIGHT TACK COAT

FOR

ASPHALT PAVEMENT JOINT ADHESIVE

FOR

BS - 4

PIN 3755.41

BROUGHT FORWARD

ESTIMATE OF

QUANTITIES DOLLARS CTS DOLLARS CTS

551.014089 634

LINEAR FOOT

551.12 8

EACH

551.13 1

LUMP SUM

551.14 2

EACH

553.020001 1

EACH

ITEMS WITH UNIT BID PRICE WRITTEN IN WORDS UNIT BID PRICE AMOUNT BID

ITEM

STEEL H-PILES (HP 14X89)

FOR

SPLICES FOR STEEL H-PILES

FOR

FURNISHING EQUIPMENT FOR DRIVING PILES

FOR

DYNAMIC PILE TESTING

FOR

COFFERDAMS (TYPE 2)

FOR

BS - 5

PIN 3755.41

BROUGHT FORWARD

ESTIMATE OF

QUANTITIES DOLLARS CTS DOLLARS CTS

553.020002 1

EACH

555.97130016 105.6

CUBIC YARD

555.9902 1

8$ 75 8$ 75

FIXED PRICE QUALITY UNIT

8.75

556.03 900

EACH

557.1019 93.3

SQUARE YARD

ITEMS WITH UNIT BID PRICE WRITTEN IN WORDS UNIT BID PRICE AMOUNT BID

ITEM

COFFERDAMS (TYPE 2)

FOR

CONCRETE FOR STRUCTURES, (REINFORCEMENT INCLUDED

AND NO BAR LIST IN PLANS)

FOR

PERFORMANCE CONCRETE QUALITY ADJUSTMENT - CONCRETE

FOR STRUCTURES

FOR Eight Dollars and Seventy Five Cents

SHEAR STUD CONNECTORS FOR BRIDGES

FOR

STRUCTURAL APPROACH SLAB WITH INTEGRAL WEARING

SURFACE TYPE 9 FRICTION

FOR

BS - 6

PIN 3755.41

BROUGHT FORWARD

ESTIMATE OF

QUANTITIES DOLLARS CTS DOLLARS CTS

557.1119 197.8

SQUARE YARD

557.29 291.1

SQUARE YARD

557.9901 1

7$ 92 7$ 92

FIXED PRICE QUALITY UNIT

7.92

558.02 270

SQUARE YARD

559.01 2848

SQUARE FOOT

ITEMS WITH UNIT BID PRICE WRITTEN IN WORDS UNIT BID PRICE AMOUNT BID

ITEM

SUPERSTRUCTURE SLAB WITH INTEGRAL WEARING SURFACE

BOTTOM FORMWORK REQUIRED - TYPE 9 FRICTION

FOR

WINTER SURFACE TREATMENT - SUPERSTRUCTURE SLABS AND

STRUCTURAL APPROACH SLABS

FOR

PERFORMANCE CONCRETE QUALITY ADJUSTMENT -

SUPERSTRUCTURE AND APPROACH SLAB

FOR Seven Dollars and Ninety Two Cents

LONGITUDINAL SAWCUT GROOVING OF STRUCTURAL SLAB

SURFACE

FOR

PROTECTIVE SEALING OF STRUCTURAL CONCRETE ON NEW

BRIDGE, DECKS AND BRIDGE DECK OVERLAYS

FOR

BS - 7

PIN 3755.41

BROUGHT FORWARD

ESTIMATE OF

QUANTITIES DOLLARS CTS DOLLARS CTS

564.0501 1

LUMP SUM

564.20010008 43550

POUND

565.30130101 8

EACH

568.51 120

LINEAR FOOT

568.70 128

LINEAR FOOT

ITEMS WITH UNIT BID PRICE WRITTEN IN WORDS UNIT BID PRICE AMOUNT BID

ITEM

STRUCTURAL STEEL, TYPE 1

FOR

HOT-DIP GALVANIZING OF STRUCTURAL STEEL

FOR

TEMPORARY WOOD SUPPORT

FOR

STEEL BRIDGE RAILING (FOUR RAIL)

FOR

TRANSITION BRIDGE RAIL

FOR

BS - 8

PIN 3755.41

BROUGHT FORWARD

ESTIMATE OF

QUANTITIES DOLLARS CTS DOLLARS CTS

606.10 36

LINEAR FOOT

606.120101 1

EACH

606.120201 3

EACH

607.97000008 30

LINEAR FOOT

608.020102 13

TON

ITEMS WITH UNIT BID PRICE WRITTEN IN WORDS UNIT BID PRICE AMOUNT BID

ITEM

BOX BEAM GUIDE RAILING

FOR

BOX BEAM END PIECE

FOR

BOX BEAM GUIDE RAILING END ASSEMBLY, TYPE IIA

FOR

REMOVE AND RESET EXISTING FENCE

FOR

ASPHALT SIDEWALKS, DRIVEWAYS AND BICYCLE PATHS, AND

VEGETATION CONTROL STRIPS

FOR

BS - 9

PIN 3755.41

BROUGHT FORWARD

ESTIMATE OF

QUANTITIES DOLLARS CTS DOLLARS CTS

610.1403 143

CUBIC YARD

610.1602 1280

SQUARE YARD

619.01 1

LUMP SUM

619.04 8

EACH

619.1711 40

LINEAR FOOT

ITEMS WITH UNIT BID PRICE WRITTEN IN WORDS UNIT BID PRICE AMOUNT BID

ITEM

TOPSOIL - LAWNS

FOR

TURF ESTABLISHMENT - LAWNS

FOR

BASIC WORK ZONE TRAFFIC CONTROL

FOR

TYPE III CONSTRUCTION BARRICADES

FOR

TEMPORARY POSITIVE BARRIER - CATEGORY 1 (PINNING

PROHIBITED)

FOR

BS - 10

PIN 3755.41

BROUGHT FORWARD

ESTIMATE OF

QUANTITIES DOLLARS CTS DOLLARS CTS

620.05 351

CUBIC YARD

620.0801 81

CUBIC YARD

625.01 1

LUMP SUM

637.11 9

MONTH

637.34 7500

1$ 00 7,500$ 00

DOLLARS-CENTS

ITEMS WITH UNIT BID PRICE WRITTEN IN WORDS UNIT BID PRICE AMOUNT BID

ITEM

STONE FILLING (HEAVY)

FOR

BEDDING MATERIAL, TYPE 1

FOR

SURVEY OPERATIONS

FOR

ENGINEER'S FIELD OFFICE - TYPE 1

FOR

OFFICE TECHNOLOGY AND SUPPLIES

FOR One Dollar and No Cents

BS - 11

PIN 3755.41

BROUGHT FORWARD

ESTIMATE OF

QUANTITIES DOLLARS CTS DOLLARS CTS

647.61 2

EACH

663.33 1

EACH

663.34 1

EACH

697.03 72000

1$ 00 72,000$ 00

DOLLARS-CENTS

698.04 2600

1$ 00 2,600$ 00

DOLLARS-CENTS

ITEMS WITH UNIT BID PRICE WRITTEN IN WORDS UNIT BID PRICE AMOUNT BID

ITEM

REMOVE AND DISPOSE SIGNS, GROUND MOUNTED TYPE A SIGN

SUPPORTS AND FOUNDATIONS - SIZE I (UNDER 30 SQUARE

FEET)

FOR

ADJUST EXISTING VALVE BOX ELEVATION

FOR

ADJUST EXISTING HYDRANT ELEVATION

FOR

FIELD CHANGE PAYMENT (FCP)

FOR One Dollar and No Cents

ASPHALT PRICE ADJUSTMENT

FOR One Dollar and No Cents

BS - 12

PIN 3755.41

BROUGHT FORWARD

ESTIMATE OF

QUANTITIES DOLLARS CTS DOLLARS CTS

698.05 1900

1$ 00 1,900$ 00

DOLLARS-CENTS

698.06 100

1$ 00 100$ 00

DOLLARS-CENTS

ITEMS WITH UNIT BID PRICE WRITTEN IN WORDS UNIT BID PRICE AMOUNT BID

ITEM

FUEL PRICE ADJUSTMENT

FOR One Dollar and No Cents

STEEL/IRON PRICE ADJUSTMENT

FOR One Dollar and No Cents

FOR

FOR

FOR

BS - 13

PIN 3755.41

BROUGHT FORWARD

ESTIMATE OF

QUANTITIES DOLLARS CTS DOLLARS CTS

699.040001 1

LUMP SUM

PLEASE BE SURE A BID IS ENTERED FOR EACH ITEM

TOTAL OR GROSS SUM WRITTEN IN WORDS FOR BASE BID:

NOTE: In the event that there are discrepancies with the Bid Schedule, the values written in words will be the accepted unit price.

ITEMS WITH UNIT BID PRICE WRITTEN IN WORDS UNIT BID PRICE AMOUNT BID

ITEM

RETURN WITH BID

SUBTOTAL

MOBILIZATION (4% MAXIMUM OF SUBTOTAL)

FOR

BASE BID

TOTAL

BS - 14

BID BOND

KNOW ALL PERSONS BY THESE PRESENTS, that ____________________________________

(Name of Contractor / Proposer)

(Address)

(hereinafter called the "Principal") and the _________________________________________________ a corporation created and existing under the laws of the State of ________________, having its principal office in the ____________ of _________________________ and authorized as a surety in the State of

New York (such surety or Co-sureties are hereinafter called the "Surety"), are held and firmly bound unto Seneca County (hereinafter called the "Obligee"), in the full just sum of [ Five Percent ( 5%) of Attached

Price Proposal], good and lawful money of the United States of America, for the payment of which said sum of money, well and truly to be made and done, the said Principal binds themselves (himself/herself, itself), their (his/her, its) heirs, executors and administrators, successors and assigns, and the said Surety binds itself, its successors and assigns jointly and severally, firmly by these presents:

WHEREAS, the said Principal has submitted to Seneca County, a proposal for

(Project Description), and

WHEREAS, under the terms of the Laws of the State of New York as above indicated, the said

Principal has filed or intends to file this bond to guarantee that the Principal will execute all required contract proposal documents and furnish such faithful performance or other bonds as may be required by law in accordance with the terms of the Principal's said proposal.

NOW, THEREFORE, the condition of the foregoing obligation is such, that if the said Principal shall promptly execute and submit, and Seneca County shall accept, all required contract proposal documents including such faithful performance bond or other bonds as may be required by law in accordance with the terms of the Principal's said proposal, then this obligation shall be null and void, otherwise to remain in full force and virtue.

In case of multiple or co-sureties, the Co-Sureties agree to empower a single representative with authority to act on behalf of all of the Co-Sureties with respect to this Bond, so that the Obligee will have no obligation to deal with multiple sureties hereunder. All correspondence from the Obligee to the Co-Sureties and all claims under this Bond shall be sent to such designated representative, and all correspondence so sent shall be deemed to have been sent to all Co-Sureties. The Co-Sureties also agree to designate a single agent for service of process with respect to any actions on this Bond, which agent shall either be a natural person or a corporation qualified to act as an agent for service of process under the laws of the State of New York. The designated representative and agent for service of process may be changed only by delivery of written notice (by personal delivery or by certified mail, return receipt requested) to the Obligee designating a single new representative and/or agent, signed by all of the Co-Sureties. The initial representative shall be:

(Name of Representative) (Address)

(City, State, Zip) and the initial agent for service of process shall be:

(Name of Initial Agent)

0710 BB-1 EI 19-009

L 07/01/19

(Address)

(City, State, Zip)

IN TESTIMONY WHEREOF, the said Principal has hereunto set his/her (their, its) hand and the said Surety has caused this instrument to be signed by its authorized officer.

Signed and delivered this ____ day of ________________ 20____ in the presence of:

(Company)

By ___________________________________________) Principal

(Signature)

(Title of Authorized Officer)

(Company)

By __________________________________________) Surety (or Co-Surety)

(Signature)

(Title of Authorized Officer)

(Company)

By __________________________________________) Co-Surety

(Signature)

(Title of Authorized Officer)

(Company)

By __________________________________________) Co-Surety

(Signature)

(Title of Authorized Officer)

(The Surety Company shall append a single copy of a statement of its financial condition and a copy of the resolution authorizing the execution of Bonds by officers of the Company to the bond(s).)

0710 BB-2 EI 19-009

(Acknowledgment of principal, unless it be a corporation)

STATE OF NEW YORK ss.:

COUNTY OF______________

On this _____ day of _____________ 20 ___, before me personally came ________________________ to me known and known to me to be the person described in and who executed the foregoing instrument and acknowledged that he/she executed the same.

Notary Public

(Acknowledgment of principal, if a corporation)

STATE OF NEW YORK ss.:

COUNTY ______________

On this _____ day of _____________ 20 ___, before me personally came _________________________ to me known and known to me to be the person, who being by me duly sworn, did depose and say that he/she resides in _________________________ that he/she is the ______________________ of

___________________________ the corporation described in and which executed the foregoing instrument; and that he/she signed his/her name thereto by order of the Board of Directors of said Corporation.

Notary Public

(Acknowledgment of contractor, if a limited liability company)

STATE OF NEW YORK ss.:

COUNTY OF ______________

On this ____ day of _____________ 20 ____, before me personally came _________________________ to me known, and known to me to be the person who being duly sworn, did depose and say that he/she resides in _________________________; that he/she is the duly authorized member of the limited liability company described in and which executed the foregoing instrument; and that he/she executed the foregoing instrument on behalf of the limited liability company for the purposes set forth therein as the act and deed of said limited liability company.

Notary Public

(Acknowledgment of Surety Company)

STATE OF NEW YORK ss.:

COUNTY OF ______________

On this _____ day of _____________ 20 ___, before me personally came ________________________ to me known and known to me to be the person, who being by me duly sworn, did depose and say that he/she resides in _____________________. that he/she is the ___________________ of

_________________________________ the corporation described in the foregoing instrument; and that he/she signed his/her name thereto by order of the Board of Directors of said Corporation.

Notary Public

0710 BB-3 EI 19-009

WC-1

AFFIDAVIT OF WORKER’S COMPENSATION

State of

SS:

County of of being duly sworn, deposes and says that he now carries or that he has applied for a Worker’s Compensation Policy to cover the operations, as set forth in the preceding contract, and to comply with the provisions thereof.

Signed:

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

Notary Public

ID-1

CERTIFICATION OF COMPLIANCE IRAN DIVESTMENT ACT

As a result of the Iran Divestment Act of 2012 (the “Act”), Chapter 1 of the 2012 Laws of New York, a new provision has been added to the State Finance Law (SFL), § 165-a, and New York General Municipal Law § 103-g, both effective April 12, 2012. Under the Act, the Commissioner of the Office of General Services (OGS) will be developing a list (Prohibited Entities List) of “persons” who are engaged in “investment activities in Iran” (both are defined terms in the law).

Pursuant to SFL § 165-a(3)(b), the initial list is expected to be issued no later than 120 days after the Act’s effective date, at which time it will be posted on the OGS website.

By submitting a bid in response to this solicitation or by assuming the responsibility of a Contract awarded hereunder, each Bidder/Contractor, any person signing on behalf of the Bidder/Contractor and any assignee or subcontractor and, in the case of a joint bid, each party thereto, certifies, under penalty of perjury, that once the Prohibited Entities List is posted on the OGS website, that to the best of its knowledge and belief, that each Bidder/Contractor and any subcontractor or assignee is not identified on the Prohibited Entities List created pursuant to SFL § 165-a(3)(b).

Additionally, Bidder/Contractor is advised that once the Prohibited Entities List is posted on the OGS website, any Contractor seeking to renew or extend a Contract or assume the responsibility of a Contract awarded in response to this solicitation, must certify at the time the Contract is renewed, extended or assigned that it is not included on the Prohibited Entities List.

During the term of the Contract, should the County receive information that a Bidder/Contractor is in violation of the above-referenced certification, the County will offer the person or entity an opportunity to respond. If the person or entity fails to demonstrate that it has ceased its engagement in the investment which is in violation of the Act within 90 days after the determination of such violation, then the County shall take such action as may be appropriate including, but not limited to, imposing sanctions, seeking…