MABR – WWTP - UV Disinfection Installation Project – Project No. 32082.20 BID FORM Section 004100

BID FORM Section 004100 – Page 1

SECTION 004100 - BID FORM

ARTICLE 1 – BID RECIPIENT

1.01 This Bid is submitted to:

Owner: Municipal Authority of the Borough of Ringtown (MABR)

Project No.: 32082.20

1.01 The undersigned Bidder proposes and agrees, if this Bid is accepted, to enter into an Agreement with

Owner in the form included in the Bidding Documents to perform all Work as specified or indicated in the Bidding Documents for the prices and within the times indicated in this Bid and in accordance with the other terms and conditions of the Bidding Documents.

ARTICLE 2 – BIDDER’S ACKNOWLEDGEMENTS

2.01 Bidder accepts all of the terms and conditions set forth in the Instructions to Bidders, which are incorporated herein by reference, including without limitation those terms and conditions regarding the disposition of Bid security. After the commencement of opening of Bids, no Bid may be withdrawn during the period specified for the holding of Bids as hereinafter set forth, except as provided in Pennsylvania Act 4 of 1974, P.L. 9, relating to withdrawal of a Bid in the event of a mistake. The Owner shall award the Contract to the lowest responsive and responsible Bidder, or shall reject all Bids within sixty (60) days of the date of Bid opening, and no Bidder may withdraw his Bid before the expiration of such sixty (60) day period; provided however, if the award of the Contract is delayed by required approval of another government agency, the sale of bonds, closing on project loans or the award of a grant or grants, the Owner shall reject all Bids or award the Contract to the lowest responsible Bidder within one hundred twenty (120) days of the date of Bid opening, and in such event no Bidder may withdraw his Bid before the expiration of such one hundred twenty

(120) day period. Extensions of the date for the award of the Contract may be made by the mutual written consent of the Owner and lowest responsible Bidder.

ARTICLE 3 – BIDDER’S REPRESENTATIONS

3.01 In submitting this Bid, Bidder represents that:

A. Bidder has examined and carefully studied the Bidding Documents, other related data identified in the Bidding Documents, and the following Addenda, receipt of which is hereby acknowledged:

Addendum No. Addendum 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, and performance of the Work.

C. Bidder is familiar with and is satisfied as to all Laws and Regulations that may affect cost, progress, and performance of the Work.

D. Bidder has carefully studied all: (1) reports of explorations and tests of subsurface conditions at or contiguous to the Site and all drawings of physical conditions relating to existing surface or

BID FORM Section 004100 – Page 2 subsurface structures at the Site (except Underground Facilities) that have been identified in SC-

4.02 as containing reliable "technical data," and (2) reports and drawings of Hazardous Environmental Conditions, if any, at the Site that have been identified in SC-4.06 as containing reliable "technical data."

E. Bidder has considered the information known to Bidder; information commonly known to contractors doing business in the locality of the Site; information and observations obtained from visits to the Site; the Bidding Documents; and the Site-related reports and drawings identified in the Bidding Documents, with respect to the effect of such information, observations, and documents on (1) the cost, progress, and performance of the Work; (2) the means, methods, techniques, sequences, and procedures of construction to be employed by Bidder, including applying the specific means, methods, techniques, sequences, and procedures of construction expressly required by the Bidding Documents; and (3) Bidder’s safety precautions and programs.

F. Based on the information and observations referred to in Paragraph 3.01.E above, Bidder does not consider that further examinations, investigations, explorations, tests, studies, or data are necessary for the determination of this Bid for performance of the Work at the price(s) bid and within the times required, and in accordance with the other terms and conditions of the Bidding Documents.

G. Bidder is aware of the general nature of work to be performed by Owner and others at the Site that relates to the Work as indicated in the Bidding Documents.

H. Bidder has given Engineer written notice of all conflicts, errors, ambiguities, or discrepancies that Bidder has discovered in the Bidding Documents, and the written resolution thereof by Engineer is acceptable to Bidder.

I. The Bidding Documents are generally sufficient to indicate and convey understanding of all terms and conditions for the performance of the Work for which this Bid is submitted.

ARTICLE 4 – BIDDER’S CERTIFICATION

4.01 Bidder certifies that:

A. This Bid is genuine and not made in the interest of or on behalf of any undisclosed individual or entity and is not submitted in conformity with any collusive agreement or rules of any group, association, organization, or corporation;

B. Bidder has not directly or indirectly induced or solicited any other Bidder to submit a false or sham Bid;

C. Bidder has not solicited or induced any individual or entity to refrain from bidding; and

D. Bidder has not engaged in corrupt, fraudulent, collusive, or coercive practices in competing for the Contract. For the purposes of this Paragraph 4.01.D:

1. “corrupt practice” means the offering, giving, receiving, or soliciting of any thing of value likely to influence the action of a public official in the bidding process;

2. “fraudulent practice” means an intentional misrepresentation of facts made (a) to influence the bidding process to the detriment of Owner, (b) to establish bid prices at artificial non-competitive levels, or (c) to deprive Owner of the benefits of free and open competition;

BID FORM Section 004100 – Page 3

3. “collusive practice” means a scheme or arrangement between two or more Bidders, with or without the knowledge of Owner, a purpose of which is to establish bid prices at artificial, non-competitive levels; and

4. “coercive practice” means harming or threatening to harm, directly or indirectly, persons or their property to influence their participation in the bidding process or affect the execution of the Contract.

ARTICLE 5 – BASIS OF BID

5.01 Bidder will complete the Work in accordance with the Contract Documents for the following price(s) as included in Exhibit A.

5.02 Unit Prices have been computed in accordance with Paragraph 11.03.B of the General Conditions.

5.03 Bidder acknowledges that estimated quantities are not guaranteed, and are solely for the purpose of comparison of Bids, and final payment for all unit price Bid items will be based on actual quantities, determined as provided in the Contract Documents

5.04 All specifications sections are considered incidental to ALL the unit price items unless otherwise noted.

ARTICLE 6 – TIME OF COMPLETION

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

6.02 Bidder accepts the provisions of the Agreement as to liquidated damages.

6.03 The terms used in this Bid which are defined in the General Conditions of the construction contract included as part of the Contract Documents have the meaning assigned to them in the General Conditions

6.04 Bidder understands that the OWNER reserves the right to reject any or all bids, reject any or all items, and further reserves the right to delete any item or parts of items

6.05 Bidder understands that the OWNER shall award the contract on the basis of the lowest total sum bid submitted, which total sum bid shall include the total of the base bid plus any alternates selected by the OWNER.

BID FORM Section 004100 – Page 4

ARTICLE 7 – ATTACHMENTS TO THIS BID

7.01 The following documents are submitted with and made a condition of this Bid:

A. Required Bid Security;

B. Bid Form (Section 004100);

C. Electronic PennBid Bid Table Form;

D. Agreement of Surety Form;

E. PSATS CDL Program Contractor’s Statement of Compliance Form;

F. Non-Collusion Affidavit Form;

G. Nondiscrimination/Sexual Harassment Clause;

H. Certification of Bidder Regarding Equal Employment Opportunity;

I. Federal Contract Provisions Certification Form;

J. Buy American Certification;

K. Bidder Certification of Prequalification Classification and Work Capacity Form

L. Certification of Non-Segregated Facilities

M. Compliance Illegal Alien Labor Act;

N. Compliance with The State Contractor Responsibility Program;

O. Contract Provision Right to Know Law;

P. Contractor Integrity Provision;

Q. Provisions Concerning the Americans With Disabilities Act;

R. Public Works Employment Verification Form;

S. Stop-Call Before You Dig;

T. Evidence of authority to do business in the state of the Project; or a written covenant to obtain such license within the time for acceptance of Bids; and

U. Required Bidder Qualification Statement with Supporting Data.

BID FORM Section 004100 – Page 5

ARTICLE 8 – DEFINED TERMS

8.01 The terms used in this Bid with initial capital letters have the meanings stated in the Instructions to Bidders, the General Conditions, and the Supplementary Conditions.

BID SUBMITTAL

9.01 This Bid is submitted by:

If Bidder is:

An Individual

Name (typed or printed):

By:

(Individual’s signature)

Doing business as:

A Partnership

Partnership Name:

By:

(Signature of general partner -- attach evidence of authority to sign)

Name (typed or printed):

A Corporation

Corporation Name:

(SEAL)

State of Incorporation:

Type (General Business, Professional, Service, Limited Liability):_______

By:

(Signature -- attach evidence of authority to sign)

Name (typed or printed):

Title:

(CORPORATE SEAL)

Attest

Date of Qualification to do business in PA is ____/____/____.

A Joint Venture

BID FORM Section 004100 – Page 6

Name of Joint Venture:

First Joint Venturer Name:

(SEAL)

By:

(Signature of first joint venture partner -- attach evidence of authority to sign)

Name (typed or printed):

Title:

Second Joint Venturer Name: (SEAL)

By:

(Signature of second joint venture partner -- attach evidence of authority to sign)

Name (typed or printed):

(Each joint venturer must sign. The manner of signing for each individual, partnership, and corporation that is a party to the joint venture should be in the manner indicated above.)

Bidder's Business Address

Phone No. _____________________________________ Fax No.

E-mail ______________________________ _______

SUBMITTED on , 20____.

State Contractor License No. . [If applicable]

Contractor Federal ID No.

Contractor UEI No.

BID BOND

EJCDC C-435 Bid Bond (Damages Form) Prepared by the Engineers Joint Contract Documents Committee.

Any singular reference to Bidder, Surety, Owner, or other party shall be considered plural where applicable.

BIDDER (Name and Address):

SURETY (Name and Address of Principal Place of Business):

OWNER (Name and Address):

Municipal Authority of the Borough of Ringtown P.O. Box 350 Ringtown, PA 17967

BID

Bid Due Date:

Description (Project Name and Include Location):

UV-Disinfection Installation Project – Spring & South Center Streets, Ringtown, PA 17967

BOND

Bond Number:

Date (Not earlier than Bid due date):

Penal sum $ (Words) (Figures)

Surety and Bidder, intending to be legally bound hereby, subject to the terms set forth below, do each cause this Bid Bond to be duly executed by an authorized officer, agent, or representative.

BIDDER SURETY

(Seal) (Seal) Bidder’s Name and Corporate Seal Surety’s Name and Corporate Seal

By: By:

Signature Signature (Attach Power of Attorney)

Print Name Print Name

Title Title

Attest: Attest:

Signature Signature

Title Title Note: Above addresses are to be used for giving any required notice. Provide execution by any additional parties, such as joint venturers, if necessary.

EJCDC C-435 Bid Bond (Damages Form) Prepared by the Engineers Joint Contract Documents Committee.

1. Bidder and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors, and assigns to pay to Owner upon default of Bidder any difference between the total amount of Bidder’s Bid and the total amount of the Bid of the next lowest, responsible Bidder who submitted a responsive Bid as determined by Owner for the work required by the Contract Documents, provided that:

1.1 If there is no such next Bidder, and Owner does not abandon the Project, then Bidder and Surety shall pay to Owner the penal sum set forth on the face of this Bond, and

1.2 In no event shall Bidder’s and Surety’s obligation hereunder exceed the penal sum set forth on the face of this Bond.

1.3 Recovery under the terms of this Bond shall be Owner’s sole and exclusive remedy upon default of Bidder.

2. Default of Bidder shall occur upon the failure of Bidder to deliver within the time required by the Bidding Documents (or any extension thereof agreed to in writing by Owner) the executed Agreement required by the Bidding Documents and any performance and payment bonds required by the Bidding Documents.

3. This obligation shall be null and void if:

3.1 Owner accepts Bidder’s Bid and Bidder delivers within the time required by the Bidding Documents (or any extension thereof agreed to in writing by Owner) the executed Agreement required by the Bidding Documents and any performance and payment bonds required by the Bidding Documents, or

3.2 All Bids are rejected by Owner, or

3.3 Owner fails to issue a Notice of Award to Bidder within the time specified in the Bidding Documents (or any extension thereof agreed to in writing by Bidder and, if applicable, consented to by Surety when required by Paragraph 5 hereof).

4. Payment under this Bond will be due and payable upon default of Bidder and within 30 calendar days after receipt by Bidder and Surety of written notice of default from Owner, which notice will be given with reasonable promptness, identifying this Bond and the Project and including a statement of the amount due.

5. Surety waives notice of any and all defenses based on or arising out of any time extension to issue Notice of Award agreed to in writing by Owner and Bidder, provided that the total time for issuing Notice of Award including extensions shall not in the aggregate exceed 120 days from Bid due date without Surety’s written consent.

6. No suit or action shall be commenced under this Bond prior to 30 calendar days after the notice of default required in Paragraph 4 above is received by Bidder and Surety and in no case later than one year after Bid due date.

7. Any suit or action under this Bond shall be commenced only in a court of competent jurisdiction located in the state in which the Project is located.

8. Notices required hereunder shall be in writing and sent to Bidder and Surety at their respective addresses shown on the face of this Bond. Such notices may be sent by personal delivery, commercial courier, or by United States Registered or Certified Mail, return receipt requested, postage pre-paid, and shall be deemed to be effective upon receipt by the party concerned.

9. Surety shall cause to be attached to this Bond a current and effective Power of Attorney evidencing the authority of the officer, agent, or representative who executed this Bond on behalf of Surety to execute, seal, and deliver such Bond and bind the Surety thereby.

10. This Bond is intended to conform to all applicable statutory requirements. Any applicable requirement of any applicable statute that has been omitted from this Bond shall be deemed to be included herein as if set forth at length.

If any provision of this Bond conflicts with any applicable statute, then the provision of said statute shall govern and the remainder of this Bond that is not in conflict therewith shall continue in full force and effect.

11. The term “Bid” as used herein includes a Bid, offer, or proposal as applicable.

BQ-1

STATEMENT OF BIDDER’S QUALIFICATIONS

All questions must be answered, and the data given must be clear and comprehensive. If necessary, questions may be answered on separate attached sheets. The bidder may submit any additional information he desires.

1. Name of Bidder.

2. Permanent main office address.

3. When organized.

4. If a corporation, where incorporated.

5. How many years have you been engaged in the contracting business under your present firm or trade name?

6. Contracts on hand: (schedule, showing amount of each contract and the appropriate anticipated dates of completion.)

7. General character of work performed by your company.

8. Have you ever failed to complete any work awarded to you? If so, for whom and why?

9. Have you ever defaulted on a contract? If so, for whom and why.

10. List the more important projects recently completed by your company, stating the approximate cost for each, the month and year completed, and project references.

11. List your major equipment available for this contract?

12. Experience in construction work similar in importance to this project.

13. Background and experience of the principal members of your organization, including the officers.

14. Credit available: ($_____________________)

15. Give Bank references.

16. Will you, upon request, complete a detailed financial statement and furnish any other information that may be required by the Owner?

17. The undersigned hereby authorizes and requests any persons, firm, or corporation to furnish any information requested by the , County, Pennsylvania, in verification of the information provided in this STATEMENT OF BIDDER’S QUALIFICTIONS.

Dated this ______ day of ___________________, 20_____.

(Name of Bidder) By: ______________________________________ Title: _____________________________________

AGREEMENT OF SURETY

AS-1

(Note: This Agreement must be properly executed and must accompany the certified check or bid bond, whichever is furnished as proposal security).

AGREEMENT OF SURETY

KNOW ALL MEN BY THESE PRESENTS, that we , as Surety, a corporation existing under the laws of the State of _________________________________________________ and authorized to transact business in the Commonwealth of Pennsylvania, hereby agree to execute within the time limit specified in the Contract, the Bonds, in the forms and in the amounts required for to faithful performance and proper fulfillment of the Contract for the ________________________________________________________ on behalf of hereinafter called the Bidder, provided that the above Contract be awarded to the Bidder within sixty

(60) days after the date of receipt of Bids; and the Surety further agrees that should the Surety, after notification of such award, omit or refuse to execute the required bonds, then the Surety shall pay to ______________________________________________________, any difference between the total amount specified in said Bidder's proposal for the required work and the amount for which said Owner may procure the same work, if the latter amount be in excess of the former, and after deduction therefrom of payment made by reason of the forfeiture of the Proposal Security.

DATE CORPORATE SURETY

CORPORATE SEAL

BY

TITLE

BUSINESS ADDRESS

Rev. 02/15 PSATS CDL Program Form Contractor

Contractor’s Statement of Compliance with CDL Testing Program Requirements

Due to the nature of the work that this contractor may perform for this employer, this contractor must use employees who perform safety-sensitive functions for which a Commercial Driver’s License (CDL) is typically required. Section 49 CFR 382.301(c)(2) of the federal CDL regulations requires that, prior to the first time an employer uses a CDL employee employed by another entity (i.e., a contractor to whom the township is awarding a contract), and every six months of the contract, this employer must certify that any CDL employees used by each contractor remain covered by a qualified CDL drug and alcohol testing program.

An original signed copy of this form must be permanently retained by the employer with this contract and a new form received every 6 months of the contract’s duration.

If the contractor is not participating in a qualified CDL drug and alcohol testing program at the time of the awarding of the contract, or at any six-month re-certification point, then all the contractor’s CDL employees must obtain a negative result on a pre-employment drug test before beginning (or continuing) contracted work for this employer.

Contractor Name

By Signing here, I, as the contractor’s authorized representative, verify that this contractor named above is a current participant in the below identified CDL testing program conforming to 49 CFR Part 40.

Contractor’s Authorized Representative

Today’s Date / /

Signature of Authorized Representative

CDL Testing Program Name

Testing Program Contact Person

Testing Program Address

Phone #: City State Zip

Contact person confirms program conforms to 49 CFR Part 40? ( ) Yes ( ) No

Contact person confirms list of contractors’ CDL employees covered in this program and that all drivers are qualified to driver under 49 CFR Part 382.301? ( ) Yes ( ) No

NON-COLLUSION AFFIDAVIT

NON-COLLUSION AFFIDAVIT

STATE OF

COUNTY OF _______________

Contract __________________

I state that I am of__________________________________ [Title] [Name of Firm] and that I am authorized to make this affidavit on behalf of my firm, and its owners, directors, and officers. I am the person responsible in my firm for the price(s) and the amount of this bid.

I state that:

(1) The price(s) and amount of this bid have been arrived at independently and without consultation, communication or agreement with any other contractor, bidder or potential bidder.

(2) Neither the price(s) nor the amount of this bid, and neither the approximate price(s) nor approximate amount of this bid, have been disclosed to any other firm or person who is a bidder or potential bidder, and they will not be disclosed before bid opening.

(3) No attempt has been made or will be made to induce any firm or person to refrain from bidding on this contract, or to submit a bid higher than this bid, or to submit any intentionally high or noncompetitive bid or other form of complementary bid.

(4) The bid of my firm is made in good faith and not pursuant to any agreement or discussion with, or inducement from, any firm or person to submit a complementary or other noncompetitive bid.

(5) , it’s affiliates, subsidiaries, officers, [Name of my Firm] directors and employees and have not in the last four years been convicted or found liable for any act prohibited by State or Federal law in any jurisdiction, involving conspiracy or collusion with respect to bidding on any public contract, except as follows:

I state that understands and acknowledges that the [Name of my Firm] above representations are material and important and will be relied on by _________________ in awarding the contract(s) for which this bid is submitted. I understand, and my firm understands that any misstatement in this affidavit is and shall be treated as fraudulent concealment from ________________ of the true facts relating to the submission of bids for this contract.

[Name and Company Position]

[Signature] [Date]

SWORN TO AND SUBSCRIBED BEFORE ME

THIS DAY OF , 20____

Notary Public

(SEAL)

My Commission Expires:

NONDISCRIMINATION/SEXUAL HARASSMENT CLAUSE

The Contractor agrees:

1. In the hiring of any employee(s) for the manufacture of supplies, performance of work, or any other activity required under the contract or any subcontract, the Contractor, each subcontractor, or any person acting on behalf of the Contractor or subcontractor shall not discriminate by reason of race, gender, creed, color, sexual orientation, gender identity or expression, or in violation of the Pennsylvania Human Relations Act (PHRA) and applicable federal laws, against any citizen of this commonwealth who is qualified and available to perform the work to which the employment relates.

2. Neither the Contractor nor any subcontractor nor any person on their behalf shall in any manner discriminate by reason of race, gender, creed, color, sexual orientation, gender identity or expression, or in violation of the PHRA and applicable federal laws, against or intimidate any employee involved in the manufacture of supplies, the performance of work, or any other activity required under the contract.

3. Neither the Contractor nor any subcontractor nor any person on their behalf shall in any manner discriminate by reason of race, gender, creed, color, sexual orientation, gender identity or expression, or in violation of the PHRA and applicable federal laws, in the provision of services under the contract.

4. Neither the Contractor nor any subcontractor nor any person on their behalf shall in any manner discriminate against employees by reason of participation in or decision to refrain from participating in labor activities protected under the Public Employee Relations Act, Pennsylvania Labor Relations Act or National Labor Relations Act, as applicable and to the extent determined by entities charged with such Acts' enforcement, and shall comply with any provision of law establishing organizations as employees' exclusive representatives.

5. The Contractor and each subcontractor shall establish and maintain a written nondiscrimination and sexual harassment policy and shall inform their employees in writing of the policy. The policy must contain a provision that sexual harassment will not be tolerated and employees who practice it will be disciplined. Posting this Nondiscrimination/Sexual Harassment Clause conspicuously in easily-accessible and well-lighted places customarily frequented by employees and at or near where the contracted services are performed shall satisfy this requirement for employees with an established work site.

6. The Contractor and each subcontractor shall not discriminate by reason of race, gender, creed, color, sexual orientation, gender identity or expression, or in violation of PHRA and applicable federal laws, against any subcontractor or supplier who is qualified to perform the work to which the contract relates.

7. The Contractor and each subcontractor represents that it is presently in compliance with and will maintain compliance with all applicable federal, state, and local laws, regulations and policies relating to nondiscrimination and sexual harassment. The Contractor and each subcontractor further represents that it has filed a Standard Form 100 Employer Information Report ("EE0-1") with the U.S. Equal Employment Opportunity Commission ("EEOC") and shall file an annual EE0-1 report with the EEOC as required for employers' subject to Title VII of the Civil Rights Act of 1964, as amended, that have 100 or more employees and employers that have federal government contracts or first-tier subcontracts and have 50 or more employees. The Contractor and each subcontractor shall, upon request and within the time periods requested by the commonwealth, furnish all necessary employment documents and records, including EE0-1 reports, and permit access to their books, records, and accounts by the contracting agency and the Bureau of Diversity, Inclusion and Small Business Opportunities for purpose of ascertaining compliance with provisions of this Nondiscrimination/Sexual Harassment Clause.

8. The Contractor shall include the provisions of this Nondiscrimination/Sexual Harassment Clause in every subcontract so that those provisions applicable to subcontractors will be binding upon each subcontractor.

9. The Contractor's and each subcontractor's obligations pursuant to these provisions are ongoing from and after the effective date of the contract through the termination date thereof. Accordingly, the Contractor and each subcontractor shall have an obligation to inform the commonwealth if, at any time during the term of the contract, it becomes aware of any actions or occurrences that would result in violation of these provisions.

10. The commonwealth may cancel or terminate the contract and all money due or to become due under the contract may be forfeited for a violation of the terms and conditions of this Nondiscrimination/Sexual Harassment Clause. In addition, the agency may proceed with debarment or suspension and may place the Contractor in the Contractor Responsibility File.

Management Directive 215.16 Amended (August 2, 2018)

This directive replaces, in its entirety, Management Directive 215.16, dated May 11, 2017.

Name:

Signed:

Date:

American Recovery and Reinvestment Act of 2009 – Buy American Certification Please check one of the following and sign where indicated.

All of the iron, steel, and manufactured goods used in the project are produced in the United States.

An appropriate waiver has been approved by the U.S. Environmental Protection Agency. (Attach a list of the items covered by the approved waiver.)

A waiver is being requested from the Buy American provision due to the following exception:

Applying the Buy American Requirement would be inconsistent with the public interest;

Iron, steel, or relevant manufactured goods are not produced in the United States in sufficient and reasonably available quantities and of a satisfactory quality; or

Inclusion of iron, steel, or manufactured goods produced in the United States will increase the cost of the overall project by more than 25 percent.

Documentation of at least one of the cases above must be provided. List below the materials that cannot comply with the Buy American provisions of the American Recovery and Reinvestment Act of 2009.

Additional sheets (attach if necessary)

Name of Contracting Firm

Signature Date

Name and Title of Signer (Please type)

This certification must be signed and the waiver approved prior to materials purchase.

OWNER NON-FEDERAL ENTITY FEDERAL CONTRACT PROVISIONS CERTIFICATION FORM 1

FEDERAL CONTRACT PROVISIONS CERTIFICATION FORM

REQUIRED CONTRACT PROVISIONS FOR NON-FEDERAL ENTITY CONTRACTS UNDER FEDERAL AWARDS-

APPENDIX II TO 2 CFR PART 200

To procure goods and services using funds under a federal grant or contract, specific federal laws, regulations, and requirements may apply in addition to those under state law. This includes, but is not limited to, the procurement standards of the Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards, 2 CFR 200 (sometimes referred to as the “Uniform Guidance”), and the State of Pennsylvania. All Vendors submitting proposals must complete this Certification Form regarding Vendor’s willingness and ability to comply with certain requirements which may be applicable to specific purchases using federal grant funds.

For each of the items below, Vendor should certify Vendor’s agreement and ability to comply, where applicable, by having Vendor’s authorized representative complete and initial the applicable boxes and sign the acknowledgment at the end of this form. If you fail to complete any item in this form, the Owner will consider and may list the Vendor’s response as “NO,” the Vendor is unable or unwilling to comply. A “NO” response to any of the items may, if applicable, impact the ability of Owner to purchase from the Vendor using federal funds.

The following provisions are required and apply when federal funds are expanded by the Owner for any contract resulting from this procurement process.

(A) Contracts for more than the simplified acquisition threshold currently set at $150,000, which is the inflation adjusted amount determined by the Civilian Agency Acquisition Council and the Defense Acquisition Regulations Council (Councils) as authorized by 41 U.S.C. 1908, must address administrative, contractual, or legal remedies in instances where contractors violate or breach contract terms, and provide for such sanctions and penalties as appropriate.

Pursuant to Federal Rule (A) above, when federal funds are expended by the Owner, Owner reserves all rights and privileges under the applicable laws and regulations with respect to this procurement in the event of breach of contract by either party.

Does vendor agree? YES ______ Initials of Authorized Representative of vendor

(B) Termination for cause and convenience by the grantee or subgrantee including the manner by which it will be effected and the basis for settlement. (All contracts in excess of $10,000)

Pursuant to Federal Rule (B) above, when federal funds are expended by the Owner, Owner reserves the right to immediately terminate any agreement in excess of $10,000 resulting from this procurement process in the event of a breach or default of the agreement by Vendor, in the event vendor fails to: (1) meet schedules, deadlines, and/or delivery dates within the time specified in the procurement solicitation, contract, and/or purchase order; (2) make any payments owed; or (3) otherwise perform in accordance with the contract and/or the procurement solicitation.

OWNER NON-FEDERAL ENTITY FEDERAL CONTRACT PROVISIONS CERTIFICATION FORM 2

The Owner also reserves the right to terminate the contract immediately, with written notice to vendor, for convenience, if Owner believes, in its sole discretion that it is in the best interest of the Owner to do so. The vendor will be compensated for work performed and accepted and goods accepted by the Owner as of the termination date if the contract is terminated for convenience of the Owner. Any award under this procurement process is not exclusive and the Owner reserves the right to purchase goods and services from other vendors when it is in the best interest of the Owner.

Does vendor agree? YES ______ Initials of Authorized Representative of vendor

(C) Equal Employment Opportunity. Except as otherwise provided under 41 CFR Part 60, all contracts that meet the definition of “federally assisted construction contract” in 41 CFR Part 60-1.3 must include the equal opportunity clause provided under 41 CFR 60-1.4(b), in accordance with Executive Order 11246, “Equal Employment Opportunity” (30 FR 12319,12935,3 CFR Part, 1964-1965 Comp., p.339), as amended by Executive Order 11375, ”Amending Executive Order 11246 Relating to Equal Employment Opportunity,” and implementing regulations at 41 CFR Part 60, “Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor.”

Pursuant to Federal funds are expended by the Owner on any federally assisted construction contract, the equal opportunity clause is incorporated by reference herein.

Does vendor agree to abide by the above? YES ______ Initials of Authorized Representative of vendor

(D) Davis-Bacon Act, as amended (40 U.S.C. 3141-3148). When required by Federal program legislation, all prime construction contracts in excess of $2,000 awarded by non-Federal entities must include a provision for compliance with the Davis-Bacon Act (40 U.S.C. 3141-3144, and 3146-3148) as supplemented by Department of Labor regulations (29 CFR Part 5, “Labor Standards Provisions Applicable to Contracts Covering Federally Financed and Assisted Construction”). In accordance with the statute, contractors must be required to pay wages to laborers and mechanics at a rate not less than the prevailing wages specified in a wage determination made by the Secretary of Labor. In addition, contractors must be required to pay wages not less than once a week. The non-Federal entity must place a copy of the current prevailing wage determination issued by the Department of Labor in each solicitation. The decision to award a contract or subcontract must be conditioned upon the acceptance of the wage determination. The non-Federal entity must report all suspected or reported violations to the Federal awarding agency. The contracts must also include a provision for compliance with the Copeland “Anti-Kickback” Act (40 U.S.C. 3145, as supplemented by Department of Labor regulations (29 CFR Part 3, “Contractors and Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans or Grants from the United States”). The Act provides that each contractor or subrecipient must be prohibited from inducing, by any means, any person employed in the construction, completion, or repair of public work, to give up any part of the compensation to which he or she is otherwise entitled. The non- Federal entity must report all suspected or reported violations to the Federal awarding agency.

Pursuant to Federal Rule(D) above, when federal funds are expanded by the Owner, during the term of an award for all contracts and subgrants for construction or repair, the vendor will be in compliance with all applicable Davis-Bacon Act provisions.

Does vendor agree? YES ______ Initial of Authorized Representative of vendor

OWNER NON-FEDERAL ENTITY FEDERAL CONTRACT PROVISIONS CERTIFICATION FORM 3

(E) Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708). Where applicable, all contracts awarded by the non-Federal entity in excess of $100,000 that involve the employment of mechanics or laborers must include a provision for compliance with 40 U.S.C. 3702 and 3704, as supplemented by Department of Labor regulations (29 CFR Part 5). Under 40 U.S.C. 3702 of the Act, each contractor must be required to compute the wages of every mechanic and laborer on the basis of a standard work week of 40 hours. Work in excess of the standard work week is permissible provided that the worker is compensated at a rate of not less than one and a half times the basic rate of pay for all hours worked in excess of 40 hours in the work week. The requirements of 40 U.S.C. 3704 are applicable to construction work and provide that no laborer or mechanic must be required to work in surroundings or under working conditions which are unsanitary, hazardous or dangerous. These requirements do not apply to the purchases of supplies or materials or articles ordinarily available on the open market, or contracts for transportation or transmission of intelligence.

Pursuant to Federal Rule (E) above, when federal funds are expanded by the Owner, the vendor certifies that during the term of an award for all contracts by the Owner resulting from this procurement process, the vendor will be in compliance with all applicable provisions of the Contract Work Hours and Safety Standards Act.

Does vendor agree? YES ______ Initials of Authorized Representative of vendor

(F) Rights to Inventions Made Under a Contract or Agreement. If the Federal award meets the definition of “funding agreement” under 37 CFR §401.2 (a) and the recipient or subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the substitution of parties, assignment or performance of experimental, developmental, or research work under that “funding agreement.” The recipient or subrecipient must comply with the requirements of 37 CFR Part 401, “Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements,” and any implementing regulations issued by the awarding agency.

Pursuant to Federal Rule (F) above, when federal funds are expended by the Owner, the vendor certifies that during the term of an award for all contracts by Owner resulting from this procurement process, the vendor agrees to comply with all applicable requirements as referenced in Federal Rule (F) above.

Does vendor agree? YES ______ Initials of Authorized Representative of vendor

(G) Clean Air Act (42 U.S.C. 7401-7671q) and the Federal Water Pollution Control Act (33 U.S.C. 1251-1387), as amended-Contracts and subgrants of amounts in excess of $150,000 must contain a provision that requires the non- Federal award to agree to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and the Federal water Pollution Control Act as amended (33 U.S.C. 1251-1387). Violations must be reported to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA).

Pursuant to Federal Rule (G) above, when federal funds are expended by the Owner the vendor certifies that during the term of an award for all contracts by the Owner resulting from this procurement process, the vendor agrees to comply with all applicable requirements as referenced in Federal Rule (G) above.

Does vendor agree? YES ______ Initials of Authorized Representative of vendor

OWNER NON-FEDERAL ENTITY FEDERAL CONTRACT PROVISIONS CERTIFICATION FORM 4

(H) Debarment and Suspension (Executive Orders 12549 and 12689) – A contract award (see 2 CFR 180.220) must not be made to parties listed on the government wide exclusions in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that Implement Executive Orders 12549 (3 CFR Part 1986 Comp., p.189) and 12689 (3 CFR Part 1989 Comp., p. 235), “Debarment and Suspension.” SAM Exclusions contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549.

Pursuant to Federal Rule (H) above, when federal funds are expended by the Owner, the vendor certifies that during the term of an award for all contracts by the Owner resulting from this procurement process, the vendor certifies that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation by any federal department or agency.

Does vendor agree? YES ______ Initials of Authorized Representative of vendor

(I) Byrd Anti-Lobbying Amendment (31 U.S.C. 1352)-Contractors that apply or bid for an award exceeding $100,000 must file the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C 1352. Each tier must also disclose any lobbying with non-Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the non- Federal award.

Pursuant to Federal Rule (I) above, when federal funds are expended by the Owner, the vendor certifies that during the term and after the awarded term of an award for all contracts by the Owner resulting from this procurement process, the vendor certifies that it is in compliance with all applicable provisions of the Byrd Anti- Lobbying Amendment

(31 U.S.C. 1352). The undersigned further certifies that:

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

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

3. The undersigned shall require that the language of this certification be included in the award documents for all covered sub-awards exceeding $100,000 in Federal funds at all appropriate tiers and that all subrecipients shall certify and disclose accordingly.

OWNER NON-FEDERAL ENTITY FEDERAL CONTRACT PROVISIONS CERTIFICATION FORM 5

(J) A Non-Federal entity that is a state agency or agency of a political subdivision of a state and its contractors must comply with section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act. The requirements of Section 6002 include procuring only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR Part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition, where the purchase price of the item exceeds $10,000 or the value of the quantity acquired during the preceding fiscal year exceeded $10,000; procuring solid waste management services in a manner that maximizes energy and resource recovery; and establishing an affirmative procurement program for procurement of recovered materials identified in the EPA guidelines.

Pursuant to Federal Rule (J) above, when federal funds are expended by the Owner the certifies that during the term of an award for all contracts by the Owner resulting from this procurement process, the vendor agrees to comply with all applicable requirements as referenced in Federal Rule (J) above.

RECORD RETENTION REQUIREMENTS FOR CONTRACTS PAID FOR WITH FEDERAL FUNDS 2 CFR §200.333

When federal funds are expended by the Owner for any contract resulting from this procurement process, the vendor certifies that it will comply with the record retention requirements detailed in 2 CFR §200.333. The vendor further certifies that vendor will retain all records as required by 2 CFR §200.333 for a period of three years after grantees or subgrantees submit final expenditure reports or quarterly or annual financial reports, as applicable, and all other pending matters are closed.

CERTIFICATION OF COMPLIANCE WITH EPA

REGULATIONS APPLICABLE TO GRANTS, SUBGRANTS, COOPERATIVE AGREEMENTS, AND CONTRACTS IN

EXCESS OF $100,000 OF FEDERAL FUNDS

When federal funds are expended by the Owner for any contract resulting from this procurement process in excess of $100,000, the vendor certifies that the vendor is in compliance with all applicable standards, orders, regulations, and/or requirements issued pursuant to the Clean Air Act of 1970, as amended (42 U.S.C. 1857(h)), Section 508 of the Clean Water Act, as amended (33 U.S.C. 1368), Executive Order 117389 and Environmental Protection Agency Regulation, 40 CFR Part 15.

CERTIFICATION OF COMPLIANCE WITH THE ENERGY POLICY AND CONSERVATION ACT

When federal funds are expended by the Owner for any contract resulting from this procurement process, the vendor certifies that the vendor will be in compliance with mandatory standards and policies relating to energy efficiency which are contained in the state energy conservation plan issued in compliance with the Energy Policy and Conservation Act (Pub. L. 94 163, 89 Stat. 871).

OWNER NON-FEDERAL ENTITY FEDERAL CONTRACT PROVISIONS CERTIFICATION FORM 6

CIVIL RIGHTS / DISCRIMINATION:

When federal funds are expended by the Owner for any contract resulting from this procurement process, the vendor certifies that the vendor will comply with the provisions of Title VI of the Civil Rights Act of 1964. No person shall, on the grounds of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance.

SMALL AND MINORITY FIRMS, WOMEN’S BUSINESS ENTERPRISE, AND LABOR SURPLUS AREA FIRMS Necessary affirmative steps to procure from minority firms, women’s business enterprises, and labor surplus area firms whenever possible.

Does vendor agree? YES ______ Initials of Authorized Representative of vendor

Vendor agrees to comply with all federal, state and local laws, rules, regulations and ordinances, as applicable. It is further acknowledged that the vendor certifies compliance with all provisions, laws, acts, regulations, etc. as specifically noted above.

Vendor’s Name/Company Name: __________________________________________________________

Address, City, State and Zip Code: __________________________________________________________

Phone Number: _____________________________Fax Number: ________________________________

Printed Name and Title of Authorized Representative: _________________________________________

Email Address: _________________________________________________________________________

Signature of Authorized Representative: ____________________________________________________

Date: _________________________________________________________________________________

Updated May 5, 2020

BIDDER CERTIFICATION OF PREQUALIFICATION CLASSIFICATION AND

WORK CAPACITY FORM

In accordance with the requirements of PennDOT Publication 408 – Specifications, Section 102

- Bidding Requirements and Conditions, the bidder hereby certifies that they meet the following to qualify their proposal as an acceptable bid:

1. The Contractor has the necessary eligible prequalification rating, as required by Sections

102.01 and 102.06(c), Publication 408. A prequalification rating is considered eligible when the bidder’s assigned current maximum capacity exceeds the sum of both (a) the total of all uncompleted work the Contractor has under contract at the time of bid submission and (b) the total bid price of this proposal (less any credit for sublettings as allowed by Section 457.15 of the Regulations on Prequalification of Prospective Bidders).

2. The classified types of work, on which the Contractor is eligible to bid, constitutes over 50 percent of the total bid price (the cost of specialty items may be deducted from the total bid price before computing the amount of work required to be performed by the Contractor) as indicated in Section 108.01, Publication 408.

3. To the best of their knowledge, each proposed subcontractor is prequalified in…