4-IFB260244 Certification Forms.pdf

Section IV – Certifications Page 31

BIDDER INFORMATION AND SIGNATURE PAGE

COMPETITIVE SEALED BID SUBMITTED BY:

I acknowledge receipt of the following Addenda:

Addendum #1: ____

Addendum #2: ____

Addendum #3: ____

Any Additional Addendum (write in numbers): _____________________________________

Full Legal Name of Bidder: __________________________________________________

Title: __________________________________________________

E-Mail Address: __________________________________________________

Address: __________________________________________________

Telephone __________________________________________________

Metro Louisville Revenue

Commission Number: _________________________________________________

Federal ID Number : _________________________________________________

Consultant's DUNS Number:

Consultant must be registered as a vendor in the federal Central Consultant Registration (CCR). The online registration is at www.ccr.gov. Is the consultant registered in CCR? Yes No

The following individual is authorized to submit this response on behalf of ___________________

(Bidder). By signing below, Bidder agrees to bind itself unconditionally to all the requirements in this

Bid.

Authorized Agent Signature: ____________________________________________

Printed Name: ____________________________________________

Title:____________________________________________

Date: ____________________

Section IV – Certifications Page 32

To be completed by Louisville Metro Government only if Bidder is awarded a contract under this Bid.

A contract is awarded by Louisville Metro Government to Bidder according to the terms and conditions of IFB______________________.

Kevin Moore

Purchasing Director

Date: _________________

Contract Term: Effective Date ____________________ Expiration Date:_________________

Items Covered: _______________________________

Section IV – Certifications Page 33

LOUISVILLE METRO GOVERNMENT LOUISVILLE, KENTUCKY

PROPOSAL or BID BOND

KNOW ALL MEN BY THESE PRESENTS that we, , as

PRINCIPAL, and the, a corporation organized and existing under the laws of the State of , having its principal place of business at

, as SURETY, are held and firmly bound unto the in its official capacity as agent of the

, hereinafter called the , as OBLIGEE, in the penal sum of

5% of the total bid ( DOLLARS) lawful money of the United States of

America, for the payment of which, well and truly to be made, we bid ourselves, our heirs, executors, administrators, successors and assigns jointly and severally, firmly by these presents.

WHEREAS the principal is herewith submitting its bid proposal, attached hereto, with the

, dated __________________, ______, for Project No. [ ], County Jefferson for work described in said bid proposal.

The CONDITION OF THE ABOVE OBLIGATION IS SUCH that, if the aforesaid principal shall be awarded the contract, the said principal will, within fifteen (15) days after the notice of such award, execute the contract with required performance and payment bond, provide satisfactory evidence of required liability insurance

(furnish evidence of compliance with process agent’s requirements (See 1.2.15, Spec.) and provide the proposed work schedule, then this obligation shall be null and void. Upon the failure or refusal of the principal herein to provide all of the foregoing requirements or the omission, failure or refusal to provide any one of the same, then in this event the bond shall be considered forfeited and the principal and the surety will pay unto he obligee the penal sum of 5% of the total bid ( DOLLARS) upon demand, which is the amount of this bid bond and for which the principal and surety have obligated themselves herein, as agreed damages. However, in no event shall the surety’s liability exceed the penal sum hereof.

SIGNED, sealed and dated this _________ day of ___________________________, __________

PRINCIPAL: ___________________________

Attest:

_________________________________, BY _____________________________________

(Corporate Seal)

SURETY:

Attest:

__________________________________, BY ______________________________________

Section IV – Certifications Page 34

PROVISIONS RELATIVE TO KRS 45A.485

During the performance of the contract, the contractor and all subcontractors agree to comply with applicable provisions of:

1. KRS 136 Corporation and Utility Taxes

2. KRS 139 Sale and Use Taxes

3. KRS 141 Income Taxes

4. KRS 337 Wages and Hours

5. KRS 338 Occupational Safety and Health of Employees

6. KRS 341 Unemployment Compensation

7. KRS 342 Workers Compensation

Any final determinations of a violation by the contractor within the previous five (5) years pursuant to the applicable statutes above are revealed as follows:

Section IV – Certifications Page 35

NON-COLLUSION CERTIFICATION

LOUISVILLE METRO GOVERNMENT

COUNTY JEFFERSON

PROJECT NO. [ ]

I, _________________________________________ , ______________________________ , (Name of officer signing certification) (Title) under penalty of perjury under the laws of the United States, do hereby certify that

(Name of Individual, Co-Partnership, or Corporation submitting bid) its agent, officers or employees have not directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken action in restraint of free competitive bidding in connection with this proposal.

(Signature) (Title)

Section IV – Certifications Page 36

Section IV – Certifications Page 37

CERTIFICATION OF BID PROPOSAL

We (I) proposed to furnish all labor, equipment and materials necessary to construct and/or improve the subject project in accordance with the plans, the Transportation Cabinet's Standard Specifications for Road and Bridge

Construction (current edition) special provisions, notes applicable to the project as indicated herein and all addenda issued on this project subsequent to purchase of proposal.

We (I) attach a bid guaranty as provided in the special provisions in an amount not less than 5% of the total bid. We agree to execute a contract in accordance with this proposal within 15 calendar days after the receipt of the notice of award for the project.

We (I) have examined the site of proposed work, project plans, specifications, special provisions, and notes applicable to the project referred to herein. We understand that the quantities shown herein are estimated quantities subject to increase or decrease as provided in the specifications.

We (I) acknowledge receipt of all addendum(s) (if applicable) and have made necessary revisions to the bid proposal. We have considered all addendum(s) in calculation of the submitted bid and applied the updated bid items, which are included.

The bidder certifies that his own organization will perform no less than 30 percent of the total value of the contract per the Kentucky Standard Specifications for Road and Bridge Construction, Current Edition, Section 108.01

Subcontracting of Contract.

(Name of Individual, Co-Partnership, or Corporation submitting bid)

(Printed Name of Officer or Authorized Agent and Title)

(Signature of Officer or Authorized Agent) (Date)

When two or more organizations bid as a joint venture, enter names of each organization and an authorized agent for each organization must sign above.

Section IV – Certifications Page 38

BUY AMERICA / BUILD AMERICA, BUY AMERICA (BABA)

MATERIALS CERTIFICATE OF COMPLIANCE

The Contractor hereby certifies that it will comply with all relevant provisions of the Build America, Buy America

Act, contained within the Infrastructure Investment and Jobs Act, Pub. L. NO. 117-58, §§ 70901-52, the requirements of 23 U.S.C. § 313, 23 C.F.R. § 635.410 and 2 C.F.R § 184.

Date Submitted: ___________________________________________

Contractor: ___________________________________________

Signature: ___________________________________________

Printed Name: ___________________________________________

Title: ___________________________________________

NOTE: THIS CERTIFICATION IS IN ADDITION TO ANY AND ALL REQUIREMENTS OUTLINED IN THE

CURRENT EDITION OF THE STANDARD SPECIFICATIONS FOR ROAD AND BRIDGE CONSTRUCTION

AND/OR SPECIAL NOTES CONTAINED IN THE PROJECT PROPOSAL.