4-ITB EXHIBIT B-5 Additional Certification Forms eProcurement.docx
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- Attached to
- Bend Bikeways Construction for SE 9th Street, NE Bear Creek Road, and SE 15th Street - North
- Solicitation number
- 26-3233
- Issued by
- Deschutes County, Oregon
About this file
This is an Exhibit B-5 Statement of Assurances and Certifications form issued by the City of Bend, Oregon for the Bend Bikeways Construction project covering SE 9th Street, NE Bear Creek Road, and SE 15th Street - North (Project No. 1TBKE, Solicitation No. 26-3233). The project involves construction of shared use paths adjacent to three separate roads, including pathway and ADA ramps, retaining walls, drainage and stormwater infrastructure, signing, striping, and landscape restoration. Work requires traffic control and coordination with the City's Project Manager over a multiple-month completion period. Bidders must sign the contract within seven calendar days of award and provide a Performance and Payment Bond if required.
The form requires bidder certification of compliance with applicable federal, state, and local regulations, including Title VI of the Civil Rights Act of 1964, the Americans with Disabilities Act, Oregon Workers' Compensation Law, and prevailing wage requirements under ORS 279C.800 to 279C.870 and Federal Labor Standard Provisions. Bidders must identify whether they qualify as "Resident Bidders" under ORS 279A.120, disclose any organizational or individual conflicts of interest, confirm site inspections and review of plans and specifications, and certify that neither the bidder nor employees hold positions as City officials or relatives of City officials with decision-making authority or financial interest in the project. The project includes federal funding requirements, and bidders may be required to provide DUNS numbers or SAMS UEI numbers depending on funding source. Bidders must also identify their surety company information for bonding purposes.
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Text version
Exhibit B-5 Statement of Assurances & Certifications Bend Bikeways Construction for SE 9th Street, NE Bear Creek Road, and SE 15th Street – North Project No. 1TBKE Solicitation No. 26-3233 Bidder certifies that it has have carefully examined the Bid and Contract Documents for the activity required by the specifications and shall, if a trade contract, furnish all machines, tools, apparatus, and other means of construction and do the work and furnish all the materials necessary to complete the work in the manner, in the time, and according to the methods as specified in the Contract Documents Bidder certifies that if its Bid is accepted, it shall within 7 calendar days after the Contract Award, sign the Contract and shall, at that time, deliver to the City of Bend the Performance and Payment Bond (if required).
Bidder certifies that the Bid submitted is genuine and not a sham or collusive Bid, or made in the interest or on behalf of any person not therein named; and further certifies that it has not directly or indirectly induced or solicited any Bidder or suppliers to put in a sham Bid, or any other person or corporation to refrain from bidding; and that Bidder has not in any manner sought by collusion to secure an advantage over any other Bidder or Bidders.
Bidder certifies that it shall do the Work as specified and at the price as quoted in conformance to all applicable City, State and Federal Regulations and shall indemnify the City of Bend against all claims arising out of any actions caused by Bidder or Bidder’s Subcontractors.
Bidder certifies that it:
| 1. | Shall comply with Title VI of the Civil Rights Act of 1964, with Section V of the Rehabilitation Act of 1973, and with all applicable requirements of Federal and State civil rights and rehabilitation statues, rules and regulations. | ||
| 2. | Shall comply with the Americans with Disabilities Act (ADA) of 1990, as amended by the ADA Amendments Act (ADAAA) of 2008 and any subsequent amendments (42 U.S.C. § 12101, et seq.) (Pub No. 101-336), ORS 659A, and all regulations and administrative rules established pursuant to those laws. | ||
| 3. | Has not and shall not discriminate against a subcontractor in awarding a subcontract because the subcontractor is a minority, women or emerging small business enterprise certified under ORS 200.055 or a business enterprise that is owned or controlled by or that employs a disabled veteran, as defined in ORS 408.225. | ||
| 4. | Is a subject employer under the Oregon Workers' Compensation Law and shall comply with ORS 656.017, which requires contractors to provide all workers with compensation coverage. | ||
| 5. | We Certify that we | ARE | ARE NOT (mark one) a “Resident Bidder” as defined by ORS 279A.120. As defined in ORS 279A.120, “Resident Bidder” means a bidder that has paid unemployment taxes or income taxes in this state in the twelve calendar months immediately preceding submission of the bid, has a business address in this state, and has stated in the bid whether the bidder is a “Resident Bidder”. Resident of State ___________________. |
| 6. | Shall, in the performance of any Contract awarded by the City of Bend, comply with the City of Bend’s policy of non-discrimination, which prohibits discrimination on the basis of race, color, religion, sex, disability, family status, national origin, gender preference or gender identity. | ||
| 7. | Shall include requirements in its subcontracts requiring its Subcontractors to comply with all statutes, laws, regulations and policies referred to this Section. | ||
| 8. | Has inspected all work sites and has carefully reviewed the plans and specifications and understands the nature and location of the work; the conformation of the grounds; the character, quality, and quantities needed preliminary to and during the prosecution of the work; the general and local conditions; and all other matters which can in any way affect the work. Bidder understands that no verbal agreement or conversation with any officer, agent, or employee of the City, either before or after the submission of Bid, shall affect or modify any of the terms or obligations of the Contract Documents. | ||
| 9. | Is not a City official/employee, and that to the best of its knowledge, Contractor, nor any of its employee(s), officer(s) or director(s) are not a City official/employee or a relative of any City official/employee who: i) has responsibility in making decisions or ability to influence decision-making on the Bid or project to which this Price Agreement pertains; ii) has or will participate in evaluation or management of the Bid; or iii) has or will have financial benefits in the Bid. Contractor understands that should it elect to employ any former City official/employee during the term of the Bid then that the former City official/Contractor employee must comply with applicable government ethics and conflicts of interest provisions in ORS Chapter 244, including but not limited to ORS 244.040(5) and ORS 244.047. |
10. Accepts all the specifications, terms and conditions contained herein, and in the event of a forthcoming agreement containing these same specifications, terms and conditions, we would agree without exception. Any exception to these terms should be attached to this Exhibit.
(If Davis Bacon wages are applicable the following change in blue will be made to this section.)
11. Shall comply with the provisions of ORS 279C.800 to 279C.870 (BOLI Wage Requirements) and Federal Labor Standard Provisions. Contractor has reviewed the prevailing wage provisions of the Contract Documents which references applicable wage rates publications.
| 12. | Has reviewed the City’s Public Contracts Conflict of Interest Policy (Administrative Policy No. FIN-0102) and that Bidder’s Firm and its subcontractors | DO / | DO NOT have any Organizational Conflict of Interest, prior work on this project, and/or Individual Conflict of Interest (applicable to any individual identified in the Invitation to Bid). (If Bidder checks “DO”, explain the conflict or prior work and why the conflict or prior work does not exclude Bidder from bidding on this project under the City’s policy). |
| 12. | Acknowledges project includes Federal funding requirements and agrees to comply with requirements and submit forms as required by funding agency. |
Name of Bidder: __________________________________________________
By______________________________________ Date __________________ (Signature of Authorized Official)
By______________________________________ Phone _________________ (Type or Print Name and Title)
CCB# ___________________ No. Years Registered w/CCB _______________
Are there any outstanding claims against your firm: Yes|_| No|_|
Payment and Performance Bond (list additional information below if not same):
Surety Company ____________________________________________________
Contact at Surety ______________________________ Phone # ______________ (Add the following if Davis Bacon:)
DUNS number _________________ OR ARPA funds request SAMS UEI number Data Universal Numbering System (DUNS) number must be obtained (http://fedgov.dnb.com/webform/ or call 1-866-705-5711 )
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