6-03. Proposal Section.pdf

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PROPOSAL SECTION

BID SUBMISSION CHECKLIST

Name of Local Contracting Agency: City of Clairton

Project Title: MILLER AVENUE DEMOLITIONS

RVE File Number: PA020692T002

A. Bid Submission Checklist. The following documents must be submitted to the Local Contracting

Agency via PennBid prior to the advertised bid opening. Failure to submit a bid guarantee will result in rejection of the bid. Failure to submit any other documents listed on this Bid Submission Checklist may result in rejection of the bid.

1. Bid Pricing Section Form (completed online through PennBid).

2. Bid Security.

3. Consent of Surety.

4. Proposal Section. The Proposal Section includes the following documents which must be completed and submitted:

a) Bid Submission Checklist (P-1)

b) Statement of Corporate Ownership (P-3).

c) Nondiscrimination Requirements (P-5).

d) Non-collusion Affidavit (P-7).

e) Bid Security (P-10).

f) Consent of Surety (P-11).

g) Background Questionnaire (P-12).

h) Subcontractor Declaration (P-14).

i) Certificate of Bidder Showing Ability to Perform Contract (P-17).

j) Acknowledgement of Receipt of Changes to Bid Documents Form (P-19).

5. Public Works Employment Verification Form

6. Allegheny County Economic Development Blight Removal Program (Act 152) Procurement Packet

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B. SIGNATURE: The undersigned does hereby acknowledge all of the documents listed above.

Furthermore, the undersigned does hereby certify that all of the documents have been completed and have been submitted to the Local Contracting Agency via PennBid prior to the advertised bid opening.

Name of Bidder

Street Address

City State Zip

Telephone Number E-mail Address

By Authorized Representative of Bidder:

Signature Date

Print Name and Title

Commonwealth of Pennsylvania )

) S.S.

County of _________________ )

On this, the _____ day of _______________, 20_____, before me a notary public, the undersigned officer, personally appeared ____________________, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledge that they executed the same for the purposes therein contained.

In witness hereof, I hereunto set my hand and official seal.

Notary Public

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STATEMENT OF CORPORATE OWNERSHIP

Check the appropriate box:

Corporation Limited Liability Company Partnership Sole Proprietor

A. No corporation or partnership shall be awarded any contract by the state, county, municipality or school district, or any subsidiary or agency thereof, unless prior to the receipt of the bid of the corporation or partnership, there is submitted to the Local Contracting Agency a statement setting forth the names of all individuals who own 10% or more of stock or interest in the corporation or partnership.

1. If the bidder is a partnership, then the statement shall set forth the names and addresses of all partners who own a 10% or greater interest in the partnership.

2. If the bidder is a corporation, then the statement shall set forth the names and addresses of all stockholders in the corporation who own 10% or more of its stock in any class.

3. If a corporation owns all or part of the stock of the corporation or partnership submitting the bid, then the statement shall include a list of the stockholders who own 10% or more of the stock of any class of that corporation.

4. If the bidder is other than a corporation or partnership, the bidder shall indicate the form of corporate ownership as listed below.

B. Bidder must complete one of the following statements:

1. Stockholders or Partners owning 10% or more of the company submitting a bid:

a) NAME: ___________________________________________________________________

ADDRESS: ________________________________________________________________

b) NAME: ___________________________________________________________________

ADDRESS: ________________________________________________________________

c) NAME: ___________________________________________________________________

ADDRESS: ________________________________________________________________

2. No Stockholder or Partner owns 10% or more of the company submitting the bid:

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3. Bid is being submitted by an individual who operates as a sole proprietorship:

4. Bid is being submitted by a corporation or partnership that operates as a (check one of the following):

Limited Partnership Limited Liability Corporation

Limited Liability Partnership Subchapter S Corporation

Stockholders or Partners owning 10% or more of the form of corporation or partnership checked above shall provide the following information:

a) NAME: ___________________________________________________________________

ADDRESS: ________________________________________________________________

b) NAME: ___________________________________________________________________

ADDRESS: ________________________________________________________________

c) NAME: ___________________________________________________________________

ADDRESS: ________________________________________________________________

d) NAME: ___________________________________________________________________

ADDRESS: ________________________________________________________________

e) NAME: ___________________________________________________________________

ADDRESS: ________________________________________________________________

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NONDISCRIMINATION REQUIREMENTS

A. Bidders are required to comply with the requirements of Title 16, Pennsylvania Code, Section 49.101, which includes the following nondiscrimination clause:

1. Contractor shall not discriminate against any employee, applicant for employment, independent contractor, or any other person because of race, color, religious creed, ancestry, national origin, age, or sex. Contractor shall take affirmative action to ensure that applicants are employed, and that employees or agents are treated during employment, without regard to their race, color, religious creed, ancestry, national origin, age, or sex. Such affirmative action shall include, but is not limited to, the following: Employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training. Contractor shall post in conspicuous places, available to employees, agents, applicants for employment and other persons, a notice to be provided by the contracting agency setting forth the provisions of this nondiscrimination clause.

2. Contractor shall in advertisements or requests for employment placed by it or on its behalf state all qualified applicants will receive consideration for employment without regard to race, color, religious creed, ancestry, national origin, age, or sex.

3. Contractor shall send each labor union or workers’ representative with which it has a collective bargaining agreement or other contract or understanding, a notice advising said labor union or workers’ representative of its commitment to this nondiscrimination clause. Similar notice shall be sent to every other source of recruitment regularly utilized by Contractor.

4. It shall be no defense to a finding of a noncompliance with Contract Compliance Regulations issued by the Pennsylvania Human Relations Commission or this nondiscrimination clause that Contractor had delegated some of its employment practices to any union, training program, or other source of recruitment which prevents it from meeting its obligations. However, if the evidence indicates that the Contractor was not on notice of the third-party discrimination or made a good faith effort to correct it, such factor shall be considered in mitigation in determining appropriate sanctions.

5. Where the practices of a union or any training program or other source of recruitment will result in the exclusion of minority group persons, so that Contractor will be unable to meet its obligations under the Contract Compliance Regulations issued by the Pennsylvania Human Relations

Commission or this nondiscrimination clause, Contractor shall then employ and fill vacancies through other nondiscriminatory employment procedures.

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6. Contractor shall comply with the Contract Compliance Regulations of the Pennsylvania Human

Relations Commission, 16 Pa. Code Chapter 49 and with all laws prohibiting discrimination in hiring or employment opportunities. In the event of Contractor’s noncompliance with the nondiscrimination clause of this contract or with any such laws, this contract may, after hearing and adjudication, be terminated or suspended, in whole or in part, and Contractor may be declared temporarily ineligible for further Commonwealth contracts, and such other sanctions may be imposed and remedies invoked as provided by the Contract Compliance Regulations.

7. Contractor shall furnish all necessary employment documents and records to, and permit access to its books, records and accounts by, the contracting agency and the Human Relations Commission, for purposes of investigation to ascertain compliance with the provisions of the Contract

Compliance Regulations, pursuant to § 49.35 (relating to information concerning compliance by contractors). If Contractor does not possess documents or records reflecting the necessary information requested, it shall furnish such information on reporting forms supplied by the contracting agency or the Commission.

8. Contractor shall actively recruit minority subcontractors or subcontractors with substantial minority representation among their employees.

9. Contractor shall include the provisions of this nondiscrimination clause in every subcontract, so that such provisions will be binding upon each Subcontractor.

10. The terms used in this nondiscrimination clause shall have the same meaning as in the Contract

Compliance Regulations issued by the Pennsylvania Human Relations Commission, 16 Pa. Code

Chapter 49.

11. Contractor obligations under this clause are limited to the Contractor’s facilities within

Pennsylvania, or, where the contract is for purchase of goods manufactured outside of

Pennsylvania, the facilities at which such goods are actually produced.

B. The undersigned further understands that their bid must be rejected as non-responsive if the requirements of Title 16, Pennsylvania Code, Section 49.101 are not complied with.

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INSTRUCTIONS FOR NON-COLLUSION AFFIDAVIT

A. This Non-Collusion Affidavit is material to any contract awarded pursuant to this bid. According to the Antibid-Rigging Act, Title 62, Pennsylvania Code, Section 4507, governmental agencies may require Non-Collusion Affidavits to be submitted together with bids.

B. This Non-Collusion Affidavit must be executed by the member, officer or employee of the bidder who makes the final decision on prices and the amount quoted in the bid.

C. Bid rigging and other efforts to restrain competition, and the making of false sworn statements in connection with the submission of bids are unlawful and may be subject to criminal prosecution. The person who signs the affidavit should examine it carefully before signing and assure himself or herself that each statement is true and accurate, making diligent inquiry, as necessary, of all other persons employed by or associated with the bidder with responsibilities for the preparation, approval or submission of the bid.

D. In the case of a bid submitted by a joint venture, each party to the venture must be identified in the bid documents and an affidavit must be submitted separately on behalf of each party.

E. The term “complementary bid” as used in the affidavit has the meaning commonly associated with that term in the bidding process, and includes the knowing submission of bids higher than the bid of another firm, any intentionally high or noncompetitive bid, and any other form of bid submitted for the purpose of giving a false appearance of competition.

F. Failure to submit an affidavit with the bid in compliance with these instructions may result in disqualification of the bid.

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NON-COLLUSION AFFIDAVIT

Title of Project: MILLER AVENUE DEMOLITIONS

Local Contracting Agency: City of Clairton

Commonwealth of Pennsylvania )

I state that I am the ____________________ (Title) of ____________________ (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 the 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. _____________________________ (Name of Firm), its affiliates, subsidiaries, officers, directors, and employees are not currently under investigation by any governmental agency 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 proposing and/or bidding on any public contract, except as follows:

I state that _________________________ (Name of Firm) understands and acknowledges that the above representations are material and important, and will be relied upon by the Local Contracting Agency in awarding the contract(s) for which this bid is submitted. I understand and my firm understands that any

P-9 misstatement in this affidavit is and shall be treated as fraudulent concealment from the Local Contracting

Agency of the true facts relating to the submission of bids for this contract.

On this, the _____ day of _______________, 20_____, before me a notary public, the undersigned officer, personally appeared ____________________, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledge that they executed the same for the purposes therein contained.

In witness hereof, I hereunto set my hand and official seal.

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BID SECURITY

Title of Project: MILLER AVENUE DEMOLITIONS

Local Contracting Agency: City of Clairton

A. Bid security in the form of either a bid bond in the amount of 10% of the total amount bid or a cashier's check in the amount of 10% of the total amount bid is to be submitted to the Local Contracting Agency via PennBid prior to the bid opening time. Bid bonds may be provided in the form of AIA Document

A310 or an equivalent. Bid security must be made payable to the Local Contracting Agency.

B. All bidders must have an original copy of their bid security in their own possession prior to the advertised bid opening and must be able to deliver an original copy of their bid security to the Local

Contracting Agency within three (3) business days of receipt of a written request from the Local

Contracting Agency. Failure to deliver an original copy of bid security to the Local Contracting Agency within three (3) business days will result in rejection of the bid.

C. If the successful bidder has posted a bid bond, cashier's check, or any other form of security and refuses to accept a contract when tendered, they will be required to forfeit such bid security.

D. Any payment made to the Local Contracting Agency by reason of default of the bidder shall not be construed as a penalty, but as liquidated damages for breach of contract.

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CONSENT OF SURETY

A. Attach a Consent of Surety from a Surety Company, meeting the requirements described herein, stating that if the bidder is awarded the contract that the Surety Company will supply the bonds for the contract.

1. Consent of Surety must be an irrevocable, unconditional commitment by the Surety Company to issue on behalf of the bidder the bond or bonds upon award of the project in the full amount specified.

2. Consent of Surety must include all bonds required by the contract documents (i.e. performance, labor and material payment, maintenance, environmental, etc.).

3. Consent (Certificate) of Surety is not waivable and will be considered a material defect resulting in rejection of bid if omitted from bid package.

4. Consent of Surety must not contain any provision that would serve to limit the Surety Company's liability to "spread the second" bidder in the event the bidder fails to enter into a contract upon award.

B. Sample wording for Consent of Surety is shown below:

CONSENT OF SURETY

KNOW ALL MEN BY THESE PRESENTS, that for and consideration of the sum $ ________.____, lawful money of the United States of America, the receipt whereof is hereby acknowledged, paid the undersigned, and for other valuable consideration, the ___________________________ (Insurance

Company Name), ______________________________ (Insurance Company Address), existing under the laws of the Commonwealth of Pennsylvania and licensed to do business in the same, certifies and agrees that if the contract for ____________________ (Contracting Agency) for

____________________ (Project Title) is awarded to ____________________ (Bidder), the undersigned will execute the bond or bonds required of the contract documents and will become Surety in the full amount set forth in the contract documents for the faithful performance of all obligations of the Bidder, provided however, that this commitment shall expire sixty (60) calendar days from the bid opening, unless agreed upon by Bidder, Owner and Surety to be extended.

Signed, sealed and dated this _____ day of _______________, 20_____.

__________________________________________ (Insurance Company Name)

By __________________________________________ (Attorney-in-Fact)

(To be accompanied by an Affidavit authorizing the Attorney-in-Fact to sign the Consent of Surety and

Bid Bond.)

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Background Questionaire

A. In accordance with the paragraph entitled "Qualifications of Bidders" of the Information for Bidders, provide the following information:

1. Date of Organization of Company: _______________

2. Name and Address of Officers:

a) President: _________________________________________________________________

b) Vice President: _____________________________________________________________

c) Secretary: _________________________________________________________________

d) Treasurer: _________________________________________________________________

3. Experience:

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

b) How many years of experience does your organization have with the type of construction work involved in this contract? __________________

c) What are the latest projects (within the last 5 years) that your organization has completed?

(Attach additional pages if necessary)

# Project Name Contract

Amount

Date of

Completion Contracting Agency

d) References for projects listed above:

# Project Name Contact Name Telephone Number

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4. Have you ever failed to complete any work awarded to you (within the last 10 years)? _______

a) If so, where and why? _______________________________________________________

5. Have you or has any officer or your organization ever been an officer or partner of some other contracting organization that failed to complete any work (within the last 10 years)? _________

a) If so, state the name of the individual, position and the name of the other organization:

b) Did this other contracting agency ever fail to complete any work awarded to it (within the last

10 years)? ____________

(1) If so, where and why? ____________________________________________________

6. Provide a listing of all uncompleted contracts presently held by your organization:

# Name of Contract Contracting Agency Contract Amount

7. State approximately the largest amount of work that your organization has completed within any calendar year (within the last 5 years) or similar nature to the work being bid on. ____________

8. List the equipment presently available for the performance of the work under the proposed contract

(attach additional pages if necessary). _______________________________________

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9. For any contract which includes more than 500 square yards or 50 tons of asphalt paving work, list the make and model of the following paving equipment to be used (attach additional pages if necessary).

a) Milling Machine: ____________________________________________________________

b) Roller: _____________________________________________________________________

c) Bituminous Tack Distributor: ___________________________________________________

d) Bituminous Paver: ___________________________________________________________

Note: Failure by a bidder to list equipment which meets the requirements of the specifications of this contract shall not invalidate the bid nor absolve the bidder of their responsibility to secure and use equipment which meets the requirements of the specifications.

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SUBCONTRACTOR DECLARATION

A. Each bidder shall set forth in their bid the names, addresses and license numbers (where required) of each subcontractor for the furnishing of plumbing and gas fitting, and kindred work, and of the steam and hot water heating and ventilating apparatus, steam power plants and kindred work, and electrical work, structural steel and ornamental iron work, if any, for the construction, alteration or repair of public buildings.

B. A general contractor that intends to utilize a specific subcontractor to perform work in one or more of the specialty trade categories shall provide the required information with regard to that subcontractor in the appropriate space for each specialty trade category applicable to the contract.

C. There shall be submitted proof that each subcontractor is qualified in accordance with the rules and regulations of the state in which the project is located, when such rules and regulations exist.

D. A general contractor that intends to perform work in one or more specialty trade categories either through the use of its own employees or the general contractor themselves, rather than through the utilization of a subcontractor, shall write the word "IN-HOUSE" next to each applicable category and then insert the name and license number (where required), of each such employee of the general contractor or the general contractor themselves in the appropriate spaces provided for each specialty trade category applicable to the contract. If the contract does not involve any of the specialty trade categories below, insert the word "NONE" in the appropriate spaces provided. (Attach additional pages if necessary)

1. Plumbing.

Name: Telephone:

Address:

License #:

2. Heating, Ventilating and Air Conditioning.

Name: Telephone:

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3. Electrical.

Name: Telephone:

4. Other: ____________________

5. Other: ____________________

6. Other: ____________________

7. Other: ____________________

8. Other: ____________________

9. Other: ____________________

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CERTIFICATE OF BIDDER SHOWING ABILITY TO PERFORM CONTRACT

Title of Project: MILLER AVENUE DEMOLITIONS

Local Contracting Agency: City of Clairton

AFFIDAVIT

Commonwealth of Pennsylvania )

Before me, the undersigned notary public, this day, personally appeared ____________________ known to me (or satisfactorily proven), who being sworn according to law, deposes the following:

I, ____________________ of the (City, Town, Township, Borough, etc.) of ____________________ in the County of ____________________ and the State of ____________________ of full age, being duly sworn according to law on my oath depose and say that:

A. I am a(n) owner, partner, shareholder or officer of the company set forth below and am duly authorized to execute this affidavit on its behalf.

B. Select the appropriate statement:

I own, lease or control the necessary equipment required by the plans, specifications, and advertisement under which bids are asked for.

I do not own, lease or control the necessary equipment required by the plans, specifications, and advertisements under which bids are asked for.

C. If the bidder does not own, lease or control all of the necessary equipment, provide the source from which the equipment will be obtained: (Attach additional pages if necessary.) _________________

1. Attach certification from the owner, lessee or person in control of the equipment definitely granting to the bidder the control of the equipment required during such time as may be necessary for the completion of that portion of the contract for which it is necessary.

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

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ACKNOWLEDGEMENT OF RECEIPT OF CHANGES TO BID DOCUMENTS FORM

A. By listing and initialing next to each notice, revision or addenda to the bid advertisement, specifications or bid documents, the undersigned bidder hereby acknowledges their receipt. In lieu of listing addenda hereon, bidders may acknowledge receipt of addenda by including a signed copy of the addenda with the bidder’s electronic bid. (Attach additional pages if necessary)

Local Contracting Agency Designation Date

Received

Bidder's

Initials Notice, Revision or

Addenda Number Title or Description

B. The undersigned bidder hereby acknowledges receipt of all questions and answers submitted or distributed through PennBid.

C. The undersigned bidder hereby certifies that the submitted bid takes into account the provisions of all notices, revisions, or addenda, including any changes to the bid advertisement, specifications or bid documents. Failure by a bidder to include all such provisions may result in rejection of their bid.

D. The Local Contracting Agency's record of distribution for questions, answers, notices, revisions, or addenda shall take precedence.

Acknowledged by Bidder:

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PUBLIC WORKS EMPLOYMENT VERIFICATION

A. In accordance with the Public Works Employment Verification Act (Act No. 127 of 2012), a public works contractor or subcontractor shall participate in the E-Verify Program and shall, subject to the requirements of Federal law governing the use of the E-Verify Program, use the E-Verify Program to verify employment eligibility of each new employee.

B. In conducting the verification required by the Public Works Employment Verification Act, a public works contractor or subcontractor shall not discriminate against an employee on the basis of race, ethnicity, color or national origin.

C. As a precondition of being awarded a contract for a public work, prior to the execution of the contract, a public works contractor shall provide the public body with a completed Public Works Employment

Verification Form, provided herein, acknowledging its responsibilities under and its compliance with the Public Works Employment Verification Act. Contracts between a public works contractor and its subcontractors shall contain information about the requirements of the Public Works Employment

Verification Act.

D. Prior to commencing work on a public works project, a subcontractor shall provide the public body with a completed Public Works Employment Verification Form, provided herein, acknowledging its responsibilities under and its compliance with the Public Works Employment Verification Act.

Contracts between an subcontractor and its subcontractors shall contain information about the requirements of the Public Works Employment Verification Act.

ALLEGHENY COUNTY ECONOMIC DEVELOPMENT

BLIGHT REMOVAL PROGRAM (ACT152)

PROCUREMENT

PACKET

Revised January 2022

LEAD SAFE DEMOLITION REQUIREMENTS

This program will require lead safe demolition for all residential structures, child occupied facilities, such as schools and day care facilities, and any commercial or industrial facility constructed prior to 1978. These structures, if awarded funds, will require the use of wet wet wet demolition techniques.

For any lead safe demolition the following pre-demolition requirements apply:

All supervisors and demolition license holders must have completed the OSHA Lead Awareness Training for Construction within the last twelve months, which is available as online training for a modest fee. All activities by the Contractor and its employees during the demolition process must comply with CFR 1926.62, Lead Exposure in Construction.

A trained supervisor/staff member is to be on-site in the lead specific work area to ensure compliance.

The Contractor must distribute notice to all residents/organizations on properties that either adjoin the property containing the structure targeted for demolition or are within two hundred (200) feet of the structure targeted for demolition and to make a reasonable and good faith effort to conduct door-to-door notification; both activities must be conducted no less than three days or no more than ten days prior to the start of demolition activities. The notice must be in the form of door hangers, flyers, or other items suitable for distribution and must include: intent to demolish, date work will begin, name of the contractor performing the demolition, and contact information for the contractor in case of emergency, as well as recommended safety information for surrounding properties.

The contractor must place lawn signs outside of the structure proving notice of the demolition as per the following: one (1) on front lot line of the property facing the street, and one (1) at each of the lot lines on either side of the front yard facing the adjacent properties. The signs must be placed no less than five (5) days before work begins, but no more than ten (10) days ahead.

If either of the properties immediately adjacent to the demolition site have an occupied structure with an open window(s) on the first floor facing the demolition site, the Contractor should contact the adjacent property owner(s) and request that the window(s) be closed. Contractor should note any and all communications, or lack thereof, with adjacent property owners and provide that information to the grantee, as soon as possible.

The Contractor must make a reasonable and good faith effort to politely request any children appearing under the age of twelve (12) who are outside on the block during demolition to go inside. If any child refuses to go inside after one request, the Contractor must note this and provide notice to the grantee after the completion of demolition.

10.

INCLUDE IN BID

SPECIFICATIONS

Residential demolition will use wet wet wet techniques when removing the structure. This practice involves pre-wetting the structure to be demolished, wetting during demolition, and wetting during material loading.

Dust suppression by water uses a dispersal point close to the position of dust generation in order to be most effective in both dust suppression and minimizing the volume of water used, and thus run-off containing lead particles. Ideally, this practice results in zero visible dust emissions.

However, if visible dust is generated, adjust the wetting techniques to control emissions by increasing the volume of water or increasing the area over which the water is applied. The aim is to use the least amount of water possible while still controlling fugitive dust emissions. Non-potable water is used where possible and appropriate.

The best practices for wet wet wet demolition are:

1. Water is applied to the exterior and interior of building surfaces prior to initiating demolition activities as well as continuously during the knock-down phase to prevent dust generation.

2. During the knock-down phase, water is applied directly to the materials being crushed to prevent dust generation.

3. Water is applied to debris during handling, crushing, and loading. During working hours, water is applied to uncovered storage piles.

Plastic sheeting must be placed around the structure extending at least ten(10) feet from the structures perimeter.

Any debris placed in a dumpster must be covered

All debris hauled from the site must be covered

11.

INCLUDE IN BID

Demolition Project Our team will be on site during time specified to demolish the structure at the listed address. The demolition is being performed with Lead Safety in mind;

therefore, it is requested that you keep your windows closed during demolition operations. It is strongly recommended that you remain inside during operations.

Contractor Name and Contact Information

Company Name_____________________________________

Phone Number _____________________________________

Email address ______________________________________

Demolition Site Address

Date and Time of Demolition

Daytime hours ___________________________________

Date _________________________________________

(must be posted at least 3 days before schedule to start demo but no more than 10 days before)

INCLUDE IN BID

SPECIFICATIONS

12.

INCLUDE IN BID

Project Name:

Project Number:

Grantee:

Project Manager:

Project Location:

Allegheny County Economic Development Projects

Procurement Compliance Package Checklist

PROCUREMENT DOCUMENTS TO BE SUBMITTED BY THE PRIME CONTRACTOR/SUBCONTRACTOR/SUPPLIER

The documents listed on this checklist must be included in your bid submission, unless otherwise noted below. These documents are to be submitted to the Grantee by all contractors and forwarded to the ACED Project Manager for final approval. The documents pertaining to Subcontractors must be provided within 10 days of the project award letter, if not included with the Prime Contractor’s original bid proposal.

INITIAL TO INDICATE THE DOCUMENTS HAVE BEEN PROVIDED

Grantee / Project Manager

Notice to Prime Contractors/Subcontractors This document must be included in the bid package and completed by the Prime Contractor/Subcontractor as part of the original bid proposal.

Affirmative Action / MWBE Certification This document must be included in the bid package and completed by the Prime Contractor/Subcontractor as part of the original bid proposal.

M/W/DBE/VOSB Solicitation & Commitment Statement This document must be included in the bid package and completed by the Prime Contractor/Subcontractor as part of the original bid proposal.

Award Verification for Prime/ Subcontractors (Form-PL3/PL4) This document must be included in the bid package and completed by the Agency/Prime Contractor/Subcontractor as part of the original bid proposal.

Schedule of Subcontractors This document must be included in the bid package and submitted no more than 10 days after contract is awarded.

Agency Prime Contractor/Subcontractor Verification This document must be included in the bid package and submitted no more than 10 days after contract is awarded.

Fringe Benefit Letter This document must be included in the bid package and completed by the Prime Contractor/Subcontractor as part of the original bid proposal.

Pennsylvania Certified Payrolls/ Apprentice Registrations Upon being awarded the contract, all contractors must submit a weekly certified payroll sheet to the Project Manager. The first and last payroll sheets must be notarized. This document is two (2) pages; include deduction explanations. Provide valid apprenticeship program documents for all apprentices.

Construction Stoppage Statement This document is provided to the Project Manager if the project requires a delay of work for six weeks or more.

New Hires-Pennsylvania Act 127 (Pennsylvania Public Works Employment Verification Program) This document is required for projects with estimated total cost greater than $25,000.

Award Verification for Suppliers / Professional Services -PL5 This document is to be submitted for all suppliers or professional services receiving $1,000 or more.

Agency/Prime Contractor/SubcontractorSupplier / Professional Services Verification This document must be included in the bid package and submitted no more than 10 days after contract is awarded.

Allegheny County Economic Development Projects Procurement Compliance / Bid Package Documents

NOTICE TO PRIME CONTRACTORS/SUBCONTRACTORS

PROJECT NAME_ PROJECT #

Acknowledgement by Prime Contractor Subcontractor

Company Name_

Authorized Official:

Signature: Date:

PROJECT LOCATION

GRANTEE_

All contractors for the above-named project understand that any payment request for the project will not be processed by Allegheny County Economic Development until all requirements are met. It is the responsibility of the Grantee to make sure that all the paperwork is submitted by everyone on the project before request for payments are submitted.

It is further understood that the Prime Contractor is responsible for collecting all paperwork for each Subcontractor hired and must submit it to the Grantee, along with a signed agreement between the Prime and Subcontractor(s). Both Prime and Subcontractors are required to retain copies of all paperwork for this State-funded project for a period of three years after completion of the project.

The contractor understands that no basic wage can be lower than the wage issued: if fringe benefits are not paid into a special fund, the fringe benefits listed for any particular trade in the wage decision is added to, and becomes part of, the basic hourly wage for the employee performing the work.

All payrolls must be forwarded within seven days after the pay period. Payrolls must be certified on the reverse side and the signatures must be hand written in blue ink. No Stamped, initialed, or photo copied signatures are accepted. THE FIRST (INITIAL) AND LAST (FINAL) PAYROLLS MUST BE

NOTARIZED.

This form must be signed by the Prime Contractor or Subcontractor

Allegheny County Economic Development Projects

Procurement Compliance / Bid Package Documents

AFFIRMATIVE ACTION /MWBE CERTIFICATION

PRIME / SUBCONTRACTOR AFFIRMATIVE ACTION CERTIFICATION

PRIME/SUBCONTRACTOR — Agrees to comply with the U.S. Department of Labor Model Affirmative Action (41-CFR-60-

1.4) Plan.

MINORITY BUSINESS AND FEMALE UTILIZATION CERTIFICATION

(Company Name) , Contractor, will abide by and initiate all of my subcontracts to the greatest extent feasible, the requirements of Executive Order 11625 and Executive Order 12138 regarding utilization of Minority and Female Business on this project.

SIGNATURE _DATE

NAME_ TITLE

CONTRACTOR’S FEDERAL ID NUMBER_ PHONE#

PROJECT NAME_

LOCATION PROJECT #

INCLUDE IN BID

SPECIFICATIONS

15.

Allegheny County Economic Development

M/W/DBE/VOSB Solicitation and Commitment Statement A good faith effort must be made to meet the ACED M/W/DBE/VOSB contract goals of 13% MBE, 2% WBE, and 5% VOSB PARTICIPATION.

ALL COLUMNS MUST BE COMPLETELY FILLED IN FOR ALL MWDBE/VOSB SUBCONTRACTORS AND SUPPLIERS

SOLICITATION AND COMMITMENT

MINORITY, WOMEN AND DISADVANTAGED BUSINESS ENTERPRISES and VETERAN-OWNED SMALL BUSINESSES

PROJECT

NUMBER

NAME OF FIRM ADDRESS PHONE NUMBER

List below ALL M/W/DBE/VOSB solicited - whether or not commitment was obtained - Copy this form as necessary

MBE_ WBE DBE_ VOSB_ TYPE(S) OF SUBCONTRACT WORK

OR MATERIALS

DATE SOLICITED COMMITMENT MADE GIVE REASON(S) IF NO

COMMITMENT MADE CERTIFIED BY: YES(IF YES GIVE DATE)

MONTH DAY YR

NO

COMPANY NAME

SOLICITATION METHOD

ADDRESS AMOUNT COMMITTED

QUOTE RECEIVED

$ AMOUNT

% OF TOTAL BID

CONTACT PERSON / PHONE # YES NO

MBE_ WBE DBE_ VOSB_ TYPE(S) OF SUBCONTRACT WORK

OR MATERIALS

DATE SOLICITED COMMITMENT MADE GIVE REASON(S) IF NO

COMMITMENT MADE CERTIFIED BY: YES(IF YES GIVE DATE)

MONTH DAY YR

NO

COMPANY NAME

SOLICITATION METHOD

ADDRESS AMOUNT COMMITTED

QUOTE RECEIVED

$ AMOUNT

% OF TOTAL BID CONTACT PERSON / PHONE # YES NO

MBE_ WBE DBE_ VOSB_ TYPE(S) OF SUBCONTRACT WORK

OR MATERIALS

DATE SOLICITED COMMITMENT MADE GIVE REASON(S) IF NO

COMMITMENT MADE CERTIFIED BY: YES(IF YES GIVE DATE)

MONTH DAY YR

NO

COMPANY NAME

SOLICITATION METHOD

ADDRESS AMOUNT COMMITTED

QUOTE RECEIVED

$ AMOUNT

% OF TOTAL BID

CONTACT PERSON / PHONE # YES NO

Prepared by: Signature: Title:_ Date:

AWARD VERIFICATION FOR PRIME/ SUBCONTRACTORS - PL3/PL4

THIS FORM MUST BE COMPLETED, SIGNED, AND SUBMITTED FOR ALL CONTRACTORS USED ON THE JOB.

ALL INFORMATION MUST BE FILLED IN COMPLETELY OR FORM MUST BE RESUBMITTED.

PL3- Award Notice for Prime Contractor PL4- Award Notice for Subcontractor

State City

Email IRS ID #

No WBE: Yes No DBE: Yes No VOSB: Yes No

If your company is a MBE/ WBE/ DBE/ VOSB company is it certified with Allegheny County’s Office of Minority & Women Business? Yes No_ Certification #_ Expiration Date

No If yes, Certification #_ Is it certified under the PAUCP? (PA Unified Certification Program) Yes Expiration Date Other Certification? (type, #, expiration date)

RACIAL / ETHNIC CODES:

1. White American 2. Black American 3. Native American 4. Hispanic American

6. Hasidic Jews

Date: Contractor Signature:

Print Name: Title:

THIS PART IS TO BE FILLED OUT BY OPERATING AGENCY ONLY:

Project Contract Award Amount $

Project Location:

Contractor Contract Amount $

Date

Project #:

Project Name:

Title

17.

Zip Code

INCLUDE IN BID

SPECIFICATIONS

Is Prime Contractor/Subcontractor: MBE: Yes

Company Name

Address

Telephone Number

DUNS # CAGE # CAGE Expiration

5. Asian/Pacific American

This portion to be completed by Prime Contractor / Subcontractor:

Date Contract Awarded to Contractor Above:

Estimated Construction Start Date:

Agency Signature:

Print Name

Revised January 2022 t106346 Pencil

SCHEDULE OF SUBCONTRACTORS

PRIME CONTRACTORS: This form must be submitted to the GRANTEE no more than ten days after you have received a bid award letter notifying you that you have been awarded the contract. Failure to submit this form could disqualify your bid.

SUB CONTRACTORS: This form must be completed and submitted to the prime contractor

PROJECT NAME

PROJECT LOCATION PROJECT #

CONTRACTOR’S NAME

IRS ID#_ DATE

COMPANY NAME

ADDRESS

CITY STATE

IRS ID# TELEPHONE#

Is Subcontractor a MBE? Yes Is Subcontractor a WBE? Yes Is Subcontractor a DBE? Yes Is Subcontractor a VOSB? Yes

Type of Work

COMPANY NAME

ADDRESS

CITY ZIP

IRS ID#

No No No

No

TELEPHONE#

Is Subcontractor a MBE? Yes Is Subcontractor a WBE? Yes Is Subcontractor a DBE? Yes Is Subcontractor a VOSB? Yes

Type of Work

COMPANY NAME

ADDRESS

CITY ZIP

IRS ID#

No No No No

TELEPHONE#

Is Subcontractor a MBE? Yes Is Subcontractor a WBE? Yes Is Subcontractor a DBE? Yes Is Subcontractor a VOSB? Yes

Type of Work

COMPANY NAME

ADDRESS

CITY ZIP

IRS ID#

No No No

No

TELEPHONE#

Is Subcontractor a MBE? Yes Is Subcontractor a WBE? Yes Is Subcontractor a DBE? Yes Is Subcontractor a VOSB? Yes

Type of Work

INCLUDE IN BID

SPECIFICATIONS

18.

ZIP

No No No No

Check here if no sub contractors will be utilized by the above contractor

STATE

STATE STATE

AGENCY > PRIME CONTRACTOR / SUBCONTRACTOR VERIFICATION

(Agency/Prime/Subcontractor Legal Name) has an agreement with

(Prime/Subcontractor Legal Name) to work on the

(Project Name)_ located in the area of , PA.

If awarded the contract, the above Agency/Prime Contractor/Subcontractor intends to have a written, binding contract with the above Prime Contractor or Subcontractor to perform the following work:

(Provide Brief Description of the Type of Work Agreed Upon)

Agency’s Authorized Signature:_____________________________________________ Date:

Agency’s Printed Name:___________________________________________________ Title:

Prime Contractor’s Authorized Signature:_____________________________________ Date:

Prime Contractor’s Printed Name: __________________________________________ Title:

Subcontractor’s Authorized Signature:_______________________________________ Date:

Subcontractor’s Printed Name: _____________________________________________ Title

INCLUDE IN BID

SPECIFICATIONS

19.

The contract dollar amount as specified in the written agreement is $

The portion of the above to be reimbursed/paid with County funds is $

THIS FORM MUST BE SUBMITTED FOR EVERY PRIME / SUBCONTRACTOR HIRED FOR THIS COUNTY-FUNDED PROJECT AND SUBMITTED TO THE AGENCY. THIS FORM IS TO BE SUBMITTED 10 DAYS AFTER CONTRACT IS AWARDED.

Project #:

FRINGE BENEFIT LETTER

Wage Decision Serial #

IRS ID#

City State

Project Name_

Project #

Contract Amount $

Prime/Subcontractor Company Name (Circle One)_

Address:

FRINGE BENEFITS:

All Fringe Benefits will be paid as follows:

_Fringes will be included in the basic hourly wage rates.

_Fringes will be paid into the following Benefit Plans: (List Hourly Fringe Benefit Rate)

Name of Plan:

Address:

City:

Classification: Hourly Fringe Benefit Rate

Name of Plan:

Address:

City:

Classification: Hourly Fringe Benefit Rate

Name of Plan:

Address:

City:

Classification: Hourly Fringe Benefit Rate

Prime/ Subcontractor’s Signature

Printed Name: Date:

INCLUDE IN BID

SPECIFICATIONS

20.

Zip Code

State: Zip Code:

State: Zip Code:

State: Zip Code:

Contractor or

WEEKLY PAYROLL CERTIFICATION FOR PUBLIC WORKS PROJECTS

ALL INFORMATION MUST BE COMPLETED

CONTRACTOR

ADDRESS

SUBCONTRACTOR

ADDRESS

BUREAU OF LABOR LAW COMPLIANCE

PREVAILING WAGE DIVISION

7TH & FORSTER STREETS

HARRISBURG, PA 17120 1-800-932-

PAYROLL NUMBER WEEK ENDING DATE PROJECT AND LOCATION

PROJECT SERIAL # PROJECT #

EMPLOYEE NAME

APPR.

RATE

WORK

CLASSIFICATION

DAY AND DATE

S-

TIME

0-

TIME

BASE

HOURY

RATE

TOTAL FRINGE

BENEFITS

(C=Cash)

(FB=Contributio)n*

TOTAL

DEDUCTIONS

s

GROSS PAY

FOR

PREVAILIN

G RATE

JOB(S)

CHECK #

HOURS WORKED EACH DAY

C:

FB:

C:

FB:

C:

FB:

C:

FB:

C:

FB:

LLC -25 REV 10-03 (Page 1)

21.

THE NOTARIZATION MUST BE COMPLETED ON FIRST AND LAST SUBMISSIONS ONLY. ALL OTHER

INFORMATION MUST BE COMPLETED WEEKLY.

*FRINGE BENEFITS EXPLANATION (FB): Bona fide benefits contribution, except those required by Federal or State

Law (unemployment tax, workers’ compensation, income taxes, etc.)

Please specify the type of benefits provided and contributions per hour:

1) Medical or hospital care

2) Pension or retirement

3) Life insurance

4) Disability

5) Vacation, holiday

6) Other (please specify)

CERTIFIED STATEMENT OF COMPLIANCE

1. The undersigned, having executed a contract with

(AWARDING AGENCY, CONTRACTOR OR SUBCONTRACTOR)

for the construction of the above-identified project, acknowledges that:

(a) The prevailing wage requirements and the predetermined rates are included in the aforesaid contract.

(b) Correction of any infractions of the aforesaid conditions is the contractor’s or subcontractor’s responsibility.

(c) It is the contractor’s responsibility to include the Prevailing Wage requirements and the predetermined rates in any subcontract or lower tier subcontract for this project.

2. The undersigned certifies that:

(a) Neither he nor his firm, nor any firm, corporation or partnership in which he or his firm has an interest is debarred by the Secretary of Labor and Industry pursuant to Section 11(e) of the PA Prevailing Wage Act, Act of August

15, 1961, P.L. 987 as amended, 43 P.S.§ 165-11(e).

(b) No part of this contract has been or will be subcontracted to any subcontractor if such subcontractor or any firm, corporation or partnership in which such subcontractor has an interest is debarred pursuant to the aforementioned statute.

3. The undersigned certifies that:

(a) the legal name and the business address of the contractor or subcontractor are:

(b) The undersigned is: a single proprietorship a corporation organized in the state of partnership other organization (describe)

(c) (c)The name, title and address of the owner, partners or officers of the contractor/subcontractor are:

NAME TITLE ADDRESS

The willful falsification of any of the above statements may subject the contractor to civil or criminal prosecution, provided in the PA Prevailing Wage Act of August 15, 1961, P.L. 987, as amended, August 9, 1963, 43 P.S. § 165.1 through 165.17.

(DATE)

(SEAL)

(TITLE)

Taken, sworn and subscribed before me this Day

LLC -25 REV 10-03 (Page 2) of A .D., 22.

CONSTRUCTION STOPPAGE STATEMENT

If there is no work performed on the project for SIX WEEKS or MORE, this form must be completed and submitted to the Grantee by the Contractor.

State Zip Code

Company Name

Company Address

City

Telephone Number

Project #

Project Name

Project Address City Zip Code

I certify that work on this project will be delayed for a period of six (6) weeks or more effective as of this date _. The work on this project will resume on (date)_ .

The payroll number which was last submitted to the GRANTEE was payroll number .

Therefore when the work resumes, the payrolls will be numbered starting with the next sequential number from the last payroll submitted.

Authorized Signature: Prime Contractor_ Date

Print Name Prime Contractor

Authorized Signature: Subcontractor_ Date

Print Name Subcontractor

This form must be submitted to the GRANTEE to be forwarded to the Project Manager at the Allegheny

County Economic Development.

Received by (Grantee Name)

Authorized Signature Date

Received by ACED Project Manager_

Signature Date

INCLUDE IN BID

SPECIFICATIONS

23.

State

Allegheny County Economic Development Projects

Pennsylvania Public Works Employment Verification Program

The Commonwealth of Pennsylvania enacted Act 127 of 2012, known as the Public Works

Employment Verification Act (‘the Act’) which requires all public work contractors and subcontractors to utilize the Federal Government’s E-Verify system to ensure that all employees performing work on public work projects are authorized to work in the United States.

The Department defines a “Public Work” to be construction, reconstruction, demolition, alteration and/or repair work other than maintenance work, done under contract and paid for in whole or in part out of the funds of a public body where the estimated cost of the total project is in excess of twenty-five thousand dollars ($25,000) but shall not include work performed under a rehabilitation or manpower training program.

The Department of General Services’ Public Works Employment Verification Compliance

Program is responsible for the administration, education and enforcement of the Public Works

Employment Verification Act 127 of 2012. It provides contractors and subcontractors with educational outreach, conducts investigations when complaints are received and random audits to ensure compliance with the requirements of this Act.

Please direct your questions to the Public Works Employment Verification Compliance Office

Mail: Department of General Services Public Works

Employment Verification Compliance Office

Room 105 Tent Bldg.

18th & Herr…