6-2026 Insurance and Non- Collushion and Background forms (REQUIRED).docx

Section J Consent/Agreement of Surety

VENDOR/CONTRACTOR’S INSURANCE REQUIREMENTS

COMPREHENSIVE GENERAL LIABILITY

Before the Contract is awarded, the Contractor shall take out and maintain during the life of this Contract such Public Liability and Property Damage insurance as shall protect him and any sub-contractors, if any, performing work covered by this Contract, from all claims for loss arising form Property damage, personal injury and bodily injury including accidental death. Such Insurance Policy shall include Products and Completed Operations coverage and include coverage for damages that may arise from the Operations of the Contractor or by any sub-contractor or by anyone directly or indirectly employed by either of them. This insurance shall include coverage for explosion, collapse, underground hazard, and completed operations coverage. The Combined Single Limit of Liability required is $1,000,000 per occurrence with a deductible of no more than $1,000.

Tredyffrin Township shall be included as additional insured on the Contractor’s Comprehensive General Liability insurance policy.

VEHICLES

Comprehensive Business Automobile Coverage shall be maintained with a Combined Single Limit of Liability in an amount no less than $1,000,000 per occurrence with no deductible.

Tredyffrin Township shall be included as additional insured on the Contractor’s Automobile Liability insurance policy.

CATASTROPHE UMBRELLA LIABILITY

One million dollars in excess of Primary General.

WORKER’S COMPENSATION

Worker’s Compensation Insurance required by Pennsylvania law covering all Owners employees and all employees of the general contractors and all subcontractors. The alternative is a current certificate of Exempt status from the Pennsylvania Department of Labor and Industry, if the Owner is an Exempt Self-Insurer in the State of Pennsylvania.

EMPLOYER’S LIABILITY INSURANCE:

Employer’s Liability Insurance with limits no less than $1,000,000.00 per accident or employee disease.

Tredyffrin Township shall be named as an additional insured on all policies insofar as the specified Contract is concerned. In addition, the Contractor shall furnish the County with a certificate of insurance showing the type, amount, class of operations covered, effective dates and dates of expiration. All policies should also contain a sixty (60) day notice of cancellation clause.

NOTE:

SECTION D

INSURANCE REQUIREMENTS

If the owner maintains a self-insurance program or a limited self-insurance program for any or all of the exposures listed above, a complete description of the program with information on excess carriers and funding arrangements should be provided. In the event that the worker’s compensation is self-insured, a copy of the current exemption shall be provided.

Tredyffrin Township, Chester County D-2

BID GUARANTEE

KNOW ALL MEN BY THESE PRESENTS, THAT WE, the undersigned, , as Principal, and held firmly bound unto as OWNER in the penal sum of for the payment of which, well and truly to be made, we hereby jointly and severally bind ourselves, successors and assigns.

Signed, this day of , 20 .

The Condition of the above obligation is such that whereas the Principal has submitted to Tredyffrin Township a certain BID, attached hereto and hereby made a part hereof to enter into a contract in writing, for the Tredyffrin Township Superpave TT2026-PW02

NOW, THEREFORE,

(a) If said BID shall be rejected, or

(b) If said BID shall be accepted and the Principal shall execute and deliver a contract in the Form of Contract attached hereto (properly completed in accordance with said BID) and shall furnish a BOND for his faithful performance of said contract, and for the payment of all persons performing labor or furnishing materials in connection there with and shall in all other respects perform the agreement created by the acceptance of said BID, then this obligation shall be void, otherwise the same shall remain in force and effect; it being expressly understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed the penal amount of this obligation stated.

The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its BOND shall be in no way impaired or affected by any extension of the time within which the OWNER may accept such BID; and said Surety does hereby waive notice of any such extension.

IN WITNESS WHEREOF, the Principal and the Surety have hereunto set their hands and seals, and such of them as are corporations have caused their corporate seals to be hereto affixed and these presents to be signed by their proper officers, the day and year first set above.

Principal

Surety

SECTION E

BID GUARANTEE

By:

Tredyffrin Township, Chester County E-3

INSTRUCTIONS FOR NON-COLLUSION AFFIDAVIT

1. This Non-Collusion Affidavit is material to any contract awarded pursuant to this bid. According to the Pennsylvania Antibid-Rigging Act, 73 P.S. 1611 et seq., governmental agencies may require Non-Collusion Affidavits to be submitted together with bids.

2. 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.

3. 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 this bid.

4. 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.

5. 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 lower than the bid of another firm, any intentionally low or noncompetitive bid, and any other form of bid submitted for the purpose of giving a false appearance of competition.

SECTION F

NON-COLLUSION AFFIDAVIT

6. Failure to file an Affidavit in compliance with these instructions may result in disqualification of the bid.

Tredyfrin Township, Chester County F-1

NON-COLLUSION AFFIDAVIT

Contract/Bid No.

State of :

: s.s. County of :

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 lower than this bid, or to submit any intentionally low 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) , its affiliates, Subsidiaries, officers, Name of Firm 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 the 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 Title Name of firm understands and acknowledges that the representations are material and important, and will be relied on by Tredyffrin Township 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 Tredyffrin Township of the true facts relating to the submission of bids for this contract.

Name

Company Position

SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY

OF , 20

SECTION F

NON-COLLUSION AFFIDAVIT

Tredyfrin Township, Chester County F-3

Notary Public

My Commission Expires:

CONTRACTOR’S QUALIFICATION STATEMENT

THE UNDERSIGNED certifies under oath the truth and correctness of all statements and of all answers to questions made hereinafter.

Berwyn, Pennsylvania 19312-1079

SUBMITTED BY:

ADDRESS:

PRINCIPAL’S NAME:

MAILING ADDRESS (If different than above):

Check one – Corporation ( ), Partnership ( ), Individual ( ), Joint Venture ( ), or Other ( )

1.0 How long has your organization been in business as a Contractor?

2.0 How many years has your organization been in business under its present business name?

2.1 Under what other or former names has your organization operated?

a.

b.

c.

3.0 If a Corporation, answer the following:

a. Date of incorporation:

b. State of incorporation:

c. President's Name:

d. Vice-president's Names:

e. Secretary’s Name:

f. Treasurer's Name:

3.1 List names and addresses of all parties holding greater than ten percent (10%) interest in the corporation:

4.0 If an Individual or a Partnership, answer the following:

a. Date of organization:

b. Names and addresses of all partners (state whether General or Limited Partnership):

5.0 If other than a Corporation or Partnership, describe organization and name Principals:

6.0 List the States and the categories in which your organization is legally qualified to do business. Indicate registration or license numbers if applicable.

7.0 Organization normally performs the following type of work:

7.1 On the contracts we are awarded as the General or Prime contractor, our organization normally performs % of the work with our own forces.

8.0 Have you ever failed to complete any contract work that was awarded to you? Yes ( ) or No ( ).

If your answer was YES, fully describe the circumstances surrounding that failure.

9.0 Within the last five years, has any Officer or Partner of your organization been an Officer or Partner of any other organization that defaulted on a contract? Yes( ) or No( )

If YES, attach a separate sheet explaining the default.

10.0 On a separate sheet of paper, list all major contracts that your organization has in progress, giving the name of the project, the owner’s name, the owner’s contact person and telephone number, the engineer and/or architect, the contract amount, percent complete and the scheduled completion date.

11.0 On a separate sheet of paper, list the major projects your organization has completed in the past five (5) years, giving the name of the project, the owner’s name, the owner’s contact person and telephone number, the date of completion, the contract amount, and percent work completed with own forces. Include descriptions of the types and sizes of these projects. The sizes of these projects should be at least 50% of the total amount of the project under consideration, for which this contractor’s qualification statement is prepared.

12.0 On a separate sheet of paper, list the construction experience of the key individuals of your organization.

13.0 On a separate sheet of paper, list the rolling stock and powered equipment that your organization owns or rents. Annotate the type and the quantities of the equipment that you intend to use on this job site.

3. 4.

15.0 Bank References:

1. 2.

3. 4.

16.0 Name and address of Bonding Company, including the agent’s name and address:

Company

Agent

17.0 Dated this day of , 20 .

Name of Organization:

By:

Title:

18.0 M being duly sworn, deposes

and says that he/she, is the of , and that the answers to the foregoing questions and statements herein contained are true and correct.

Sworn to and subscribed before me this day of , 20 .

Notary Public My Commission Expires:

SECTION G

CONTRACTOR’S QUALIFICATION STATEMENT

Tredyffrin Township Chester County G-5

BIDDER CERTIFICATION OF PREQUALIFICATION CLASSIFICATION AND

WORK CAPACITY, FORM CS-4309 (7-90)

In accordance with the requirements of PennDOT Publication 408 – Specifications, Section 102 - Bidding Requirements and Conditions, the bidder hereby certifies that he meets the following to qualify his proposal as an acceptable bid:

1. He 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 he has under contract at the time of bid submission and (b) the total bid price of this proposal (less any credit for sub-lettings as allowed by Section 457.15 of the Regulations on Prequalification of Prospective Bidders).

2. The classified types of work, on which he is eligible to bid, constitutes over 50% 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 preformed by the bidder with his own forces) as indicated in Section 108.01, Publication 408.

3. To the best of his knowledge, each proposed subcontractor (as set forth on attached list marked “List of Subcontractors”) is prequalified in conformance with said Regulations, mentioned above, for the contract items designated, and each has adequate eligible prequalification (defined above) to cover amount of subcontract as evidenced by the “certificate of capacity” signature of each subcontractor herein after listed.

Upon request, submit to the Owner Form CS-4311, Status of Contracts on Hand.

The making of a false certification of any of the above bidding requirements shall constitute cause for rejection of the bidder’s proposal and shall subject the bidder to making of payment to the Owner of an amount of five (5%) percent of the total amount of the bid as liquated damages, or disqualification of the bidder from bidding on future work for a period of ninety (90) calendar days, or both, as deemed appropriate. Should the bidder fail to make said payment within thirty (30) calendar days of notification the bidder shall be disqualified for a period of one (1) year. An application for renewal of prequalification will not be considered by the Owner until the bidder makes payment.

If Subcontractors are not named, no credit will be allowed on General Contractor’s prequalification.

LIST OF SUBCONTRACTORS

CERTIFICATE OF CLASSIFICATION AND CAPACITY BY SUBCONTRACTORS

We hereby certify that we have work classifications and current capacity (maximum capacity rating or less uncompleted contract work as defined by Section 45738 of Prequalification Regulations) to cover the items noted above for subletting to our organizations.

TOTAL $

SECTION H

FORM CS-4309 (7-90)

Signatures may be placed on form after letting, but prior to award of contract.

Tredyffrin Township Chester County H-2

THE UNDERSIGNED certifies under oath the truth and correctness of all statements and of all answers to questions made hereinafter.

Berwyn, Pennsylvania 19312-1079

SUBMITTED BY:

ADDRESS:

PRINCIPAL’S NAME:

MAILING ADDRESS (If different than above):

Check one – Corporation ( ), Partnership ( ), Individual ( ), Joint Venture ( ), or Other ( )

1.0 How long has your organization been in business as a Contractor?

2.0 How many years has your organization been in business under its present business name?

2.1 Under what other or former names has your organization operated?

a.

b.

c.

3.0 If a Corporation, answer the following:

a. Date of incorporation:

b. State of incorporation:

c. President's Name:

d. Vice-president's Names:

e. Secretary’s Name:

f. Treasurer's Name:

3.1 List names and addresses of all parties holding greater than ten percent (10%) interest in the corporation:

4.0 If an Individual or a Partnership, answer the following:

a. Date of organization:

b. Names and addresses of all partners (state whether General or Limited Partnership):

5.0 If other than a Corporation or Partnership, describe organization and name Principals:

6.0 List the States and the categories in which your organization is legally qualified to do business. Indicate registration or license numbers if applicable.

7.0 Organization normally performs the following type of work:

7.1 On the contracts we are awarded as the General or Prime contractor, our organization normally performs % of the work with our own forces.

7.2 On the contracts we are awarded as the sub-contractor, our organization normally performs % of the work with our own forces.

8.0 Have you ever failed to complete any contract work that was awarded to you as the General, Prime, or sub-contractor? Yes ( ) or No ( ).

If your answer was YES, fully describe the circumstances surrounding that failure.

9.0 Within the last five years, has any Officer or Partner of your organization been an Officer or Partner of any other organization that defaulted on a contract? Yes( ) or No( )

If YES, attach a separate sheet explaining the default.

10.0 On a separate sheet of paper, list the major projects your organization has completed in the past five (5) years, giving the name of the project, the owner’s name, the owner’s contact person and telephone number, the date of completion, the contract amount, and percent work completed with own forces. Include descriptions of the types and sizes of these projects. The sizes of these projects should be at least 50% of the total amount of the project under consideration, for which this contractor’s qualification statement is prepared.

11.0 On a separate sheet of paper, list all major contracts that your organization has completed in the past five years, giving the name of the project, the owner’s name, the date of completion, and the contract amount.

12.0 On a separate sheet of paper, list the construction experience of the key individuals of your organization.

13.0 On a separate sheet of paper, list the rolling stock and powered equipment that your organization owns or rents. Annotate the type and the quantities of the equipment that you intend to use on this job site.

3. 4.

15.0 Bank References:

1. 2.

3. 4.

16.0 Name and address of Bonding Company, including the agent’s name and address:

Company

Agent

17.0 Dated this day of , 20 .

Name of Organization:

By:

Title:

18.0 M being duly sworn, deposes

and says that he/she, is the of , and that the answers to the foregoing questions and statements herein contained are true and correct.

Sworn to and subscribed before me this day of , 20 .

Notary Public My Commission Expires:

SECTION I

SUB-CONTRACTOR’S QUALIFICATION STATEMENT

Tredyffrin Township, Chester County I-5

CONSENT/AGREEMENT OF SURETY

The undersigned Name of Surety Company a corporation organized and existing under the laws of and authorized to do business in the Commonwealth of Pennsylvania do hereby consent and agree with Tredyffrin Township that if the proposal of , for the project

Tredyffrin Townsip Superpave TT2026-PW02

Be accepted and a contract for said work be awarded to said bidder, it will, upon its being so awarded, become the surety for said Bidder on such surety bonds as are called for in the Bid Documents.

Signed and sealed: Date

Name of Surety