7-00 35 13 00 41 00 00 42 43 00 43 13 00 45 12 Bid Proposal Workbook Template DAP.xls

XLS spreadsheet 136 KB Posted

Attached to
PW-Cibolo Hills Parkway
Solicitation number
26-0148
Issued by
Tarrant County, Texas

About this file

This is a Bid Proposal Workbook Template for the City of Fort Worth's Developer Awarded Projects program, specifically for the Cibolo Hills Parkway project (City Project No. 106104). The project encompasses four primary units: Unit I (Water Improvements) consisting of approximately 1,569 linear feet of 16-inch PVC waterline, 283 linear feet of 16-inch DIP waterline, and 30-inch steel casing by open cut with associated gate valves, fire hydrants, and appurtenances; Unit III (Drainage Improvements) including 1,069 linear feet of 21-inch through 42-inch reinforced concrete pipe, 1,010 linear feet of storm box culverts, and associated inlets, junction boxes, and headwalls; Unit IV (Paving Improvements) comprising 6,369 square yards of 10-inch concrete pavement, 24,287 square feet of concrete sidewalk, lime stabilization, pavement markings, and signage; and Unit V (Street Lighting Improvements) featuring 22 roadway lighting assemblies with LED fixtures, conduit, electrical conductors, and foundations. The workbook provides unit price bid forms for each work component with estimated quantities and allows bidders to submit alternative bids where applicable.

All bidders must submit conflict of interest questionnaires or certifications, prequalification statements for specified work types, bid bonds equal to five percent of the maximum bid price, and compliance documentation for non-resident bidders per Texas Government Code Chapter 2252. Bidders are required to acknowledge acceptance of all contract terms, certify the bid is genuine and not collusive, and confirm awareness of insurance requirements and liquidated damages provisions. The workbook includes spaces for bidders to enter unit prices and calculate extended bid amounts, with the total bid amount serving as the publicly read figure at bid opening. All submitted bids are subject to verification through multiplication of unit prices by estimated quantities. Bidders must also identify prequalified contractors and subcontractors for major work types and complete all required forms and addenda acknowledgments prior to submission.

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00 35 13

SECTION 00 35 13
CONFLICT OF INTEREST STATEMENT
Each bidder, offeror or respondent to a City of Fort Worth procurement is required to complete a
Conflict of Interest Questionnaire or certify that one is current and on file with the City Secretary's
Office pursuant to state law.
If a member of the Fort Worth City Council, any one or more of the City Manager or Assistant
City Managers, or an agent of the City who exercise discretion in the planning, recommending,
selecting or contracting with a bidder, offeror or respondent is affiliated with your company, then
a Local Government Officer Conflicts Disclosure Statement (CIS) may be required.
You are urged to consult with counsel regarding the applicability of these forms and Local
Government Code Chapter 176 to your company.
The referenced forms may be downloaded from the links provided below.
Form CIQ (Conflict of Interest Questionnaire) (state.tx.us)
https://www.ethics.state.tx.us/data/forms/conflict/CIS.pdf
CIQ Form does not apply
CIQ Form is on file with City Secretary
CIQ Form is being provided to the City Secretary
CIS Form does not apply
CIS Form is on File with City Secretary
CIS Form is being provided to the City Secretary
BIDDER:
By:
Signature:
Title:
END OF SECTION

&R&9&A

CONFLICT OF INTEREST STATEMENT

Page &P of &N

&L&10CITY OF FORT WORTH

STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS

Revised February 24, 2020&R&10&F Form CIQ (Conflict of Interest Questionnaire) (state.tx.us)

00 41 00

SECTION 00 41 00 BID
Publicly Bid Developer Awarded Projects - BID FORM
TO:GRBK Edgewood LLC.
5501 Headquarters Drive, Suite 300W
Plano, TX 75024
FOR:Cibolo Hills Parkway
City Project No.:106104
Units/Sections:
UNIT I: WATER IMPROVEMENTS
UNIT III: DRAINAGE IMPROVEMENTS
UNIT IV: PAVING IMPROVEMENTS
UNIT V: STREET LIGHTING IMPROVEMENTS
1. Enter Into Agreement
The undersigned Bidder proposes and agrees, if this Bid is accepted, to enter into an Agreement with Developer in the form included in the Bidding Documents to perform and furnish all Work as specified or indicated in the Contract Documents for the Bid Price and within the Contract Time indicated in this Bid and in accordance with the other terms and conditions of the Contract Documents. This Agreement may not be used outside of the public bidding process through the City of Fort Worth.
2. BIDDER Acknowledgements and Certification
2.1.In submitting this Bid, Bidder accepts all of the terms and conditions of the INVITATION TO BIDDERS and INSTRUCTIONS TO BIDDERS, including without limitation those dealing with the disposition of Bid Bond.
2.2.Bidder is aware of all costs to provide the required insurance, will do so pending contract award, and will provide a valid insurance certificate meeting all requirements in the construction contract.
2.3.Bidder certifies that 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.
2.4.Bidder has not directly or indirectly induced or solicited any other Bidder to submit a false or sham Bid.
2.5.Bidder has not solicited or induced any individual or entity to refrain from bidding.
2.6.Bidder has not engaged in corrupt, fraudulent, collusive, or coercive practices in competing for the Contract. For the purposes of this Paragraph:
a."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.
b."fraudulent practice" means an intentional misrepresentation of facts made (a) to influence the bidding process to the detriment of Developer (b) to establish Bid prices at artificial non-competitive levels, or (c) to deprive Developer of the benefits of free and open competition.
c."collusive practice" means a scheme or arrangement between two or more Bidders, with or without the knowledge of Developer, a purpose of which is to establish Bid prices at artificial, non-competitive levels.
d."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.
3. Prequalification
The Bidder acknowledges that the following work types must be performed only by prequalified contractors and subcontractors:(
a.(ex.Water Distribution, Development, 12-inch diameter and smaller by open-cut (Specify New Development or Redevelopment))
b.(ex. Sewer Collection System, Development, 12-inches and smallerby open-cut (Specify New Development or Redevelopment))
c.(ex. Augur Boring - 24-inch diameter casing and less)
d.(ex. CCTV, 12-inches and smaller)
d.(ex. Lift Station and Force Main)
e.(ex. Concrete Paving Construction, Reconstruction (15,000 SY & Greater))
f.(ex. Roadway and Pedestrian Lightihng)
4. Time of Completion
4.1.Bidder agrees to complete WORK for FINAL ACCEPTANCE withinworking days
after the date when the Contract Time commences to run as provided in the General Conditions.
4.2.Bidder accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Work {and/or achievement of Milestones} within the times specified in the Agreement.
5. Attached to this Bid
The following documents are attached to and made a part of this Bid:
a.This Bid Form, Section 00 41 00
b.Required Bid Bond, Section 00 43 13 issued by a surety meeting the requirements of paragraph 4.01 of the Standard City Conditions of the Construction Contract for Developer Awarded Projects
c.Proposal Form, Section 00 42 43
d.Vendor Compliance to State Law Non Resident Bidder, Section 00 43 37
eMWBE Forms (if applicable)
f.Prequalification Statement, Section 00 45 12
g.Conflict of Interest Affidavit, Section 00 35 13
h.Any additional documents that may be required by Section 12 of the Instructions to Bidders
i.Bidder pre-qualification application (if applicable)
6. Total Bid Amount
6.1.Bidder will complete the Work in accordance with the Contract Documents for the following bid amount. In the space provided below, please enter the total bid amount for this project. Only this figure will be read publicly by the City at the bid opening.
6.2.It is understood and agreed by the Bidder in signing this proposal that the total bid amount entered below is subject to verification and/or modification by multiplying the unit bid prices for each pay item by the respective estimated quantities shown in this proposal and then totaling all of the extended amounts.
6.3TOTAL BID
6.4ALTERNATIVE BID<Alternative Bid Amount Here>
<use this if applicable, otherwise delete>
7. Bid Submittal
This Bid is submitted onby the entity named below.
Respectfully submitted,Receipt is acknowledged of the following Addenda:Initial
By:____________________________________________Addendum No. 1:
(Signature)Addendum No. 2:
Addendum No. 3:
Addendum No. 4:
(Printed Name)
Title:
Company:Corporate Seal:
Address:<Seal Here>
State of Incorporation:
Email:
Phone:
END OF SECTION

&R&"Arial,Regular"&8&A

DAP BID FORM FOR PUBLICLY BID PROJECTS ONLY

Page &P of &N &L&"Arial,Regular"&8CITY OF FORT WORTH

STANDARD CONSTRUCTION BID FORM - DEVELOPER AWARDED PROJECTS

Form Revised April 2, 2014&R&"Arial,Regular"&8&A BID FORM DAP Willhelm, Debbie:

Enter value for number of days.

00 42 43 - SEC II & SEC III

SECTION 00 42 43
Developer Awarded Projects - PROPOSAL FORM
CIBOLO HILLS PARKWAY - SECTION II & SECTION III
UNIT PRICE BIDBidder's Application
Project Item InformationBidder's Proposal
Bidlist Item No.DescriptionSpecification Section No.Unit of MeasureBid QuantityUnit PriceBid Value
UNIT III: DRAINAGE IMPROVEMENTS
13305.0109 Trench Safety33 05 10LF2079$0.00
23301.0012 Post-CCTV Inspection of Storm Drain33 01 32LF2079$0.00
33341.0201 21" RCP, Class III33 41 10LF304$0.00
43341.0205 24" RCP, Class III33 41 10LF84$0.00
53341.0208 27" RCP, Class III33 41 10LF166$0.00
63341.0309 36" RCP, Class III33 41 10LF386$0.00
73341.0402 42" RCP, Class III33 41 10LF129$0.00
83341.2003 10x6 Box Culvert33 41 10LF808$0.00
93341.2004 10x7 Box Culvert34 41 10LF202$0.00
103349.0001 4' Storm Junction Box33 49 10EA2$0.00
113349.0002 5' Storm Junction Box33 49 10EA1$0.00
123349.0102 4' Manhole Riser33 49 10EA2$0.00
133349.6001 10' Recessed Inlet33 49 20EA7$0.00
143349.7001 4' X 4' Drop Inlet33 49 20EA1$0.00
153349.7002 5' X 5' Drop Inlet33 49 20EA1$0.00
163137.0104 Medium Stone Riprap, dry31 37 00SY1443$0.00
179999.0001 PW-1 15° Skew 4:1 Wingwall W/ 5' Extended Curb00 00 00EA2$0.00
189999.0002 36" 6:1 Sloped End HW00 00 00EA2$0.00
199999.0003 42" 4:1 Sloped End HW00 00 00EA1$0.00
209999.0004 Remove 20 LF of 42" RCP and Headwall00 00 00LS1$0.00
219999.0005 12" Large Stone Type "A" Dry Rip Rap00 00 00SY110$0.00
229999.0006 Reuse and Install 12" Large Stone Type "A" Dry Rip Rap00 00 00SY43$0.00
239999.0007 Inlet Protection00 00 00EA9$0.00
TOTAL UNIT III: DRAINAGE IMPROVEMENTS$0.00
UNIT IV: PAVING IMPROVEMENTS
13211.0400 Hydrated Lime (42 lbs/sy)32 11 29TON145.4$0.00
23211.0502 8" Lime Treatment32 11 29SY6920$0.00
33213.0105 10" Conc Pvmt32 13 13SY6369$0.00
43213.0301 4" Conc Sidewalk (10')32 13 13SF24287$0.00
53217.2103 REFL Raised Marker TY II-A-A32 17 23EA57$0.00
63217.0504 Preformed Thermoplastic Contrast Markings - 24” Stop Bars00 00 00LF44$0.00
73217.1003 Lane Legend DBL Arrow32 17 23EA2$0.00
83213.0506 Barrier Free Ramp, Type P-132 13 20EA2$0.00
93291.0100 Topsoil32 91 19CY958$0.00
103292.0100 Block Sod Placement32 92 13SY5746$0.00
119999.0008 Construct Std. Pvmt Header00 00 00LF46$0.00
129999.0009 Constr Barricade00 00 00EA2$0.00
139999.0010 Remove Barricade and Connect to Existing Pavement Header00 00 00EA2$0.00
149999.0011 REFL PAV MRK TY I(Y)(6")(DBL)(SLD)00 00 00LF2241$0.00
159999.0012 Gravel Access Road00 00 00SY139$0.00
169999.0013 Stop Signs00 00 00EA2$0.00
179999.0014 All Way Sign R1-3P00 00 00EA3$0.00
189999.0015 Street Sign (Speed Limit) R2-100 00 00EA1$0.00
199999.0016 Street Sign R4-700 00 00EA1$0.00
209999.0017 Street Sign R5-100 00 00EA1$0.00
219999.0018 Street Sign Pole00 00 00EA4$0.00
229999.0019 6" Yellow Skip Lane Line w/ Type II-CR 4" Raised Pvmt Markers00 00 00LF122$0.00
TOTAL UNIT IV: PAVING IMPROVEMENTS$0.00
UNIT V: STREET LIGHTING IMPROVEMENTS
12605.3015 2" CONDT PVC SCH 80 (T)26 05 33LF2157$0.00
23441.3003 Rdwy Illum Assmbly TY 18,18A,19, and D-4034 41 20LF11$0.00
33441.3201 LED Lighting Fixture (138W)34 41 20EA22$0.00
43441.1632 Install Type 33A Arm34 41 20EA22$0.00
53441.3302 Rdwy Illum Foundation TY 3,5,6, and 834 41 20EA11$0.00
63441.1405 NO 2 Insulated Elec Condr34 41 10LF6471$0.00
73441.1502 Furnish/Install Ground Box Type B, w/Apron34 41 10EA3$0.00
TOTAL UNIT V: STREET LIGHTING IMPROVEMENTS$0.00
Bid Summary
UNIT III: DRAINAGE IMPROVEMENTS$0.00
UNIT IV: PAVING IMPROVEMENTS$0.00
UNIT V: STREET LIGHTING IMPROVEMENTS$0.00
Total Construction Bid$0.00
This Bid is submitted by the entity named below:
BIDDER:BY:<Name of Principal Here>
<Company Name Here>
<Address Here><Signature Here>
<Address Here or Blank>TITLE:<Title Here>
<City, State Zip Code Here>DATE:<Date Here>
Contractor agrees to complete WORK for FINAL ACCEPTANCE within# daysworking days after the date when the
CONTRACT commences to run as provided in the General Conditions.
END OF SECTION

&R&8&A

DAP - BID PROPOSAL

Page &P of &N

&L&8CITY OF FORT WORTH

STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS - DEVELOPER AWARDED PROJECTS

Form Version May 22, 2019&R&8Northbound Brewer Blvd City Project No. 103435 &F

00 42 43 - 16in Water

SECTION 00 42 43
Developer Awarded Projects - PROPOSAL FORM
CIBOLO HILLS PARKWAY - 16-INCH WATERLINE
UNIT PRICE BIDBidder's Application
Project Item InformationBidder's Proposal
Bidlist Item No.DescriptionSpecification Section No.Unit of MeasureBid QuantityUnit PriceBid Value
UNIT I: WATER IMPROVEMENTS
13305.0109 Trench Safety33 05 10LF1917$0.00
23311.0001 Ductile Iron Water Fittings w/ Restraint33 11 11TON3.93$0.00
33311.0541 16" Water Pipe33 11 10, 33 11 12LF1569$0.00
43311.0551 16" DIP Water33 11 10LF283$0.00
53305.0203 Imported Embedment/Backfill, CLSM33 05 10CY407.3$0.00
63305.2005 16" Water Carrier Pipe33 05 24LF65$0.00
73305.1005 30" Casing By Open Cut33 05 22LF65$0.00
83312.3006 16" Gate Valve w/ Vault33 12 20EA3$0.00
93312.0106 Connection to Existing 16" Water Main33 12 25EA2$0.00
103312.1002 2" Combination Air Valve Assembly for Water33 12 30EA1$0.00
113312.0001 Fire Hydrant33 12 40EA2$0.00
123312.6002 6" Blow Off Valve33 12 60EA1$0.00
139999.0020 16" Cleaning Wye00 00 00EA1$0.00
TOTAL UNIT I: WATER IMPROVEMENTS$0.00
Bid Summary
UNIT I: WATER IMPROVEMENTS$0.00
Total Construction Bid$0.00
This Bid is submitted by the entity named below:
BIDDER:BY:<Name of Principal Here>
<Company Name Here>
<Address Here><Signature Here>
<Address Here or Blank>TITLE:<Title Here>
<City, State Zip Code Here>DATE:<Date Here>
Contractor agrees to complete WORK for FINAL ACCEPTANCE within# daysworking days after the date when the
CONTRACT commences to run as provided in the General Conditions.
END OF SECTION

&R&8&A

DAP - BID PROPOSAL

Page &P of &N

&L&8CITY OF FORT WORTH

STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS - DEVELOPER AWARDED PROJECTS

Form Version May 22, 2019&R&8Northbound Brewer Blvd City Project No. 103435 &F

00 42 43 (A) - 16in Water ALT

Note: Provide the unit price for this alternate bid, but do not add its total to the project amount; it’s for City and developer cost calculations only
SECTION 00 42 43
Developer Awarded Projects - PROPOSAL FORM
CIBOLO HILLS PARKWAY - 16-INCH WATERLINE ALTERNATE
UNIT PRICE BIDBidder's Application
Project Item InformationBidder's Proposal
Bidlist Item No.DescriptionSpecification Section No.Unit of MeasureBid QuantityUnit PriceBid Value
UNIT I: WATER IMPROVEMENTS
13305.0109 Trench Safety33 05 10LF1917$0.00
23311.0001 Ductile Iron Water Fittings w/ Restraint33 11 11TON1.27$0.00
33311.0541 8" Water Pipe33 11 10, 33 11 12LF1569$0.00
43311.0551 8" DIP Water33 11 10LF283$0.00
53305.0203 Imported Embedment/Backfill, CLSM33 05 10CY407.3$0.00
63305.2005 8" Water Carrier Pipe33 05 24LF65$0.00
73305.1003 20" Casing By Open Cut33 05 22LF65$0.00
83312.3003 8" Gate Valve33 12 20EA2$0.00
93312.0117 Connection to Existing 4"-12" Water Main33 12 25EA2$0.00
103312.1002 2" Combination Air Valve Assembly for Water33 12 30EA1$0.00
113312.0001 Fire Hydrant33 12 40EA2$0.00
129999.0021 8" Cleaning Wye00 00 00EA1$0.00
TOTAL UNIT I: WATER IMPROVEMENTS$0.00
Bid Summary
UNIT I: WATER IMPROVEMENTS$0.00
Total Construction Bid$0.00
Note: Provide the unit price for this alternate bid, but do not add its total to the project amount; it’s for City and developer cost calculations only
This Bid is submitted by the entity named below:
BIDDER:BY:<Name of Principal Here>
<Company Name Here>
<Address Here><Signature Here>
<Address Here or Blank>TITLE:<Title Here>
<City, State Zip Code Here>DATE:<Date Here>
Contractor agrees to complete WORK for FINAL ACCEPTANCE within# daysworking days after the date when the
CONTRACT commences to run as provided in the General Conditions.
Note: Provide the unit price for this alternate bid, but do not add its total to the project amount; it’s for City and developer cost calculations only
END OF SECTION

&R&8&A

DAP - BID PROPOSAL

Page &P of &N

&L&8CITY OF FORT WORTH

STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS - DEVELOPER AWARDED PROJECTS

Form Version May 22, 2019&R&8Northbound Brewer Blvd City Project No. 103435 &F

00 43 13

SECTION 00 43 13
BID BOND
KNOW ALL BY THESE PRESENTS:
That we,, known as
"Bidder" herein anda corporate surety
duly authorized to do business in the State of Texas, known as “Surety” herein, are held and firmly bound unto the City of Fort Worth, a municipal corporation created pursuant to the laws of Texas, known as “City” herein, in the penal sum of five percent (5%) of Bidder’s maximum bid price, in lawful money of the United States, to be paid in Fort Worth, Tarrant County, Texas for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.
WHEREAS, the Principal has submitted a bid or proposal to perform Work for the following project
designated as<Final Bid Amount Here>
NOW, THEREFORE, the condition of this obligation is such that if the City shall award
the Contract for the foregoing project to the Principal, and the Principal shall satisfy all requirements and conditions required for the execution of the Contract and shall enter into the Contract in writing with the City in accordance with the terms of such same, then this obligation shall be and become null and void. If, however, the Principal fails to execute such Contract in accordance with the terms of same or fails to satisfy all requirements and conditions required for the execution of the Contract, this bond shall become the property of the City, without recourse of the Principal and/or Surety, not to exceed the penalty hereof, and shall be used to compensate City for the difference between Principal’s total bid amount and the next selected bidder’s total bid amount.
PROVIDED FURTHER, that if any legal action be filed on this Bond, venue shall lie in Tarrant County,
Texas or the United States District Court for the Northern District of Texas, Fort Worth Division.
IN WITNESS WHEREOF, the Principal and the Surety have SIGNED and SEALED this instrument by
duly authorized agents and officers on this theday of, 2026.
PRINCIPAL:
BY:
Signature
ATTEST:
Witness as to PrincipalName and Title
Address:
SURETY:
BY:
Signature
Name and Title
Address:
Witness as to SuretyTelephone Number:
Attach Power of Attorney (Surety) for Attorney-in-Fact
*Note:If signed by an officer of the Surety Company, there must be on file a certified extract from the by laws showing that this person has authority to sign such obligation. If Surety’s physical address is different from its mailing address, both must be provided. The date of the bond shall not be prior to the date the Contract is awarded.

&R&8&A

BID BOND

Page &P of &N

00 43 37

SECTION 00 43 37
VENDOR COMPLIANCE TO STATE LAW NON RESIDENT BIDDER
Texas Government Code Chapter 2252 was adopted for the award of contracts to nonresident bidders. This law provides that, in order to be awarded a contract as low bidder, nonresident bidders (out-of-state contractors whose corporate offices or principal place of business are outside the State of Texas) bid projects for construction, improvements, supplies or services in Texas at an amount lower than the lowest Texas resident bidder by the same amount that a Texas resident bidder would be required to underbid a nonresident bidder in order to obtain a comparable contract in the State which the nonresident’s principal place of business is located.
The appropriate blanks in Section A must be filled out by all nonresident bidders in order for your bid to meet specifications. The failure of nonresident bidders to do so will automatically disqualify that bidder. Resident bidders must check the box in Section B.
A.Nonresident bidders in the State of, our principal place of business,
are required to bepercent lower than resident bidders by State Law. A copy of the
statute is attached.
Nonresident bidders in the State of, our principal place of business,
are not required to underbid resident bidders.
B.The principal place of business of our company or our parent company or majority owner is
in the State of Texas.
BIDDER:
By:
(Signature)
Title:
Date:
END OF SECTION

00 45 12

SECTION 00 45 12
PREQUALIFICATION STATEMENT
Each Bidder for a City or Non-City procurment is required to complete the information below by identifying the prequalified contractors and/or subcontractors whom they intend to utilize for the major work type(s) listed.
Major Work TypeContractor/Subcontractor Company NamePrequalification Expiration Date
<List Work Type Here or Blank>
Example: Wastewater New Development Open Cut (35” and under); Water New Development Open Cut (24” and under)<Company Name Here or Blank><Date Here or Blank>
<List Work Type Here or Blank><Company Name Here or Blank><Date Here or Blank>
<List Work Type Here or Blank><Company Name Here or Blank><Date Here or Blank>
<List Work Type Here or Blank><Company Name Here or Blank><Date Here or Blank>
The undersigned hereby certifies that the contractors and/or subcontractors described in the table above are currently prequalified for the work types listed.
BIDDER:
<Company Name Here>BY: <Name of Principal>
<Address Here>
<Address Here or Blank>
<City, State, Zip Code Here>(Signiture)
TITLE <Title Here>
DATE: <Date Here>

&R&8&A

PREQUALIFICATION STATEMENT

Page &P of &N

&L&8CITY OF FORT WORTH

STANDARD CONSTRUCTION SPECIFICATION DOCUMENTS

Revised 09/30/2021&R&8&F

File details come from the government source that posted it. Updated .