EARL TOWNSHIP

19 SCHOOLHOUSE ROAD

BOYERTOWN, PA 19512

BID DOCUMENTS

FOR

2026 ROAD WORK

BID PROPOSALS DUE: THURSDAY, APRIL 16, 2026 by 2:00 PM

VIA PENNBID

BID OPENING: THURSDAY, APRIL 16, 2026 AT 3:00PM

VIA PENNBID

BID AWARD: MONDAY, APRIL 20, 2026 AT 7:00PM

AT THE EARL TOWNSHIP BUILDING

INVITATION TO BIDDERS

Bid proposals will be received by the Earl Township Board of Supervisors until 2 pm, prevailing time, Thursday, April 16, 2026 via PennBID (https://pennbid.bonfirehub.com) only for the following scope of work:

2026 Roadwork – placement of ¾” 9.5mm Leveling Course (appx. 1,806 Tons) and 9.5mm

Wearing Course overlay (approx. 3,609 Tons) and 4” 25mm Base Course (appx. 734 SY), base repair (appx. 388 SY), milling (appx. 3,085 SY) and other work as specified in the Bid

Documents. An alternate bid for 260 SY of paving fabric is also included.

Bids will be opened via PennBID and results posted online at approximately 3 pm, prevailing time, Thursday April 16, 2026. The contract will be awarded or rejected, during the Earl

Township Board of Supervisors meeting held on Monday, April 20, 2026 at 7:00 p.m. at the Earl

Township Municipal Building, 19 Schoolhouse Road, Boyertown, PA 19512.

Contract documents are available through the PennBID system; Bids must be submitted on forms furnished by the Township and available on PennBID.

All work must be completed between by August 21, 2026. Liquidated damages apply at a rate of $500.00 per calendar day.

Pennsylvania Prevailing Wage Rates apply to this Contract.

A pre-bid review/inspection is required and can be arranged by contacting the Earl Township

Roadmaster at (610) 342-6590 between 7 am & 3 pm, Monday-Friday.

A certified check or bank draft, payable to Earl Township or a satisfactory bid bond executed by the bidder and acceptable sureties in an amount equal to ten percent (10%) of the bid shall be submitted with the bid. In addition, the following documents must be included with the bid package: proof of PennDOT prequalification, workman’s compensation affidavit, insurance certificate, CDL compliance certificate, public works verification form and anti-collusion affidavit.

A performance bond or certified check in the amount of 100% of the contract price as well as the payment bond shall be furnished by the successful bidder within 20 days after contract is awarded.

Earl Township reserves the right to reject any or all bids submitted or any part thereof or item therein that may not be in the public’s best interest. The Township also reserves the right to waive any defects, errors, omissions, irregularities or informalities in bids received.

Township of Earl

Janice Haller

Secretary-Treasurer https://pennbid.bonfirehub.com/

Earl Township 2026 Paving Locations

Base Bid

Leveling Course plus Wearing Course:

1. Sunset Hill Road – Approximately 2,910’ x 25’ (average) from Route 73 to Mountain Road; Road width varies from 22 to 27’.

2. Terrace Road –Approximately 2,916’ x 23’ (average) from Route 73 to Pond; Road width varies with portions at 21’ and others at 28’.

3. Hauseman Road

a. Approximately 1,467’ x 23’ - from Colebrookdale Twp Line to Pond Road

b. Approximately 648’ x 23’ from Colebrookdale Twp Line to Sawmill Road

4. Grims Mill Road – 833’ x 23’ from Pond Road to Colebrookdale Township Line

5. Pond Road – 2,261’ x 22’ (average) from Grims Mill Road to Route 73; Road width varies 20’ to

24’

6. Kristine Avenue – Approximately 1,464’ x 25’ (average) from Terrace Road to Cul-de-Sac (50’

Radius); Road width ranges from 24’ to 28’.

7. Laura Court – 726’ x 25’ (average) from Terrace Road to Cul-de-Sac (50’ Radius)

Base Repair:

1. Pond Road total 86 SY

- #1 – 4’ x 27’

- #2 - 10’ x 60’

2. Sunset Hill Road - total 93 SY

- #1 – 8’ x 84’

- #2 – 4’ x 22’

3. Laura Court – 209 SY

-#1 57’ x 30’ area to be investigated and base repair done in this area

Base Course Installation & Temporary Paving Removal

1. Sunset Hill Road

a. Remove 2” depth temporary paving and 2” stone base along recent 2’ road widening (534 SY)

b. Remove 2” depth temporary paving and 2” stone base along 7 new inlet boxes and over 7 culvert pipes (200 SY).

c. Install 4” compacted depth Superpave Base Course, 25mm in above removal areas

(734 SY)

Milling:

1. Kristine Ave – 7’ wide along curbline, both sides of road, tapered from 0” to 1-1/2” and around cul-de-sac bulb (rolled curb on this street) - 2616 SY

2. Laura Court – 7’ wide along curbline (233’ section) and around outer edge cul-de-sac bulb curb

(315’) (rolled curb on this street) – 469 SY

Alternate Bid 1

Laura Court, Install 260 SY Paving fabric - Petromat 4598 by Propex (1-800-621-1273) or approved equal.

MS-944 02-01 PROPOSAL & CONTRACT (THIS PROPOSAL INCLUDES

(WHEN EXECUTED) INSTRUCTIONS TO BIDDERS)

A. DEPOSIT OF PROPOSALS.

Bids shall be submitted via PennBID for EARL TOWNSHIP

“2026 Roadwork” Municipality Name and Type for Letting of

April 16, 2026 JANICE HALLER

Date Secretary

Sealed Proposals will be received on or before

2:00 P.M., on April 16, 2026 via PennBID 19 SCHOOLHOUSE RD

Time Address

Bids will be opened on PennBID and posted approximately BOYERTOWN, PA 19512

3:00 P. M. on the above Bid Due Date. Proposals must be submitted via PennBID.

1. The contractor proposes to furnish and deliver all materials (including Form TR-465 Daily Bituminous Mixture

Certification) and to do and perform all work in the bid for the following project as more specifically set forth in the

Schedule of Prices (Attachment), in accordance with drawings and specifications on file at the Earl Township Municipal

Building at the above address as well as the supplements and special requirements contained herein and/or attached hereto and current PennDOT specifications (Publication 408), except (a) volumetric testing of bituminous paving materials is not required (Sec. 409). Bidders need to be prequalified by PennDOT (Sec. 102.01).

2. If designated as the successful bidder, the contractor may begin work on the date specified in the notice to proceed, or as otherwise provided in the special requirements, and will complete all work on or before August 21, 2026. If all work is not completed on time, liquidated damages will be assessed at the rate of $_500.00 per additional calendar day.

3. Accompanying this proposal is a certified check or bid Bond in the amount of 10% of the bid made payable to the municipality as a proposal guarantee which, it is understood, will be forfeited in case the contractor fails to comply with the requirement of the proposal.

B. PROPOSAL OF: _____________________________________________________________________________ Name of Contractor

Address

CONTRACTOR’S CERTIFICATION

It is hereby certified as follows:

1. The only person(s) interested in this proposal as principal(s) is (are): ________________________________

2. None of the above persons are employees of the municipality.

3. This proposal is made without collusion with any other person, firm, or corporation.

4. All plans and specifications referred to above and the site of the work have been examined by the contractor.

The contractor understands that the quantities indicated herein are approximate and are subject to change as may be required; and that all work is payable on the basis of the unit prices listed on the Schedule of Prices (Attachment

1).

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5. The contractor will comply with all requirements of the laws and implementing regulations of the Commonwealth of

Pennsylvania and the United States relating to human relations, equal opportunity and non-discrimination in employment, and will pay to workmen employed in the performance of the contract the wages to which they may be entitled.

6. The contractor will provide the municipality with a 100% performance bond, conditioned upon the faithful performance of the contractor in accordance with the plans, specifications and conditions thereof, and a 100% payment bond conditioned on the prompt payment of all material furnished and labor supplied or performed in the prosecution of the work, in accordance with the Public Work’s Contractors’ Bond Law of 1967; These items shall be submitted within 20 days of notice of award.

7. The contractor, with the bid submission, shall include a dually signed copy of the project specifications, an affidavit accepting the provisions of the Workmen’s Compensation Act of 1915, as amended, an insurance certificate, an anti-collusion affidavit, a public works employment verification form, CDL compliance certificate and proof of PennDOT prequalification.

8. “The parties agree that the relationship between the Contractor and Earl Township is one of independent contractor and not the employer/employee and that the individual employees of the Contractor who will be performing the work pursuant to this contract are not employees of Earl Township. Contractor hereby certifies, represents and warrants to the Township that all persons performing any aspect of the work pursuant to this Contract who are required to have commercial driver’s license are subject to a program for drug and alcohol testing in accordance with the Omnibus Transportation Employee

Testing Act of 1991 and the federal regulations adopted pursuant thereto.”

Contractor

WITNESSED OR ATTESTED BY:

BY:______________________________________

Title (Seal)

Title

SEAL

TO BE EXECUTED ONLY IN THE EVENT THE ABOVE PROPOSAL IS ACCEPTED

ACCEPTED ON:_______________________________________

Date

Municipality

ATTESTED BY:

________________________________________ BY:_______________________________________ Title Title

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ATTACHMENT #1 (page 1 of 3)

County: Berks Municipality: Earl Township Project No.: 2026 Road Work T

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LOCATION OF WORK

Sunset hill Road, Terrace Road, Hauseman Road, Grims Mill Road, Pond Road, Kristine Avenue, Laura Court in Earl Township, Berks County; Hauseman Road in Colebrookdate Township, Berks

County. All ADTs < 1000.

DESCRIPTION OF WORK:

As indicated below and in Attachments. Follow PADOT Pub. 408.

ESCALATOR CLAUSE:

Per Pub. 408 Section 110.04 Current Edition. Bituminous Price Adjustment applies to this contract.

Contractor required to supply Form CS-1-PA when applicable. Bid index is March 2026

SCHEDULE OF PRICES

1.Item

No.

2. Approx.

Quantities

3.

Units

4.*Description 5. Unit

Price

6. Total

Tons

SY

Sunset Hill Road (2910’ long x 25’ wide)

From Route 73 to Mountain Road

Mill paving notch, sweep and apply tack coat, pave Superpave, HMA overlay Wearing Course, PG-64S-22, 0.3 to 3.0 million ESAL’s, 9.5 mm mix, 1.5” minimum compacted depth, SRL-L, and seal joints.

Place 3/4" leveling 9.5mm 0.3 – 3.0 ESALS, PG-64-22, SRL "L"

Base Repair - Excavate (mill as directed) and remove areas to be repaired to a depth of 4". Compact subgrade and place and compacted to 4"

Superpave Base Course 25mm 0.3 – 3.0 million ESALS PG-64-22 to grade. Seal joints per Pub. 408.

Remove existing 2” temporary paving and 2” stone base and replace with

4” Superpave Base Course 25mm 0.3 – 3.0 million ESALs PG-64-22 to grade.

Terrace Road (2916’ long x 23’ wide) from Route 73 to Pond

Place 3/4" leveling 9.5mm 0.3 – 3.0 million ESALS, PG-64-22, SRL "L"

Hauseman Road (1467’ long x 23’ wide) from Twp Line to Pond

Hauseman Road (648’ long x 23’ wide) from Twp Line to Sawmill

Only

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PennBID

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PennBID

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*DESCRIPTION

Must include ADT on Wearing surfaces.

USE OF CUTBACK ASPHALT IS PROHIBITED BETWEEN MAY 1st

AND OCTOBER 31st EXCEPT AS NOTED IN BULLETIN NO. 25.

ATTACHMENT #1 (page 2 of 3)

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Contractor required to supply Form CS-1-PA when applicable. Bid index is March 2026

SCHEDULE OF PRICES

1.Item

No.

2. Approx.

Quantities

3.

Units

4.*Description 5. Unit

Grims Mill Road (833’ long x 23’ wide) from Pond to Twp Line

Pond Road (2261’ x 22’) from Route 73 to Grims Mill Road

Place 3/4" leveling 9.5mm 0.3 – 3.0 ESALS, PG-64-22, SRL "L"

Kristine Ave (1464’ long x 25’ wide) from Terrace Rd to End

Curbline Milling, 7’ wide, 0 to 1-1/2” taper

Laura Court (726’ long x 25’ wide) from Terrace Rd to End

Curbline Milling, 7’ wide, 0 to 1-1/2” taper

Pricing

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PennBID

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PennBID

Pricing

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*DESCRIPTION

Must include ADT on Wearing surfaces.

ATTACHMENT #1 (page 3 of 3)

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Contractor required to supply Form CS-1-PA when applicable. Bid index is March 2026

SCHEDULE OF PRICES

1.Item

No.

2. Approx.

Quantities

3.

Units

4.*Description 5. Unit

ALTERNATE BID #1

Paving fabric shall be Petromat 4598 by Propex (1-800-621-1273) or approved equal.

Pricing

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PennBID

Pricing

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Only

Put

Pricing

On

PennBID

Pricing

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*DESCRIPTION

Must include ADT on Wearing surfaces.

Attachment 1-A

SPECIFICATIONS AND SPECIAL PROVISIONS TO CONTRACT MS-944

CONTAINS IMPORTANT INFORMATION FOR THE CONTRACTOR(S)

The Prime Contractor(s) and subcontractors must comply with all of the following provisions:

TRAFFIC CONTROL

- Traffic Control and Safety Devices to be provided by the Contractor(s) in compliance with the current MUTCD, PennDOT Publication 212 and Publication 213.

- Roadways may be closed to through traffic, however, school buses, emergency vehicles and residents in the work area must be able to pass through during work hours.

GENERAL

- A pre-bid meeting is mandatory and can be scheduled by contacting Township Roadmaster Brad McIlvee at (610) 342-

6590 between the hours of 7:00 a.m. and 3:00 p.m. Monday through Friday.

- Work may not begin until the replacement seven culverts and seven inlet boxes and 2’ road widening on Sunset Hill Road is completed. Culvert contract includes 2” temporary pavement restoration along widening and culverts and is required to be completed by April 30, 2026. Roadwork may begin upon receipt of Notice to Proceed.

- Work to be completed on or before August 21, 2026. After 8/21/26, liquidated damages apply at $500/day.

- The Contractor(s) shall notify the Municipality and public five (5) calendar days prior to the start of the project.

- Prevailing wages apply to this project.

- Delivery tickets shall be submitted for all materials.

- Submit Bill of Lading for each shipment of bituminous material per Section 702.1(c) of PENNDOT Spec. Form 408.

- CS-4171 Certificate of Compliance and/or TR-465 Daily Bituminous Mixture Certification is required for all materials.

- Final Completion Certificate & Notice of Completion required

- Contractor(s) is (are) responsible for defects that occur within one year of applications.

- Municipality will inspect the project.

- Municipality reserves the right to limit work completed.

- Municipality reserves the right to procure material which best suits their requirements after all bids & items are reviewed.

- Municipality reserves the right to make an award on the basis of the aggregate total for all like items on which quotations are received.

- Future award of Contracts will be based on quality of work as determined by the Municipality.

- Pennsylvania Prevailing Wage Rates apply to this Contract.

- Completion of NON-COLLUSION AFFIDAVIT required.

- Contractor(s) shall be PENNDOT prequalified and must supply proof of prequalification with the bid package.

- Contractor(s) to supply proof of CDL Drug and Alcohol Compliance.

- The successful bidder(s) must provide a 100% Performance Bond and a 100% Payment Bond within 20 days of the award of the contract.

-Notice to Proceed will be the date of contract acceptance.

- Contractor(s) must complete and submit CS-1PA, Price Adjustment of Bituminous Material if applicable.

- Where Contract references current PennDOT specifications (Publication 408) or PennDOT Specifications Form 408, the latest version applies.

- Contractor’s equipment may not leave project location until the contracted work has been completed.

- Incidental preparation and clean up required by Contractor. (Project Construction Materials)

- Township is responsible for replacing permanent paving markings.

- Township is responsible for obtaining any necessary storm sewer inlet box or manhole risers.

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County: Berks Municipality: Earl Township Project No.: 2025 Road Work

Attachment 1-A

SPECIFICATIONS AND SPECIAL PROVISIONS TO CONTRACT MS-944

CONTAINS IMPORTANT INFORMATION FOR THE CONTRACTOR(S)

BITUMINOUS PAVING

- Complete all testing in accordance with PENNDOT Specifications Form 408 Section 409 except volumetric testing.

- Tack Coat is required per Section 460 / 409 of PennDOT Specifications Form 408 and is incidental to paving.

- Bituminous Seal on all abutting pavement, manholes, inlets and curbs required after wearing course.

- Saw cut or Milled Paving Notch per RC-28M is required and incidental to paving.

- Existing driveways shall be transitioned to maintain positive drainage along roadway gutterline and sufficient access to property as necessary.

- Milling of driveway notches is to be done as directed by the Township Roadmaster and in a fashion that maintains the shoulder slope and provides a smooth transition from the driveways to the shoulder and shall be considered incidental to the contract.

- Any needed milling around existing inlet boxes in areas where lane milling is not proposed shall be considered incidental to the contract.

- Roadway is to be power broomed by the Contractor prior to start of paving.

- Contractor to remove all excess material from the project site.

- Roadway cross-slope shall match existing unless otherwise directed by Township inspector. Minimum cross-slope to be

¼” per foot and if existing cross-slope does not meet this, then leveling course shall be utilized to achieve said grade.

-Scratch/leveling course to be placed at discretion of appointed inspector(s).

-Scratch/leveling course must be compacted with a pneumatic tired roller.

- Paving must be done in two passes.

My signature signifies that I have read and understand the above conditions and special provisions to this contract, and by being authorized by this company to act as their authorized representative, and on their behalf hereby agree to adhere to any and all of the provisions pertaining to this contract.

Contractor’s Representative Date Municipality’s Representative Date

______________________________________________ _____ EARL TOWNSHIP_ _

Company Municipality

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MS-944S PAYMENT BOND Attachment 3

KNOW ALL MEN BY THESE PRESENTS, that we as PRINCIPAL and a corporation incorporated under the laws of the State of as SURETY, are held and firmly bond unto the , in the full and just sum of

($ )dollars, lawful money of the United States of America, to be paid to the said or its assigns, to which payment 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 above bounden Principal has entered into a contract with the above municipality hereinafter called Obligee, bearing even date herewith, for the improvement of a certain section of highway or bridge in said Municipality consisting of:

for approximately the sum of: ($ ) dollars.

NOW, THEREFORE, the condition of this obligation is such that if the above bounden PRINCIPAL shall and will promptly pay or cause to be paid in full all sums of money which may be due by contract or otherwise, to any individual, firm, partnership, association or corporation, for all material furnished or labor supplied or performed in the prosecution of the work, whether or not the said for material or labor entered into and became component parts of the work and for rental of the equipment used and services rendered by public utilities in, or in connection with the prosecution of such work, then this obligation to be void, otherwise to remain in full force and effect.

The PRINCIPAL and SURETY, hereby, jointly and severally, agree with the Obligee herein that any individual firm, partnership, association or corporation, which has performed labor or furnished material in the prosecution of the work as provided, and any public utility which has not been paid in full therefor, may sue in assumpsit on this Payment Bond in his, their, or its own name and may prosecute the same to final for such sum or sums as maybe justly due him, them or it, and have execution thereon.

Provided, however, that the Obligee shall not be liable for the payment of any costs of expenses of such suit.

RECOVERY by any individual, firm, partnership, association or corporation hereunder shall be subject to the provisions of the “Public Works Contractors’ Bond Law of 1967", Act No. 385, approved December 20, 1967,P.L. 869, which Act shall be incorporated herein and made a part hereof, as fully and completely as though its provisions were fully and at length herein recited.

It is further provided that any alterations which may be made in the terms of the contract or in the work to be done or materials to be furnished or labor to be supplied or performed under it or the giving by the Obligee of any extension of time for the performance of the contract or any other forbearance on the part of either the Obligee or the Principal to the other, shall not in any way release the PRINCIPAL and the SURETY or SURETIES of any such alteration, extension of forbearance being hereby waived.

IN WITNESS WHEREOF, the said PRINCIPAL and SURETY have duly executed this Bond under seal this day of ,20 .

PLACE

HERE

WITNESS:

CONTRACTOR

TITLE:

BY:

TITLE:

PLACE

HERE

WITNESS:

SURETY COMPANY

TITLE: TITLE:

AFFIDAVIT RE

Attachment 4

ACCEPTING PROVISIONS OF THE WORKMEN’S COMPENSATION ACT

State of )

) ss:

County of ) he has being duly sworn according to law deposes and says that they have it has accepted the provisions of the Workmen’s Compensation Act of 1915 of the Commonwealth of Pennsylvania, with has his its supplements and amendments, and have insured their liability thereunder in accordance with the terms of said its

Act with .

(SURETY COMPANY)

( TYPE OR PRINT) CONTRACTOR

BY

SIGNATURE

Sworn to and subscribed before me this day of A.D. 20 .

SIGNATURE

My Commission Expires ( DATE )

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D-7126 ( 7-09 )

ANTI-COLLUSION AFFIDAVIT

County Berks

Municipality Earl Township

Project Number 2026 Road Work

State of Fed. Project No.

( If Applicable )

County of

The undersigned deponent deposes and says that he is the ____________________ of the Company; that he is authorized to make this affidavit on behalf of said company in compliance with section 102.06 (e) of Department Specifications, Publication 408, as amended and that the said company has not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive bidding in connection with such contract.

(Contractor)

BY

Sworn to and subscribed before me the undersigned notary public this day of , .

Notary Public

My Commission expires

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Rev 2/15 PSATS CDL Program Form Contractor

Contractor’s Statement of Compliance with

CDL Testing Program Requirements

Due to the nature of the work that this contractor may perform for this employer, this contractor must use employees who perform safety-sensitive functions for which a Commercial

Driver’s License (CDL) is typically required. Section 49 CFR 382.301(c)(2) of the federal CDL regulations requires that, prior to the first time an employer uses a CDL employee employed by another entity (i.e., a contractor to whom the township is awarding a contract), and every six months of the contract, this employer must certify that any CDL employees used by each contractor remain covered by a qualified CDL drug and alcohol testing program.

An original signed copy of this form must be permanently retained by the employer with this contract and a new form received every 6 months of the contract’s duration.

If the contractor is not participating in a qualified CDL drug and alcohol testing program at the time of the awarding of the contract, or at any six-month re-certification point, then all the contractor’s CDL employees must obtain a negative result on a pre-employment drug test before beginning (or continuing) contracted work for this employer.

Contractor Name__________________________________________________________________________

By signing here, I, as the contractor’s authorized representative, verify that the contractor named above is a current participant in the below identified CDL testing program conforming to 49 CFR Part 40.

Contractor’s Authorized Representative ________________________________________________________

Today’s Date ____/____/____

Signature of Authorized Representative ________________________________________________________

CDL Testing Program Name ________________________________________________________________

Testing Program Contact Person ____________________________________________________________

Testing Program Address __________________________________________________________________

Phone #: ( ) City ______________________________ State _____ Zip __________

Contact person confirms program conforms to 49 CFR Part 40? (_____) Yes (______) No

Contact person confirms list of contractor’s CDL employees covered in this program and that all drivers are qualified to driver under 49 CFR Part 382.301? (_____) Yes (______) No

Commonwealth of Pennsylvania

Public Works Employment Verification Form

Public Works Employment Verification Office Department of General Services Bureau of Procurement 6th floor, Forum Place 555 Walnut Street

Harrisburg, PA 17101-1914

717-346-8115 ra-gsgseverify.pa.gov

Instructions: Complete and return the form to the contracting Public Body prior to the award of the contract.

Business or Organization Name (Employer)

Address

City State Zip Code

Check One:

Contractor

Subcontractor

Contracting Public Body

Contract/Project No.

Project Description

Project Location

Date enrolled in E-Verify

As a contractor/subcontractor for the above referenced public works contract, I hereby affirm that as of the above date, our company is in compliance with the Public Works Employment Verification Act (‘the

Act’) through utilization of the federal E-Verify Program (EVP) operated by the United States

Department of Homeland Security. To the best of my/our knowledge, all employees hired post January

1, 2013 are authorized to work in the United States.

It is also agreed to that all public works contractors/subcontractors will utilize the federal EVP to verify the employment eligibility of each new hire within five (5) business days of the employee start date throughout the duration of the public works contract. Documentation confirming the use of the federal

EVP upon each new hire shall be maintained in the event of an investigation or audit.

I, , authorized representative of the company above, attest that the information contained in this verification form is true and correct and understand that the submission of false or misleading information in connection with the above verification shall be subject to sanctions provided by law.

Authorized Representative Signature Date of Signature

CERTIFICATE OF INSURANCE

NAME OF INSURED

ADDRESS

COVERAGE LIMITS OF LIABILITY EXPIRATION POLICY NO.

DATE

I. WORK.MEN'S State/Federal Statutory COMPENSATION Employer's Liability $I 00,000/$500,000/$100,000

Bodily Injury Property Damage

2. COMPREHENSfVE D Comprehensive Form Each Occurrence Each Occurrence COMMERCIAL D Premises- ($2,000,000 rcq 'd) ($ 1,000,000 req 'd)

GENERAL

LIABlLITY

Operations Explosion & Collapse Annual Aggregate Annual Aggregate

D Hazard ($2,000.000 re 'd ($1,000,000 re 'd D Underground Hazard D Products/ Completed

Operations Hazard D Contractural

Insurance D Broad Form Property

D Damage Independent Contractors

D Personal Injury Including Employees Each Occurrence Aggregate

($ 1,000,000 req 'd) ($1,000,000 rcq 'd)

3. AUTOMOTfVE D Comprehensive Form Each Person Each Occurrence LIABILITY D Owned ($500,000 req 'd) ($250,000 req 'd)

Hired OR D Non-Owned

Each Occurrence Combined Single ($1,000,000 req 'd) Limit of$1,000,000

4. EXCESS LIABILITY D Umbrella Form Each Occurrence ($5,000,000) D Other Than Umbrella

Form Annual Aggregate ($5,000,000)

5. OTHER-PROPERTY D Builders Risk Full Replacement Cost INSURANCE Installation Floater

Technicon Enterprises Inc. II Earl Township

Name (print):

Running Avg. of 5

%AC

Daily No. 1

Wearing Course

Specimen #1Test Results Pass #8

Plant:

Location:

Binder Course Base Course

Signature:

Title:

Publication 408, Section:

P.O. No.

Consigned to:

Material Class:

Plant Code:

Daily No. 2

County

PennDOT Maintenance

Municipality

Contractor S.R.

Group / P.O.C. No. ECMS No.

ESALS SRL PG Grade

Section

County

Date Shipped:

Daily No. 3

Daily AASHTO T209 Density:

Pass #200

Daily Avg.

Specimen #2 Specimen #1 Specimen #2

Air Voids VMA

CS-4171B (2-16) Formerly TR-465

CERTIFICATE OF COMPLIANCE

FOR DAILY BITUMINOUS MIXTURES

Please select the Payment factor percentage below, based on Pub 408 Sec.409.4(a) Table H:

Defective Pavement: The material as listed above shipped on this date does not conform to the certification tolerances for 100% pay as listed in Pub 408 Sec. 409.2(e) Table A. QC test results are being forwarded to the Inspector-In-Charge which indicate material must be removed and replaced or accepted at 50% CUP with District Executive approval in writing. Our records attesting to this statement are open for inspection by a Department Representative for not less than THREE years from the date of shipment.

Job Mix Formula: (Year-Number):

100% Payment Factor: The material as listed above shipped on this date conforms fully with the specification requirements of the Pennsylvania Department of Transportation. Our records, attesting to this statement, are open for inspection by a Department Representative for not less than THREE years from the date of shipment.

85% Payment Factor: The material as listed above shipped on this date does not conform to the certification tolerances for 100% pay as listed in Pub 408 Sec. 409.2(e) Table A. A reduced pay factor has been applied and QC test results are being forwarded to the Inspector-In-Charge. Our records attesting to this statement are open for inspection by a Department Representative for not less than THREE years from the date of shipment.

Tons Shipped:

MS-NCP

MUNICIPALITY

Name of Contractor

Performance of work as specified on the above numbered contract is completed and final pavement inspection has been made by the contractor and municipality in accordance with the terms of the contract awarded.

DATE OF AWARD

Both copies of this form to be filled by the Contractor-Municipality on completion of final pavement restoration

NOTICE OF COMPLETION

IN REFERENCE TO PROJECT #

Signature of Contractor

Signature of Municipality pavement restoration.

*DATE

period of one year from this date.

* The contractor is responsible for maintenance of permanent pavement repairs for a

By the affixing of my signature I hereby certify that final accordance with the above contract # and is hereby accepted inspection has been made and all work has been performed in

FINAL COMPLETION CERTIFICATE

THIS PORTION TO BE COMPLETED BY MUNICIPALITY

Authorized Agent for the Municipality by the municipality as completed.

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