900070 bid forms 2023.pdf

BID – PROJECT #900070 PAGE 1 of 4

CITY OF EUGENE

BID

MARCH 9, 2023, 2:00 P.M. PROJECT #900070

BID #4

TO THE CITY ENGINEER BIDDER:___________________

EUGENE, OREGON

The undersigned Bidder declares:

That Bidder has carefully examined and incorporates in this Bid, by this reference all documents included in the Contract Documents and Specifications for this job which includes but is not limited to the Plans, City Standard

Specifications and Standard Drawings, Supplemental Specifications and Special Provisions, and City of Eugene

Amendments #1 and #2, Addenda, Bid Schedule, Prevailing Wage Rates, Contract Form, and Bond Form for

8TH AVENUE STREETSCAPE AND BIKEWAY

FEDERAL AID PROJECT: 2385(108) ODOT KEY NO: 21378

PUBLIC IMPROVEMENT PROJECT

That Bidder has made an examination of the site of the proposed work and has made such investigations as are necessary to determine the character of the material and the conditions to be encountered, independently of the indication on the plans; and that if the Bid is accepted, Bidder will contract with the City of Eugene as provided in the

Solicitation Document, will to the extent of this Bid, provide the necessary machinery, tools, apparatus, and other means of construction, and will furnish all material and labor as specified, or called for by the Plans or necessary to complete the work in the manner specified and in accordance with the requirements of the Engineer.

The undersigned also agrees that Bidder will commence work and will have the project completed as specified in the Special Provisions and that Bidder will pay as liquidated damages to the City for any delay as specified in the Special Provisions.

BIDDER INFORMATION:

A. Bonds

All Bids shall be accompanied by a Bid guaranty in the amount of 10% of the total amount of the Bid.

Acceptable Surety companies are limited to those authorized to do business in the State of Oregon. Forfeiture of Bid guaranties is covered by 00130.60, and return of guaranties is covered by 00130.70.

The Bid guaranty shall be either a Surety bond, irrevocable letter of credit issued by an insured institution as defined in ORS 706.008, or security in the form of a cashier's check or certified check made payable to the Agency.

(See ORS 279C.365(4).)

If a Surety bond is submitted, Bidders shall use the Agency's standard Bid Bond form included with the paper

Bid Booklet. Bidders shall submit the bond with original signatures and the Surety's seal affixed.

BID – PROJECT #900070 PAGE 2 of 4

B. Registration

Except for a Bidder on a Federal-Aid project, the Bidder shall have a valid Certificate of Registration with the Construction Contractor Board/State Landscape Contractors Board in order to submit a Bid or offer to undertake any Construction Work in the State of Oregon and shall furnish the Bidder’s registration number and expiration date below. (ORS 279C.365(1)(k), ORS 701.021, ORS 701.026 and ORS 671.530). On a Federal-Aid project, see

00130.40 regarding registration requirements.

REGISTRATION NO. ____________________ EXPIRATION DATE __________________

The undersigned Bidder agrees that all subcontractors performing work on the public improvement Contract will be registered with the Construction Contractors Board or licensed by the State Landscape Contractor’s Board before the subcontractors commence work under the Contract. (ORS 701.021, ORS 701.026 and ORS 671.530).

C. Experience

The information on this form may be utilized by the Agency to consider whether a Bidder has met the standards of responsibility set forth in ORS279C.375.

Current Contracts in Force/Previous Experience – minimum of three required of similar nature with public sector work.

Contract #1

Location (city/state)

Owners Name

Type of Work

% Completed

Estimated Completion Date

Contract #2

Location (city/state)

Owners Name

Type of Work

Contract #3

Location (city/state)

Owners Name

Type of Work

BID – PROJECT #900070 PAGE 3 of 4

CERTIFICATIONS

Bidder also agrees and certifies to the following:

A. Non-Involvement in Any Debarment and Suspension – The Bidder, its owners, directors, principals, and officers:

a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;

b. Have not within a three-year period preceding this Bid been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity

(Federal, State, or local) with commission of any of the offenses enumerated in the preceding paragraph of this Certification; and

d. Have not within a three-year period preceding this Bid had one or more public transactions (Federal, State, or local) terminated for cause or default.

Where the prospective primary participant is unable to certify to any of the statements in this Certification, the prospective primary participant shall attach an explanation to this Bid.

List exceptions in writing on one or more pages, as necessary, with the heading, “Certification Exceptions, Bid Insert,” and attach all pages to this Bid Certification. For each exception noted, indicate to whom the exception applies, initiating agency, and date(s) of action.

B. The undersigned Bidder acknowledges that the amount of damages City might suffer by reason of a failure to complete the project by the completion date noted above would be difficult or impossible to compute, and therefore agrees that the stipulated amount of liquidated damages set forth in 00180.85 for such delay is a fair and reasonable measure of damages, and therefore Bidder agrees that it will not contest such sum as being other than a true measure of damages in the event of a failure to complete the project by the stipulated completion date.

C. The provisions of ORS 279C.800 to 279C.870 pertaining to prevailing wage rates shall be complied with;

D. Where asbestos abatement is required the abatement shall be done by Department of Environmental Quality certified workers and the abatement shall be performed in conformity with DEQ and OSHA regulations and other standards related to work place safety

E. Bidder is ____ is not ____ a Resident Oregon Bidder, as defined by ORS 279A.120. "Resident Bidder" means a Bidder that has paid unemployment taxes or income taxes in this state during the 12-calendar months immediately preceding submission of the bid, has a business address in this state, and has stated in the bid whether the Bidder is a "Resident Bidder;"

BID – PROJECT #900070 PAGE 4 of 4

F. Bidder shall comply with and cause its subcontractors to comply with all applicable provisions of federal, state and local statutes, ordinances, rules and regulations

The following forms must be also completed, signed and returned with the Bidder’s submission package:

✓ Bid Guaranty

✓ Affidavit of Noncollusion

✓ Certificate of Bidder/Contractor Employee Drug Testing Program

✓ Certificate of Non-Discrimination in Sub-Contracting

✓ Certificate of Compliance with Oregon Tax Laws

✓ DBE Commitment Certification and Utilization Form (DBE goal >0)

✓ Certification of Lobbying Activities

✓ Certification of Workers’ Compensation Coverage

✓ Conflict of Interest (COI) Disclosure

✓ Bid Schedule

✓ Acknowledged Addenda (if any issued)

The First-Tier Subcontractor Disclosure Form must be completed, signed and returned within two (2) hours of the Bid Closing:

The Agency may consider any Bid that does not include the mandatory submission forms identified in this section, filled out completely and appropriately endorsed, to be non-responsive. The Agency reserves the right to waive minor informalities and irregularities in determining the responsiveness of individual Bids. Non-responsive

Bids shall not be considered for award.

The full name and residence of all parties and persons interested in this bid as principals are as follows:

NAME RESIDENCE

Submitted by: _______________________________________________________________________

Name of Bidder _______________________________________________________________________

Signature of Authorized Agent ____________________________________________________________

Title _______________________________________________________________________

Business Address of Bidder _______________________________________________________________

Phone ______________________________________________________________________

Email

Date ______________________________________________________________________

BID BOND

KNOW ALL PERSONS BY THESE PRESENTS, that hereinafter called the Principal, and , a

Corporation organized and existing under and by virtue of the laws of the state duly authorized to do surety business in the State of Oregon as Surety, are held and firmly bound unto the City of Eugene hereinafter called the Agency, in the penal sum of

Dollars ($ ), for the payment of which, well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.

THE CONDITION OF THIS BOND IS SUCH THAT, WHEREAS, the Principal herein is herewith submitting his or its Bid Proposal for said Bid Proposal, by reference thereto, being hereby made a part hereof.

NOW THEREFORE, if the said Bid Proposal submitted by the said Principal be accepted, and the Contract be awarded to said Principal, and if the said Principal shall execute the proposed

Contract as required by the bidding and the Contract Documents within the time set by said

Documents, then this obligation shall be void. If the Principal shall fail to execute the proposed

Contract, the Surety hereby agrees to pay to the County the penal sum as liquidated damages.

Signed and sealed this day of , 20 .

Principal

By :

Surety

By:

Attorney-in-Fact

A certified copy of the Agent’s Power-of-Attorney must be attached hereto.

FIRST-TIER SUBCONTRACTOR DISCLOSURE STATEMENT

Project Title: 8TH Avenue Streetscape and Bikeway Federal Aid Project: 2385(108)

ODOT Key No: 21378 Project No. 900070 Bid Closing: Date: March 9, 2023 Time: 2:00 p.m.

Disclosure Deadline: Within two working hours of the bid closing date and time.

Submit the form by:

An attachment to the Bid using the OregonBuys website (see 00110.05(e)), at the time designated for receipt of Bids;

Email transmission to the email address Eugene.PWE.Bidding@eugene-or.gov; or Fax transmission to 541-682-8410.

Bidders are required to submit a first tier subcontractor disclosure form, substantially as described in ORS 279C.370, within two working hours of the Bid Closing date and time.

BIDDER INFORMATION

Bidder’s Name:

Contact Person: ________________________________________________

Bidder’s Telephone Number: _________________________________________

List below the Name, Dollar Value, and Construction Contractors Board (“CCB”) License Number, and Category of Work that will be performed by each subcontractor that will be furnishing labor, or labor and materials. Enter “NONE” if there are no subcontractors that need to be disclosed (IF NEEDED, ATTACH ADDITIONAL SHEETS).

Name/Address Dollar Value/CCB# Category of Work

1) ______________________ _________________________ _______________________

2) ______________________ _________________________ _______________________

3) ______________________ _________________________ _______________________

Name/Address Dollar Value/CCB# Category of Work

4) ______________________ _________________________ _______________________

5) ______________________ _________________________ _______________________

6) ______________________ _________________________ _______________________

7) ______________________ _________________________ _______________________

8) ______________________ _________________________ _______________________

The above listed first-tier subcontractor(s) will provide labor or labor and materials with a Dollar Value equal to or greater than:

a) 5% of the total Base Bid amount less deductive alternates, if any, or $15,000, whichever is larger. If the Dollar Value is less than $15,000 do not list the subcontractor above; or

b) $350,000 regardless of the percentage of the total contract price.

FAILURE TO SUBMIT THIS FORM BY THE DISCLOSURE DEADLINE WILL RESULT IN

A BID SUBMITTED BECOMING NON-RESPONSIVE, AND SUCH BIDS SHALL NOT BE

CONSIDERED FOR AWARD.

AFFIDAVIT OF NONCOLLUSION

TO: CITY OF EUGENE, A MUNICIPAL CORPORATION OF THE STATE OF OREGON

STATE OF OREGON )

) SS

COUNTY OF LANE )

(Bidder's Firm Name)

I, the undersigned, as (sole owner) (a partner) (officer of the foregoing corporation) (agent of the above bidder), being first duly sworn on oath, depose and say:

That the attached bid has been arrived at by the bidder, independently, and has been submitted without collusion with, and without any agreement, understanding or planned course of action with, any other contractor, bidder, or vendor on materials, supplies, equipment or services, described in the invitation to bid, designed to limit independent bidding or competition.

The contents of the bid herein presented and made have not been communicated by the bidder or (his) (their) or (its) employees or agents to any person not an employee or agent of the bidder or its surety on any bond furnished with the bid, and will not be communicated to any such person prior to the official opening of the bid.

I have fully informed myself regarding the accuracy of the foregoing statements, and the same are made by me based on my personal information.

I have read and understood the Book of Contract Documents and the Specifications for the attached Bid.

Signature _________________________________

Title _________________________________

Subscribed and sworn before me this __________ day of ____________________________, 20_______.

My commission expires: ______________________ ________________________________________ Notary Public for Oregon

Form #P-07

Certificate of Bidder/Contractor Employee Drug Testing Program

ORS 279C.505(2)

BIDDER’S NAME:

ORS 279C.505(2) provides that every public improvement contract contain a condition that the contractor shall demonstrate that an employee drug testing program is in place. The City’s award of the contract (the “Contract”) for which this certificate is required is conditioned, in part, upon the bidder’s demonstration of compliance with the provisions of ORS 279C.505. If the bidder named above (the “Bidder”) is awarded the Contract, this certificate shall become a part of, and shall constitute a continuing representation and warranty under, the Contract.

To induce the City of Eugene to award the Contract to the Bidder, the undersigned, as the duly authorized representative of the Bidder, hereby represents and warrants, on behalf of the Bidder:

1) That Bidder has and enforces, and at all times during the term of the Contract will have and enforce, a written employee drug testing policy that, at a minimum:

a) Requires pre-employment drug testing;

b) Requires drug testing of an employee when the Bidder has reasonable cause to believe the employee is under the influence of drugs;

c) Requires compliance with the Oregon Department of Transportation Commercial Drivers License drug testing regulations.

2) A copy of the Bidder’s current written employee drug testing policy will be available for inspection by the City at any time upon the City’s request.

3) The Bidder/Contractor understands and agrees that its representations and warranties herein will become a continuing part of the Contract and that breach of any of the foregoing will be sufficient grounds for disbarment under ORS 279C.130.

The City of Eugene shall not be liable, either directly or indirectly, in any dispute arising out of the substance or procedure of Contractor’s drug testing program. Nothing in this drug testing provision shall be construed as requiring Contractor to violate any legal, including constitutional, rights or any employee, including but not limited to, selection of which employees to test and the manner of such testing. The City shall not be liable for Contractor’s negligence in establishing or implementing, failure to establish or implement a drug testing policy, or for any damage or injury caused by Contractor’s employees acting under the influence of drugs while performing work covered by this contract. These are Bidder/Contractor’s sole responsibilities.

In Witness Whereof, the Bidder has caused this document to be executed by its duly authorized representative on the date shown below.

Signature:

Printed Name:__________________________ Title:

Date:

August 2022

CERTIFICATE OF NON-DISCRIMINATION IN

SUB-CONTRACTING

By signature of the authorized representative of the bidder/proposer, it is hereby certified that I/we have not discriminated and will not discriminate, in violation of subsection (1) of ORS 279A.110 against a disadvantaged business enterprise, a minority-owned business, a woman-owned business, a business that a service-disabled veteran owns or an emerging small business in awarding a subcontract.

Contractor Registration Number Name of Contractor (Print)

Date Signature, Member of Firm or Officer of Corporation

Title

Updated 4-2021

CERTIFICATE OF COMPLIANCE WITH OREGON TAX LAWS

By signature of the authorized Bidder, the undersigned hereby certifies under penalty of perjury that the undersigned is authorized to act on behalf of Bidder, that the undersigned has authority and knowledge regarding Bidder’s payment of taxes, and that Bidder is, to the best of the undersigned’s knowledge, not in violation of any Oregon Tax Laws. For purposes of this certification, “Oregon Tax Laws” means a state tax imposed by ORS 320.005 to 320.150 (Amusement Device Taxes), ORS 403.200 to 403.250 (Tax for Emergency Communications), and ORS Chapters 118 (Inheritance Tax), 314 (Income Tax), 316 (Personal Income Tax), 317 (Corporation Excise Tax), 318 (Corporation Income Tax), 321 (Timber and Forestland Tax), and 323 (Cigarettes And Tobacco Products Tax), and any local taxes administered by the Department of Revenue under ORS 305.620.

Date Signature, Member of Firm or Officer of Corporation

09-01-20 15

BB38_DBE_COMMIT_CERT 734-2785

Project Name ____________________________________ Bid Opening Date ___________________

DBE COMMITMENT CERTIFICATION AND UTILIZATION FORM

This DBE Certification and Utilization Form applies solely to meeting the assigned DBE contract goal for DBE participation. If the assigned DBE contract goal is greater than zero, each Bidder, including DBE prime Bidders, shall complete and submit this form with their Bid. SHOULD THE BIDDER FAIL TO COMPLETELY FILL OUT, SIGN, AND SUBMIT THIS FORM WITH THE BID WHEN THE ASSIGNED DBE CONTRACT GOAL IS GREATER THAN ZERO, THE BIDDER WILL BE CONSIDERED NON-RESPONSIVE. This certification shall be deemed a part of the resulting contract.

The Bidder acknowledges and certifies that this form accurately represents receipt of and consent from the listed DBE firm as to the use of the referenced itemized quote below for the performance of this project. Bidder certifies that it had direct contact with the named DBE firms regarding participation of this project. Bidder certifies, if awarded this project, that it shall award subcontracts to or enter into agreements with the named DBE's.

If the Bidder is submitting evidence of good faith efforts to secure participation, Bidder certifies that the good faith efforts documentation is true, accurate and correctly reports the actions taken by the Bidder.

Bidder's Authorized Representative (PRINT)

Bidder's Authorized Representative (SIGN) Date Name of Contractor (Company Name)

PART I

These columns to be completed by Bidder These columns to be completed by Agency

Name of DBE Firm Type of Work *

Function ** (examples:

Sub., Supp., DBE Man., Serv., Brok.)

Subcontract Amount

(or expenditure amount or fee/commission amount)

Goal Participation

DBE Amount ****

* From " Certification Office of Business Inclusion and Diversity " ** From "Function" column below. *** From "Goal Participation %" column below.

**** (Subcontract Amount x Goal Participation %)

Function Goal Participation % This section to be completed by Agency

Subcontractor 100% (of subcontract amount) ASSIGNED DBE CONTRACT GOAL %

Supplier (Regular Dealer) 60% (of supply expenditure amount) TOTAL DBE AMOUNT $

DBE Manufacturer 100% (of material expenditure amount) TOTAL BID AMOUNT $

Service Provider 100% (of fee or commission) DBE COMMITMENT

(TOTAL DBE AMOUNT ÷ TOTAL BID AMOUNT)

(calculated to two decimal places (0.01))

Broker 100%

(of brokerage fee only)

Additional sheets may be used by copying this form.

Bidder must sign each additional sheet to certify its content and completion of form.

09-01-20 16

BB38_DBE_COMMIT_CERT 734-2785

PART II

If Bidder’s participation commitment to eligible DBEs is less than the assigned DBE contract goal, Bidder shall submit documentation of "good faith efforts" as evidence of actions to secure DBE participation.

Bidder’s documentation of "good faith efforts" shall meet the requirements provided in the Disadvantaged Business Enterprise (DBE) Commitment Requirements, item no. 4(c) DBE Commitment Certification Form Part II - Good Faith Efforts, which outlines the activities considered for good faith efforts.

CERTIFICATION OF WORKERS’ COMPENSATION COVERAGE

The Contractor, for the purposes of this Contract, hereby certifies that it is currently providing Oregon Workers’ Compensation coverage for all its employees and will maintain coverage throughout the course of the project through one of the following methods:

1. “Carrier-Insured Employer” (State Accident Insurance Fund Corp. or other authorized insurer)

Insurance Company Name ___________________________________

ID/Policy Number___________________________________________

2. “Self-Insured Employer” (Certified by the Workers’ Compensation Division)

ID number as assigned by the Workers’ Compensation Division________________________________

3. I am an independent contractor and will perform all work under this contract without the assistance of others.

In the event of cancellation or change in the information above, Contractor certifies that it will immediately notify the Agency of said cancellation or change and will obtain alternate coverage.

Dated_________________20___

(Contractor’s Signature)

REMINDER - ADDITIONAL INFORMATION NEEDED

Has your insurance carrier filed with Oregon Workers’ Compensation Division a guaranty contract as proof of coverage for your employees working in Oregon?

For filing information, contact the Workers’ Compensation Division at Labor and Industries Building:

Salem, OR 97310; Phone (503) 947-7810.

CERTIFICATION OF LOBBYING ACTIVITIES

The Bidder certifies to the best of my knowledge and belief, that:

No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an employee of any Federal agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal agency, a Member of Congress, an officer of employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions to the ODOT Procurement Office - Construction Contracts Unit, MS# 2-2, 3930 Fairview Industrial Drive SE, Salem, Oregon 97302-1166. Copies of Standard Form-LLL are available at the above location.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this Certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required Certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

The prospective participant also agrees by submitting his or her Bid that he or she shall require that the language of this Certification be inserted in all lower tier subcontracts, which exceed $100,000 and that all such subrecipients shall certify and disclose accordingly.

Date Signature, Member of Firm or Officer of Corporation

EUGENE CONFLICT OF INTEREST (COI) DISCLOSURE FORM

Public Improvement Procurements

ORS279C and Eugene Purchasing Regulations Division 49

City of Eugene Public Works Engineering

Project Title

City of Eugene Project No.:

Bid Closing:

Firms proposing to enter into a Contract with the City of Eugene must be in conformance with the City of Eugene Conflict of Interest Guidelines. The COI Guidelines are available at the City of Eugene Standard Specifications for Construction webpage.

Bidders are required to submit the COI Disclosure Form to the Agency as part of their bid.

This COI Disclosure Form must be signed in ink by a principal of the Firm to certify that it is correct. A Firm’s certification that this disclosure form is correct includes the disclosure by its Associates and Subcontractors.

My signature certifies that as disclosure on or attached to the present form:

(a) The Firm’s disclosures are complete, accurate, and not misleading.

(b) The Firm has provided the City of Eugene COI Guidelines to all Associates and Subcontractors (if any) and the present form includes or has attached any required COI disclosures from those sources.

I hereby certify that I am authorized to sign this COI Disclosure Form as a Representative for the Firm identified below:

Bidder Firm’s Legal Name:

Contact Person:

Bidder’s Telephone:

Signature:

Date:

Read questions 1 – 7 on page 2.

☐I have read and complied with the COI Guidelines and the COI Disclosure Form and did not answer “Yes” to any of the questions on page 2. If this box is marked, submit page 1 with the proposal. No additional information is submitted at this time.

If the answer is “Yes” to any of the questions, submit the entire completed and signed COI Disclosure Form with the proposal.

CONFLICT OF INTEREST (COI) DISCLOSURE FORM

Answer all questions “No”, “Yes” or “N/A”. If the answer is “yes” to any question, then use the comments field to explain the response. If you are uncertain about the response to the question, answer “yes” and use the comment field to explain. Information to include in the comments field includes, but is not limited to, furnishing all relevant facts that are necessary to make the response complete, accurate, and not misleading; identifying any actions that must be taken to avoid, neutralize, or mitigate such conflicts of interest.

If the answer is “Yes” to any of the questions, submit page 2 answering all questions “No”, “Yes” or “N/A”. Provide entire form with Proposal submittal.

1. Is any Associate of the Firm a former employees of the Agency within the last two years? ☐Yes If “Yes”, complete and attach the “Relatives and Former Agency Employees – Roles and Signatures” form (Part A and/or B, as applicable).

2. Is any Associate of the Firm a Relative or Member of the Household of a current Agency employee that had or will have any involvement with this Procurement or Contract Authorization? ☐Yes If “Yes”, complete and attach the “Relatives and Former Agency Employees – Roles and Signatures” form (Part A and/or B, as applicable).

3. Does the Firm or any Associate of the Firm have an Actual, Apparent or Potential Conflict Of Interest (“Individual” or “Organizational”) with regard to any known member of an Agency Procurement evaluation or selection team?

☐No ☐Yes Comments: Click here to enter text.

4. Has the Firm or an Associate of the Firm offered to a Public Official, or is the Firm aware of any Public Official that has solicited or received, directly or indirectly, any pledge or promise of employment or other benefit based on the understanding that the Public Official’s vote, official action or judgment would be influenced thereby?

☐No ☐Yes Comments: Click here to enter text.

5. Has (or will) the Firm or an Associate of the Firm provided a direct beneficial financial interest to any person within two years after the person ceased to hold a position as a Public Official who was involved in the Procurement or Authorization for the Contract, or is the Firm aware of any such person or Public Official who has or will receive a direct beneficial financial interest within the two year period?

☐No ☐Yes Comments: Click here to enter text.

6. Is the Firm aware of any current or former Public Official that has an Actual, Apparent or Potential Conflict Of Interest with respect to the Procurement or award of this Contract or performing the work for Agency?

☐No ☐Yes Comments: Click here to enter text.

7. Have Subcontractors or other Associates furnished COI Disclosure Forms, separate from the present form, which included conflicts or potential conflicts of interest? (If “yes”, attach the disclosures.)

☐No ☐Yes ☐N/A (If no conflicts identified) Comments: Click here to enter text.

CONFLICT OF INTEREST (COI) DISCLOSURE FORM

Relatives and Former Agency Employees – Roles and Signatures

Use Part A to list each employee of the Firm that was employed by Agency within the last two years, state the job the employee performed for the Agency, the role the employee now serves for the Firm and the date the employee left Agency. Use Part B for Firm Associates with Relatives or Members of the Household working for Agency that had or will have involvement with this Procurement or Contract.

Part A: Employees that left Agency in the last two years

Employee Name/Signature Job Performed for Agency

Current Role with Firm Date left Agency

Name: ______________________

Sign:________________________

Involved with this Procurement on behalf of Agency? Yes / No (circle one)

Involved with Proposal development for this Procurement? Yes / No (circle one)

Name: ______________________

Sign:________________________

Involved with this Procurement on behalf of Agency? Yes / No (circle one)

Involved with Proposal development for this Procurement? Yes / No (circle one)

Part B: Identify Associates of the Firm that are Relatives or Members of the Household of Agency employees currently working for Agency, if the Agency employee had or will have any involvement with this Procurement of Contract.

Firm Associate’s Name: Name and Relationship of Relative or Member of Household Employed at Agency

Role at Agency Agency employee’s role with this procurement

(Make copies of this form as needed to list additional employees)

Line No

00 00

1.00 LS

2940010 Health and Safety Plan

5,000.00 FA 1 5,000

2940000 Contaminated Soil Removal

1.00 LS

2900030 CWRR Report

1.00 LS

2900010 Pollution Control Plan

101.00 EA

2800190 Inlet Protection

1.00 LS

2800170 Concrete Washout Facility

1.00 LS

2800010 Erosion Control

8.00 EA

1.00 LS

2250630 City Provided Special Info Signs

2.00 EA

2250550 Portable Changeable Message Signs

924.00 SF

2250020 Temporary Pedestrian Work Zone Traffic Control

1.00 LS

2250010 Temp. Work Zone Traffic Control, Complete

2250490 Legend Removal

521.00 FT

2100010 Mobilization

Project Number 900070 Project Name 8th Avenuee Streetscape and Bikeway

BID SCHEDULE

Pay Item No. Description

Quantity Unit Unit Value in $ | Extended Value in $ |

Bid Advertisement Date 2/13/2023

1.00 LS

2250480 Stripe Removal

Printed on: 2/10/2023 Page 1 of 10

Project Number 900070 Project Name 8th Avenuee Streetscape and Bikeway

BID SCHEDULE

Pay Item No. Description

Quantity Unit Unit Value in $ | Extended Value in $ |

Bid Advertisement Date 2/13/2023

20.00 EA

4700030 Concrete Stormwater Manhole

4.00 EA

4451470 3" Cleanout

278.20 FT

4450140 12 Inch PVC Storm Pipe

1,146.50 FT

4450130 10 Inch PVC Storm Pipe

70.10 FT

4450095 3 Inch PVC Pipe

1.00 LS

4420015 CSLM Cap Over Duct Bank, 2 Inches Thick

132.00 FT

4300120 4" Perforated PVC Drain Pipe

1,424.70 FT

4150020 Mainline Video Inspection

1,240.00 CY

3300010 General Excavation

3100080 Removal of Inlets

35.00 FT

3100100 Removal of Rock Wall

1,436.90 SF

3100095 Remove Concrete Surfacing

1.00 EA

3100090 Removal of Manholes

18.00 EA

3100020 Removal of Pipes

4.00 FT

Printed on: 2/10/2023 Page 2 of 10

Project Number 900070 Project Name 8th Avenuee Streetscape and Bikeway

BID SCHEDULE

Pay Item No. Description

Quantity Unit Unit Value in $ | Extended Value in $ |

Bid Advertisement Date 2/13/2023

13.00 EA

4900130 Manhole Frame and Cover - Stormwater

9.00 EA

4900120 Manhole Frame and Cover - Wastewater

1.00 EA

4900100 Extra for Manhole Over Existing Pipe

3.00 EA

4900090 Connection to Existing Pipe

23.00 EA

4900070 Connection to Existing Structures

1.00 EA

4900050 Adjusting Catch Basins

22.00 EA

4900040 Adjusting Boxes

4.00 EA

4900035 Modify Existing Curb Inlet

2.00 EA

4900032 Concrete Inlet Top and Lid, Type 4 A

33.00 EA

4900010 Minor Adjustment of Manholes

33.00 EA

4709999 Planter Overflow Inlet

29.00 EA

4700410 Modified Planter Inlet

2.00 EA

4700370 Catch Basins, With Cast Iron Bike Proof Grates

2.00 EA

4700260 Concrete Inlets, Type 2-1/2A

Printed on: 2/10/2023 Page 3 of 10

Project Number 900070 Project Name 8th Avenuee Streetscape and Bikeway

BID SCHEDULE

Pay Item No. Description

Quantity Unit Unit Value in $ | Extended Value in $ |

Bid Advertisement Date 2/13/2023

360.80 SY

7480040 12 Inch Asphalt Concrete Pavement Repair

222.00 SY

7480025 8 Inch Asphalt Concrete Pavement Repair

2,378.50 TN

7440060 Level 2, 1/2 Inch ACP Mixture with 35% RAM

763.20 SY

6400050 Aggregate Working Platform, 12" thick

2,927.90 SY

6200045 Cold Plane Pavement Removal, Varies, Park Blocks

2,878.90 SY

6200040 Cold Plane Pavement Removal, 4 Inches Deep

5,833.30 SY

6200030 Cold Plane Pavement Removal, 2 Inches Deep

1,067.20 SY

6200030 Cold Plane Pavement Removal, 3 Inches Deep

14.00 EA

4901980 Reconnect Weep Hole

15.00 EA

4901850 Abandon Pipe in Place

8.00 EA

4901830 Plug Pipe Void in Existing Structure

1.00 EA

4900360 12 Inch Concrete Pipe Repair

1.00 EA

4900170 10 Inch PVC Pipe Repair

1.00 EA

4900152 Replace Catch Basin Frame and Bike-Proof Grate

Printed on: 2/10/2023 Page 4 of 10

Project Number 900070 Project Name 8th Avenuee Streetscape and Bikeway

BID SCHEDULE

Pay Item No. Description

Quantity Unit Unit Value in $ | Extended Value in $ |

Bid Advertisement Date 2/13/2023

5,312.90 SF

7590150 Concrete Walks, 4 Inches Thick

40.40 SF

7590120 Concrete Driveways, 7 Inches Thick

4,232.80 SF

7590091 Concrete Traffic Separator

26.70 FT

7590086 Concrete Curbs, 12 Inches Wide Planter Curb

177.00 FT

7590085 Concrete Curbs, 18 Inches Wide Planter Curb and Gutter

716.50 FT

7590084 Concrete Curbs, Planter Curb and Gutter

285.30 FT

7590080 Concrete Curbs, Planter Curb

1,294.20 FT

7590040 Concrete Curb, Notched Curb

22.10 FT

7590020 Concrete Curb, Standard Curb

41.00 FT

7590015 Concrete Curbs, 12" Wide Curb and Gutter

1,870.70 FT

7590010 Concrete Curbs, Curb and Gutter

2.00 EA

7560330 Flexible to Rigid Pavement Transitions

386.90 SY

7560030 Plain Concrete Pavement, Dowelled, 8 inches Thick

168.60 SY

7480055 15 Inch Asphalt Concrete Pavement Repair

Printed on: 2/10/2023 Page 5 of 10

Project Number 900070 Project Name 8th Avenuee Streetscape and Bikeway

BID SCHEDULE

Pay Item No. Description

Quantity Unit Unit Value in $ | Extended Value in $ |

Bid Advertisement Date 2/13/2023

3.00 EA

8550010 Bi-Directional White Type 1 Markers

1.00 LS

8409999 Modular Bus Island

4.00 EA

8150100 Bollards

389.50 SF

7599996 Concrete Curbs, Curb and Fillet

4.60 FT

7590530 Concrete Weir

1.00 EA

7590510 Parallel Covered Spillway and Splash Pad

3.00 EA

7590500 Angle Inlet With Spillway

393.10 SF

7590392 Truncated Domes on New Surfaces, Radial

2,023.10 SF

7590390 Truncated Domes on New Surfaces

271.00 FT

7590361 Valley Gutter, 18" Wide

1,104.30 FT

7590361 Valley Gutter, Modified

58.70 FT

7590360 Valley Gutter

16,712.20 SF

7590160 Concrete Walks, 7 Inches Thick

10,410.00 SF

7590151 Concrete Ramp, 4 Inches Thick

Printed on: 2/10/2023 Page 6 of 10

Project Number 900070 Project Name 8th Avenuee Streetscape and Bikeway

BID SCHEDULE

Pay Item No. Description

Quantity Unit Unit Value in $ | Extended Value in $ |

Bid Advertisement Date 2/13/2023

4.00 EA

8670180 Pavement Legend, Type B-HS: Shared Lane Marking

84.00 EA

8670160 Pavement Legend, Type B-HS: On-Street Parking

23.00 EA

8670141 Pavement Legend, Type B-HS: Off Street Bicycle Stencil On Concrete

14.00 EA

8670140 Pavement Legend, Type B-HS: Bicycle Lane Stencil

5.00 EA

8670139 Pavement Legend, Type B-HS: Bicycle Detector Loop Stencil

1.00 EA

8670080 Pavement Legend, Type B-HS: "Bus"

18.00 EA

8670020 Pavement Legend, Type B-HS: Arrows

1,630.00 SF

8670012 Pavement Bar, Type B-HS

1.00 LS

8650030 Methyl Methacrylate, Extruded, Surface, Non-Profiled

1,110.00 FT

8600020 Painted Curbs

5.00 EA

8560015 Tuff Curb with Tubular Markers

31.00 EA

8560010 Permanent Surface Mounted Tubular Markers

9.00 EA

8550090 Bi-Directional Blue Type 1AR Markers

86.00 EA

8550030 Bi-Directional Yellow Type 1 Markers

Printed on: 2/10/2023 Page 7 of 10

Project Number 900070 Project Name 8th Avenuee Streetscape and Bikeway

BID SCHEDULE

Pay Item No. Description

Quantity Unit Unit Value in $ | Extended Value in $ |

Bid Advertisement Date 2/13/2023

00 00

00 00

112 9900190 Major Adjustment of Junction Box

14.00 EA

9900180 Minor Adjustment of Junction Box

1.00 LS

9900025 Traffic Signal Removal, Complete

1.00 LS

9900020 Traffic Signal Modification, Complete

3.00 EA

9870082 Adjustment of Telecommunications Manhole Lid

3.00 EA

9870081 Adjustment of Telecommunications Vault Lid

10,000.00 FA 1 10,000

9870080 Telecommuncations, Complete

5,000.00 FA 1 5,000

9700085 Adjustment of Illumination Wiring

1.00 LS

9700080 Illumination, Complete

152.00 SF

9400020 Signs, Standard Sheeting, Sheet Aluminum

24.00 EA

9050040 Remove and Reinstall Existing Signs

25.00 EA

9050020 Remove Existing Signs

1,000.00 SF

8670220 Pavement Bar, Type B-HS: Green

6.00 EA

8670210 Pavement Legend, Type B-HS: Speed Hump Marking

EA3.00

Printed on: 2/10/2023 Page 8 of 10

Project Number 900070 Project Name 8th Avenuee Streetscape and Bikeway

BID SCHEDULE

Pay Item No. Description

Quantity Unit Unit Value in $ | Extended Value in $ |

Bid Advertisement Date 2/13/2023

00 00

1.00 EA

10650040 Remove and Reinstall Trash Can

2.00 EA

10650030 Remove and Reinstall Bike Rack

5.00 EA

10500015 Remove and Reinstall Existing Post and Chain

315.00 FT

10500010 Remove and Rebuild Chain-Link Fence

6,770.00 SF

10400290 Rock Mulch

4,243.00 SF

10400190 Bark Mulch

22,000.00 FA 1 22,000

10400144 Plants, Materials Only

3,082.00 EA

10400143 Plants, 4" Pot - Install Only

125.00 EA

10400142 Plants, 3 Gallon - Install Only

1,491.00 EA

10400141 Plants, 1 Gallon - Install Only

778.10 SY

10400070 Stormwater Facility Blended Soil, 18" Deep

31.80 CY

10400020 Topsoil, 36" Deep

441.00 SF

10300090 Lawn Seeding

24.00 EA

10200010 Tree Protection Fencing

Printed on: 2/10/2023 Page 9 of 10

Project Number 900070 Project Name 8th Avenuee Streetscape and Bikeway

BID SCHEDULE

Pay Item No. Description

Quantity Unit Unit Value in $ | Extended Value in $ |

Bid Advertisement Date 2/13/2023

00 00

00 00

TOTAL BID:

10800025 Remove and Reinstall Existing Bench

22.00 EA

10800010 Remove Existing Parking Meters

3,000.00 FA 1 3,000

NO CHANGES SHALL BE MADE TO THE PAY ITEM QUANTITIES CONTAINED HEREIN. ANY CORRECTIONS TO

THE BIDDERS' ENTRIES SHALL BE MADE IN INK AND SHALL BE INITIALED BY THE BIDDER.

4000001 On The Job Training

750.00 HR 20 15,000

1120100 Irrigation Repair/Relocation

1.00 EA

1.00 EA

10700040 Remove and Reinstall Existing Mailbox

10800020 Remove and Reinstall Parking Meter

26.00 EA

Printed on: 2/10/2023 Page 10 of 10