ARFQ 0608 COR1900000001 - Addendum #2.pdf

ARFQ 0608 COR1900000001

Lakin Correctional Center and Jail

Replacement of Rooftop Units Project

Addendum #2

Clarifications:

C1: Please see attached Purchasing Affidavit. Vendor must submit with their bid documents.

C2: Please see attached Drug Free Workplace Conformance Affidavit. Vendor must submit with their bid documents.

C3: Please see attached Disclosure of Interested Parties to Contracts. Vendor must submit with their bid documents.

C4: Please see attached Bid Bond Prep Instructions and Bid Bond Form. Vendor must submit with their bid documents.

STATE OF WEST VIRGINIA

Purchasing Division

PURCHASING AFFIDAVIT

CONSTRUCTION CONTRACTS: Under W. Va. Code § 5-22-1(i), the contracting public entity shall not award a construction contract to any bidder that is known to be in default on any monetary obligation owed to the state or a political subdivision of the state, including, but not limited to, obligations related to payroll taxes, property taxes, sales and use taxes, fire service fees, or other fines or fees.

ALL CONTRACTS: Under W. Va. Code §5A-3-10a, no contract or renewal of any contract may be awarded by the state or any of its political subdivisions to any vendor or prospective vendor when the vendor or prospective vendor or a related party to the vendor or prospective vendor is a debtor and: (1) the debt owed is an amount greater than one thousand dollars in the aggregate; or (2) the debtor is in employer default.

EXCEPTION: The prohibition listed above does not apply where a vendor has contested any tax administered pursuant to chapter eleven of the W. Va. Code, workers’ compensation premium, permit fee or environmental fee or assessment and the matter has not become final or where the vendor has entered into a payment plan or agreement and the vendor is not in default of any of the provisions of such plan or agreement.

DEFINITIONS:

“Debt” means any assessment, premium, penalty, fine, tax or other amount of money owed to the state or any of its political subdivisions because of a judgment, fine, permit violation, license assessment, defaulted workers’ compensation premium, penalty or other assessment presently delinquent or due and required to be paid to the state or any of its political subdivisions, including any interest or additional penalties accrued thereon.

“Employer default” means having an outstanding balance or liability to the old fund or to the uninsured employers' fund or being in policy default, as defined in W. Va. Code § 23-2c-2, failure to maintain mandatory workers' compensation coverage, or failure to fully meet its obligations as a workers' compensation self-insured employer. An employer is not in employer default if it has entered into a repayment agreement with the Insurance Commissioner and remains in compliance with the obligations under the repayment agreement.

“Related party” means a party, whether an individual, corporation, partnership, association, limited liability company or any other form or business association or other entity whatsoever, related to any vendor by blood, marriage, ownership or contract through which the party has a relationship of ownership or other interest with the vendor so that the party will actually or by effect receive or control a portion of the benefit, profit or other consideration from performance of a vendor contract with the party receiving an amount that meets or exceed five percent of the total contract amount.

AFFIRMATION: By signing this form, the vendor’s authorized signer affirms and acknowledges under penalty of law for false swearing (W. Va. Code §61-5-3) that: (1) for construction contracts, the vendor is not in default on any monetary obligation owed to the state or a political subdivision of the state, and (2) for all other contracts, that neither vendor nor any related party owe a debt as defined above and that neither vendor nor any related party are in employer default as defined above, unless the debt or employer default is permitted under the exception above.

WITNESS THE FOLLOWING SIGNATURE:

Vendor’s Name: ___________________________________________________________________________________

Authorized Signature: ______________________________________________ Date: ___________________________

State of _____________________________

County of ______________________, to-wit:

Taken, subscribed, and sworn to before me this ___ day of ____________________________, 20___.

My Commission expires ______________________________, 20___.

AFFIX SEAL HERE NOTARY PUBLIC ____________________________________

Purchasing Affidavit (Revised 01/19/2018)

WV-73

Approved / July 7, 2017

State of West Virginia

DRUG FREE WORKPLACE CONFORMANCE AFFIDAVIT

West Virginia Code §21-1D-5

STATE OF WEST VIRGINIA,

COUNTY OF , TO-WIT:

I, , after being first duly sworn, depose and state as follows:

1. I am an employee of ; and, (Company Name)

2. I do hereby attest that (Company Name) maintains a written plan for a drug-free workplace policy and that such plan and policy are in compliance with West Virginia Code §21-1D.

The above statements are sworn to under the penalty of perjury.

Printed Name:

Signature:

Title:

Company Name:

Date:

Taken, subscribed and sworn to before me this day of , .

By Commission expires

(Seal)

(Notary Public)

Rev. July 7, 2017

West Virginia Ethics Commission

Disclosure of Interested Parties to Contracts

Pursuant to W. Va. Code § 6D-1-2, a state agency may not enter into a contract, or a series of related contracts, that has/have an actual or estimated value of $1 million or more until the business entity submits to the contracting state agency a Disclosure of Interested Parties to the applicable contract. In addition, the business entity awarded a contract is obligated to submit a supplemental Disclosure of Interested Parties reflecting any new or differing interested parties to the contract within 30 days following the completion or termination of the applicable contract.

For purposes of complying with these requirements, the following definitions apply:

"Business entity" means any entity recognized by law through which business is conducted, including a sole proprietorship, partnership or corporation, but does not include publicly traded companies listed on a national or international stock exchange.

"Interested party" or “Interested parties” means:

(1) A business entity performing work or service pursuant to, or in furtherance of, the applicable contract, including specifically sub-contractors;

(2) the person(s) who have an ownership interest equal to or greater than 25% in the business entity performing work or service pursuant to, or in furtherance of, the applicable contract. (This subdivision does not apply to a publicly traded company); and

(3) the person or business entity, if any, that served as a compensated broker or intermediary to actively facilitate the applicable contract or negotiated the terms of the applicable contract with the state agency.

(This subdivision does not apply to persons or business entities performing legal services related to the negotiation or drafting of the applicable contract.)

“State agency" means a board, commission, office, department or other agency in the executive, judicial or legislative branch of state government, including publicly funded institutions of higher education:

Provided, that for purposes of W. Va. Code § 6D-1-2, the West Virginia Investment Management Board shall not be deemed a state agency nor subject to the requirements of that provision.

The contracting business entity must complete this form and submit it to the contracting state agency prior to contract award and to complete another form within 30 days of contract completion or termination.

This form was created by the State of West Virginia Ethics Commission, 210 Brooks Street, Suite 300, Charleston, WV 25301-1804. Telephone: (304)558-0664; fax: (304)558-2169; e-mail: ethics@wv.gov;

website: www.ethics.wv.gov.

Revised June 8, 2018 mailto:ethics@wv.gov http://www.ethics.wv.gov/

West Virginia Ethics Commission

Disclosure of Interested Parties to Contracts

(Required by W. Va. Code § 6D-1-2)

Name of Contracting Business Entity: ____________________ Address: _________________________________

Name of Authorized Agent: ____________________________ Address: _________________________________

Contract Number: __________________________ Contract Description: ____________________________

Governmental agency awarding contract:

☐ Check here if this is a Supplemental Disclosure

List the Names of Interested Parties to the contract which are known or reasonably anticipated by the contracting business entity for each category below (attach additional pages if necessary):

1. Subcontractors or other entities performing work or service under the Contract

□ Check here if none, otherwise list entity/individual names below.

2. Any person or entity who owns 25% or more of contracting entity (not applicable to publicly traded entities)

3. Any person or entity that facilitated, or negotiated the terms of, the applicable contract (excluding legal services related to the negotiation or drafting of the applicable contract)

Signature: ________ Date Signed: ______________________________

Notary Verification

State of _____________________________________, County of _________________________________________:

I, _______________________________________________________, the authorized agent of the contracting business entity listed above, being duly sworn, acknowledge that the Disclosure herein is being made under oath and under the penalty of perjury.

Taken, sworn to and subscribed before me this ______________ day of _______________________, _____.

Notary Public’s Signature To be completed by State Agency:

Date Received by State Agency: _________________________________ Date submitted to Ethics Commission: _____________________________ Governmental agency submitting Disclosure: ________________________

Revised June 8, 2018

REV. 6/2013

BID BOND PREPARATION INSTRUCTIONS

AGENCY (A)

RFQ/RFP# (B)

Bid Bond

(A) WV State Agency (Stated on Page 1 “Spending Unit”)

KNOW ALL MEN BY THESE PRESENTS, That we, the undersigned,

(C) of (D) , (E) , as Principal, and (F) of (G) ,

(H) , a corporation organized and existing under the laws of the State of (I) with its principal office in the City of

(J) , as Surety, are held and firmly bound unto The State of West Virginia, as Obligee, in the penal sum of (K) ($ (L) ) for the payment of which, well and truly to be made, we jointly and severally bind ourselves, our heirs, administrators, executors, successors and assigns.

The Condition of the above obligation is such that whereas the Principal has submitted to the Purchasing Section of the Department of Administration a certain bid or proposal, attached hereto and made a part hereof to enter into a contract in writing for (M)

NOW THEREFORE

(a) If said bid shall be rejected, or

(b) If said bid shall be accepted and the Principal shall enter into a contract in accordance with the bid or proposal attached hereto and shall furnish any other bonds and insurance required by the bid or proposal, and shall in all other respects perform the agreement created by the acceptance of said bid then this obligation shall be null and void, otherwise this obligation shall remain in full force and effect. It is expressly understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed the penal amount of this obligation as herein stated

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

WITNESS, the following signatures and seals of Principal and Surety, executed and sealed by a proper officer of Principal and Surety, or by Principal individually if Principal is an individual, the _(N)___ day of (O) , 20_(P)_.

Principal Seal (Q) (Name of Principal) (R)

By (S) (Must be President, Vice President, or Duly Authorized Agent)

(T) Title

Surety Seal (V)

(U) (Name of Surety)

(W)___________ Attorney-in-Fact

IMPORTANT – Surety executing bonds must be licensed in West Virginia to transact surety insurance, must affix its seal, and must attach a power of attorney with its seal affixed.

(B) Request for Quotation Number (upper right corner of page #1)

(C) Your Business Entity Name (or Individual Name if Sole Proprietor)

(D) City, Location of your Company

(E) State, Location of your Company

(F) Surety Corporate Name

(G) City, Location of Surety

(H) State, Location of Surety

(I) State of Surety Incorporation

(J) City of Surety’s Principal Office

(K) Minimum amount of acceptable bid bond is

5% of total bid. You may state “5% of bid” or a specific amount on this line in words.

(L) Amount of bond in numbers

(M) Brief Description of scope of work

(N) Day of the month

(O) Month

(P) Year

(Q) Name of Business Entity (or Individual Name if Sole Proprietor)

(R) Seal of Principal

(S) Signature of President, Vice President, or

Authorized Agent

(T) Title of Person Signing for Principal

(U) Seal of Surety

(V) Name of Surety

(W) Signature of Attorney in Fact of the Surety

NOTE 1:

Dated Power of Attorney with Surety Seal must accompany this bid bond.

Agency

REQ.P.O#

BID BOND

KNOW ALL MEN BY THESE PRESENTS, That we, the undersigned, of , , as Principal, and of , , a corporation organized and existing under the laws of the State of with its principal office in the City of , as Surety, are held and firmly bound unto the State of West Virginia, as Obligee, in the penal sum of ($ ) for the payment of which, well and truly to be made, we jointly and severally bind ourselves, our heirs, administrators, executors, successors and assigns.

The Condition of the above obligation is such that whereas the Principal has submitted to the Purchasing Section of the

Department of Administration a certain bid or proposal, attached hereto and made a part hereof, to enter into a contract in writing for

NOW THEREFORE,

(a) If said bid shall be rejected, or

(b) If said bid shall be accepted and the Principal shall enter into a contract in accordance with the bid or proposal attached hereto and shall furnish any other bonds and insurance required by the bid or proposal, and shall in all other respects perform the agreement created by the acceptance of said bid, then this obligation shall be null and void, otherwise this obligation shall remain in full force and effect. It is expressly understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed the penal amount of this obligation as herein stated.

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

WITNESS, the following signatures and seals of Principal and Surety, executed and sealed by a proper officer of Principal and

Surety, or by Principal individually if Principal is an individual, this day of , 20 .

Principal Seal (Name of Principal)

By

(Must be President, Vice President, or Duly Authorized Agent)

(Title)

Surety Seal (Name of Surety)

Attorney-in-Fact

IMPORTANT – Surety executing bonds must be licensed in West Virginia to transact surety insurance, must affix its seal, and must attach a power of attorney with its seal affixed.