ATTACHMENT C_REQUIRED DOCUMENTS.pdf

Contractor’s Certificate

Date Submitted .

I hereby certify that the attached Financial Statement fairly presents the financial condition of as of .

SIGNATURE

TITLE

Subscribed and sworn to before me this day of , 20 .

NOTARY PUBLIC

My Commission Expires

P:\PREQUAL\CONTR_AP\Jan 2013.doc

ATTACHMENT C

Date

Prequalification Review Board The City of Oklahoma City 420 W. Main Street, 7th Floor Oklahoma City, OK 73102

RE:

To Whom It May Concern:

This letter is provided for information purposes and the City of Oklahoma City and Trusts should reference the required final bonds on specific bonded projects for additional information

____________________________ (Contractor's Name) is currently applying for pre-qualification status to the City of Oklahoma City and Trusts. This is to advise the Pre-qualification Review Board That based upon the fiscal year end financial information dated _____________.

____________________________ (Surety Name) is willing to entertain bonds for this company up to the amounts of $______________ (Single Job) / $______________ (Aggregate), subject to the usual underwriting criteria. In the past we have handles bonding requirements for this company in the amounts of $______________ (Single Job) / $______________ (Aggregate).

The undersigned agrees to notify the Pre-qualification Review Board, within a reasonable period of time, once the relationship between contractor/applicant and the stated surety should cease.

Please understand that any arrangement for surety credit is a matter between contractor/applicant and ourselves and we assume no liability to any third parties.

Name of Company or Agency Name of the Contractor

Signature and Title Signature and Title

Address

Phone Number

Facsimile Number

PLEASE READ THIS LETTER CAREFULLY BEFORE SIGNING

AFFIDAVIT OF PREQUALIFICATION APPLICANT

CONFIRMING COMPLIANCE WITH FEDERAL, STATE, AND LOCAL LAWS, STATUTES,

ORDINANCES, REGULATIONS, AND REQUIREMENTS

STATE OF OKLAHOMA )

) ss.

COUNTY OF OKLAHOMA )

The undersigned, of lawful age, being duly sworn, upon his/her oath, deposes and says:

1. That the undersigned individual is the applicant company’s authorized agent who has the lawful authority to execute the within and foregoing application for, and on behalf of, the applicant.

2. That the authorized agent and applicant company acknowledges and affirms its applicant company’s duty to become knowledgeable of applicable federal, state and the City of Oklahoma City laws, regulations and requirements.

3. That the authorized agent and the applicant company will make itself and its applicant company knowledgeable of applicable federal, state and the City of Oklahoma City laws, regulations and requirements.

4. That the authorized agent and its applicant company has complied with and will maintain compliance with applicable federal, state and the City of Oklahoma City laws and federal, state and local statutes, codes, ordinances, regulations and requirements, including but not limited to:

a. Occupational Safety and Health Administration (OSHA)

b. Oklahoma Department of Environmental Quality (ODEQ)

c. Corps of Engineers (COE)

d. Americans with Disabilities Act (ADA)

e. Building, plumbing, electrical, storm water, structural codes,

f. Occupational and licensing requirements,

g. Status Verification System (25 O.S. 1312 et seq., as amended)

h. Such other of applicable federal, state and Oklahoma City laws, statutes, codes, ordinances, regulations and requirements as may be applicable to President, owner, manager, authorized agent or its activities.

5. That the authorized agent and its company have complied with and will maintain compliance with the OSHA 10-hour Construction Certification for all of the applicant company’s employees on the work site.

6. That the authorized agent and its company will comply with any amendments and additions to applicable federal, state and Oklahoma City laws, regulations and requirements upon and after its respective effective date.

7. That the applicant company will indemnify and hold harmless the City and its public trusts for applicant company and applicant company’s contractor’s and subcontractor’s failure to comply with applicable federal, state and Oklahoma City laws, regulations and requirements.

FURTHER AFFIANT SAYETH NOT.

DATED this _______ day ________, 20____.

Signed by Applicant’s Authorized Agent: _______________________________

Title: ________________________ Print Name: __________________________________

Subscribed and sworn to before me this _______ day of ______________________, 20____.

Notary Public

Commission Expires: __________________ Commission Number: _____________________

ANTI/NON-COLLUSION AFFIDAVIT

STATE OF _____________________)

COUNTY OF ___________________)

__________________________, being of lawful age and duly sworn on oath, hereby declares and states:

A. I certify:

1. I am a duly authorized agent of ____________________, the Construction Manager, for the purpose of certifying the facts pertaining to the existence of collusion among and between individuals or business entities responding to this request for qualifications and Awarding Public Agency officials or employees, as well as facts pertaining to the giving or offering of things of value to Awarding Public Agency personnel in return for special consideration in connection with the award of this Contract;

2. I am fully aware of the facts and circumstances surrounding the making and the providing of the qualifications to which this statement relates and have been personally and directly involved in events leading to the submission of such qualifications; and

3. Neither the Construction Manager nor anyone subject to the Construction Manager’s direction or control has been a party:

i. To any collusion among business entities responding to this request for qualifications in restraint of freedom of competition by agreement to submit qualifications or to refrain from submitting qualifications;

ii. To any collusion with any Awarding Public Agency official or employee as to quantity, quality, or price in this prospective Contract, or as to any other terms of such prospective Contract, nor

iii. To any discussions between business entities responding to this request and any Awarding Public Agency official or employee concerning exchange of money or other thing of value for special consideration in connection with this prospective Contract.

B. I certify, if awarded this Contract, neither the Construction Manager that I represent nor anyone subject to the Construction Manager’s direction or control has paid, given, or donated or agreed to pay, give, or donate to any officer or employee of the Awarding Public Agency any money or other thing of value, either directly or indirectly, in procuring the Contract to which this statement relates.

Name, Title

Subscribed and sworn to before me this ________ day of __________________, 20_____.

Notary Public

My Commission Expires:

Commission No.

BUSINESS RELATIONSHIP AFFIDAVIT

The undersigned as Construction Manager or Construction Manager’s Authorized Agent, being of lawful age and being first duly sworn on oath, hereby swears, affirms and states that the undersigned has thoroughly read and understands the provisions and terms of this Business Relationship Affidavit and is fully knowledgeable of Construction Manager's and its officers’ and directors’ business relationships and associations and hereby affirmatively so states that as a part of this request for qualifications.

The undersigned as Construction Manager or Construction Manager’s Authorized Agent further swears, affirms, and states that the Submitter does not have any partnership, joint venture, or other business relationship presently in effect or which existed within one (1) year prior to the date of this sworn statement and has not had any such relationship with the Architect or any other party to this project except, if any, as stated on the lines below.

The undersigned as Construction Manager or Construction Manager’s Authorized Agent further swears, affirms, and states that no officer or director of the Construction Manager has a partnership, joint venture, or other business relationship presently in effect and no officer or director of the Construction Manager has had any such relationship within one (1) year prior to the date of this sworn statement with any officer or director of the Architect or other party to this project except, if any, as stated on the lines below.

If Construction Manager or any of its officers or directors has or within the one (1) year prior to the date of this statement has had any such relationships, the Construction Manager or Construction Manager’s Authorized Agent must state the names of all persons having such business relationships and the positions they hold or held with the Construction Manager and/or their respective companies or firms on the lines provided below:

(THE CONSTRUCTION MANAGER MUST STATE ANY BUSINESS RELATIONSHIP MEETING

THE ABOVE DESCRIPTION ON THE LINES ABOVE, IF NO DISCLOSURE IS MADE ON THE

ABOVE LINES THEN CONSTRUCTION MANAGER WILL BE IRREFUTABLY DEEMED TO

HAVE STATED AND SWORN UNDER PENALTY OF LAW THAT CONSTRUCTION MANAGER

AND ITS OFFICERS OR DIRECTORS HAS NO SUCH RELATIONSHIPS.)

STATE OF __________________________)

) ss.

COUNTY OF __________________________)

The undersigned, as Construction Manager or Construction Manager’s Authorized Agent, hereby expressly adopts and affirmatively incorporates herein by reference the above recitation as the sworn statement of the Construction Manager and the signatory.

Name of Individual, Partnership, Limited Liability

Company, or Corporation herein called Construction Manager

Signature of Construction Manager or Construction Manager’s Authorized Agent

Type or print name and title of person who signed above

Signed and sworn to or affirmed before me on this ______ day of _______________________ , 20_____, by the above-named Construction Manager or Construction Manager’s Authorized Agent.

Notary Public

My Commission Expires:

Commission No.

This Affidavit required for Public Improvement Projects by 61 Oklahoma Statutes Supp. 2008 § 108.

CERTIFICATE OF NONDISCRIMINATION

In connection with the performance under this Contract, the Construction Manager agrees as follows:

A. The Construction Manager agrees not to discriminate against any employee or applicant for employment because of race, creed, sex, color, national origin, ancestry, age or disability as defined by the Americans with Disabilities Act of 1990, Sec. 3(2). Construction Manager shall ensure that employees are treated without regard to their race, creed, sex, color, national origin, ancestry, age or disability, as defined by the Americans with Disabilities Act of 1990, Sec. 3(2). Such actions shall include, but not be limited to, the following: employment, upgrading, demotion or transfer, recruiting or recruitment, advertising, layoff or termination, rate of pay or other forms of compensation and selection for training, including apprenticeship. The Construction Manager agrees to post a copy of this completed certificate in a conspicuous place available to employees and applicants for employment.

B. The Construction Manager will also require these same non-discrimination terms and conditions in any Subcontractor Contracts associated with this Contract.

C. In the event of the Construction Manager's noncompliance with this Nondiscrimination Certificate, the Contract may be canceled, terminated, or suspended by the Awarding Public Agency. The Construction Manager may be declared by the Awarding Public Agency ineligible for further contracts until satisfactory proof of intent to comply shall be made by the Construction Manager or Subcontractors.

I have read the above and agree to abide by these requirements:

Name of Construction Manager Entity

Signature of Construction Manager or Authorized Agent

Type or print name and title of person who signed above

This Certificate is required by Oklahoma City Municipal Code, Chapter 25, Article III § 25-41, as incorporated by reference in the City of Oklahoma City's Standard Specifications for the Construction of Public Improvements or otherwise in the Subcontractor Contracts.