Bid Forms.pdf

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APPENDIX A

BID FORMS AND CERTIFICATES

BID FORMS – SECTION 1

AWARD FORMS– SECTION 2

REQUIREMENTS, PAYMENT AND CLOSEOUT

SECTION 3

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BID FORMS – SECTION 1

Forms to be submitted with Bid:

Bid Form 1-1

Non – Collusion Affidavit of Prime Bidder Form 1-3 Bid Bond Form 1-4

Certificate as to Corporate Principal 1-6 Statement of Bidder’s Qualifications 1-7

Acceptance of Provisions of the Workmen’s Compensation Act 1-9 Certificate of Compliance with the Prohibition of Illegal Alien Labor on Assisted Projects Act 1-10

Affidavit of Eligibility for Public Works 1-12 Public Works Employment Verification Form – Prime Contractor 1-14 Affidavit of Review and Acknowledgement of Insurance Requirements 1-15

Forms to be submitted after Bid:

1 original Bid Bond by low Bidder 1 original Bid Bond by next 2 lowest Bidders when requested by the Borough.

2026 Borough of East Stroudsburg General and Water Funds Paving Project

Appendix A – Bid Forms – 1- 1

BID FORM

Gentlemen:

1. The undersigned, having familiarized (himself) (themselves) (itself) with the existing conditions on the Project Area affecting the cost of the work, and with the Contract Documents (which include the Invitation to Bid, Instructions to Bidders, the form of Bid, the form of the Bid Bond, the form of Contract (or Agreement), the form of Non-Collusion Affidavit, Addenda (if any), GENERAL CONDITIONS, GENERAL CONDITIONS - PART II, , SPECIAL CONDITIONS, TECHNICAL SPECIFICATIONS, and Form of Surety Bond or Bonds; as prepared by: UTRS CEE.

2. In the event quantities need to be added or deleted, the following unit prices on the following pages shall apply:

Incidentals to the items includes removal/disposal of debris, maintenance and protection of traffic, site restoration, mobilization, demobilization, testing, superintendence, bonding and insurance costs. Resetting of signs includes removal from the existing location and all new hardware necessary to reset the sign

Hereby proposes to furnish all supervision, technical personnel, labor, materials, machinery, tools, equipment and services including utility, transportation and security services and to perform and complete all work specified under individual contract for the 2026 Borough of East Stroudsburg General and Water Funds Paving Project.

3. In submitting this bid, the Bidder understands that the unrestricted right is reserved by the Borough of East Stroudsburg to reject any and all bids, or parts thereof. If written notice of the acceptance of this bid is mailed, faxed or delivered to the undersigned within forty-five (45) days after the opening thereof (or ninety (90) days under conditions specified under Section 115 of Instruction to Bidders), or at any time thereafter before this Bid is withdrawn, the undersigned agrees to execute and deliver an agreement in the prescribed form and furnish the required bonds within ten (10) days after the Agreement is presented to him for signature.

4. Security in the sum of ________________________________________________ Dollars

($________________________________) in the form of _________________________________

_______________________________________, payable to the Borough of East Stroudsburg, is submitted herewith in accordance with the INSTRUCTIONS TO BIDDERS.

5. Attached hereto is an affidavit in proof that the undersigned has not entered into collusive agreement with any person in respect to this Bid or any other Bid or the submitting of Bids for the Contract for which this Bid is submitted.

6. The Bidder is prepared to submit a financial and experience statement upon request.

7. The Bidder hereby acknowledged the receipt of the following addendum, if any, via Penn Bid.

8. Bidder will complete the work for the prices outlined in the attached bid sheets.

9. Bidder agrees that the work will be substantially completed on or before the dates indicated in the Agreement. .

10. Bidder accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the work on time.

11. Bidder accepts the bonding requirements as set forth in the Contract Documents.

12. Bidder agrees that they have visited the site of the proposed work and have familiarized themselves with the project, the existing conditions relating to construction and labor, the difficulties and restrictions attending the performance of the Contract, and have thoroughly examined the Contract Documents, Technical Specifications, and all other Contract Documents. The Bidder agrees to bring to the Owner’s and Engineer’s attention immediately, any discrepancies, inconsistencies, or any other variation between existing and proposed conditions in the Contract Documents.

13. Bidder Tax Identification Number: ___________________________________

14. Bidder Dun & Bradstreet Number: ___________________________________

Appendix A – Bid Forms – 1- 2

BID FORM (Continued)

15. Contact Information – Name, Address, Telephone Number, Cell Phone Number, e-mail address

SUBMITTED this ____ day of _________________________, _20_____.

If BIDDER is:

An Individual

By ________________________________ (SEAL) (Individual’s Name)

Doing Business as:

Business address: ___________________________________

Phone No.: __________________________ e-mail.: __________________________

A Partnership

____________________________________ (SEAL)

(Firm’s Name)

By _____________________________________ (General Partner)

Business address: _________________________________

Phone No.: __________________________ e-mail.: __________________________

A Corporation

____________________________________ (SEAL) __________________________________

(Corporation’s Name) (State of Incorporation)

By _____________________________________ __________________________________ (Name of Person Authorized to Sign) (Title)

Attest ________________________________________ (Secretary or Corporate Officer)

Business address: _________________________________ Phone No.: __________________________

_________________________________ e-mail.: __________________________

Appendix A – Bid Forms – 1- 3

NON-COLLUSION AFFIDAVIT OF PRIME BIDDER

State of ____________________________________) ss

County of __________________________________)

________________________________________________ being first duly sworn deposes and says that:

(1)(S) He is ______________________________________________________________ (owner, partner, officer, representative or agent) of _____________________________________________________________________________________________________.

(2) (S)He is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid;

(3) Such Bid is genuine and is not a collusive or sham bid;

(4) Neither the said Bidder nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this affiant, has in any way colluded, conspired, connived, or agreed, directly or indirectly, with any other Bidder, firm or person to submit a collusive or sham Bid in connection with such Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other Bidder, firm or person to fix the price or prices in attached Bid or of any other Bidder, or, to fix any overhead, profit, or cost element of the bid price or the bid price of any other Bidder, or to secure through collusion, conspiracy, connivance, or unlawful agreement any advantage against any other Bidder, or any person interested in the proposed Contract;

(5) The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the Bidder or any of its agents, representatives, owners, employees, or parties in interest, including this affiant.

(Signed)

Title

Subscribed and sworn to before me this ____________________ day of ____________________ 20_____

Title

My commission expires_____________________________________

Appendix A – Bid Forms – 1- 4

BID BOND

KNOW ALL MEN BY THESE PRESENTS, That we the undersigned, _________________________________________________________ as PRINCIPAL, and _________________________ (Name of Principal) as SURETY are held and firmly bound onto the Borough of East Stroudsburg hereinafter called the Owner, in the penal sum of

_________________________________________________________________ Dollars ($____________________________) lawful money of the United States for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assign, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION

IS SUCH, that whereas the Principal has submitted the accompanying Bid, dated __________________________ 20_____, for the

2026 Borough of East Stroudsburg General and Water Funds Paving Project

NOW, THEREFORE, if the Principal shall not withdraw said Bid within the period specified therein after the opening of the same, or, if no period is specified, within ninety (90) days after the said opening, and shall within the period specified therefor, or, if no period be specified within ten (10) days after the prescribed forms are presented to him for signature, enter into a written contract with the Owner in accordance with the Bid as accepted, and give bond with good and sufficient surety or sureties, as may be required, for the faithful, performance and proper fulfillment of such Contract; or in the event of the withdrawal of said Bid within the period specified, or the failure to enter into such Contract and give such bond within the time specified, if the Principal shall pay the Owner the difference between the amount specified in said Bid and the amount for which the Owner may procure the required work or supplies or both, if the latter amount be in excess of the former, then the above obligation shall be void and of no effect, otherwise to remain in full force and virtue.

IN WITNESS WHEREOF, the above bounded parties have executed this instrument under their several seals this

____ day of _____________________ 20_________, the name and corporate seal of each corporate party being thereto affixed and these presents duly signed by its undersigned representative, pursuant to authority of its governing body.

Appendix A – Bid Forms – 1- 5

BID BOND

(Continued)

In presence of:

_________________________________ ____________________________(SEAL)

(Individual Principal)

(Business Address including City, State and Zip Code)

___________________________(SEAL)

(Individual Principal)

(Business Address including City, State and Zip Code)

Attest:

(Corporate Principal)

(Business address including City, State and Zip Code)

By __________________________________

Attest:

(Countersigned) (Corporate Surety)

By ______________________________ Attorney-in-Fact, State of

(power of attorney for person signing for surety company must be attached to bond)

Appendix A – Bid Forms – 1- 6

CERTIFICATE AS TO CORPORATE PRINCIPAL

I, _____________________________, certify that I am the __________________________ of the corporation named as

Principal in the within bond; that ___________________________________, who signed the said bond on behalf of the

Principal was then _____________________________ of said corporation; that I know his signature, and his signature thereto is genuine; and that said bond was duly signed, sealed and attested to, for and in behalf of said corporation by authority of its governing body.

______________________________(Corporate)

______________________________(Seal)

TITLE

DATE

Appendix A – Bid Forms – 1- 7

STATEMENT OF BIDDER'S QUALIFICATIONS

(To be submitted by the Bidder with Bid.)

All questions must be answered and the data given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate attached sheets. The Bidder may submit any additional information he desires.

1. Name of Bidder.

2. Permanent main office address, including City, State and Zip Code.

3. When organized.

4. If a corporation, where incorporated.

5. How many years have you been engaged in the contracting business under your present firm or trade name?

6. Contracts on hand: (List a schedule of these contracts, showing gross amount of each contract and the appropriate anticipated dates of completion).

7. General character of work performed by your company.

8. Have you ever failed to complete any work awarded to you? If so, where and why?

9. Have you ever defaulted on a contract? If so, where and why?

10. List the more important contracts recently completed by you, stating approximate gross final contract amount for each, and the month and year completed.

11. List your major equipment available for this contract.

12. Experience in work similar in character to this project. Similar means contracts for installing pavement and, curb with similar conditions including but not limited to similar quantities.

13. Background and experience of the principal members of your organization including the officers and key personnel who will be assigned to this project such as the project manager, site superintendent and/or site foreman.

14. Credit available: $______________________________.

15. Give bank reference.

16. Will you upon request, fill out a detailed financial statement and furnish any other information that may be required by the Owner.

17. (a) Have you ever been a party to or otherwise involved in any action or legal proceeding involving matters related to age, sex, race, color, nationality, or religion? If so, give full details.

(b) Have you ever been accused of discrimination based upon age, sex, race, color, nationality, or religion in any action or legal proceeding, including any proceeding related to any Federal Agency? If so, give full details.

18. The undersigned hereby authorizes and requests any person, firm or corporation to furnish any information requested by the Owner in verification of the recitals comprising this Statement of Bidder’s Qualifications.

Appendix A – Bid Forms – 1- 8

STATEMENT OF BIDDER'S QUALIFICATIONS

(CONTINUED)

Date at ___________________________ this _____________ day of _____________________20______

(Name of Bidder)

By ______________________________________

Title ______________________________________

State of ____________________________)

SS

County of __________________________)

_____________________________________________________ being duly sworn, deposes and says that he is the __________________________________ of __________________________________________ (Name of Organization) and that the answers to the foregoing questions and all statements therein contained are true and correct.

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

Notary Public

My Commission expires _____________________________

Appendix A – Bid Forms – 1- 9

AFFIDAVIT

ACCEPTANCE OF PROVISIONS OF THE WORKMEN’S COMPENSATION

ACT

State of ) ) ss:

County of )

____________________________ being duly sworn according to the law that (they have/it has/he has) accepted the provisions of the Workmen’s Compensation Act of 1915 of the Commonwealth of

Pennsylvania, with its supplements and amendments, and (have/has) insured (his/their/its) liability thereunder in accordance with the terms of said Act with ____________________________________.

(Insurance Company)

(Print or Type Contractor)

BY:________________________________

Signature

Sworn to and subscribed before me this ________ day of ___________________________ A.D., 20___.

My commission expires ________________

Appendix A – Bid Forms – 1- 10

CERTIFICATE OF COMPLIANCE WITH THE PROHIBITION OF

ILLEGAL ALIEN LABOR ON ASSISTED PROJECTS ACT

State of ____________________________________) ss

County of __________________________________)

________________________________________________ being first duly sworn deposes and says that:

I. (S)He is __________________________________ of

(owner, partner, or officer) hereinafter called the “Contractor”.

II. During the term of the Contract, the said Contractor agrees to the following provisions as listed on this page and in the Contract Documents and Specifications;

(1) The Contractor agrees to comply with the Prohibition of Illegal Alien Labor on Assisted Projects Act.

(2) Pursuant to the Act of May 11, 2006 (P.L. 173, No. 43), known as the Prohibition of Illegal Alien Labor on Assisted Projects Act, the Contractor shall not knowingly employ, or knowingly permit any of its subcontractors to knowingly employ, the labor services of an illegal alien on activities funded in whole or in part by a grant or loan issued by the Commonwealth of Pennsylvania.

(3) In the event that the Contractor

i. Knowingly employs, or knowingly permits any of its subcontractors to knowingly employ, the labor services of an illegal alien on activities funded in whole or in part by grants or loans issued by an executive agency of the Commonwealth of Pennsylvania; and

ii. the Contractor or any of its subcontractors are sentenced under Federal law for an offense involving knowing use of labor by an illegal alien on activities funded in whole or in part by grants or loans issued by an executive agency of the Commonwealth of Pennsylvania, The Contractor shall forfeit and repay to the Borough of East Stroudsburg all moneys paid to the Contractor in the performance of the Contract.

(4) The Contractor shall include the provisions of this Certificate of Compliance with the Prohibition of Illegal Alien Labor on Assisted Projects Act in every subcontract so that such provisions will be binding upon each subcontractor.

(5) The Borough of East Stroudsburg may cancel or terminate the Contract, and all money due or to become due under the Contract may be forfeited for a violation of the Prohibition of Illegal Alien Labor on assisted Projects Act.

(Signed)

Title

Appendix A – Bid Forms – 1- 11

Subscribed and sworn to before me this ____________________ day of ____________________ 20________

Title

My commission expires________________________________________

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Appendix A – Bid Forms – 1- 12

AFFIDAVIT OF ELIGIBILITY FOR PUBLIC WORKS

State of ) ss

County of ) being first duly sworn deposes and says that:

(1) (S)He is of (Bidder).

(owner, partner, officer, representative or agent)

(2) (S)He is fully informed of the business affairs of bidder including the existence of all permits and contracts held, and the ability of bidder to perform public contracts in any Federal, State and/or local jurisdiction.

(3) That neither bidder or any of its officers, partners, owners, shareholders, agents, representatives, employees, or parties of interest, including affiant, have been disbarred, prohibited, suspended, banned or otherwise restricted from working on any publicly funded work projects in any Federal, State, and/or local jurisdiction in the United States within the last ten (10) years.

(4) Further, that neither bidder or any of its officers, partners, owners, shareholders, agents, representatives, employees or parties of interest, including affiant, have had any contracts with any Federal, State, and/or local jurisdiction terminated as a result of a violation of law or ethical rule.

(5) If the answer to either or both paragraphs 2 and 3 are in the affirmative, please state for each action taken:

(a) The reason for each action taken __________________________

(b) The person, entity, business or governmental agency taking the action.

(Include name, address, and telephone number.)_____________________

(c) Resolution of any action taken __________________________________

(6) Penalty of Perjury. I understand that the statements herein are made subject to the penalties of 18 Pa. C.S.A. §4904 relating to unsworn falsifications to authorities.

(Signed) ___________________________

Appendix A – Bid Forms – 1- 13

Title Subscribed and sworn to before me the day of _______________, 20__

Notary Public

State of _______________________ My commission expires __________

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Ann Wingert Typewriter Borough of East Stroudsburg

Ann Wingert Typewriter 10205.656

Ann Wingert Typewriter 2026 Borough of East Stroudsburg General and Water Funds Paving Project

Ann Wingert Typewriter Various Streets within the Borough of East Stroudsburg.

Ann Wingert Typewriter Appendix A - Bid Forms I-14

AFFIDAVIT OF REVIEW AND ACKNOWLEDGEMENT OF INSURANCE

REQUIREMENTS

STATE OF : COUNTY OF _________________________:

I, , being duly sworn according to law, depose and say that:

1. (S)He is (Owner, Partner, Officer, Representative or Agent) of

, hereinafter called the “Contractor”.

2. I have personally reviewed the insurance requirements set forth in Section 203 of this Contract.

3. I have personally reviewed conditions of application for Partial Payments and Final Payment set forth in Section 237 of this Contract.

4. I am aware of that the Borough of East Stroudsburg (“Borough”) has conditionally approved a modification, requested by the Contractor, to retain The Blanket Notification to Other of Cancellation or Non-Renewal Endorsement Paragraph c. of the insurance endorsement documents. This paragraph would appear to make 30-day notice to the Township of cancellation of insurance coverage more of a courtesy of the Contractor’s insurance company rather than a strict requirement.

5. Penalty Perjury. I understand that the statements herein are made subject to the penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities.

Title Sworn to and subscribed before me this day of ____ _______________, 20____.

Notary Public My Commission Expires:

Appendix A – Bid Forms 1-15

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05-AFFIDAVIT INSURANCE