Bid Project _2024 STM_38 BID DOCUMENTS_02_22_.pdf

Invitation To Bid For the Construction of

Bid Project #2024 STM-38 – Donnie Simmons Way Culvert Upgrades

Sealed bids will be received by the City of Statesboro (City) at 22 West Grady Street, Statesboro, Georgia 30458 until 3:00 PM EST on Wednesday, March 27, 2024 at the office of Darren Prather, Director of Central Services. At this time, bids will be publicly opened and read aloud in the Statesboro Municipal Court Room, subsequently. All bids must be submitted in a sealed envelope addressed to Darren Prather, Director of Central Services and Purchasing via FedEx, UPS USPS, or hand-delivered. Emailed bids, unsealed bids, and bids received after the designated time will not be considered.

The project includes the installation of a new 72” x 48” box culvert, Catch Basins, Curb and Gutter, water-main utility relocations and traffic striping at the Culvert located on Donnie Simmons Way between Kent Street and Morris Street.

The BID DOCUMENTS may be examined at the following location:

City Hall City of Statesboro Engineering Department 50 East Main Street Statesboro, GA 30458

A required pre-bid conference will be held at 10:00 A.M. EST on Wednesday, March 13, 2024, in the Statesboro Municipal Courtroom. The Statesboro Municipal Court is located at 22 West Grady Street, Statesboro Georgia 30458. Project scheduling, coordination, and questions of interpretation will be addressed at this time.

All bids must be accompanied by a Bid Bond in an amount not less than five percent (5%) of the Base Bid. Performance Bond and Payment Bond, each in the amount of One Hundred percent (100%) of the Contract amount, will be required of the successful bidder. Bonds must be written by an acceptable Surety Company licensed to do business in the States of Georgia and listed in the Department of the Treasury, Circular 570, latest edition.

NOTE: Contractor and all subcontractors must obtain a business license in Georgia, be fully insured, and be a Licensed Contractor in the State of Georgia.

INSURANCE: Contractor shall maintain the following insurance:

a) Comprehensive general liability, including blanket contractual, covering bodily injuries with limits of no less than $1,000,000 per occurrence, and property damage with limits of no less than $1,000,000 per occurrence.

b) Commercial automobile liability, including blanket contractual, covering bodily injuries with limits of no less than $1,000,000 per occurrence, and property damage with limits of no less than $1,000,000 per accident.

c) Statutory worker’s compensation insurance, including $1,000,000 employer’s liability insurance.

d) Employee dishonesty and/or crimes coverage with respect to personnel of Contractor having access to City buildings, with limits of no less than $50,000 per occurrence.

All insurance shall be provided by an insurer(s) acceptable to the City and shall provide for thirty

(30) days prior notice of cancellation to the City. Upon request, Contractor shall deliver to the City a certificate or policy of insurance evidencing Contractor’s compliance with this requirement.

Contractor shall abide by all terms and conditions of the insurance and shall do nothing to impair or invalidate the coverage.

Before the City of Statesboro will execute a contract, the contractor will provide proof of insurances as required per state law.

The successful bidder shall secure and pay for all permits, assessments, charges or fees required in connection with the proposed construction.

All work to be performed under this project must be substantially complete within 120 consecutive calendar days, and punch list items for final acceptance will be allotted 30 days, for a total of 150 consecutive calendar days following receipt of the Notice to Proceed.

The City of Statesboro reserves the right to reject any or all bids, including without limitation, the right to reject any and all nonconforming, non-responsive, unbalanced or conditional bids and to reject the bid of any bidder whom the Owner believes would not be in the best interest of the Project to make an award to that bidder whether because the bid not responsive, the bidder is unqualified, or of doubtful financial ability or fails to meet any other pertinent standard or criteria established by the Owner.

General Requirements, Specifications, and Notes

1) Any Request for Information (RFI) concerning this bid project request must be emailed to Darren Prather at bidinfo@statesboroga.gov no later than Tuesday, March 19, 2024 at 3:00

PM EST.

2) It is the bidder’s responsibility to ensure that all attachments are included in the bid package received. For this bid package, the following attachments apply:

a. Invitation to bid (ITB) documents provided herein

b. Drawings to be obtained electronically. Contractor responsible for field verifying all measurements.

c. Bid Table

3) It is the intent of the City of Statesboro to encourage participation by Minority and Female-owned Business Enterprises (MFBE) for all procurement processes. The construction phase of this project shall include a minimum 20% MFBE participation of total construction cost. All submittals for this ITB must include a signed affidavit, provided herein, acknowledging compliance with 20% MFBE requirement at time of submittal of sealed bids. Upon submittal of sealed bids pre-qualified contractors will be required to provide proof of MFBE certification, preferably analogous with GDOT DBE certification. If general /prime contractor is not a certified MFBE or provide list of MFBE subcontractors, their certifications, identify percentage of participation by each sub-contractor in the MFBE Participation Report provided herein.

4) All bids must be submitted on the Bid Form provided herein.

5) All bids must be accompanied by an E-Verify affidavit provided herein.

6) All bids must be accompanied by a Non-Collusion affidavit provided herein.

7) All sheets must be fully completed. All bids shall be sealed and clearly marked on the outside envelope: “Bid Project #2024 STM-38 - Donnie Simmons Way Culvert Upgrades”. All bid packages shall be submitted to the attention of Darren Prather, Director of Central Services, 22 West Grady Street, Statesboro, GA 30458, prior to the time established in the ITB. For additional information on the bid package, please contact Darren at (912) 764-0642.

8) Bidders will be fully responsible for the delivery of their bids in a timely manner. Reliance upon a postal service shall be at the bidder’s risk. Late bids will not be considered.

9) PRICES, NEGOTIATIONS, AND MISTAKES. All prices and notations must be in ink.

Mistakes may be crossed out and corrections typed or printed adjacent to the mistake and initialed in red ink by the person who signed the bid. Prices shall be stated in units and quotations made separately on each item. Mathematical calculations on all bid submittals will be checked by the City and any mistakes corrected. The City of Statesboro will not post the bid submittal results until after the mathematical verification process has been completed. In case of conflict, unit price will govern. Where there is conflict between words and figures, words will govern.

10) Upon approval of the bid by the City the Notice to Proceed shall be issued in a timely manner following the execution of the Contract Documents.

11) Failure to complete all work within the 150 consecutive calendar days of being given the Notice to Proceed as established in the Invitation to Bid and the Contract Documents, including extensions granted thereto, shall entitle the City of Statesboro to retain from compensation otherwise due to be paid to the Contractor, or otherwise recover by all remedies of law an amount equal to that listed in the Section 108.08 of Georgia Department of Transportation’s Standard Specifications 2021. It is agreed by and between the City of Statesboro and the

Contractor that this sum has been established, not as a penalty, but as liquidated damages and that it is reasonable and acceptable, as the City provides services necessary for the health and welfare of the public and due to the impracticability and extreme difficulty of fixing and ascertaining the actual damages assessed for each consecutive calendar day of delay in the completion date.

12) All installed work shall be performed in accordance with the most recent GDOT Standards and Details.

13) All Materials intended for use on the project must be submitted to the City of Statesboro prior to installation.

14) The City of Statesboro reserves the right to reject any defective material on site. All materials shall be installed in accordance with the most recent GDOT standards.

15) The City of Statesboro reserves the right to add, modify, or delete quantities. Contractor will be paid for actual in place quantities completed and accepted for pay items listed in the scope of work schedule. Contractor will not be entitled to an adjustment of unit price on an item which increased or decreased from the original plan quantity.

16) Contractors shall only bid on those items provided in the scope of work. No alternative material types submitted by the contractor will be considered during the bidding phase.

17) The Contractor is responsible for coordinating work with the City of Statesboro to ensure access to properties impacted by project activities are adequately maintained. The contractor will be responsible for any damage on these properties due to construction.

18) The contractor shall exercise caution, as to not damage any infrastructure, either private or public, not related to this project (i.e., overhead utilities, sidewalks, asphalt, mailboxes, landscaping, etc.) Repairs for all damages will be the responsibility of the contractor.

19) The quantities shown on the Bid Schedule and Bid Table are estimated for bidding purposes only. Exact quantities are to be verified before ordering. Any overages will not be paid unless prior approval is obtained by the City Engineer or their representative.

20) The Contractor is responsible for visiting the site and verify the nature of required work including required quantities.

21) The City will pay the contractor upon receipt of a W-9 and an invoice properly filled out quantifying the installed work in the period requested for payment to the City of Statesboro Engineering Department. Contractor should include “Bid Project #2024 STM-38 - Donnie Simmons Way Culvert Upgrades” on the invoice.

22) The construction site shall be cleaned from construction debris and equipment before a final walk through for acceptance can occur for release of retainage.

23) Contractor is to warranty labor and materials for a minimum of 12 months from acceptance of work by the City.

INFORMATION FOR BIDDERS

Sealed BIDS for Bid Project #2024 STM-38 – Donnie Simmons Way Culvert Upgrades will be received by the City of Statesboro at 22 West Grady Street, Statesboro, Georgia 30458 until 3:00 PM EST on Wednesday, March 27, 2024 at the office of Darren Prather, Director of Central Services. At this time, bids will be publicly opened and read aloud in the Statesboro Municipal Court Room, subsequently. All bids must be submitted in a sealed envelope addressed to Darren Prather, Director of Central Services and Purchasing via FedEx, UPS USPS, or hand-delivered. Emailed bids, unsealed bids, and bids received after the designated time will not be considered.

Each BID must be submitted in a sealed envelope, addressed to the City of Statesboro, Attention Darren Prather, 22 West Grady Street, Statesboro Georgia 30458. Each sealed envelope containing a BID must be plainly marked on the outside as BID for Bid Project #2024 STM-38 - Donnie Simmons Way Culvert Upgrades and the envelope should bear on the outside the name of the BIDDER, address, license number if applicable, and the name of the project for which the BID is submitted. If forwarded by mail, the sealed envelope containing the BID must be enclosed in another envelope addressed to the OWNER at City of Statesboro, Attention Darren Prather, 22 West Grady Street, Statesboro Georgia 30458.

All BIDS must be made on the required BID form. All blank spaces for BID prices must be filled in, in ink or typewritten, and the BID form must be fully completed and executed when submitted.

Only one copy of the BID form is required.

The OWNER may waive any informalities or minor defects or reject any and all BIDS. Any BID may be withdrawn prior to the above scheduled time for the opening of BIDS or authorized postponement thereof. Any BID received after the time and date specified shall not be considered.

No BIDDER may withdraw a BID within 60 days after the actual date of the opening thereof.

Should there be reasons why the contract cannot be awarded within the specified period the time may be extended by mutual agreement between the OWNER and the BIDDER.

Georgia Department of Transportation (GDOT) Standard Specifications for Construction of Transportation Systems, 2013 Edition, to include most recent revisions, are the governing standards for this project. All striping shall be in accordance with current MUTCD Standards.

BIDDERS must satisfy themselves of the accuracy of the estimated quantities in the BID Schedule by examination of the site and a review of the drawings and specifications including ADDENDA.

After BIDS have been submitted, the BIDDER shall not assert that there was a misunderstanding concerning the quantities of WORK or of the nature of the WORK to be done.

The OWNER shall provide to BIDDERS prior to BIDDING, all information that is pertinent to, and delineates and describes, the land owned, and rights-of-way acquired or to be acquired.

The CONTRACT DOCUMENTS contain the provisions required for the construction of the PROJECT. Information obtained from an officer, agent, or employee of the OWNER or any other person shall not affect the risks or obligations assumed by the CONTRACTOR or relieve him from fulfilling any of the conditions of the contract.

Attorneys-in-fact who sign BID BONDS or payment BONDS and performance BONDS must file with each BOND a certified and effective dated copy of their power of attorney.

The party to whom the contract is awarded will be required to execute the Agreement within ten

(10) Calendar days from the date when NOTICE OF AWARD is delivered to the BIDDER. The NOTICE OF AWARD shall be accompanied by the necessary Agreement form. In case of failure of the BIDDER to execute the Agreement, the OWNER may at his option consider the BIDDER in default.

The OWNER within ten (10) days of receipt of acceptable Agreement signed by the party to whom the Agreement was awarded shall sign the Agreement and return to such party an executed duplicate of the Agreement. Should the OWNER not execute the Agreement within such period, the BIDDER may by WRITTEN NOTICE withdraw his signed Agreement. Such notice of withdrawal shall be effective upon receipt of the notice by the OWNER.

The NOTICE TO PROCEED shall be issued within ten (10) days of the execution of the Agreement by the OWNER. Should there be reasons why the NOTICE TO PROCEED cannot be issued within the ten (10) day period or within the period mutually agreed upon, the CONTRACTOR may terminate the Agreement without further liability on the part of either party.

The OWNER may make such investigations as he deems necessary to determine the ability of the BIDDER to perform the WORK, and the BIDDER shall furnish to the OWNER all such information and data for this purposed as the OWNER may request. The OWNER reserves the right to reject any BID if the evidence submitted by, or investigation of, such BIDDER fails to satisfy the OWNER that such BIDDER is properly qualified to carry out the obligations of the Agreement and to complete the WORK contemplated therein.

A conditional or qualified BID will not be accepted. Award will be made to the most responsible

BIDDER.

OWNER reserves the right to award project based on base bid only or any combination of alternates, if applicable, at their sole discretion.

All applicable laws, ordinances, and the rules and regulations of all authorities having jurisdiction over construction of the PROJECT shall apply to the contract throughout.

Each BIDDER is responsible for inspecting the site and for reading and being thoroughly familiar with the CONTRACT DOCUMENTS. The failure or omission of any BIDDER to do any of the foregoing shall in no way relieve any BIDDER from any obligation in respect to his BID.

The low BIDDER shall supply the names and addresses of major material SUPPLIERS and SUBCONTRACTORS when requested to do so by the OWNER. All bidders must have a State of Georgia Contractors License.

GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT AFFADAVIT AND

AGREEMENT

Effective July 1, 2007, the following language is required to be included in all contracts entered into by the City of Statesboro for the physical performance of services within this State of Georgia:

A. Pursuant to the Georgia Security and Immigration Compliance Act of 2006, the Proposer understands and agrees that compliance with the requirements of O.C.G.A § 13-10-91 and Georgia Department of Labor Rule 300-10-.02 are conditions of this Agreement. The proposer further agrees that such compliance shall be attested by the Proposer through execution of the proposer affidavit required by Georgia Department of Labor Rule 300-10-1-.07, or a substantially similar proposer affidavit. The Proposer’s fully executed affidavit is attached hereto and is incorporated into this Agreement by reference herein.

B. By initialing in the appropriate line below, the Proposer certifies that the following employee-number category as identified in O.C.G.A § 13-10-91 is applicable to the Proposer.

1. ___________500 or more employees;

2. ___________100 or more employees;

3. ___________Fewer than 100 employees.

C. The Proposer understands and further agrees that, in the event the Proposer employs or contracts with any subcontractor in connection with this Agreement, the Proposer shall:

1. Secure from each such subcontractor an indication of the employee-number category as identified in O.C.G.A § 13-10-91 that is applicable to the subcontractor;

2. Secure from each subcontractor an attestation of the subcontractor’s compliance with O.C.G.A § 13-10-91 and Georgia Department of Labor Rule 300-10-1.02 by causing each such subcontractor to execute the subcontractor affidavit required by Georgia Department of Labor Rule 300-10-1- .08, or substantially similar subcontractor affidavit. The Proposer further understands and agrees that the Proposer shall require the executed subcontractor affidavit to become a part of the agreement between the Proposer and each such subcontractor. The proposer agrees to maintain records of each subcontractor attestation required hereunder for inspection by the City of Statesboro at any time.

Contractor: _________________________ EEV*UserID#: ________________________

Authorized Signature: _________________ Date: ________________

Title: ______________________________

SUBSCRIBED AND SWORN TO ME THIS THE ____ DAY OF _____________. 20__.

___________________________ (Seal) Notary Public

My commission Expires: __________________

*As of the effective date of O.C.G.A § 13-10-91, the applicable federal work authorization program is the “EEV/Basic Pilot Program” operated by the U.S. Citizenship and Immigration Services Bureau of the U.S.

Department of Homeland Security, injunction with the Social Security Administration (SSA).

AFFIDAVIT VERIFYING STATUS

FOR CITY PUBLIC BENEFITS APPLICATION

By executing this affidavit under oath, as an applicant for the award of a contract with the City of Statesboro, Georgia, I ____________________ [Name of natural person applying on behalf of individual, business, corporation, partnership, or other private entity] am stating the following as required by O.C.G.A § 50-36-1:

1. ___ I am a United States citizen

OR

2. ___ I am a legal permanent resident 18 years of age or older or I am an otherwise qualified alien or non-immigrant under the Federal Immigration and Nationality Act 18 years or older and lawfully present in the United States. *

In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A § 16-10-20.

Signature of Applicant: ______________ Date: ____________

Printed Name: ______________

*Alien Registration Number for non-citizens:_____________________

SUBSCRIBED AND SWORN BEFORE ME THIS _____ DAY OF ___________, 20__

Notary Public

My commission Expires:

*Note: O.C.G.A § 50-36-1(e)(2) requires that aliens under the Federal Immigration and Nationality Act, Title 8 U.S.C as amended, provide their registration number. Because legal permanent residents are included in the federal definition of “alien”, legal permanent residents must also provide their alien registration number. Qualified aliens that do not have an alien registration number may supply another identifying number below.

CONTRACTOR AFFIDAVIT UNDER O.C.G.A. § 13-10-91(b)(1)

By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13- 10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services on behalf of City of Statesboro has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-91. Furthermore, the undersigned contractor will continue to use the federal work authorization program throughout the contract period and the undersigned contractor will for the physical performance of services in satisfaction of such contract only with subcontractors who present an affidavit to the contractor with the information required by O.C.G.A. § 13-10-91(b). Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:

Federal Work Authorization User Identification Number: ________________________

Date of Authorization: _________________

Name of Contractor: __________________________________

Name of Project: 2024 STM-38 Donnie Simmons Way Culvert Upgrades

Name of Public Employer: City of Statesboro

I hereby declare under penalty of perjury that the foregoing is true and correct.

Executed on ______________________, 20__ in________________ (city), ___ (state).

Signature of Authorized Officer or Agent: _______________________________

SUBSCRIBED AND SWORN BEFORE ME ON THIS THE___DAY OF__________, 2024.

Notary Public My Commission Expires: ___________________

BID FORM

Bid of__________________________ (hereafter called “BIDDER”), organized and existing under the laws of the State of Georgia doing business as*_______________________________.

To the City of Statesboro (hereinafter called “OWNER”).

Incompliance with your Advertisement for Bids, BIDDER hereby proposes to perform all

WORK for the construction of Bid Project #2024 STM-38 - Donnie Simmons Way Culvert

Upgrades in strict accordance with the CONTRACT DOCUMENTS, within the time set forth therein, and at the prices stated below.

By submission of this BID, each BIDDER certifies, and in the case of a joint BID each party thereto certifies as to his own organization, that this BID has been arrived at independently, without consultation, communication, or agreement as to any matter relating to this BID with any other BIDDER or with any competitor.

BIDDER hereby agrees to commence WORK under this contract on or before a date to be specified in the NOTICE TO PROCEED and to fully complete the PROJECT within 150 consecutive calendar days thereafter.

BIDDER acknowledges receipt of the following ADDENDUM:

*Insert “a corporation”, “a partnership”, or “an individual” as applicable.

Bid- Table City of Statesboro

Donnie Simmons Way Culvert Upgrades – Bid Project #2024- STM-38 General Conditions No. Item No. Item Description Qty. Unit Unit Price Total 1 106-1000 Materials Testing 1 LS 2 150-1000 Traffic Control 1 LS 3 151-1000 Mobilization 1 LS 4 210-0100 Grading Complete 1 LS Erosion and Sedimentation Control

No. Item No. Item Description Qty. Unit Unit Price Total 5 163-0232 Temporary Grassing 0.25 Acre 6 163-0541 Rock Tilter Dam, Type 3, 18-in 1 EA 7 163-0550 Inlet Sediment Trap 3 EA 8 700-6910 Permanent Grassing 0.25 Acre 9 700-7000 Agricultural Lime 0.1 TN 10 700-8000 Fertilizer Mixed Grade 0.04 TN 11 716-1000 Erosion Control Mats, Waterways (SS: Ero Control Blanket-

Coconut / Straw)

328 SY

Roadway / Culvert

No. Item No. Item Description Qty. Unit Unit Price Total 12 207-0203 Foundation Backfill Matl, Tp II (pipe bedding) 50 CY 13 310-5060 Gr Aggr Base Course, 6 inch, Incl Matl 51 TN 14 402-3113 Rec. Asph. Conc. 12.5mm SP, GP 1/2, Incl Bitum Matl &

Lime (220lbs/sy)

47 TN

15 413-1000 Bituminous Tack Coat 35 GAL 16 441-0104 Concrete Sidewalk, 4 in 31 SY

17 441-6012 Concrete Curb & Gutter, 8in x 30 in, Tp. 2 120 LF 18 500-3002 Class AA concrete: 72"x48" single barrel culvert, 54 ' long. 61 CY 19 511-1000 Bar Reinf Steel, GASTD 2401 72"x48", 54' 8309 LBS 20 550-1180 Storm Drain Pipe, 18in, H 1-10, RCP 16 LF 21 550-1240 Storm Drain Pipe, 24in, H 1-10, RCP 8 LF 22 603-2018 Storm Dumped RipRap, Tp. 3, 18-in 172 SY 23 603-7000 Plastic Filter Fabric, Woven 200-lb Tensile All Directions 172 SY 24 653-1501 Thermoplastic Solid Traf Stripe, 5 in, white 200 LF 25 653-1502 Thermoplastic Solid Traf Stripe, 5 in, yellow 200 LF 26 663-4311 Storm Sewer Manhole, TP. 1, Addl Depth, CL 1 1 EA 27 668-1100 Catch Basin - 1034D, GP 1 2 EA 28 670-1060 Water Main, 6 in, C900 PVC, Including Fittings 50 LF 29 670-1460 Connect to Existing Water Main 2 EA

BID BOND

KNOW ALL MEN BY THESE PRESENTS, that we, the undersigned, __________________, (herein called the “Principal”), and _____________________, as Surety, are held firmly bound to The City of Statesboro (herein called the “OWNER”) in the sum of:___________DOLLARS

($____________________) lawful money of the United States of America, for the payment of which will and truly be made, we bind ourselves, our heirs, executors, administrators, successors and assignees, jointly and severally, firmly by these presents, SIGNED, SEALED, AND

DATED this ____ day of ____________, 20__.

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

City of Statesboro a certain BID, attached hereto and hereby made a part hereof to enter into a contract in writing, for the

NOW, THEREFORE,

a) If said BID shall be rejected, or

b) If said BID shall be accepted and the Principal shall execute and deliver a contract in the

Form of Contract attached hereto (properly completed in accordance with said BID) and shall furnish a BOND for their faithful performance of said contract, and for the payment of all persons performing labor or furnishing materials in connection therewith, and shall in all other respects perform the agreement created by the acceptance of said BID, then this obligation shall be void, otherwise the same shall remain in force and effect; it being 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 the time within which the OWNER may accept such BID; and said SURETY does hereby waive notice of any such extensions.

IN WITNESS WHEREOF, the Principal and the Surety have hereunto set their hands and seals, and such of them as are corporations have caused their corporate seals to be hereto affixed and these presents to be signed by their proper officers, the day and year first set forth above.

ATTEST: ___________________________

Principal

_____________________________ BY: _______________________

Principal Secretary

(SEAL)

Witness to Principal (Address)

Surety

ATTEST:

(Surety) Secretary

(SEAL)

(Witness to Surety) (Attorney-in-Fact)

Address

IMPORTANT – Surety companies executing BONDS must appear on the Treasury Department’s most current list (Circular 570 as amended) and be authorized to transact business in the states where the project is located.

NON-COLLUSION AFFIDAVIT OF PRIME BIDDER/SUBCONTRACTOR

State of Georgia City of Statesboro

___________________________, being the first duly sworn, deposes and says that:

He/she is of______________________________(Owner, partner, etc.) (Company) the Bidder that has submitted the attached Bid;

1.He/she is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid;

2.Such Bid is genuine and is not a collusive or sham Bid;

3.Neither the said Bidder nor any of its officers, partners, owners, subcontractors, 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 sham Bid in connection with the 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 price or prices in the attached Bid or of any other Bidder, or to fix overhead, profit or cost element of the bid price or the bid price of any other bidder, or to secure through any collusion, conspiracy, connivance or unlawful agreement and advantage against City of Statesboro or any person interested in the proposed contract;

4.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;

Signature: ______________________ Date: _____________________

Name: ________________________ Title: _____________________

Notary: _______________________

My Commission Expires:

CERTIFICATION REGARDING DEBARMENT SUSPENSION, AND OTHER

RESPONSIBILITY MATTERS - PRIMARY COVERED TRANSACTIONS

INSTRUCTIONSFORCERTIFICATION

1. By signing and submitting this bid, the prospective primary participant is providing the certification set out below.

2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit it an explanation of why it cannot provide the certification ser out below. The certification or explanation will be considered in connection with the department of agency’s determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation could disqualify such person from participation in this transaction.

3. The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available, the City may terminate this transaction for cause or default.

4. The prospective primary participant shall provide immediate written notice to the department or agency to which this bid is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

5. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, bid, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the department to which this bid is being submitted for assistance in obtaining a copy of those regulations.

6. The prospective primary participant agrees by submitting this bid that should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is proposed for debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction.

7. The prospective primary participant further agrees by submitting this bid that it will include the clause titled ''Certification Regarding Debarment, Suspension, Ineligibility and

Voluntary Exclusion- Lower Tier Covered Transaction,'' provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

8. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not proposed for debarment under 48 CFR part 9, subpart 9.4, debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the list of Parties Excluded from Federal Procurement and Non-procurement Programs.

9. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

10. Except for transactions authorized under paragraph 6 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under 49 CFR pan 9, subpart 9.4, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default.

CERTIFICATION

(1) The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals:

a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded 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 governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and

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

(2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this bid.

Organization Name: ___________________ Project Name: _____________________

Name & Title: ___________________________ Signature: __________________________

MINORITY / FEMALE OWNED BUSINESS ENTERPRISE (MFBE) AFFADAVIT

Section 1: Business ID

I attest that I am a majority stake holder in a minority or female owned business enterprise:

_____ Yes _____No

Employer Identification # (EIN): _______________________ State of Corporation: ______

MFBE Ownership: ______Minority ______Female (check both if applicable)

MFBE Owned Certification #: ________________

Section 2: Business Information

Business Name: __________________ DBA Name: ________________________

Company Corporation Type: ________ Ownership Ethnicity: _________________

Company Ownership Gender: _______________

Section 3: Business Contact Information

Business Address: __________________ City: __________ State: _____Zip: _______

Business Phone #: _________________ Company Website: _____________________

Section 4: Business Principal Information

Principal Name: _____________________ Principal Title: ___________________

Principal Phone #: ____________________ Principal E-Mail: _____________________

Section 5: Project Participation Information

Project Name: _________________________ Project Participation by Business (%): ____

% Business Project Participation as: General Contractor: _____ Subcontractor: _______

Disclaimer and Signature I certify that my answers are true and complete to the best of my knowledge.

Signature:____________________ Printed Name: ________________ Date:____

Notary Signature: __________________ Seal: __________________ Date: _____