DEP CONSTRUCTION BID SUBMISSION FORMS ARFQ DEP23-27 MCCOY WELL PLUGGING.pdf

DEP Construction Bid Submission Review Form Revised September 21, 2022

State of West Virginia

Department of Environmental Protection

Construction Bid Submission Review Form

This list has been provided for informational purposes only and is not to be construed as a complete list of request for quotation or bidding requirements for any individual construction project. This list does not and cannot include every item, mistake or oversight that could cause a contractor’s bid to be disqualified. Rather, this list is intended to draw attention to some of the most common problems that occur in the bidding process for construction projects. All potential bidders must read the request for quotation, all additional documents, and all instructions relating thereto (“Bid Documents”) in their entirety to identify the actual request for quotation and bidding requirements. Failure to read the Bid Documents in their entirety and comply with the stated requirements contained therein may result in bid disqualification.

Errors that shall be reason for immediate bid disqualification

4.

1. Failure to attend a mandatory pre-bid meeting

2. Failure to supply a valid bid bond

4. Failure to meet any mandatory requirement of the RFQ

5. Failure to submit bid prior to the bid closing date and time

7. Federal debarment

8. State of West Virginia debarment or suspension

9. Outstanding environmental enforcement actions

10. Unresolved DEP vendor complaints

Errors that May Be Reason for Bid Disqualification Before Contract Award

1. Debt to the State or Political Subdivision (must be resolved prior to award)

2. Workers’ Compensation or Unemployment Compensation delinquency (must be resolved prior to award)

3. Failure to obtain required bonds and/or insurance

Failure to supply West Virginia contractor's license number with bid or within one day of DEP request to do so.

Failure to provide sub contractor listing within one business day of bid opening or one business day of request to do so by DEP, if applicable.

5. Failure to supply a signed drug free workplace affidavit with bid or within one day of the DEP request to do so.

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.

WV-73

Approved / April 30, 2020

DRUG FREE WORKPLACE CONFORMANCE AFFIDAVIT

West Virginia Code §21-1D-5

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:

STATE OF WEST VIRGINIA,

COUNTY OF ____________________________, TO-WIT:

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

By Commission expires

(Seal)

(Notary Public)

Rev. July 7, 2017

WV-72

Approved / Revised 08/01/15

Purchasing Division

CERTIFIED DRUG-FREE WORKPLACE REPORT COVERSHEET

In accordance with West Virginia Code § 21-1D-7b, no less than once per year, or upon completion of the project, every contractor shall provide a certified report to the public authority which let the contract. That report must include each of the items identified below in the Required Report Content section.

Instructions: Vendor should complete this coversheet, attach it to the required report, and submit it to the appropriate location as follows: For contracts more than $25,000, the report should be mailed to the West Virginia Purchasing Division at 2019 Washington Street East, Charleston, WV 25305. For contracts of $25,000 or less, the vendor should mail the report to the public authority issuing the contract.

Contract Identification:

Contract Number:

Contract Purpose:

Agency Requesting Work: _____

Required Report Content: The attached report must include each of the items listed below. The vendor should check each box as an indication that the required information has been included in the attached report.

Information indicating the education and training service to the requirements of West Virginia Code §

21-1D-5 was provided;

Name of the laboratory certified by the United States Department of Health and Human Services or its successor that performs the drug tests;

Average number of employees in connection with the construction on the public improvement;

Drug test results for the following categories including the number of positive tests and the number of negative tests: (A) Pre-employment and new hires; (B) Reasonable suspicion; (C) Post-accident; and

(D) Random.

Vendor Contact Information:

Vendor Name: ____________________ Vendor Telephone: ___________________

Vendor Address: ___________________ Vendor Fax: ________________________

___________________ Vendor E-Mail: