Disclosures.docx

DISCLOSURE AFFIDAVIT AND ATTESTATIONS FOR COMPETITIVE BIDS

The District will neither consider nor recommend a bid that does not include completed disclosure statement.

IRAN ECONOMIC SANCTIONS ACT CERTIFICATION

Section 3 of 2012 PA 517 imposes a vendor certification requirement on request for proposals issued by Grant Public Schools.

(1) Beginning April 1, 2013, an Iran linked business is not eligible to submit a bid on a request for proposal with a public entity.

(2) Beginning April 1, 2013, a public entity shall require a person that submits a bid on a request for proposal with the public entity to certify that it is not an Iran linked business.

In response to this legislation, Grant Public Schools requires the following information. The Vendor (respondent) certifies that:

____ IT IS an Iran linked business as defined in MCL 129.312.

____ IT IS NOT an Iran linked business as defined in MCL 129.312.

Company Name: _______________________________________________________________________________________ Name of person providing data (please print): _______________________________________________________________ Title: ______________________________________ Signature: _________________________________________________ Phone: ____________________________ Date: _______________________________________

DISCLOSURE OF FAMILIAL RELATIONSHIPS FOR COMPETITIVE BIDS

Disclose any familial relationship that exists between the District or any employee of the bidder and any member of the Schools Board of Education or Superintendent. (MCL 380.1267)

______ THERE IS NO FAMILIAL RELATIONSHIP.

______THE FOLLOWING FAMILIAL RELATIONSHIP exists:

Attach additional pages if necessary to disclose familial relationship(s).

FIRM NAME ______________________________________________________________________________

AFFIANT NAME (Printed)__________________________________ _____ ______ DATE___________ __________

I, ______________________________________________, having been duly sworn on oath, say that I am the above-named, (printed name of affiant) andhave personally prepared the foregoing affidavit, and that the same is true to the best of my knowledge and belief.

(signature of affiant)

Subscribed and sworn to before me, this _________day of _____________ , 20____.

[signature of Notary] [typed name of Notary]

NOTARY PUBLIC My commission expires: ________________, 20____.

ALLOWANCE(S): Bid sum includes all allowance(s), if any. Refer to Section 00 2413 Scopes of Work for Bid Categories: Yes No

TAXES, PERMITS, BONDS AND FEES: Bid sum includes all applicable taxes, permits. bonds and fees, required by all legal authorities at the location of the Work. Yes No

Experience Modification Rate (EMR) DISCLOSURE:

Provide the current EMR for your company. _____

ASBESTOS-FREE PRODUCT INSTALLATION: It is hereby understood and agreed that no products/materials containing asbestos, including chrysotile, amosite, crocidolite, tremolite, anthophyllite, actinolite or any combination of these materials that have been chemically treated and/or altered shall be installed or introduced into the building by the contractor or his employees, agents, subcontractors, or other individuals or entities over whom the contractor has control. The contractor, its subcontractors of any tier, and vendors of any tier shall be required to sign a certification statement ensuring that all products or materials installed or introduced into a building will be asbestos-free.

NON-COLLUSIVE CERTIFICATION: By submission of this bid, each bidder and each person signing on behalf of any bidder certifies, and in the case of a joint bid each party thereto certifies as to its own organization, under penalty of perjury, that to the best of knowledge and belief.

1. The prices in this bid have been arrived at independently without collusion. consultation. communication, or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any other bidder or any competitor;

2. Unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the bidder and will not knowingly be disclosed by the bidder prior to opening, directly or indirectly, to any other bidder or to any competitor;

3. No attempt has been made or will be made by the bidder to insure any other person, partnership, or corporation to submit or not to submit a bid for the purpose of restricting competition;

4. The person signing this bid or proposal certifies that he has fully informed himself regarding the accuracy of the statements contained in this certification. and under the penalties of perjury, affirms the truth thereof, such penalties being applicable to the bidder as well as to the person signing in its behalf.

5. That attached hereto (if corporate bidder) is a certified copy of resolution authorizing the execution of this certificate by the signature of this bid or proposal in behalf of the corporation bidder.

AGREEMENT: Undersigned agree{s) to execute an agreement for work covered by this proposal on the form included in of these bid documents, and in accordance with the Section 00 7200 General Conditions of the Contract, Section 00 7300 Supplementary Conditions, and other Contract Documents, provided the Bidder be notified of proposal's acceptance within ninety (90) days after due date of opening. Undersigned further agrees that this proposal shall remain open during such ninety (90) day period. Signature below serves as acknowledgment that Bidder understands Bid Documents and Appendices, and Bidder assumes full responsibility for the cost impact of same. Undersigned also acknowledges that Owner reserves right to accept or reject any and all bids with or without cause, and/or to waive informalities in bidding.

BID ATTESTATION: The Bidder, having examined the Bidding Documents and all other related documents and being familiar with the site of the proposed work including the availability of materials and labor and weather conditions hereby proposes to furnish au labor, materials, tools, equipment, machinery, equipment rental, transportation, superintendence. all services. and to perform all work in the category(ies} bid for construction of the Athletic Field Lighting Project All applicable taxes, permits, fees. and bond costs are included in the Base Bid s, all listed Alternates. and all Unit Prices.

FIRM NAME

DATE___________________________

PRINT NAME/TITLE SIGNATURE SIAG SIGNATURE