Essential Bid Documents.docx.pdf

EQUAL OPPORTUNITY STATEMENT

Kearsley Community Schools authority:

To whom it May Concern:

It is the publicly stated policy of ______________________________not to discriminate against any employee, applicant for employment, contractor, or material supplier, because of race, religion, color, national origin, ancestry or sex. With regard to employment, such non-discrimination includes, but is not limited to, our (my) policies of recruitment, recruitment, advertising, selection for apprenticeship or other training, rates of pay, promotion, transfer, lay-off or termination.

In all advertising for employment, subcontractors, or suppliers we (1) shall state that all applicants or respondents will receive consideration without regard to race, religion, color, national origin, ancestry or sex.

We (I) understand that any contract with Kearsley Community Schools shall be in consideration of our maintaining the above mentioned non-discrimination policy.

We (I) understand that we (I) may be required to submit further information covering the race, color and work classification for our employees and those of our sub-contractors to be employed on this project.

NAME OF BIDDER (COMPANY): _____________________________________________

SIGNATURE: _____________________________________________

NAME: _____________________________________________

(Typed or Printed)

TITLE:

Form D-4 Kearsley Community Schools

Contractor Certification of Asbestos-Free Installation

Name of Building:

1. Contractor name and address:

Name

Street City State Zip Code

2. Brief scope of contracted activities:

3. Certification statement:

I , presenting and having authority for

(Company), hereby certify that any and all products/materials which will be and/or have been installed or introduced into the above mentioned building, (project name and/or number) are asbestos free (or less than 1% asbestos by weight).

Print Name

Signature

Title

FAMILIAL DISCLOSURE FORM

All bidders must complete the following disclosure form in compliance with MCL 380.1267 and attach this information to the bid.

By the attached sworn and notarized statement, we are disclosing the following familial relationship(s) that exists between the owner or any employee of the bidder and any member of the Kearsley Community School District Board, Intermediate School Board, or Board of Directors or the superintendent of the school district, immediate superintendent of the intermediate school district, or chief executive officer of the public school academy.

Disclose any familial relationship and complete the form below in its entirety:

The following are familial relationships as described above (provide employee name, family contact name, family contact position, and familial relationship or check the box NONE).

Owner/ Employee Name Related To: Relationship

1. _____________________ __________________ ____________

2. _____________________ __________________ ____________

3. _____________________ __________________ ____________

4. _____________________ __________________ ____________

5. _____________________ __________________ ____________

__ NONE

Signature(s)

Title:

Name of Firm:

STATE OF )

) SS

COUNTY OF )

On this day of , 2021, before me a Notary Public in and for said county, personally appeared , agent of the said firm and who acknowledged the same to be his free act and deed as such agent.

Notary Public

My Commission Expires___________________ _________________

AFFIDAVIT OF COMPLIANCE – IRAN ECONOMIC SANCTIONS ACT

Michigan Public Act No. 517 of 2012

The undersigned, the owner or authorized officer of the below named contractor (the “Contractor”), pursuant to the compliance certification requirement provided in the Kearsley Community Schools (the “School District”) hereby certifies, represents and warrants that the Contractor (including its officers, directors and employees) is not an “Iran linked business” within the meaning of the Iran Economic Sanctions Act, Michigan Public Act No. 517 of 2012 (the “Act”), and that in the event Contractor is awarded a contract as a result of the aforementioned RFP, the Contractor will not become an “Iran linked business” at any time during the course of performing the Work or any services under the contract.

The Contractor further acknowledges that any person who is found to have submitted a false certification is responsible for a civil penalty of not more than $250,000.00 or 2 times the amount of the contract or proposed contract for which the false certification was made, whichever is greater, the cost of the School District’s investigation, and reasonable attorney fees, in addition to the fine. Moreover, any person who submitted a false certification shall be ineligible to bid on a request for proposal for three (3) years from the date the it is determined that the person has submitted the false certification.

CONTRACTOR:

BIDDER’S FIRM NAME

BY (SIGNATURE)

PRINTED NAME AND TITLE

STATE OF MICHIGAN )

)SS

COUNTY OF )

Subscribe and sworn before me on this Seal:

day of , 20 , a Notary Public in and for County, Notary Public

My Commission expires