Final_RFB_605_2000000360_1_SO_FORM.PDF

Document ID: RFB 605 2000000360 Page: 1

Commonwealth of Kentucky

SOLICITATION

Addenda: No Addenda #:

TITLE: Mast Arm Poles for Richwood and D3

Date Issued:

12/11/19 Record Date:

2019-12-11

Solicitation Closes Date:

1/7/20 Time:

10:00

Solicitation No:

RFB 605 2000000360

Online Bidding Prohibited: Yes

For Information Call:

Brandon Milby 502-782-3979

Bid Receiving Location:

KYTC Division of Purchases Bid Clerk 200 Mero Street 4th Floor Frankfort KY 40622

Vendor Customer Number:

Vendor Name:

Phone Number:

Fax Number:

Email Address:

Ordering

Address:

City, State, Zip:

Contact Name:

Contact Email:

Contact Phone Number:

Payment

Address:

City, State, Zip:

Contact Name:

Contact Email:

Contact Phone Number:

Ownership Type

__ Sole Proprietorship __ Partnership __ Corporation __ Other_________________________

SIGNATURE OF AUTHORIZED AGENT IS REQUIRED UNLESS RESPONSE

IS SUBMITTED ELECTRONICALLY. FAILURE TO SIGN SHALL RENDER

THE BID INVALID.

Signature X_________________________________________ FEIN#____________________ Date____________

All offers subject to all terms and conditions contained in this solicitation.

Document ID: RFB 605 2000000360 Page: 2

Line Items

Commodity Group: Default Commodity Group

Line CL Description Quantity UOM Unit Cost Line Total or Contract Amnt

1 Mastarm single arm 44 foot with 19 foot attachment

1.00000 EA

Comm Code Comm Description Manufacturer Model # Manuf Part #

34067 Poles and Stanchions

Extended Description Mastarm single arm 44 foot with 19 foot attachment

2 Mastarm single arm 47.5 foot with 19.5 foot

Mastarm single arm 47.5 foot with 19.5 foot attachment

3 Mastarm single arm 47 foot with 19 foot

Mastarm single arm 47 foot with 19 foot attachment

4 Mastarm single arm 56 foot with 19 foot

Mastarm single arm 56 foot with 19 foot attachment

Document ID: RFB 605 2000000360 Page: 3

5 Mastarm single arm 43 foot with 19 foot

Mastarm single arm 43 foot with 19 foot attachment

6 Mastarm single arm 43 foot with 19 foot

Mastarm single arm 43 foot with 19 foot attachment

7 Mastarm single arm 52.5 foot with 18 foot

Mastarm single arm 52.5 foot with 18 foot attachment

8 Mastarm single arm 57.5 foot with 18 foot

Mastarm single arm 57.5 foot with 18 foot attachment

Document ID: RFB 605 2000000360 Page: 4

9 Mastarm single arm 43 foot with 17 foot

Mastarm single arm 43 foot with 17 foot attachment

10 Mastarm single arm 47 foot with 17 foot

Mastarm single arm 47 foot with 17 foot attachment

11 Mastarm single arm 28 foot with 19 foot

This line to be awarded separately.

Shipping Information KYTC District 6 - Boone Co Traffic Barn

3640 O'Hara Road

Erlanger KY 41018

Billing Information KYTC Division of Traffic Operations

200 Mero Street 3rd Floor Frankfort KY 40622

Document ID: RFB 605 2000000360 Page: 5

Submission Checklist

The following items will be required to be submitted with bid:

Item The bidder with the lowest price receives the maximum score.

The bidder with the best delivery time receives the maximum score.

Section 1 - Specifications – Commodity

The Kentucky Transportation Cabinet Division of Purchases issues this solicitation on behalf of the Division of Traffic Operations to award a one- time contract for: Mast Arm Poles.

Vendor should submit the name and address of the pole manufacturer. This information shall be received prior to contract award. Upon receipt of the drawings and calculations, the manufacturer shall be the same manufacturer as the one identified.

After bids are evaluated and scored, Division of Purchases will notify the best evaluated bidder to submit the required drawings and calculations. The vendor will have ten (10) business days from notice to submit the drawings and calculations to the Division of Purchases. The Division of Traffic Operations will review drawings and calculations and submit any errors to the Division of Purchases. The bidder will be given the opportunity to correct any noted errors within five (5) business days. Once revisions are submitted they will be reviewed a second time by the Division of Traffic Operations. If revisions are not acceptable or if the drawings and calculations are not submitted by the established deadlines, the bidder shall be rejected and the next best evaluated value bidder will be asked for drawings and calculations. Bidders cannot change their bidding price after the bid closes.

1.00 - Specifications of Commodity

Except as provided herein, conform to all requirements of the Transportation Cabinet/Department of Highways' 2019 Standard Specifications for Road and Bridge Construction. Section references are to the Standard Specifications.

All arms shall be designed to have a three (3) degree rise from the vertical pole. The rise may be changed when design in submitted to the vendor for shop drawings.

The area opening at the bottom of the pole should be a minimum of 12” (inches) in diameter.

A link to the Standard Specifications can be found at:

https://transportation.ky.gov/Construction/Pages/Standard-Specification-with-Supplemental-Specification- Included.aspx

A link to the NCHRP website:

http://www.trb.org/Publications/PubsNCHRPProjectReportsAll.aspx

A. Section 835.07 Mast Arm Poles.

Blind half couplings not required.

Limit vertical deflection to eight (8) inches for galloping. The area at the bottom of the pole shall be open throughout the whole diameter.

B. Section 835.11 ARC FLASH WARNING STICKER

There shall be a four (4) inch by six (6) inch Shock Hazard sticker installed on the center of the door. The sticker shall be Metalcraft PLY695 Prem STYLEMARK Label with .007 thickness, with UV white polycarbonate material, and with MC53FL pressure sensitive adhesive. The sticker shall have two (2) colors of black and custom color orange. For an example of sticker, see Attachment D – Shock Hazard Sticker.

Document Description Page 6

2000000360 Mast Arm Poles for Richwood and D3 https://transportation.ky.gov/Construction/Pages/Standard-Specification-with-Supplemental-Specification-Included.aspx https://transportation.ky.gov/Construction/Pages/Standard-Specification-with-Supplemental-Specification-Included.aspx http://www.trb.org/Publications/PubsNCHRPProjectReportsAll.aspx

C. Section 835.09 Anchor Bolts

Anchor bolt lengths should be based on NCHRP Report 494 Section 2.4.5.5 using #8 bars for the foundation reinforcing steel. The headed anchor bolt assembly shall be contained within 26.5 inch diameter.

The anchor bolts for each individual pole shall be banded together and shrink-wrapped. Anchor bolts and bottom of the pole base/arms shall be marked per the color code/inscribed letter as stated in the attachments to readily determine which anchor bolts/pole/arms go with which pole (on attachments).

This color code and letter shall be applied on the anchor bolts not the outside shrink-wrap.

There shall be two (2) steel templates (one can be used for the headed part of the anchor bolt if designed that way) provided per pole and the templates shall be marked per the color code in the line item description for the each pole. The templates shall be contained within 26.5 inch diameter. All templates shall be fully galvanized (ASTM 153). Minimum edge distance for bolt holes shall follow Table J3.4 of AISC Steel Construction Manual.

Except for the anchor bolts, all hardware (including the pole cap) shall be packaged in a plastic bag for storage with the pole. The plastic bag shall have the color code and designated letter clearly marked. There shall be a laminated picture of the supplied with all hardware to show what is in the hardware bag or installed on the anchor bolts. The poles shall be delivered banded together in multiplies of four (4) poles and all poles shall be staggered and square off for ease of moving around the pole yard. All pole doors shall be secured before loaded on its transport to our warehouse.

Poles will be unloaded at the shipping destination by state forces. Rail shipments are not acceptable.

See the following attachments:

Attachment F Shock Hazard Sticker

Attachment G Handhole Attachments

1.01 - Federal Language

Federal funds may be used to make payment against the resulting contract. Therefore, FHWA 1273 requirements (with the exception of Davis Bacon) and Buy America requirement section 106.04 from the 2012 Standard Specifications for Road and Bridge Construction shall be required on this solicitation and the resulting award/contract. Prevailing Wage Rates (Davis Bacon) do not apply because this is a commodity not a service contract.

Section 2 - Terms and Conditions of the Contract

2.00 - Executed Contract

The Contractor shall not deliver any items until a valid Contract has been fully executed. The Contract shall represent the entire agreement between the parties. Prior negotiations, representations, or agreements, either written or oral, between the parties hereto relating to the subject matter hereof shall be of no effect upon this Contract.

Document Description Page 7

2000000360 Mast Arm Poles for Richwood and D3

2.01 - Contract Components and Order of Precedence

The Commonwealth’s acceptance of the offer indicated by the issuance of a Contract Award by the KYTC Division of Purchases shall create a valid Contract between the Parties consisting of the following:

1. The written Contract between the Parties;

2. Any Addenda to the Solicitation;

3. Any provisions of the Solicitation and all attachments thereto;

4. The Bidder’s response to the Solicitation, and

5. The Kentucky Revised Statutes KRS 45A.

In the event of an inconsistency between provisions of the solicitation, the inconsistency shall be resolved by giving precedence in the following order: (a) the Specifications; (b) other provisions of the Solicitation, whether incorporated by reference or otherwise; (c) Contract or Master Agreement Terms and Conditions;

(d) FAP 110-10-00 – General Conditions and Instructions for Solicitations and Contracts.

2.02 - Changes and Modifications to the Contract

During the period of the contract, a modification shall not be permitted in any of its conditions and specifications, unless the contractor receives electronic or written approval from the KYTC Division of Purchases. If the contractor finds at any time that existing conditions make modification in requirements necessary, the contractor shall report the matter promptly to the KYTC Division of Purchases for consideration and decision. All contract modifications shall be subject to the provisions of 200 KAR 5:311.

2.03 - Basis of Shipment

Quotations of unit prices on this solicitation shall be F.O.B. Destination Freight Prepaid and Allowed to the receiving agency. The vendor shall be fully responsible for all shipments and freight charges involved to the ordering agency. The responsibility for filing freight claims lies with the vendor.

2.04 - Notices

Unless otherwise instructed, all notices, consents, and other communications required and/ or permitted by the Contract shall be in writing.

After the Award of Contract, all programmatic communications are to be made to the Agency Contact Person listed below with a copy to the Division of Purchases.

Kerry Roberts

Division of Traffic Operations

Kentucky Transportation Cabinet

Phone: 502-782-3979

E-mail: Kerry.Roberts@ky.gov

With a Copy to:

Brandon Milby

Document Description Page 8 mailto:Kerry.Roberts@ky.gov

Division of Purchases

Kentucky Transportation Cabinet

Phone: 502-782-3979

E-mail: Brandon.Milby@ky.gov

From the issue date of this solicitation until a Contractor(s) is selected and the selection is announced, Offerors are not permitted to communicate with any Commonwealth staff concerning this solicitation

After the award of a contract, all programmatic communications are to be made to the Agency Contact Person identified in the contract document with a copy to the Division of Purchases Buyer.

After the Award of a contract, all communications of a contractual or legal nature are to be made to the KYTC Division of Purchases Buyer.

2.05 - Delivery

Vendor guarantees delivery of all requested items within 100 calendar days after approval of drawings. Responses greater than 120 days may be rejected as non-responsive.

The Cabinet may notify the vendor if anchor bolts are needed earlier than the poles. In such instances, delivery of anchor bolts shall be within forty five (45) calendar days after the approval of shop drawings.

The Vendor agrees that when delivery is not made within the contracted due date, one percent (1%) per day shall be deducted from the Vendor’s invoice for each day the Vendor fails to meet the contracted delivery date.

The Vendor is not responsible for, and shall not be penalized for delays in its delivery when caused by factors or events outside Vendor’s control, including but not limited to acts or omissions of the Commonwealth or third parties, acts of civil or military authority, civil disturbance, war, terrorism, pandemics, explosions, fire, floods, tornadoes or other natural disasters or acts of God.

2.06 - Inspection

All supplies, equipment and services shall be subject to inspection or tests by the Commonwealth prior to acceptance. In the event supplies, equipment or services are defective in material or workmanship or otherwise not in conformity with specified requirements, the Commonwealth shall have the right to reject the items or services or require acceptable correction at the vendor’s expense.

2.07 - Invoices

Invoices, if required, shall be prepared and transmitted to the agency receiving the goods or services.

One copy shall be marked "original" unless otherwise specified. Each invoice shall contain at least the following information:

a. Contract and order number;

b. Item numbers;

c. Description of supplies or services;

d. Sizes;

Document Description Page 9

e. Quantities;

f. Service Dates;

g. Unit prices; and

h. Extended totals.

2.08 - Payments

The vendor shall be paid, upon the submission of proper invoices to the receiving agency at the prices stipulated for the supplies delivered and accepted, or services rendered. Unless otherwise specified, payment will not be made for partial deliveries accepted. Payments will be made within thirty (30) working days after receipt of goods and vendor’s invoice in accordance with KRS 45.453 and KRS 45.45A. A penalty payment of one percent (1%) per month shall be added to the amount due the vendor for each full or partial month that the payment exceeds 30 working days.

2.09 - Post Contract Agreements

This contract will constitute the entire agreement between the State and awarded contractor. Unless contractually provided, the Commonwealth shall not be required to enter into nor sign further agreements, leases, company orders or other documents to complete or initiate the terms of the contract. Any such documents so obtained will be non-binding on the State and be cause for breach of contract.

2.10 - Termination of Contracts

A contract may be terminated for default by the vendor, for the convenience of the Commonwealth, or for lack of appropriation in accordance with 200 KAR 5:312.

2.11 - Endorsements

The Contractor shall not refer to the Award of Contract in commercial advertising in such a manner as to state or imply that the firm or its services are endorsed or preferred by the Commonwealth of Kentucky.

2.12 - Registration with the Secretary of State by a Foreign Entity

Pursuant to KRS 45A.480(1)(b), an agency, department, office, or political subdivision of the Commonwealth of Kentucky shall not award a state contract to a person that is a foreign entity required by KRS 14A.9-010 to obtain a certificate of authority to transact business in the Commonwealth (“certificate”) from the Secretary of State under KRS 14A.9-030.

For all foreign entities required to obtain a certificate of authority to transact business in the Commonwealth, if a copy of the certificate is not received within the time specified by the Division of Purchases, the foreign entity’s solicitation response may be deemed non-responsive.

If the foreign entity is not required to obtain a certificate as provided in KRS 14A.9-010, the foreign entity should identify the applicable exception in its solicitation response. Foreign entity is defined within KRS 14A.1-070.

Vendors are required to remain in active status and good standing during the life of the contract.

Businesses can register with the Secretary of State at https://secure.kentucky.gov/sos/ftbr/welcome.aspx

Document Description Page 10

2.13 - Discrimination

Discrimination (because of race, religion, color, national origin, sex, sexual orientation, gender identity, age, or disability) is prohibited. This section applies only to contracts utilizing federal funds, in whole or in part. During the performance of this contract, the contractor agrees as follows:

1. The contractor will not discriminate against any employee or applicant for employment because of race, religion, color, national origin, sex, sexual orientation, gender identity or age. The contractor further agrees to comply with the provisions of the Americans with Disabilities Act (ADA), Public Law 101-336, and applicable federal regulations relating thereto prohibiting discrimination against otherwise qualified disabled individuals under any program or activity. The contractor agrees to provide, upon request, needed reasonable accommodations. The contractor will take affirmative action to ensure that applicants are employed and that employees are treated during employment without regard to their race, religion, color, national origin, sex, sexual orientation, gender identity, age or disability. Such action shall include, but not be limited to the following; employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensations; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices setting forth the provisions of this non-discrimination clause.

2. The contractor will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age or disability.

3. The contractor will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or understanding, a notice advising the said labor union or workers' representative of the contractor's commitments under this section, and shall post copies of the notice in conspicuous places available to employees and applicants for employment. The contractor will take such action with respect to any subcontract or purchase order as the administering agency may direct as a means of enforcing such provisions, including sanctions for noncompliance.

4. The contractor will comply with all provisions of Executive Order No. 11246 of September 24, 1965 as amended, and of the rules, regulations and relevant orders of the Secretary of Labor.

5. The contractor will furnish all information and reports required by Executive Order No. 11246 of September 24, 1965, as amended, and by the rules, regulations and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his books, records and accounts by the administering agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules, regulations and orders.

6. In the event of the contractor's noncompliance with the nondiscrimination clauses of this contract or with any of the said rules, regulations or orders, this contract may be cancelled, terminated or suspended in whole or in part and the contractor may be declared ineligible for further government contracts or federally-assisted construction contracts in accordance with procedures authorized in Executive Order No. 11246 of September 24, 1965, as amended, and such other sanctions may be imposed and remedies invoked as provided in or as otherwise provided by law.

7. The contractor will include the provisions of paragraphs (1) through (7) of section 202 of Executive Order 11246 in every subcontract or purchase order unless exempted by rules, regulations or orders of the Secretary of Labor, issued pursuant to section 204 of Executive Order No. 11246 of September 24, 1965, as amended, so that such provisions will be binding upon each subcontractor or vendor. The contractor will take such action with respect to any subcontract or purchase order as the administering agency may direct as a means of enforcing such provisions including sanctions for noncompliance;

provided, however, that in the event a contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by the agency, the contractor may request the United States to enter into such litigation to protect the interests of the United States.

2.14 - Kentucky Sales and Use Taxes

Document Description Page 11

Sales of tangible personal property or services to the State of Kentucky and its agencies are not subject to state sales or use taxes.

2.15 - Access to Records

The contractor, as defined in KRS 45A.030 (9) agrees that the contracting agency, the Finance and Administration Cabinet, the Auditor of Public Accounts, and the Legislative Research Commission, or their duly authorized representatives, shall have access to any books, documents, papers, records, or other evidence, which are directly pertinent to this contract for the purpose of financial audit or program review. Records and other prequalification information confidentially disclosed as part of the bid process shall not be deemed as directly pertinent to the contract and shall be exempt from disclosure as provided in KRS 61.878(1)(c). The contractor also recognizes that any books, documents, papers, records, or other evidence, received during a financial audit or program review shall be subject to the Kentucky Open Records Act, KRS 61.870 to 61.884.

2.16 - Records Retention

The Finance and Administration Cabinet may inspect the place of business of the Vendor or any sub Vendor under the master Agreement contract awarded or to be awarded by the Commonwealth. In accordance with KRS 45A.150, the Finance and Administration Cabinet may audit the books and records of any person who has submitted cost or pricing data under KRS 45A.120 at any time until three years from the date of final payment under the prime contract, and by any subcontractor for a period of three years from the date of final payment under the subcontract. Such books and records shall be maintained by the contractor for a period of three years from the date of final payment under the contract and by any subcontractor for a period of three years from the date of final payment under the subcontract. The Finance and Administration Cabinet shall be entitled to audit the books and records of a contractor or any subcontractor under any negotiated contract or subcontract other than a firm fixed-price type contract, provided, however, that this provision shall not limit the right to audit stated above. Such books and records shall be maintained by the contractor for a period of three years from the date of final payment under the prime contract and by the subcontractor for a period of three years from the date of final payment under the subcontract. The contractor shall place such the same audit requirement in any agreement it may have with a subcontractor under this contract.

2.17 - Governing Law

This Contract shall be governed by and construed in accordance with the laws of the Commonwealth of Kentucky and any litigation with respect to this Contract shall be brought in state or federal court in Franklin County, Kentucky in accordance with KRS 45A.

Document Description Page 12

ANNUAL AFFIDAVIT FOR BIDDERS, OFFERORS, AND CONTRACTORS

FOR OFFICIAL USE ONLY:

Dates will be completed by Purchasing Staff Maximum Length One-Year

Affidavit Effective Date: ___________________

Affidavit Expiration Date: __________________

FOR BIDS AND CONTRACTS IN GENERAL:

I. Each bidder or offeror swears and affirms under penalty of perjury, that to the best of their knowledge:

a. In accordance with KRS 45A.110 and KRS 45A.115, neither the bidder or offeror as defined in KRS 45A.070(6), nor the entity which he/she represents, has knowingly violated any provisions of the campaign finance laws of the Commonwealth of Kentucky; and the award of a contract to the bidder or offeror or the entity which he/she represents will not violate any provisions of the campaign finance laws of the Commonwealth.

b. The bidder or offeror swears and affirms under penalty of perjury that, to the extent required by Kentucky law, the entity bidding, and all subcontractors therein, are aware of the requirements and penalties outlined in KRS 45A.485; have properly disclosed all information required by this statute;

and will continue to comply with such requirements for the duration of any contract awarded.

c. The bidder or offeror swears and affirms under penalty of perjury that, to the extent required by Kentucky law, the entity bidding, and its affiliates, are duly registered with the Kentucky Department of Revenue to collect and remit the sales and use tax imposed by KRS Chapter 139, and will remain registered for the duration of any contract awarded.

d. The bidder or offeror swears and affirms under penalty of perjury that the entity bidding is not delinquent on any state taxes or fees owed to the Commonwealth of Kentucky and will remain in good standing for the duration of any contract awarded.

e. The bidder or offeror swears and affirms under penalty of perjury that the entity bidding, is not currently engaged in, and will not for the duration of the contract engage in, the boycott of a person or entity based in or doing business with a jurisdiction with which Kentucky can enjoy open trade, as defined in Executive Order No. 2018-905.

f. The bidder or offeror swears and affirms that the entity bidding, and all subcontractors therein, have not violated any of the prohibitions set forth in KRS 11A.236 during the previous ten (10) year, and further pledge to abide by the restrictions set forth in such statute for the duration of the contract awarded.

FOR “NON-BID” CONTRACTS (I.E. SOLE-SOURCE; NOT-PRACTICAL OR FEASIBLE TO BID; OR

EMERGENCY CONTRACTS, ETC):

II. Each contractor further swears and affirms under penalty of perjury, that to the best of their knowledge:

a. In accordance with KRS 121.056, and if this is a non-bid contract, neither the contractor, nor any member of his/her immediate family having an interest of 10% or more in any business entity

Document Description Page 13

2000000360 Mast Arm Poles for Richwood and D3 http://www.lrc.state.ky.us/KRS/045A00/110.PDF http://www.lrc.state.ky.us/KRS/045A00/115.PDF http://www.lrc.state.ky.us/KRS/045A00/070.PDF http://www.lrc.state.ky.us/KRS/045A00/485.PDF http://www.lrc.ky.gov/KRS/139-00/CHAPTER.HTM http://www.lrc.ky.gov/KRS/121-00/056.PDF involved in the performance of any contract awarded, have contributed more than the amount specified in KRS 121.150 to the campaign of the gubernatorial slate elected in the election last preceding the date of contract award.

b. In accordance with KRS 121.330(1) and (2), and if this is a non-bid contract, neither the contractor, nor officers or employees of the contractor or any entity affiliated with the contractor, nor the spouses of officers or employees of the contractor or any entity affiliated with the contractor, have knowingly contributed more than $5,000 in aggregate to the campaign of a candidate elected in the election last preceding the date of contract award that has jurisdiction over this contract award.

c. In accordance with KRS 121.330(3) and (4), and if this is a non-bid contract, to the best of his/her knowledge, neither the contractor, nor any member of his/her immediate family, his/her employer, or his/her employees, or any entity affiliated with any of these entities or individuals, have directly solicited contributions in excess of $30,000 in the aggregate for the campaign of a candidate elected in the election last preceding the date of contract award that has jurisdiction over this contract.

As a duly authorized representative for the bidder, offeror, or contractor, I have fully informed myself regarding the accuracy of all statements made in this affidavit, and acknowledge that the Commonwealth is reasonably relying upon these statements, in making a decision for contract award and any failure to accurately disclose such information may result in contract termination, repayment of funds and other available remedies under law. If the bidder bidder, offeror, or contractor becomes non-compliant with any statement during the affidavit effective period, I will notify the Finance and Administration Cabinet, Office of Procurement Services immediately. I understand that the Commonwealth retains the right to request an updated affidavit at any time.

Signature Printed Name

Title Date

Company Name

Address

Commonwealth of Kentucky Vendor Code (if known) _______________________________

Subscribed and sworn to before me by (Affiant) (Title) of this _____day of ____________,20___.

(Company Name)

Notary Public [seal of notary] My commission expires:

Document Description Page 14 http://www.lrc.ky.gov/KRS/121-00/150.PDF http://www.lrc.ky.gov/KRS/121-00/330.PDF http://www.lrc.ky.gov/KRS/121-00/330.PDF

Attachment D

REQUIRED AFFIDAVIT FOR BIDDERS, OFFERORS AND

CONTRACTORS CLAIMING RESIDENT BIDDER STATUS

The bidder or offeror hereby swears and affirms under penalty of perjury that, in accordance with KRS 45A.494(2), the entity bidding is an individual, partnership, association, corporation, or other business entity that, on the date the contract is first advertised or announced as available for bidding:

1. Is authorized to transact business in the Commonwealth;

2. Has for one year prior to and through the date of advertisement

a. Filed Kentucky income taxes;

b. Made payments to the Kentucky unemployment insurance fund established in KRS 341.49; and

c. Maintained a Kentucky workers’ compensation policy in effect.

The BIDDING AGENCY reserves the right to request documentation supporting a bidder’s claim of resident bidder status. Failure to provide such documentation upon request shall result in disqualification of the bidder or contract termination.

Document Description Page 15

Attachment E

REQUIRED AFFIDAVIT FOR BIDDERS, OFFERORS AND CONTRACTORS

CLAIMING QUALIFIED BIDDER STATUS

I. The bidder or offeror swears and affirms under penalty of perjury that the entity bidding, and all subcontractors therein, meets the requirements to be considered a “qualified bidder” in accordance with 200 KAR 5:410(3); and will continue to comply with such requirements for the duration of any contract awarded.

Please identify below the particular “qualified bidder” status claimed by the bidding entity.

________ A nonprofit corporation that furthers the purposes of KRS Chapter 163

_______ Per KRS 45A.465(3), a "Qualified nonprofit agency for individuals with severe disabilities" means an organization that:

(a) Is organized and operated in the interest of individuals with severe disabilities; and

(b) Complies with any applicable occupational health and safety law of the United States and the Commonwealth; and

(c) In the manufacture or provision of products or services listed or purchased under KRS 45A.470, during the fiscal year employs individuals with severe disabilities for not less than seventy-five percent (75%) of the man hours of direct labor required for the manufacture or provision of the products or services; and

(d) Is registered and in good standing as a nonprofit organization with the Secretary of State.

The BIDDING AGENCY reserves the right to request documentation supporting a bidder’s claim of qualified bidder status. Failure to provide such documentation upon request may result in disqualification of the bidder or contract termination.

Document Description Page 16 http://www.lrc.state.ky.us/kar/200/005/410reg.htm http://www.lrc.state.ky.us/kar/200/005/410reg.htm