Form_21126D.pdf
PDF 55 KB Posted
- Attached to
- Bid-PW Bloomington Ave/Minnehaha Pkwy HSIP
- Solicitation number
- 0000004226
- Issued by
- Hennepin County, Minnesota
About this file
This is a bid proposal form (Form 21126D) for the City of Minneapolis Public Works Department related to the Bloomington Ave/Minnehaha Pkwy Highway Safety Improvement Program (HSIP) project in Minnesota. The form establishes the contractual framework and bidder requirements for suppliers to provide all materials, labor, equipment, and incidental services necessary to complete the project in accordance with specifications, event line items, and related documentation. The proposal acknowledges that all requirements contained in the proposal documents, addenda, amendments, plans, standard specifications, and supplemental specifications constitute binding elements of the bid and resulting contract.
Bidders must submit a proposal guaranty in the form of a certified check or bond payable to the City of Minneapolis Treasurer equal to at least 5% of the total bid amount as required by Section 1208 of the Specifications. The form requires bidders to acknowledge receipt of all addenda and comply with non-collusion affidavit requirements. Disadvantaged Business Enterprise (DBE) certification is required, with bidders obligated to meet a minimum goal percentage for subcontracting to DBEs as specified in the proposal, or the total goal if no specific percentage is indicated. Execution of the proposal requires proper signatures from authorized representatives depending on the bidder's business structure—individual, partnership, or corporation—with specific officer signatures (President, Vice-President, Secretary, and Treasurer) required for corporate entities. The State Project No. is 141-030-057.
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Text version
Form 21126D (FF Rev. 1-09) State Project No. 141-030-057
GRAND TOTAL $
The undersigned hereby acknowledges that all requirements included in the proposal, addenda, amendments, plans, standard specifications, and supplemental specifications are a part of this bid and contract.
Signed:______________________________________________
PROPOSAL GUARANTY required by 1208 of the Specifications: "A (certified check) (bond), prepared as required by 1208 of the Specifications and payable to the City of Minneapolis Treasurer, in an amount equal to at least 5% of the total amount of the bid is submitted herewith as a proposal guaranty.
DISADVANTAGED BUSINESS ENTERPRISE CERTIFICATION: Our firm will meet a minimum goal of ___ % of this contract to Disadvantaged Business Enterprises. A bidder who fails to indicate a specific goal above must fulfill the total goals indicated in the proposal.
NON-COLLUSION AFFIDAVIT: A Non-Collusion Affidavit is found in this proposal which must be signed by each bidder.
RECEIPT OF ADDENDA as required by 1210 of the Specifications:
The undersigned hereby acknowledges receipt of and has considered:
Addendum No. Dated Addendum No. Dated ________
Addendum No. Dated Addendum No. Dated ________
Signed:______________________________________________
EXECUTION OF PROPOSAL as required by 1206 of the Specifications:
This proposal dated the day of , 20
Signed: , P.O. Address as an individual.
Signed: , P.O. Address as an individual.
doing business under the name and style of
Signed: , for a partnership.
NAME BUSINESS ADDRESS
Signed: , for a corporation, incorporated under the laws of the State of Minnesota
Name of President Business Address
Name of Vice-President Business
Address____________________________
Name of Secretary Business Address___________________________
Name of Treasurer Business Address___________________________
(NOTE: Signatures shall comply with 1206 of the Specifications.)
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