HSCG87-10-B-PJT002 BID DOCUMENTS.doc

SOLICITATION, OFFER AND AWARD

HSCG87-10-B-PJT002

FIXED-PRICE CONSTRUCTION

UNITED STATES COAST GUARD

CIVIL ENGINEERING UNIT - JUNEAU

BID DOCUMENTS

KODIAK STEAM SYSTEM REPAIRS, PHASE VII; D2 to D9, N75 & 515

U. S. COAST GUARD INTEGRATED SUPPORT COMMAND, KODIAK, ALASKA

TO ACCESS THE STANDARD FORM (SF) 1442, DOUBLE-CLICK ON ABOVE ICON. AFTER OBTAINING AND PRINTING THE SF 1442, CLOSE THE DOCUMENT AND CONTINUE SCROLLING DOWN FROM THIS POINT TO OBTAIN THE REMAINDER OF THE BID DOCUMENTS. BIDDERS MUST RETURN IN HARD COPY A PROPERLY EXECUTED SF-1442, SECTION B WITH PRICE(S) FILLED IN, A PROPERLY EXECUTED SECTION K, AND, IF REQUIRED BY THE SOLICITATION, A SF-24 BID BOND, AND A CERTIFICATE OF CORPORATE PRINCIPAL.

PLEASE MAIL YOUR BID TO THE ADDRESS LISTED IN BLOCK 8 OF SF-1442. ELECTRONIC TRANSMITTALS OF BID DOCUMENTS WILL NOT BE ACCEPTED. ALL BIDS MUST INCLUDE THE SENDER’S RETURN ADDRESS ON THE MAILING ENVELOPE.

NOTICE TO OFFERORS

It is the policy of the Coast Guard to issue solicitations and make contract awards in a fair and timely manner. The Ombudsman Program for Agency Protests (OPAP) was established to investigate agency protest issues and resolve them without expensive and time-consuming litigation. Double Click on the following icon to read the notice for filing agency protests:

Double-click on icon to open

SECTION B

SUPPLIES OR SERVICES AND PRICE/COSTS

STEAM REPAIR STMH D2 TO D9, BLDG N75 & 515

INTEGRATED SUPPORT COMMAND KODIAK

KODIAK, ALASKA

B.1 BASE BID ITEM: Provide all materials, equipment, transportation, incidentals, as-builts and perform the labor to accomplish repairs to the specified portions of the underground steam distribution system for ISC Kodiak, and related work, in accordance with the solicitation terms & conditions, specifications and drawings.

TOTAL BASE BID ITEM B.1 $___________

B.2 CONTINGENT PRICING FOR STEAM UTILIDOR, MANHOLE REPAIRS AND SITE WORK DETAILED ON SHEET M205, CEU JUNEAU DRAWING S-3762-B. ASBESTOS ABATEMENT OF STEAM MAIN IS IN SECTION 02080 ASBESTOS ABATEMENT 3.3 C.

TOTAL PRICE – ITEM B.2 $____________

* THE ESTIMATED QUANTITIES LISTED ARE FOR EVALUATION PURPOSES ONLY. THE GOVERNMENT MAY ORDER THE QUANTITIES OF REPAIRS NEEDED, BUT ALSO RESERVES THE RIGHT TO ORDER NONE OF THE ABOVE REPAIRS. PAYMENT WILL BE BASED ON ACTUAL QUANTITIES ENCOUNTERED (IF ANY) AT THE APPLICABLE UNIT PRICE(S) SPECIFIED HEREIN. IT IS ANTICIPATED THAT ACTUAL QUANTITIES WILL VARY GREATLY FROM THE ESTIMATES, IT BEING RECOGNIZED THAT THE REPAIRS TO BE ENCOUNTERED IS A TOTAL UNKNOWN. BIDDERS MUST BID ON ALL ITEMS.

B.3 OPTION ITEM:

TOTAL PRICE FOR OPTION ITEM B.3

In the event Option Item B.3.1 is exercised, payment shall be computed by multiplying the actual quantities expended in meeting the requirements as shown on the drawings and described in the specifications by the unit price specified in option item B.3.1. The above estimated quantities of unit-priced option item B.3.1 shall be subject to adjustment in accordance with FAR Clause 52.211-18, VARIATION IN ESTIMATED QUANTITY (APR 1984) incorporated by reference in Section F of this solicitation.

TOTAL PRICE – ALL ITEMS

OPTION ITEM: The period for exercise of the option item will be 30 calendar days from the date of award. See Sub-section H.7.

Note: (1) Bidders must submit bids on the base bid items, contingent pricing items, and the option item listed in this Section B. FAILURE TO DO SO MAY RESULT IN REJECTION OF THE BID.

(2) The Government may reject an offer as non-responsive if it is materially unbalanced as to prices for the basic requirement and the option quantities. An offer is unbalanced when it is based on prices significantly less than cost for some work and prices which are significantly overstated for other work.

SECTION K

REPRESENTATIONS, CERTIFICATIONS AND

OTHER STATEMENTS OF OFFERS

K.1 52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS (FEB 2009)

(a)(1) The North American Industry Classification System (NAICS) code for this acquisition is 237110.

(2) The small business size standard is $33.5 million.

(3) The small business size standard for a concern which submits an offer in its own name, other than on a construction or service contract, but which proposes to furnish a product which it did not itself manufacture, is 500 employees.

(b)(1) If the clause at 52.204-7, Central Contractor Registration, is included in this solicitation, paragraph (d) of this provision applies.

(2) If the clause at 52.204-7 is not included in this solicitation, and the offeror is currently registered in CCR, and has completed the ORCA electronically, the offeror may choose to use paragraph (d) of this provision instead of completing the corresponding individual representations and certifications in the solicitation. The offeror shall indicate which option applies by checking one of the following boxes:

[ ] (i) Paragraph (d) applies.

[ ] (ii) Paragraph (d) does not apply and the offeror has completed the individual representations and certifications in the solicitation.

(c)(1) The following representations or certifications in ORCA are applicable to this solicitation as indicated:

(i)52.203-2, Certificate of Independent Price Determination. This provision applies to solicitations when a firm-fixed-price contract or fixed-price contract with economic price adjustment is contemplated, unless—

(A) The acquisition is to be made under the simplified acquisition procedures in Part 13;

(B) The solicitation is a request for technical proposals under two-step sealed bidding procedures; or

(C) The solicitation is for utility services for which rates are set by law or regulation.

(ii) 52.203-11, Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions. This provision applies to solicitations expected to exceed $100,000.

(iii) 52.204-3, Taxpayer Identification. This provision applies to solicitations that do not include the clause at 52.204-7, Central Contractor Registration.

(iv) 52.204-5, Women-Owned Business(Other Than Small Business). This provision applies to solicitations that—

(A) Are not set aside for small business concerns;

(B) Exceed the simplified acquisition threshold; and

(C) Are for contracts that will be performed in the United States or its outlying areas.

(v) 52.209-5, Certification Regarding Responsibility Matters. This provision applies to solicitations where the contract value is expected to exceed the simplified acquisition threshold.

(vi) 52.214-14, Place of Performance-Sealed Bidding. This provision applies to invitations for bids except those in which the place of performance is specified by the Government.

(vii) 52.215-6, Place of Performance. This provision applies to solicitations unless the place of performance is specified by the Government.

(viii) 52.219-1, Small Business Program Representations (Basic & Alternate I). This provision applies to solicitations when the contract will be performed in the United States or its outlying areas.

(A) The basic provision applies when the solicitations are issued by other than DoD, NASA, and the Coast Guard.

(B) The provision with its Alternate I applies to solicitations issued by DoD, NASA, or the Coast Guard.

(ix) 52.219-2, Equal Low Bids. This provision applies to solicitations when contracting by sealed bidding and the contract will be performed in the United States or its outlying areas.

(x) 52.222-22, Previous Contracts and Compliance Reports. This provision applies to solicitations that include the clause at 52.222-26, Equal Opportunity.

(xi) 52.222-25, Affirmative Action Compliance. This provision applies to solicitations, other than those for construction, when the solicitation includes the clause at 52.222-26, Equal Opportunity.

(xii) 52.222-38, Compliance with Veterans’ Employment Reporting Requirements. This provision applies to solicitations when it is anticipated the contract award will exceed the simplified acquisition threshold and the contract is not for acquisition of commercial items.

(xiii) 52.223-1, Biobased Product Certification. This provision applies to solicitations that require the delivery or specify the use of USDA-designated items; or include the clause at 52.223-2, Affirmative Procurement of Biobased Products Under Service and Construction Contracts.

(xiv) 52.223-4, Recovered Material Certification. This provision applies to solicitations that are for, or specify the use of, EPA-designated items.

(xv) 52.225-2, Buy American Act Certificate. This provision applies to solicitations containing the clause at 52.225-1.

(xvi) 52.225-4, Buy American Act-Free Trade Agreements-Israeli Trade Act Certificate. (Basic, Alternate I, and Alternate II) This provision applies to solicitations containing the clause at 52.225-3.

(A) If the acquisition value is less than $25,000, the basic provision applies.

(B)If the acquisition value is $25,000 or more but is less than $50,000, the provision with its Alternate I applies.

(C)If the acquisition value is $50,000 or more but is less than $67,826, the provision with its Alternate II applies.

(xvii) 52.225-6, Trade Agreements Certificate. This provision applies to solicitations containing the clause at 52.225-5.

(xviii) 52.225-20, Prohibition on Conducting Restricted Business Operations in Sudan-Certification.

(xix) 52.226-2, Historically Black College or

University and Minority Institution Representation. This provision applies to—

(A) Solicitations for research, studies, supplies, or services of the type normally acquired from higher educational institutions; and

(B) For DoD, NASA, and Coast Guard acquisitions, solicitations that contain the clause at 52.219-23, Notice of Price Evaluation Adjustment for Small Disadvantaged Business Concerns.

(2) The following certifications are applicable as indicated by the Contracting Officer:

[Contracting Officer check as appropriate.]

FORMCHECKBOX

(i) 52.219-19, Small Business Concern Representation for the Small Business Competitiveness Demonstration Program.

FORMCHECKBOX

(ii) 52.219-21, Small Business Size Representation for Targeted Industry Categories Under the Small Business Competitiveness Demonstration Program.

FORMCHECKBOX

(iii) 52.219-22,Small Disadvantaged Business Status.

(A) Basic

(B) Alternate I

(iv) 52.222-18, Certification Regarding Knowledge of Child Labor for Listed End Products.

(v) 52.222-48, Exemption from Application of the Service Contract Act to Contracts for Maintenance, Calibration, or Repair of Certain Equipment Certification.

(vi) 52.222-22, Exemption from Application of the Service Contract Act to Contracts for Certain Services-Certification.

(vii) 52.223-9, with its Alternate I, Estimate of Percentage of Recovered Material Content for EPA-Designated Products (Alternate I only).

(viii) 52.223-13, Certification of Toxic Chemical Release Reporting.

(ix) 52.227-6, Royalty Information.

(A) Basic

(B) Alternate I.

(x) 52.227-15, Representation of Limited Rights Data and Restricted Computer Software.

(d) The offeror has completed the annual representations and certifications electronically via the Online Representations and Certifications Application (ORCA) website at http://orca.bpn.gov. After reviewing the ORCA database information, the offeror verifies by submission of the offer that the representations and certifications currently posted electronically that apply to this solicitation as indicated in paragraph (c) of this provision have been entered or updated within the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard applicable to the NAICS code referenced for this solicitation), as of the date of this offer and are incorporated in this offer by reference (see FAR 4.1201); except for the changes identified below [offeror to insert changes, identifying change by clause number, title, date]. These amended representation(s) and/or certification(s) are also incorporated in this offer and are current, accurate, and complete as of the date of this offer.

FAR Clause # Title Date Change

Any changes provided by the offeror are applicable to this solicitation only, and do not result in an update to the representations and certifications posted on ORCA.

K.2 52.204-3

TAXPAYER IDENTIFICATION (OCT 1998)

(a) Definitions.

"Common parent," as used in this solicitation provision, means that corporate entity that owns or controls an affiliated group of corporations that files its Federal income tax returns on a consolidated basis, and of which the offeror is a member.

"Taxpayer Identification Number (TIN)," as used in this solicitation provision, means the number required by the IRS to be used by the offeror in reporting income tax and other returns.

The TIN may be either a Social Security Number or an Employer Identification Number.

(b) All offerors are required to submit the information required in paragraphs (c) through (e) of this solicitation provision in order to comply with reporting requirements of 26 U.S.C. 6041, 6041A, and 6050M and implementing regulations issued by the Internal Revenue Service (IRS). If the resulting contract is subject to reporting requirements described in FAR 4.903, the failure or refusal by the offeror to furnish the information may result in a 31 percent reduction of payments otherwise due under the contract.

(c) The TIN may be used by the Government to collect and report on any delinquent amounts arising out of the offeror's relationship with the Government (31 U.S.C. 7701 (c)(3). If the resulting contract is subject to the payment reporting requirements described in FAR 4.904, the TIN provided hereunder may be matched with IRS records to verify the accuracy of the offeror's TIN.

(d) Taxpayer Identification Number (TIN).

___ TIN: _____________________.

___ TIN has been applied for.

___ TIN is not required because:

___ Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of a trade or business in the U.S. and does not have an office or place of business or a fiscal paying agent in the United States;

___ Offeror is an agency or instrumentality of a foreign government;

___ Offeror is an agency or instrumentality of a Federal, state or local government;

(e) Type of Organization.

___ Sole proprietorship;

___ Partnership;

___ Corporate entity (not tax-exempt);

___ Corporate entity (tax-exempt);

___ Government entity (Federal, State, or local);

___ Foreign government;

___ International organization per 26 CFR 1.6049-4;

___ Other __________________.

(f) Common Parent.

___ Offeror is not owned or controlled by a common parent as defined in paragraph (a) of this clause.

___ Name and TIN of common parent:

Name _____________________________

TIN _____________________________

K.3

DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER REPORTING

Contractor is requested to fill in the appropriate information set forth below:

(1) DUNS Identification # ____________________ (this number is assigned by Dun & Bradstreet, Inc., and is contained in that company’s Data Universal Numbering System (DUNS). If the number is not known, it can be directly obtained, at no charge to the offeror, from any Dun & Bradstreet branch office at 1-800-333-0505 or e-mail globalinfo@dbisma.com. Provide (1) Company name, (2) Company address, (3) Company telephone number, (4) Line of Business, (5) Chief executive officer/key manager, (6) Date the company was started, (7) Number of people employed by the company, and (8) Company affiliation.

(2) Home Office County and Congressional District _______________________.

(3) Principal place of performance of the work required under the resulting contract (city, county, and state)

(4) Congressional District of the principal place of performance _____________________.

K.4

52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE

(FEB 1998)

This solicitation incorporates one or more solicitation provisions by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this address: http://www.arnet.gov/far/ 52.222-23 Notice of Requirement for Affirm-

FEB 1999

ative Action to Ensure Equal Employ-ment Opportunity Construction

Minority Participation Female Participation

15.9% 6.3%

(e) As used in this Notice, and in any contract resulting from this solicitation, the covered area is Kodiak, Alaska.

Bid Bond

Double click to open

Cert as to Corporate Principal

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NOTICE FOR FILING AGENCY PROTESTS

It is the policy of the Coast Guard to issue solicitations and make contract awards in a fair and timely manner. The Ombudsman Program for Agency Protests (OPAP) was established to investigate agency protest issues and resolve them without expensive and time-consuming litigation. OPAP is an independent reviewing authority that is empowered to grant a prevailing protester essentially the same relief as the General Accounting Office (GAO).

Interested parties are encouraged to seek resolution of their concerns within the Coast Guard as an Alternative Dispute Resolution (ADR) forum, rather than filing a protest with the GAO or some external forum. Interested parties may seek resolution of their concerns informally or opt to file a formal agency protest with the contracting officer or Ombudsman.

Informal forum with the Ombudsman. Interested parties who believe that a Coast Guard procurement is unfair or otherwise defective should first direct their concerns to the cognizant contracting officer. If the contracting officer is unable to satisfy the concerns, the interested party is encouraged to contact the Coast Guard Ombudsman for Agency Protests. Under this informal process, the agency is not required to suspend contract award performance. Use of an informal forum does not suspend any time requirement for filing a protest with the agency or other forum. In order to ensure a timely response, interested parties should provide the following information to the Ombudsman: solicitation/contract number, contracting office, contracting officer, and solicitation closing date (if applicable).

Formal Agency Protest with the Ombudsman. Prior to submitting a formal agency protest, protesters must first use their best efforts to resolve their concerns with the contracting officer through open and frank discussions. If the protester’s concerns are unresolved, an independent review is available by the Ombudsman. The protester may file a formal agency protest to either the contracting officer or as an alternative to that, the Ombudsman under the OPAP program. Contract award or performance will be suspended during the protest period unless contract award or performance is justified, in writing, for urgent and compelling reasons or is determined in writing to be in the best interest of the Government. The agency’s goal is to resolve protests in less than 35 calendar days from the date of filing. Protests shall include the information set forth at FAR 33.103(d)(2). If the protester fails to submit the required information, resolution of the protest may be delayed or the protest may be dismissed. This will not preclude re-filing of the protest to meet the requirement. To be timely, protests must be filed within the period specified in FAR 33.103(e). Formal protests filed under the OPAP program should be forwarded to the address below:

Commandant (G-A) U.S. Coast Guard Headquarters

Acquisition Planning and Performance Measurement

1900 Half St. SW, Room 11-0402

Washington, DC 20593 Telephone: (202) 372-3695

Fax: (202) 475-3904

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SOLICITATION OFFER

AND AWARD

(Construction, Alteration, or Repair)

1. SOLICITATION NO.

2. tYPE OF SOLICITATION sealed bid (ifb)

FORMCHECKBOX

negotiated (rfp)

3. DATE ISSUED

10/21/2009

PAGE OF PAGES

IMPORTANT - The "offer" section on page 2 must be fully completed by offeror.

4. contract nO.

HSCG87-10-C-PJT002

5. requisition/purchase request no.

2110870PJT002

6. project no.

496249

7. issued by code

8. address offer to

DEPARTMENT OF HOMELAND SECURITY UNITED STATES COAST GUARD

COMMANDING OFFICER (ko) CIVIL ENGINEERING UNIT FEDERAL BUILDING 709 W. 9th STREET, ROOM 817 P.O. BOX 21747 JUNEAU, AK 99802-1747

9. FOR INFORMATION

CALL

a. name

MICHAEL H. ROGERS

b telephone no. (Include area code) (no collect calls)

(907) 463-2417

SOLICITATION

NOTE: In sealed bid solicitations "offer" and "offeror" mean "bid" and "bidder".

10. THE GOVERNMENT REQUIRES PERFORMANCE OF THE WORK DESCRIBED IN THESE DOCUMENTS (Title, identifying no., date):

INVITATION FOR BIDS HSCG87-10-B-PJT002 INCLUDING SPECIFICATIONS AND DRAWINGS ENTITLED: STEAM REPAIR STMH D2 TO D9, BLDG N75 & 515 INTEGRATED SUPPORT COMMAND KODIAK, KODIAK, ALASKA.

SMALL BUSINESS SIZE STANDARD: THE WORK REQUIRED BY THIS SOLICITATION IS IDENTIFIED AS NORTH AMERICAN INDUSTRY CLASSIFICATION SYSTEM (NAICS) CODE 237110, AND THE APPLICABLE SMALL BUSINESS SIZE STANDARD IS $33.5 MILLION IN AVERAGE ANNUAL RECEIPTS FOR THE PAST THREE YEARS.

THIS SOLICITATION IS FORMCHECKBOX

IS NOT FORMCHECKBOX

A 100% SET-ASIDE FOR SMALL BUSINESSES.

ESTIMATED COST OF CONSTRUCTION IS BETWEEN $1,000.000.00 AND $5,000,000.00.

ANY AMENDMENTS ISSUED TO THIS SOLICITATION WILL BE POSTED SOLELY ON THE FedBizOpps WEB SITE www.fbo.gov. PROSPECTIVE BIDDERS ARE RESPONSIBLE FOR CHECKING THE WEB SITE FOR AMENDMENTS UP TO THE DATE AND TIME OF BID OPENING.

11. The contractor shall begin performance within * calendar days and complete it within * calendar days after receiving award, FORMCHECKBOX notice to proceed. This performance period is FORMCHECKBOX mandatory, FORMCHECKBOX negotiable. (See *Section F of the Schedule )

12A. THE CONTRACTOR MUST FURNISH ANY REQUIRED PERFORMANCE AND PAYMENT BONDS?

(If "YES", indicate within how many calendar days after award in Item 12B.)

YES FORMCHECKBOX

NO

12B. CALENDAR DAYS

13. ADDITIONAL SOLICITATION REQUIREMENTS:

A.

Sealed offers in original and 1 copies to perform the work required are due at the place specified in Item 8 by 3.00 PM (hour) local time 11/23/2009 (date). If this is a sealed bid solicitation, offers must be publicly opened at that time. Sealed envelopes containing offers shall be marked to show the offeror's name and address, the solicitation number, and the date and time offers are due.

B.

An offer guarantee FORMCHECKBOX is, FORMCHECKBOX is not required.

C.

All offers are subject to the (1) work requirements, and (2) other provisions and clauses incorporated in the solicitation in full text or by reference.

D.

Offers providing less than 60 calendar days for Government acceptance after the date offers are due will not be considered and will be rejected.

STANDARD FORM 1442 (Rev. 4-85)

Prescribed by GSA

FAR (48 CFR) 53.236-1(e)

53.301-1442

FEDERAL ACQUISITION REGULATION (FAR)

OFFER (Must be fully completed by offeror)

14. name and address of offeror (Include ZIP Code)

15. telephone no. (Include area code)

E-MAIL ADDRESS:_____________________

16. remittance address (Include only if different than Item 14)

DUNS:

CODE

FACILITY CODE

17. The offeror agrees to perform the work required at the prices specified below in strict accordance with the terms of this solicitation, if this offer is accepted by the Government in writing calendar days after the date offers are due. (Insert any number equal to or greater than the minimum requirement stated in Item 13D. Failure to insert any number means the offeror accepts the minimum in Item 13D.)

AMOUNTS

SEE SCHEDULE OF ITEMS SECTION B

18. The offeror agrees to furnish any required performance and payment bonds

19. ACKNOWLEDGMENT OF AMENDMENTS

(The offeror acknowledges receipt of amendments to the solicitation - give number and date of each)

AMENDMENT NO.

DATE

20A. name and title of person authorized to sign offer

(Type or print)

20B. signature

20C. offer date

AWARD (To be completed by Government)

21. items accepted:

22. amount

23. accounting and appropriation data

2/P/001/137/43/0/JT/46000/2546

24. SUBMIT INVOICES TO ADDRESS SHOWN IN

(4 copies unless otherwise specified)

ITEM

25. Other than full and open competition pursuant to

10 USC 2304(c) ( ) FORMCHECKBOX 41 USC USC 253(c) ( )

26. administered by code

27. payment will be made by

See Block 8

CO (1224) USCG Finance Center 1430A Kristina Way Chesapeake, VA 23326-1224 For payment inquiries, call: (757)523-6940

CONTRACTING OFFICER WILL COMPLETE ITEM 28 OR 29 AS APPLICABLE

FORMCHECKBOX

28. NEGOTIATED AGREEMENT (Contractor is required to sign this document and return copies to issuing office.)

Contractor agrees to furnish and deliver all items or perform all work, requisitions identified on this form and any continuation sheets for the consideration slated in this contract. The rights and obligations of the parties to this contract shall be governed by (a) this contract award, (b) the solicitation, and (c) the clauses, representations, certifications, and specifications or incorporated by reference in or attached to this contract.

FORMCHECKBOX

29. AWARD (Contractor is not required to sign this document.)

Your offer on this solicitation is hereby accepted as to the items listed. This award consummates the contract, which consists of (a) the Government solicitation and your offer, and (b) this contract award. No further contractual document is necessary.

30A. name and title of contractor or person authorized to sign

(Type or print)

31A. name of contracting officer (Type or print)

30b. signature

30C. DATE

31b. united states of america by

31c. award date

STANDARD FORM 1442 PAGE 2 (Rev. 4-85)

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NOTE: This certificate must be executed by an individual other than the person signing the bonds.

If applicable, all documents should be executed as the parent company, doing business as:

Parent Company:

dba:

(If different than parent company)

IFB/Contract Number:

CERTIFICATE AS TO CORPORATE PRINCIPAL

I, , certify that I am of (Print/type name) (Office Held) the corporation that has been named as principal in the (bid)(Payment)(and)

(Performance) bond (s); that who signed (Print/type name) said bond (s) on behalf of the principal was then (Office held) of said corporation; that I know his/her signature and that his/her signature therefore is genuine; and that said bond(s) was (were) duly signed, sealed, and attested for and on behalf of said corporation by authority of its governing body.

(Signature)

(Corporate Seal)

(Print/type name)

Witness this day of 20 .

Notary Public (Notary Seal) My Commission expires

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