ATTACHMENT A

State Corporation Commission Form Failure to complete and return this attachment may result in your bid being REJECTED or deemed NON-RESPONSIVE.

Solicitation #: 160793

Virginia State Corporation Commission (SCC) registration information.

The bidder:

is a corporation or other business entity with the following SCC identification number:

-OR-

is not a corporation, limited liability company, limited partnership, registered limited liability partnership, or business trust -OR-is an out-of-state business entity that does not regularly and continuously maintain as part of its ordinary and customary business any employees, agents, offices, facilities, or inventories in Virginia (not counting any employees or agents in Virginia who merely solicit orders that require acceptance outside Virginia before they become contracts, and not counting any incidental presence of the bidder in Virginia that is needed in order to assemble, maintain, and repair goods in accordance with the contracts by which such goods were sold and shipped into Virginia from bidder’s out-of-state location) -OR-is an out-of-state business entity that is including with this bid an opinion of legal counsel which accurately and completely discloses the undersigned bidder’s current contacts with Virginia and describes why those contacts do not constitute the transaction of business in Virginia within the meaning of § 13.1-757 or other similar provisions in Titles

13.1 or 50 of the Code of Virginia.

**NOTE** >> Check the following box if you have not completed any of the foregoing options but currently have pending before the SCC an application for authority to transact business in the Commonwealth of Virginia and wish to be considered for a waiver to allow you to submit the SCC identification number after the due date for bids (the Commonwealth reserves the right to determine in its sole discretion whether to allow such waiver):

SBSP-IFB PIM-40

ATTACHMENT B

Small Business Subcontracting Plan

IFB # 160793

It is the goal of the Commonwealth that over 42% of its purchases be made from small businesses. All potential bidders are required to include this document with their bid response in order to be considered responsive.

Small Business: "Small business (including micro)” means a business which holds a certification as such by the Virginia Department of Small Business and Supplier Diversity (DSBSD) on the due date for bids.

This shall also include DSBSD-certified women- owned and minority-owned businesses and businesses with DSBSD service disabled veteran owned status when they also hold a DSBSD certification as a small business on the bid due date. Currently, DSBSD offers small business certification and micro business designation to firms that qualify.

Certification applications are available through DSBSD online at www.SBSD.virginia.gov (Customer Service).

Bidder Name:

Preparer Name: Date:

Who will be doing the work: □ I plan to use subcontractors □ I plan to complete all work

Instructions A. If you are certified by the DSBSD as a micro/small business, complete only Section A of this form.

B. If you are not a DSBSD-certified small business, complete Section B of this form. For the bid to be considered and the bidder to be declared responsive, the bidder shall identify the portions of the contract that will be subcontracted to DSBSD-certified small business for the initial contract period in relation to the bidder’s total price for the initial contract period in Section B.

Section A If your firm is certified by the DSBSD provide your certification number and the date of certification.

Certification number: Certification Date:

Section B If the “I plan to use subcontractors box is checked,” populate the requested information below, per subcontractor to show your firm's plans for utilization of DSBSD-certified small businesses in the performance of this contract for the initial contract period in relation to the bidder’s total price for the initial contract period. Certified small businesses include but are not limited to DSBSD-certified women-owned and minority-owned businesses and businesses with DSBSD service disabled veteran-owned status that have also received the DSBSD small business certification. Include plans to utilize small businesses as part of joint ventures, partnerships, subcontractors, suppliers, etc. It is important to note that these proposed participation will be incorporated into the subsequent contract and will be a requirement of the contract. Failure to obtain the proposed participation percentages may result in breach of the contract.

http://www.sbsd.virginia.gov/

SBSP-IFB PIM-40

B. Plans for Utilization of DSBSD-Certified Small Businesses for this Procurement

Subcontract #1

Company Name: SBSD Cert #:

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Value % (Initial Term): Contact Address:

Description of Work:

Subcontract #2

Company Name: SBSD Cert #:

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Value % (Initial Term): Contact Address:

Description of Work:

Subcontract #3

Company Name: SBSD Cert #:

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Value % (Initial Term): Contact Address:

Description of Work:

Subcontract #4

Company Name: SBSD Cert #:

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Value % (Initial Term): Contact Address:

Description of Work:

Subcontract #5

Company Name: SBSD Cert #:

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Value % (Initial Term): Contact Address:

Description of Work:

ATTACHMENT C

Solicitation #: 160793

SUBCONTRACTOR APPROVAL REQUEST

No portion of the work (including equipment) shall be subcontracted to another firm or individual without prior written consent of Virginia Department of Transportation (herein referred to as VDOT). In the event that the contractor desires to subcontract some part of the work specified herein, the contractor shall furnish VDOT with the names, qualifications, and experience of their proposed subcontractors for agency approval. The primary contractor shall, however, remain fully liable and responsible for the work performed by its subcontractor(s) and shall assure compliance with all requirements of the contract.

List proposed subcontractor(s), including name, address, contact person, and type of work to be performed under this contract below.

FIRM INDIVIDUAL’S

NAME & ADDRESS

CONTACT PERSON AND

PHONE NUMBER

TYPE OF WORK TO BE

PERFORMED

TYPE OF EQUIPMENT PROPOSED SUBCONTRACTOR WILL PROVIDE

QUALIFICATIONS / EXPERIENCE LEVEL OF PROPOSED SUBCONTRACTOR

Please indicate which above proposed subcontractors are certified (with DSBSD) as Small, Women Owned or Minority Businesses.

Certification Number(s):

FOR VDOT USE ONLY:

The proposed subcontractor(s) listed above is/are approved and accepted under the terms and conditions of the contract requirements herein.

Signature of Authorized VDOT Representative Date Telephone Number

ATTACHMENT D

NORMAL AND EMERGENCY CONTACTS

Solicitation # 160793

Send Contracts To:

Bidder's Name/Title

Primary Phone Number

Bidder's Mailing Address E-mail Address

Contact Person’s Name

Cellular Telephone Number

Telephone Number - Normal Work Hours Telephone Number - After Work Hours Fax Number

E-mail Address

Contact Person’s Name

Cellular Telephone Number

Telephone Number - Normal Work Hours Telephone Number - After Work Hours Fax Number

E-mail Address

Contact Person’s Name

Cellular Telephone Number

Telephone Number - Normal Work Hours Telephone Number - After Work Hours Fax Number

E-mail Address

ATTACHMENT E

Solicitation # 160793

REFERENCES

Bidders should provide a list of at least 3 references where similar goods and/or services have been provided. Each reference shall include the name of the organization, the complete mailing address, the name of the contact person, the email, and the telephone/fax number.

FIRM’S NAME AND ADDRESS CONTACT PERSON EMAIL ADDRESS TELEPHONE / FAX #

ATTACHMENT F

CONTRACTOR/SUBCONTRACTOR LICENSE REQUIREMENT

Solicitation #: 160793

By my signature on this solicitation, I certify that this firm/individual and subcontractors is properly licensed for providing the goods/services specified. Furthermore, the contractor and subcontractors shall maintain the required license throughout the term of the contract. The contractor or their subcontractor shall immediately notify the contracting agency in writing in the event the license has been revoked.

Contractor Name:

License # Type

Subcontractor Name:

License # Type

Updated: MARCH 2020 — 2016 ROAD and BRIDGE SPECIFICATIONS (Division III) — Saved: 02/21/2020 1:30 PM

GUIDELINES - For use on all projects using the Jack-and-Bore method of pipe installation.

SP302-000120-00

VIRGINIA DEPARTMENT OF TRANSPORTATION

SPECIAL PROVISION FOR

JACK AND BORE

October 27, 2016

I. DESCRIPTION

The work covered by this section consists of providing all labor, materials, and equipment, and performing all operations required for installing the specified diameters of culvert or utility casing pipe by the jack and bore method in accordance with the requirements of the Contract documents at the locations, alignments and grades shown on the plans. This work shall also include the removal of obstructions, if encountered, in a controlled manner while maintaining face stability and avoiding loss of ground. This special provision supplements Section 302.03(a)1 of the current VDOT Road and Bridge Specifications.

Prior to bidding, the Contractor shall visit and examine the work site and all conditions thereon and take into consideration all such conditions that may affect this work. Subsurface data for the project is available for review at the District Materials Office.

II. QUALIFICATIONS

The Contractor shall be experienced in jack and bore operations and have completed a minimum of five jack and bore projects in similar ground and groundwater conditions with similar cover conditions using similar size, type, and length of pipes to be installed on this project within the last three years.

The Contractor shall furnish to the Engineer a listing of the required information including contact personnel and their current phone numbers. The Contractor shall furnish the name and experience record of the field supervisor who will be in daily responsible charge of the jack and bore operation as well as the operator for each shift. The field supervisor will be present at all times when the work is being progressed. Qualified work crew personnel shall each have a minimum of three years’ experience with jack and bore equipment similar to that proposed for this project and in similar ground and cover conditions.

III. SUBMITTALS

The Contractor shall submit five copies of the following material to the Engineer for review and acceptance at least 30 calendar days prior to beginning jack and bore construction:

1. Shop drawings and narratives describing proposed pipe jack and bore means and methods including the following: equipment, equipment layout, procedures, sequence and production schedule. For boring equipment, show design, dimensions, method of operation, and steering control capability.

2. Description of proposed line and grade control methods.

TOC , VDOT Web , OVDOT , I , II , III , IV , V , VI , VII , VIII , 2019 Supplement , 2016 Spec Book

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3. Proposed procedures, materials, and equipment for lubricating the exterior of the pipe during jacking.

4. Proposed procedures, materials, and equipment for removing, clearing or otherwise making it possible to advance past obstructions.

5. Proposed procedures, materials, and equipment to fill voids outside of the pipe created or detected during the advance of the pipe.

6. Calculations, prepared and stamped by a Registered Professional Engineer licensed in the Commonwealth of Virginia, that demonstrate the pipe to be jacked has been designed to support the maximum anticipated earth loads and superimposed live loads, including but not limited to jacking loads, that may be imposed on the pipe during and after construction. The Contractor shall determine the additional stresses imposed on the pipe during jacking operations and upgrade the quality and strength of the pipe and pipe joints to the extent necessary to withstand the additional stresses imposed by the jacking operation or change his methodology to account for additional loads and stresses.

7. Blank daily log of jack and bore progress, to be completed within 8 hours of the completion of each shift to document the jack and bore work accomplished, the amount of excavated soil, and the results of ground surface survey monitoring.

8. Description of method to remove and dispose of spoil.

9. Estimate of anticipated jacking loads.

10. Pit dimensions, locations, surface construction, profile, depth, method of excavation, shoring bracing and thrust block design, including drawings and complete calculations.

11. Plan for flood protection and dewatering of pits and tunnel structures during construction.

12. Verification that the pipe complies with applicable contract requirements.

13. Condition survey (photographs and ground survey) of existing surface conditions along the planned pipe alignments. Photographs at 100% coverage. Minimum ground survey at edges of pavement and centerline of each travel direction (along pipe alignment), and at pipe centerline and 10-foot offsets (perpendicular to pipe alignment).

14. A detailed plan for monitoring ground surface movement due to the jack and bore operation. The plan shall address the method and frequency of survey measurement. At a minimum, the plan shall include taking measurements of ground movements of all structures, roadways, and any other areas of concern within at least 25 feet on both sides of all jack and bore pipelines at a maximum spacing of 100 feet along the jack and bore route or as otherwise required by the Engineer. The Contractor shall submit initial survey readings prior to start of jack and bore operations. The plan shall include survey readings of surface monitoring points daily during active boring operations. Subsequent readings shall be performed a minimum of one week, two weeks, and four weeks after completion of jack and bore operations and at project completion.

15. Contingency plans for review and acceptance for the following potential conditions: Damage to the pipeline structural integrity and repair, loss and return to line and grade, and loss of ground.

16. Contingency plan also required for encountering obstructions. Details of proposed means and methods for obstruction removal are required along the alignment with consideration of possible

3-22 constraints on surface access, including but not limited to the use of recovery shafts. Recovery shafts shall be constructed in accordance with submittals approved by the Engineer.

17. Verification that procedures meet all applicable OSHA requirements. These procedures shall be submitted for record purposes only and will not be subject to approval by the Engineer. As a minimum, the following should be included: Protection against soil instability and ground water inflow; safety for shaft access and exit; protection against mechanical and hydraulic equipment operations and for lifting and hoisting equipment and material; ventilation and lighting; monitoring for hazardous gases; protection against flooding and means for emergency evacuation;

protection of shaft; emergency protection equipment; and safety supervisory responsibilities.

18. As-built plans of all jack and bore elements within 30 calendar days of project completion. As-built plans shall include details of the installed pipes, temporary works, permanent structures, backfill materials, post-construction surveys, construction photographs, descriptions of problems encountered, and corrective procedures implemented.

IV. EQUIPMENT AND MATERIALS

1. Pipe shall meet the following minimum requirements:

A. For culvert installations, the pipe shall be made of reinforced concrete in accordance with ASTM C76. For utility installations, the pipe shall be made of steel (ASTM A139), 0.5 inches minimum wall thickness, shall be round, with a smooth, even outer surface and shall have joints that allow for easy butt-welded connections between pipe sections. Other pipe types may only be used if approved by the Engineer.

B. Pipe ends shall be square and smooth so that the jacking loads are evenly distributed around the entire pipe joint to minimize point loads when the pipe is jacked.

C. The pipe shall be capable of withstanding the jacking forces that will be imposed by the process of installation.

D. The driving ends of the pipe and intermediate joints shall be protected against damage.

E. The detailed method proposed to cushion and distribute the jacking forces shall be submitted to the Engineer for review and acceptance.

F. Any pipe showing signs of failure shall be jacked through to the reception shaft, removed and replaced at no additional cost to the Engineer.

G. The pipe manufacturer’s design jacking loads shall not be exceeded during the installation process. The pipe shall be designed to withstand all temporary installation loads.

2. Jacking equipment shall meet the following minimum requirements:

A. The thrust blocks shall be designed to transfer jacking loads into the soil and support the maximum pressure developed by the main jacking system with a minimum factor of safety of

2.5. The thrust blocks shall be perpendicular to the pipe alignment. Special care shall be taken when setting the pipe guide rails in the jacking pit to ensure correctness of the alignment, grade, and stability. If concrete thrust blocks or a treated soil zone are utilized to transfer jacking loads into the soil, the casing shall not be jacked until the concrete or treated soil have attained the required design strength.

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B. The jacking head shall be suitable to protect the pipe from damage due to the thrust from the jacks, and to transfer that thrust from the jack to the pipe.

C. The jacking frame, upon which the pipe being jacked will rest, shall be of railroad rails or other suitable steel or wooden members set to the correct line and grade to act as guides for true alignment of the pipe.

D. The main jacking equipment installed shall have a jacking capacity that is at least 150% of the maximum calculated allowable jacking load required to install the pipe.

E. The jacking apparatus shall be strongly constructed, and set and maintained in proper relative position and alignment, in order to minimize forces that would tend to bend the pipe, cause it to deflect from true alignment, or displace the reaction blocks.

V. EXECUTION

1. Jacking and Receiving Pits shall meet the following minimum requirements:

A. The jacking and receiving pits shall be of adequate size to accommodate the boring machine, jacking head, frame, jacks, reaction blocks, added section of pipe, and other material and equipment, and to provide sufficient and safe working space. Pits shall be located as shown on the plans. The Contractor may provide additional pits to better suit the capabilities of the jack and bore equipment only with written approval of the Engineer. Any request for changes in the location or addition of shafts shall be submitted in writing. The cost of additional access shafts constructed for the Contractor’s convenience will be considered incidental to the bid price.

B. The Contractor shall choose the excavation support system used. The Contractor shall be responsible for the design of the system. The design of pits shall ensure safe boring machine exit from the jacking pit and entry into the receiving pit. The Contractor shall furnish and install equipment to keep the jacking pit free of excess water. The Contractor shall also provide surface protection during the period of construction to ensure that surface runoff does not enter the pits.

C. All pits shall be backfilled in accordance with Section 303 of the Specifications. All shoring materials, bracing, temporary supports, rubbish, and construction materials shall be removed from the job site and disposed of upon completion of jack and bore operations.

2. Pipe installation shall be addressed as follows:

A. Bracing and backstops shall be so designed and jacks shall be of sufficient rating so that the jacking can progress without stoppage, except for adding lengths of pipe.

B. The use of water or other liquids to facilitate spoil removal is prohibited.

C. If voids are created or detected outside the pipe during the advance of the pipe, the Contractor shall fill the voids in accordance with the plan submitted per Section III.5.

D. If an obstruction is encountered during the advance of the pipe, the Contractor shall remove the obstruction in accordance with the contingency plan submitted per section III.16.

3. Tolerances shall be as follows:

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A. The Contractor shall install the jack and bored pipe to within 2 inches vertically and 6 inches horizontally of the alignment shown on the plans. The installed pipe gradient shall not be less than the gradient shown on the plans.

B. Minimum pipe cover shall be 5 feet or three times the pipe outside diameter, whichever is greater, unless specified otherwise in the contract documents.

C. If the jacked pipe is out of alignment by an amount that requires redesign or reconstruction of the pipe or associated structures, the Contractor shall do so at no additional cost to the Engineer.

D. Contractor shall carry out operations to minimize settlement and heave of the ground and shall be responsible for damage due to settlement or heave from any construction induced activities. In the event of movement of the ground surface, structure or utility in excess of 0.5 inch being detected, or damage being recorded, the Engineer may order that the work be stopped and secured. Before proceeding, the Contractor shall correct any problems causing or resulting from such movement entirely at its own cost. If ground settlement or heave occurs which might affect the accuracy of temporary or permanent benchmarks, it is the Contractor’s responsibility to monitor and report such movement to the Engineer.

E. Unless otherwise noted in the Contract Documents, settlement or heave at the ground surface during and after construction shall not exceed 0.5 inch within 25 feet laterally on either side of the centerline of the pipe alignment.

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VDOT2016_3Specs_acc071522 (002).pdf