ITB 2024_018 Hugh Howell Rd at Lilburn Stone .pdf

City of Tucker

Invitation to Bid

ITB # 2024-018

HUGH HOWELL ROAD @ LILBURN STONE

MOUNTAIN ROAD INTERSECTION

IMPROVEMENT

BID MANUAL

City of Tucker 1975 Lakeside Parkway, Suite 350

Tucker, Georgia 30084

INVITATION: The City of Tucker, Georgia requests that interested parties submit bids for the Hugh Howell Road @ Lilburn Stone Mountain Road Intersection Improvement Project. Bids will be accepted until the date and time listed below and will be awarded to the responsive and responsible bidder whose bid, conforming with all the material terms and conditions of the ITB, is the lowest in price. Addenda and updates to this bid manual will be posted on the City of Tucker website http://tuckerga.gov/bids or may be requested by email procurement@tuckerga.gov.

BID ACTIVITY SCHEDULE

Invitation to Bid Issued July 30, 2024 Pre-Bid Conference N/A Deadline for Questions August 13, 2024, at 1:00 p.m. (EST) Responses to Questions Posted (Addenda) August 16, 2024 Bid Deadline August 29, 2024, at 1:00 p.m. (EST) Award at Council Meeting September 23, 2024 (Tentative) Completion from Notice to Proceed 90 calendar days

SCOPE OF WORK: Refer to Exhibit A and attached plans.

QUESTIONS: Submit all questions in writing to procurement@tuckerga.gov with the subject line “Questions: ITB #2024-018”.

PRE-BID CONFERENCE: N/A

ADDENDA: Responses to the questions received will be by addenda and will be posted on the City website www.tuckerga.gov/bids. The signed acknowledgement issued with each addendum must be submitted with the proposal. It is the vendors responsibility to verify if any addenda were created.

SUBMITTAL REQUIREMENTS: Vendor shall submit ITB Response no later than August 29, 2024 at 1:00 p.m. electronically to procurement@tuckerga.gov with the subject line “Submittal:

ITB #2024-018”. The email must contain the vendor’s contact information. Bid Submittal should be one PDF file and named <Company Name>.ITB 2024-018.Bid Submittal.pdf. Email will be opened in order to confirm receipt of the submittal, but the attached PDF file will remain unopened until the public bid opening.

BID OPENING: All bids received prior to the deadline will be opened publicly at 1:00pm EST at Tucker City all located at 1975 Lakeside Parkway, Suite 350, Tucker GA. Preliminary Bid results will be posted on the City’s website, www.tuckerga.gov/bids, following the opening of bids.

http://tuckerga.gov/bids mailto:procurement@tuckerga.gov mailto:procurement@tuckerga.gov http://www.tuckerga.gov/ http://www.tuckerga.gov/bids

BID DOCUMENT SUBMITTAL REQUIREMENTS:

1. Cost Proposal Form (Exhibit B) Provided

2. Contact Information Form (Provided)

3. W-9 Form (Provided)

4. Certificate of Current Liability, Worker’s Compensation and Vehicle Insurance

5. Notarized Contractor Affidavit Form (Provided)

6. Notarized Subcontractor Affidavit Form (Provided)

7. Proposed List of Subcontractors Form (Provided)

8. Related Experience and References Form (Provided)

9. Bid Bond Form (Provided)

10. Notarized Contractor’s Oath Form (Provided)

11. Acknowledgement of Addendum issued with each Addendum.

City of Tucker Invitation to Bid

ITB #2024-018

HUGH HOWELL ROAD @ LILBURN STONE MOUNTAIN ROAD INTERSECTION

IMPROVEMENT

EXHIBIT A:

PURPOSE, INTENT AND PROJECT DESCRIPTION

The City of Tucker (City), requests that interested parties submit formal electronic bids for the construction of the Hugh Howell Road @ Lilburn Stone Mountain Road Intersection Improvement Project. This project includes striping, traffic signal work, and minor concrete work at the intersection of Hugh Howell Road and Lilburn-Stone Mountain Road per the attached plans and specifications.

This document in its entirety for ITB 2024-018 is available for download on the City of Tucker website: www.tuckerga.gov/bids or request via email to procurement@tuckerga.gov .

GENERAL CONDITIONS

The contractor shall execute the work according to and meet the requirements of the following:

• Georgia Department of Transportation (GDOT) Specifications, Standards, and Details.

• The Contract Documents including but not limited to the scope of work, plans, and specifications.

• City of Tucker ordinances and regulations.

• OSHA standards and guidelines.

• MUTCD Traffic Control.

• Any other applicable codes, laws and regulations including but not limited to Section 45-10-

20 through 45-10-28 of the Official Code of Georgia Annotated, Title VI of the Civil Rights Act, Drug-Free Workplace Act, and all applicable requirements of the Americans with Disabilities Act of 1990.

The contractor will be responsible for providing all labor, materials, and equipment necessary to perform the work. This is a unit price bid. Payment will be made based on actual work completed.

The contractor is responsible for inspecting the jobsite prior to submitting a bid. No change orders will be issued for differing site conditions.

The successful bidder must have verifiable experience in construction of similar projects in accordance with these specifications. The bidder shall provide at least three examples and reference information (including company name, project name, contact name, phone number and email address) demonstrating experience successfully completing projects of similar scope using the related experience and references form provided.

PROSECUTION AND PROGRESS

The Contractor will mobilize with sufficient forces such that all construction identified as part of this contract shall be substantially completed within 90 days of Notice to Proceed. The contractor will be considered substantially complete when all work required by this contract has been completed (excluding final punch list work).

Upon Notice of Award, the Contractor will be required to submit a Progress Schedule.

The normal workday for this project shall be 7:00AM to 7:00PM and the normal workweek shall be Monday through Friday. Lane closures on Hugh Howell Road and Lilburn-Stone Mountain http://www.tuckerga.gov/bids mailto:

HUGH HOWELL ROAD @ LILBURN STONE MOUNTAIN ROAD INTERSECTION

IMPROVEMENT

Road are limited to the hours of 9:00AM to 4:00PM. The City will consider extended workdays or workweeks upon written request by the Contractor on a case-by-case basis. No work will be allowed on national holidays (i.e. Memorial Day, July 4th, Labor Day, etc.).

The work will require a bidder to provide all labor, administrative forces, equipment, materials, and other incidental items to complete all required work. The City shall perform a Final Inspection upon substantial completion of the work. The contractor will be allowed to participate in the Final Inspection. All repairs shall be completed by the contractor at the contractor’s expense prior to issuance of Final Acceptance. If the bid price exceeds $100,000, a one (1) year maintenance bond will be required. The contractor will complete any Punch List work within 30 calendar days.

The contractor shall be assessed liquidated damages in the amount of $500.00 per calendar day for any contract work (excluding punch list items) that is not completed by 90 calendar days from Notice to Proceed. Liquidated damages shall be deducted from the 10% retainage held by the City.

The contractor will also be assessed liquidated damages in the amount of $500.00 per calendar day for not completing any required Punch List work within 45 calendar days.

The contractor shall provide all material, labor, and equipment necessary to perform the work without delay until final completion.

The contractor shall provide a project progress schedule prior to or at the preconstruction meeting.

This schedule should accurately represent the intended work and cannot be vague or broad.

The contractor shall submit a two-week advance schedule every Friday by 2:00p.m, detailing scheduled activities for the following week.

PERMITS AND LICENSES

The contractor shall procure all permits and licenses, pay all charges, taxes and fees, and give all notices necessary and incidental to the due and lawful prosecution of the work.

BONDING AND INSURANCE REQUIREMENTS

No bid may be withdrawn for a period of forty-five (45) days after the time has been called on the date of opening.

All bids 3ust be accompanied by a Bid Bond of a reputable bonding company authorized to do business in the State of Georgia, in an amount equal to at least five percent (5%) of the total amount of the bid.

Upon Notice of Award, the successful contractor shall submit a Performance Bond payable to the City of Tucker in the amount of 100% of the total contract price. The successful contractor shall also submit a Payment Bond in the amount of 100% pursuant to O.C.G.A. § 36- 91-70 and 90.

The contractor shall procure and maintain the following insurance policies:

1. Commercial General Liability coverage at their sole cos and expense with limits of not less than $3,000,000 in combined single limits for bodily injury and/or property damage per occurrence, and such policies shall name the City of Tucker as an additional named insured.

HUGH HOWELL ROAD @ LILBURN STONE MOUNTAIN ROAD INTERSECTION

IMPROVEMENT

2. Statutory Workers Compensation and Employers Liability Insurance with limits of not less than $1,000,000, which insurance must contain a waiver of subrogation against the City of Tucker and its affiliates.

3. Commercial automobile liability insurance with limits of not less than $1,000,000 combined single limit for bodily injury and/or property damage per occurrence, and such policies shall name the City of Tucker as an additional named insured.

PUBLIC NOTIFICATION

The contractor shall be responsible for installing temporary construction zone signage in compliance with MUTCD one week prior to commencement of work requiring lane closure.

Payment for this will be included in the item for Traffic Control. The contractor shall be responsible for installing lane closure and construction signage per MUTCD guidelines. Payment for this will be included in the item for Traffic Control. Properties requiring driveway closures be notified no less than one week prior to said closures.

EXISTING CONDITIONS / DEVIATION OF QUANTITIES

All information given in this ITB concerning quantities, scope of work, existing conditions, etc. is for information purposes only. It is the Contractor’s responsibility to inspect the project site to verify existing conditions and quantities prior to submitting their bid. This is a Lump Sum bid and no payment will be made for additional work without prior written approval from the City. At no time will Contractor proceed with work outside the prescribed scope of services for which additional payment will be requested without the written authorization of the City.

TRAFFIC CONTROL

The contractor shall, at all times, conduct their work so as to ensure the least possible obstruction of traffic. The safety and convenience of the general public and the residents along the roadway and the protection of persons and property shall be provided for by the contractor as specified in the State of Georgia, Department of Transportation Standard Specifications Sections 104.05, 107.09 and 150.

Traffic whose origin and destination are within the limits of the project shall be provided ingress and egress at all times unless otherwise specified by the City. The ingress and egress includes entrances and exits via driveways at various properties, and access to the intersecting roads and streets. The contractor shall maintain sufficient personnel and equipment (including flaggers and traffic control signing) on the project at all times, particularly during inclement weather, to ensure that ingress and egress are safely provided when and where needed.

Two-way traffic shall be maintained at all times, unless otherwise specified or approved by the City. In the event of an emergency situation, the Contractor shall provide access to emergency vehicles and/or emergency personnel through or around the construction area. Any pavement damaged by such an occurrence will be repaired by the Contractor at no additional cost to the City.

The contractor shall furnish, install, and maintain all necessary and required barricades, signs and other traffic control devices in accordance with the MUTCD and DOT specifications, and take all necessary precautions for the protection of the workers and safety of the public.

All existing signs, markers and other traffic control devices removed or damaged during construction operations will be reinstalled or replaced at the contractor’s expense, except as

HUGH HOWELL ROAD @ LILBURN STONE MOUNTAIN ROAD INTERSECTION

IMPROVEMENT

otherwise called for in the plans. At no time will contractor remove regulatory signing which may cause a hazard to the public.

PROTECTION AND RESTORATION OF PROPERTY AND LANDSCAPE

The contractor shall be responsible for the preservation of all public and private property, crops, fishponds, trees, monuments, highway signs and markers, fences, grassed and sodded areas, etc.

along and adjacent to the highway, road or street, and shall use every precaution necessary to prevent damage or injury thereto, unless the removal, alteration, or destruction of such property is provided for under the contract.

When or where any direct or indirect damage or injury is done to public or private property by or on account of any act, omission, neglect or misconduct in the execution of the work, or in consequence of the non-execution thereof by the contractor, they shall restore, at his/her own expense, such property to a condition similar or equal to that existing before such damage or injury was done, by repairing, rebuilding or otherwise restoring as may be directed, or she/he shall make good such damage or injury in an acceptable manner. The contractor shall correct all disturbed areas before retainage will be released.

THERMOPLASTIC PAVEMENT MARKINGS

This work shall include Thermoplastic Pavement Markings. These final pavement markings shall match the signing & marking plans including center lines, lane lines, turn arrows, crosswalks, stop bars, etc. unless specifically directed otherwise by the City. Final pedestrian crosswalk markings shall adhere to the latest standards. Pavement marking materials shall meet GDOT standard specifications and be on the qualified products list. Temporary pavement markings, where required, shall be included in the pay item for thermoplastic pavement markings. There is no separate pay item for temporary pavement markings.

CLEANUP

All restoration and clean-up work shall be performed daily. Operations shall be suspended if the contractor fails to accomplish restoration and clean-up within an acceptable period of time. Asphalt and other debris shall be removed from gutters, sidewalks, yards, driveways, etc. Failure to perform clean-up activities may result in suspension of the work.

SAFETY

Beginning with mobilization and ending with acceptance of work, the contractor shall be responsible for providing a clean and safe work environment at the project site. The contractor shall comply with all OSHA regulations as they pertain to this project.

SPECIAL CONDITIONS

1. All disturbed or damaged grassing, landscaping beyond the project limits is to match existing conditions.

2. Contractors shall be required to meet all GDOT lane closure requirements. Signage and all other forms of traffic control shall be included in the “TRAFFIC CONTROL” quantity for the project.

3. Yellow ADA detectable warning surfaces should be included in “Concrete/ ADA ramp installation” for all ADA ramp construction.

4. Removal of any existing thermoplastic shall be done with grinding.

HUGH HOWELL ROAD @ LILBURN STONE MOUNTAIN ROAD INTERSECTION

SUBCONTRACTOR

Any contractor utilizing a subcontractor must submit a proposed list of subcontractors and a Notarized Subcontractor Affidavit (Form provided)

HUGH HOWELL ROAD @ LILBURN STONE MOUNTAIN ROAD INTERSECTION

Exhibit B: Cost Proposal

SUMMARY OF QUANTITIES QTY

SIGNAL MATERIALS - 3 SECTION SIGNAL HEAD 2

SIGNAL MATERIALS - 4 SECTION SIGNAL HEAD

W/ARROWS

SIGNAL MATERIALS - OVERHEAD R10-5A SIGN

SIGNAL MATERIALS - AUX FILE

SIGNAL MATERIALS - 7C CABLING

2,000

SIGNAL MATERIALS - 3 PAIR

1,300

SIGNAL MATERIALS - LOAD SWITCH

SIGNAL MATERIALS - PED ISOLATOR CARD

SIGNAL MATERIALS - PED SIGNALS/ PED STATIONS/

SIDE OF POLE MOUNT

6X6 LOOP INSTALLATION, COMPLETE

SIGNAGE MATERIALS

CONCRETE/ ADA RAMP INSTALLATION

STRIPING INSTALLATION

REMOVAL OF EXISTING STRIPING (GRINDING)

LUMP SUM COST:

Company Name:

Address:

Contact Person:

Phone Number:

Email Address:

Signature:

Contact Information Form

Please fill out this form with the appropriate contact information for your company.

Full Legal Name of Company:

Date:

Contractor Information:

Primary Contact Person:

Title: Telephone Number:

E-mail Address:

Secondary Contact Person:

Title: Telephone Number:

E-mail Address:

Preferred Contact for Administration: (i.e. Document Processing) (Choose one)

☐ Primary Contact ☐ Secondary Contact

Address:

City / State / Zip:

Mailing Address (If different than above):

City / State / Zip:

Federal Employee ID Number (FEIN):

REVISED 10.25.2022

GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT AFFIDAVIT

GEORGIA E-Verify and Public Contracts: The Georgia E-Verify law requires contractors and all sub-contractors on Georgia public contract (contracts with a government agency) for the physical performance of services over $2,499 in value to enroll in E-Verify, regardless of the number of employees.

Contractor Name:

Solicitation/Bid number or Project Description:

By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, entity or corporation which is engaged in the physical performance of services under a contract on behalf of the City of Tucker, Georgia has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-91.

Furthermore, the undersigned contractor will continue to use the federal work authorization program throughout the contract period as required by O.C.G.A. § 13-10-91(b) and the undersigned contractor will contract for the physical performance of services in satisfaction of such contract only with subcontractors who present and affidavit to the contractor with the information required by O.C.G.A. § 13-10-91(b). Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:

Federal Work Authorization User Identification Number Date of Authorization (EEV/E-Verify Company Identification Number)

Name of Contractor

I hereby declare under penalty of perjury that the foregoing is true and correct

Printed Name (of Authorized Officer or Agent of Contractor) Title (of Authorized Officer or Agent of Contractor)

Signature (of Authorized Officer or Agent) Date Signed

SUBSCRIBED AND SWORN BEFORE ME ON THIS THE

DAY OF , 20

[NOTARY SEAL]

Notary Public

My Commission Expires:

2024-018 Hugh Howell Road @ Lilburn Stone Mountain Road Intersection Improvement

REVISED 10.25.2022

GEORGIA SECURITY AND IMMIGRATION COMPLIANCE ACT AFFIDAVIT

GEORGIA E-Verify and Public Contracts: The Georgia E-Verify law requires contractors and all sub-contractors on Georgia public contract (contracts with a government agency) for the physical performance of services over $2,499 in value to enroll in E-Verify, regardless of the number of employees.

Contractor Name:

Subcontractor’s (Your) Name

Solicitation/Bid number or Project Description:

By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, entity or corporation which is engaged in the physical performance of services under a contract on behalf of the City of Tucker, Georgia has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-91.

Furthermore, the undersigned subcontractor will continue to use the federal work authorization program throughout the contract period as required by O.C.G.A. § 13-10-91(b) and the undersigned subcontractor will contract for the physical performance of services in satisfaction of such contract only with sub-subcontractors who present and affidavit to the contractor with the information required by O.C.G.A. § 13-10-91(b). Subcontractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:

Federal Work Authorization User Identification Number Date of Authorization (EEV/E-Verify Company Identification Number)

Name of Subcontractor

I hereby declare under penalty of perjury that the foregoing is true and correct

Printed Name (of Authorized Officer or Agent of Contractor) Title (of Authorized Officer or Agent of Contractor)

Signature (of Authorized Officer or Agent) Date Signed

SUBSCRIBED AND SWORN BEFORE ME ON THIS THE

DAY OF , 20

[NOTARY SEAL]

Notary Public

My Commission Expires:

2024-018 Hugh Howell Road @ Lilburn Stone Mountain Road Intersection Improvement

PROPOSED SUBCONTRACTOR FORM: ITB 2024-018

BIDDERS MUST RETURN THIS FORM WHICH WILL BE ADDED TO SUBMITTED PROPOSAL

Please complete this form and return as part of your bid package when it is submitted.

Name of Bidder

1. Subcontractor Name: _____________________________________________________

% of Bid Amount: __________________________________________________________

Description of Work provided: _______________________________________________

2. Subcontractor Name: _____________________________________________________

% of Bid Amount: __________________________________________________________

Description of Work provided: _______________________________________________

3. Subcontractor Name: _____________________________________________________

% of Bid Amount: __________________________________________________________

Description of Work provided: _______________________________________________

4. Subcontractor Name: _____________________________________________________

% of Bid Amount: __________________________________________________________

Description of Work provided: _______________________________________________

Please complete and submit in bid package. Duplicate if needed.

REFERENCES FORM: ITB 2024-018

BIDDERS MUST RETURN THIS FORM WHICH WILL BE ADDED TO SUBMITTED PROPOSAL

Please complete this form and return as part of your bid package when it is submitted.

Name of Bidder

REFERENCE #1

Contact Name: ___________________________________________________________

Contact Number and email: _________________________________________________

Brief Description of work provided:___________________________________________

REFERENCE #2

Contact Name: ___________________________________________________________

Contact Number and email: _________________________________________________

Brief Description of work provided:___________________________________________

REFERENCE #3

Contact Name: ___________________________________________________________

Contact Number and email: _________________________________________________

Brief Description of work provided: ___________________________________________

Please complete and submit in bid package

BID BOND

KNOW ALL MEN BY THESE PRESENTS, THAT

(Name of Contractor) at

(Address of Contractor)

(Corporation, Partnership and / or Individual) hereinafter called Principal, and

(Name of Surety)

(Address of Surety)

A corporation of the State of __________________ , and a surety authorized by law to do business in the State of Georgia, hereinafter called Surety, are held, and firmly bound unto

(Name of Obligee) City of Tucker Georgia

(Address of Obligee) 1975 Lakeside Parkway, Suite 350, Tucker, Georgia 30084

Hereinafter referred to as Obligee, in the penal sum of Dollars ($_______________) in lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly by these presents.

WHEREAS, the Principal is about to submit, or has submitted, to the City of Tucker, Georgia, a proposal for furnishing materials, labor, and equipment for:

ITB # 2024-018

HUGH HOWELL ROAD @ LILBURN STONE MOUNATIN ROAD

INTERSECTION IMPROVEMENT PROJECT

WHEREAS, the Principal desires to file this Bond in accordance with law in lieu of a certified Bidder’s check otherwise required to accompany this Proposal.

NOW, THEREFORE, the conditions of this obligation are such that if the bid is accepted, the Principal shall within ten days after receipt of notification of the acceptance execute a Contract in accordance with the Bid and upon the terms, conditions, and prices set forth in the form and manner required by the City of Tucker, Georgia, and execute a sufficient and satisfactory Performance Bond and Payment Bond payable to the City of Tucker, Georgia, each in an amount of 100% of the total Contract Price, in form and with security satisfactory to said the City of Tucker, Georgia, and otherwise, to be and remain in full force and virtue in law; and the Surety shall, upon failure of the Principal to comply with any or all of the foregoing requirements within the time specified above, immediately pay to the City of Tucker, Georgia, upon demand, the amount hereof in good and lawful money of the United States of America, not as a penalty, but as liquidated damages.

PROVIDED, FURTHER, that Principal and Surety agree and represent that this bond is executed pursuant, to and in accordance with the applicable provisions of the Official Code of Georgia Annotated, as Amended, including, but not limited to, O.C.G.A. § 13-10-20, et. Seg. And § 36- 91-50, et.

Seg. and is intended to be and shall be constructed as a bond in compliance with the requirements thereof.

Signed, sealed, and dated this _________day of _______________________A.D., 20____.

ATTEST:

(Principal Secretary) (Principal)

(SEAL) BY:

(Witness to Principal) (Address)

(Address) (Surety)

ATTEST:

BY:

(Attorney-in-Fact) and Resident Agent

(Attorney-in-Fact)

(SEAL)

(Address)

(Witness as to Surety)

CONTRACTOR’S OATH

COMES NOW, ______________________________________________ (“Contractor”), [name of Contractor] appearing by and through _______________________________________________________, [name of individual with authority to bind Contractor] its _____________________________________ (“Individual And Representative Affiant”), and [title]

[insert the names of all those required to give the oath]

(collectively, “Individual Affiants”), and each of the Individual And Representative Affiant and

Individual Affiants, after first being duly sworn, deposes and says that:

1. Contractor has not directly or indirectly violated subsection (d) of the Official Code of

Georgia Annotated Section 36-91-21, which provides as follows:

Whenever a public works construction contract for any governmental entity subject to the requirements of this chapter is to be let out by competitive sealed bid or proposal, no person, by himself or herself or otherwise, shall prevent or attempt to prevent competition in such bidding or proposals by any means whatever. No person who desires to procure such work for himself or herself or for another shall prevent or endeavor to prevent anyone from making a bid or proposal therefor by any means whatever, nor shall such person so desiring the work cause or induce another to withdraw a bid or proposal for the work.

Code Section 36-91-21(d) also applies to municipal street system contracts pursuant to

Official Code of Georgia Annotated Section 32-4-122.

2. Individual And Representative Affiant is the officer of Contractor whose duty it is to make the payment.

3. If Contractor is a partnership, then Individual and Representative Affiant and Individual

Affiants together constitute all of the partners and any officer, agent or other person who may have represented or acted for Contractor in bidding for or procuring the contract.

4. If Contractor is a corporation, then Individual and Representative Affiant and Individual

Affiants together constitute all officers, agents, or other persons who may have acted for or represented Contractor in bidding for or procuring the contract.

Further affiants sayeth not.

This ____ day of ________________, 20___.

By: _________________________________________, individually and on behalf of Contractor [signature of Individual And Representative Affiant]

Name: _____________________________ Title: ______________________________

Individual Affiants’ signatures and names:

Name: Name:

Name: Name:

Name: Name:

Subscribed and Sworn before me on this ______ day of ________________, 20_____.

NOTARY PUBLIC

My Commission Expires: