ITB 24-35TM N. Mallory Street Bicycle Lane Improvements.pdf

BID PROPOSAL AND PROJECT MANUAL

N. Mallory Street Bicycle Lane Improvements VDOT Project No. EN20-114-363/ UPC 117120

SP2023-0004

CITY OF HAMPTON

Procurement Office

Division of Finance Community, Municipal Services, Education

Hampton, Virginia

Issued: Monday, January 30, 2024

Mandatory Pre-Bid Conference: February 5, 2024, 10:00 AM

22 Lincoln Street, 4th Floor

Pre-Bid Questions Due by: February 9, 2024 - 5:00 PM

Bids Due: February 22, 2024 - 1:00 PM EST Consolidated Procurement Office

1 Franklin Street, Suite 345 Hampton, VA 23669

INVITATION FOR BID PREPARED BY:

Name: Tammy Martin Title: Senior Buyer Telephone: 757-727-2205 Email: TMartin@Hampton.gov

ITB 24-35TM - UPC 117120 - Mellen Street Bike and Pedestrian Improvements sandon.rogers Text Box

ITB 24-35TM

TOC-1 of 2

TABLE OF CONTENTS

GENERAL:

NOTICE OF ADVERTISEMENT ............................................................................................. A-1

REQUIRED BID RESPONSE DOCUMENTS:

I. BID FORM ................................................................................................................ B-1

A. BID PROPOSAL & CONTRACTOR TABULATION SHEET…………….B-1

B. ADDENDA ACKNOWLEDGEMENT……………………………………….B-3

C. BIDDER COMPLIANCE……………………………………………..……...B-4

D. BIDDER SIGNATURE………………………………………………...….....B-5

E. BIDDER CONTACT INFORMATION……………………………..……….B-6

II. VIRGINIA CONTRACTOR’S LICENSE ................................................................... B-7 III. BID BOND .............................................................................................................. B-8 IV. CERTIFICATION REGARDING DEBARMENT ...................................................... B-9

V. ANTI-COLLUSION / NON-DISCRIMINATION / DRUG-FREE WORKPLACE ....... B-10

VI. VDOT FORMS: ................................................................................................... B-12

FORM C-48 - SUBCONTRACTOR/SUPPLIER SOLICITATION AND UTILIZATION FORM

FORM C-49 - DBE GOOD FAITH EFFORTS DOCUMENTATION

FORM C-104 – BIDDER STATEMENT FEDERALLY FUNDED PROJECTS

FORM C-105 – BIDDER CERTIFICATION FEDERALLY FUNDED PROJECTS

FORM C-111 – MINIMUM DBE REQUIREMENTS

FORM C-112 – CERTIFICATION OF BINDING AGREEMENT

OTHER FORMS:

I. PRE-BID QUESTION FORM .................................................................................... C-1 II. CONTRACTOR QUESTIONNAIRE FORM .............................................................. C-2 III. CONTRACT PERFORMANCE AND PAYMENT BOND ......................................... C-8 IV. INSURANCE CERTIFICATES ............................................................................. C-10

SAMPLE AGREEMENT TEMPLATE ..................................................................................... D-1

PROJECT SPECIFIC PROVISIONS ..................................................................................... E-1

VDOT ROAD & BRIDGE SPECIFICATIONS: SPECIAL PROVISION COPIED NOTES

(SPCNs), SPECIAL PROVISION (SPs), AND SUPPLEMENTAL SPECIFICATIONS (SSs): .... F-1

DIVISION I (100 SERIES) – GENERAL PROVISIONS

DIVISION II (200 SERIES) – MATERIALS

DIVISION III (300 SERIES) – ROADWAY CONSTRUCTION

DIVISION IV (400 SERIES) – BRIDGES AND STRUCTURES

DIVISION V (500 SERIES) – INCIDENTAL CONSTRUCTION

DIVISION VI (600 SERIES) – ROADSIDE DEVELOPMENT

DIVISION VII (700 SERIES) – TRAFFIC CONTROL DEVICES

ATTACHMENTS:

PLAN SET

ITB 24-35TM - UPC 117120 - Mellen Street Bike and Pedestrian Improvements

A-1

NOTICE OF ADVERTISEMENT

PROJECT: N. Mallory Street Bicycle Lane Improvements City Project No.: SP2023-0004 VDOT Project No: EN20-114-363/ UPC 117120

LOCATION: City of Hampton, Virginia

ISSUE DATE: January 30, 2024

A Mandatory PRE-BID CONFERENCE will be held on February 5, 2024 at the Public Works Engineering Conference Room, 22 Lincoln Street, 4th, Hampton, VA 23669.

PRE-BID QUESTIONS DUE: February 9, 2024, 5:00PM Submit all pre-bid questions to Tammy Martin, Sr. Buyer TMartin@Hampton.gov via email or fax. Please utilize the form on page C-1 of this solicitation for all pre-bid questions.

The City of Hampton, Virginia will receive sealed Bids for the above titled project at the Procurement Office, located at 1 Franklin Street, Suite 345, Hampton, VA 23669 no later than on February 22, 2024, 1:00PM at which time the Bids will be publicly opened and read aloud. Any Bids received after the specified time and date will not be considered.

Faxed or emailed responses shall not be accepted. Submittal requires two (2) hard copies:

one original and one copy. Any Bids received after the specified time and date will not be considered.

Bid Documents are available electronically via the City’s Procurement and eVA websites. Contact the Procurement Office, City of Hampton at (757) 727-2200 if assistance is needed.

The Project, N. Mallory Street Bicycle Lane Improvements, was developed under State/ VDOT Project No: EN20-114-363/ UPC 117120.

The work under this Project consists of a road “diet” along N. Mallory Street with the removal and installation of pavement markings to include buffered bicycle lanes, as well as milling and overlaying on the north-east-bound side of the corridor.

This project shall be constructed in accordance with: AASHTO (American Association of State Highway and Transportation Officials) A Policy on Geometric Design of Highways and Streets, 7th Edition dated 2018, the Virginia Department of Transportation (VDOT) Road and Bridge (R&B) Specifications, dated 2020; and VDOT R&B Standards, dated 2016; the Virginia Work Area Protection Manual, 2011 Edition Rev. November 2020; the 2009 edition of the MUTCD Rev. 3 dated 2022; 2011 Virginia Supplement to the MUTCD with Revision Number 1, and the Supplemental Specifications, Special Provisions and Special Provision Copied Notes in this contract.

In accordance with the Code of Virginia § 2.2-4336, a Bid Security in the amount of five percent (5%) of the Bid shall be submitted with each Bid.

Contractor registration is required in accordance with the Code of Virginia Title 2.2 Chapter 43 and Title 54.1 Chapter 3.

It is VDOT policy that Disadvantaged Business Enterprises (DBE) as defined in 49 CFR Part 26 must have the maximum opportunity to participate in the performance of federally funded contracts. A list of DBE firms certified by the SBSD and MWAA is maintained on SBSD’s website

A-2

(http://www.SBSD.virginia.gov) under the DBE Directory of Certified Vendors. Contractors are encouraged to take all necessary and reasonable steps to ensure that DBE firms have the maximum opportunity to compete for and perform services on contract, including participation in any subsequent supplement contracts. If the contractor intends to subcontract a portion of the services on the project, the contractor is encouraged to seek out and consider DBEs as potential Sub-contractors. The contractor is encouraged to contact DBEs to solicit their interest, capability and qualifications. Any agreement between a contractor and a DBE whereby the DBE promises not to provide services to other contractors is prohibited. This project is federally funded with a DBE contract goal of eight (8%)

Withdrawal of Bids due to error shall be subject to and in accordance with Section 2.2-4330 of the Code of Virginia and the Contract Documents. The Owner reserves the right to reject any and all Bids and to waive any minor non-substantive errors in the Bid.

The City of Hampton does not discriminate in the solicitation or awarding of contracts on the basis of race, religion, faith-based organizations, color, national origin, age, disability or any other basis prohibited by state or federal law.

FHWA policy prohibits the use of convict labor and material for projects located on this project.

All bids received in accordance with the terms of the advertisement shall be publicly opened and announced by total amount. If any bid received is not read aloud, the name of the bidder and the reason for not reading the bid aloud shall be publicly announced at the letting. Negotiation with contractors, during the period following the opening of bids and before the award of the contract shall not be permitted.

Unless otherwise provided in the Invitation to Bid, the name of a certain brand, make or manufacturer shall not restrict bidders to the specific brand, make or manufacturer named and shall be deemed to convey the general style, type, character, and quality of the article desired. Any article that the public body in its sole discretion determines to be the equal of that specified, considering quality, workmanship, economy of operation, and suitability for the purpose intended, shall be accepted.

By: Tammy Martin Senior Buyer City of Hampton Procurement Department

B-1

REQUIRED BID RESPONSE DOCUMENTS

I. BID FORM

Bids to be opened: February 22, 2024

Contract time limit 60 Days

Performance Bond: 100% Payment Bond: 100% Bid Security: 5%

To: City of Hampton, Virginia

1 Franklin Street, Suite 345 Hampton, VA 23669

A. BID PROPOSAL

In compliance with the Contract Documents, titled N. Mallory Street Bicycle Lane Improvements VDOT Project No: UPC 117120 and all Addenda issued to date all of which are part of this Bid, the undersigned hereby proposes to furnish all items including materials, supervision, labor, and equipment in strict accordance with, said Contract Documents, for the total base sum of:

SEE CONTRACTOR BID TABULATION SHEET(S), STARTING NEXT PAGE

B-2

TEM

NO.

VDOT

SPECIFICATION

DESCRIPTION OF ITEM

UNIT QUANTITY

UNIT PRICE EXTENDED

PRICE

1 VDOT 512 ERADICATE EXISTING LINEAR PAVEMENT

MARKINGS (CONCRETE)

LF 1,010 $ $

2 VDOT 512

ERADICATE EXISTING NONLINEAR PAVEMENT

MARKINGS (CONCRETE)

SF 50 $ $

3 VDOT 515 FLEXIBLE PAVEMENT PLANING (0" TO 2" DEPTH) SY 11,520 $ $

4 VDOT 315 ASPHALT CONCRETE TY. SM-9.5A TON 1,255 $ $

5 VDOT 704 TYPE B CLASS I PAVE. LINE MARKING 4" LF 8,950 $ $

6 VDOT 704 TYPE B CLASS I PAVE. LINE MARKING 6" LF 14,800 $ $

7 VDOT 704 TYPE B CLASS I PAVE. LINE MARKING 12" LF 2,560 $ $

8 VDOT 704 TYPE B CLASS I PAVE. LINE MARKING 24" LF 250 $ $

9 VDOT 704

TYPE B CLASS I PAVE. SYMBOL MARKING

(HELMETED BICYCLIST)

EA 34 $ $

10 VDOT 704 PAVEMENT MESSAGE MARK SHARROW EA 3 $ $

11 VDOT 704 TYPE B CLASS I PAVE. SYMBOL MARKING (DBL

TURN ARROW THRU/RT)

EA 1 $ $

12 VDOT 704

TYPE B CLASS I PAVE. SYMBOL MARKING (LEFT

TURN ARROW)

EA 2 $ $

13 VDOT 704

TYPE B CLASS I PAVE. SYMBOL MARKING (LANE

REDUCTION ARROW)

EA 2 $ $

14 VDOT 701 SIGN PANEL SF 48 $ $

15 VDOT 700 SIGN POST STP-1 2.5", 12 GAUGE EA 10 $ $

16 VDOT 700 CONCRETE FOUNDATION STP-1 EA 10 $ $

17 VDOT 512 MAINTENANCE OF TRAFFIC LS 1 $ $

18 VDOT 513 MOBILIZATION LS 1 $ $

SUB-TOTAL THIS SHEET $

PROJECT TOTAL $

Bidder acknowledges that estimated quantities are not guaranteed and are solely for the purpose of comparison of Bids, and final payment for all Unit Price Bid items will be based on actual quantities provided, determined as provided in the Contract Documents. The prices quoted shall include without exception all materials, supervision, labor, equipment, appliances, clean-up, incidental items, applicable sales, use and other taxes, insurance, building permit or fees, and the Contractor's labor, overhead, profit, mobilization and other mark-ups, and in full accordance with the Contract Documents. Include allowance for waste where appropriate. The unit prices shall be maintained throughout the Contract Time.

Discrepancies between multiplication of units of work and unit prices will be resolved in favor of unit prices. Discrepancies between the indicated sum of any column of figures and the correct sum thereof will be resolved in the favor of the correct sum. Discrepancies between words and figures will be resolved in favor of words.

B-3

B. ADDENDA ACKNOWLEDGEMENT

The undersigned acknowledges receipt of the following addenda (if applicable):

Addendum No. __ Dated: __________

Addendum No. __ Dated: __________

Addendum No. __ Dated: __________

Addendum No. __ Dated: __________

Addendum No. __ Dated: __________

B-4

C. BIDDER COMPLIANCE

1. Bidder agrees that the City of Hampton, Virginia shall have the right to reject any and all Bids and to waive any minor non-substantive errors in the Bid. Award shall be based on the lowest responsive and responsible Bid for Base Bid.

2. Bidder agrees that all prices stated herein shall be Firm for a period of _120_ Calendar Days.

3. Bidder has carefully examined the Plans, Specifications, and all other documents pertaining thereto and thoroughly understand the contents thereof.

4. Bidder has examined the location of the proposed Work and source of supply of materials.

5. Bidder meets the prequalification requirements for bidding on this proposal. Prequalification of

Contractors and/or Subcontractors is in accordance with the VDOT R&B Specifications, Section 102.

6. Bidder agrees to bind himself upon award of the City of Hampton, Virginia under this proposal to a contract with necessary surety bond to start work within ten (10) calendar days of Notice to Proceed or as excepted by other contract language permitted by the Specifications, and to complete all Work in accordance with the Plans and Specifications within the Contract Time Limit.

7. Upon acceptance of Bidder’s response, the Bidder will be asked to execute a formal Contract and required to furnish a payment bond and a performance bond (per Code of Virginia § 2.2-4337) and a certificate of insurance (per Code of Virginia § 2.2-4332). Bidder will execute and furnish the same within ten (10) calendar days of such notice. Failure to do so will mean forfeiture of any Surety Bidder may have been required to post as part of Bidder’s response.

8. Bidder’s Business, whether organized as a stock or non-stock Corporation, limited liability company, Business trust, limited partnership, or registered as a registered limited liability partnership, is authorized to transact business in the Commonwealth of Virginia as a domestic or foreign Business entity if so required by Title 13.1 or Title 50 of the Code of Virginia, as amended, or as otherwise required by law.

Bidder shall include in his proposal the identification number issued to it by the State Corporation Commission or a statement describing why the Bidder is not required to be so authorized.

9. Bidder meets all licensing and permit requirements to conduct business in the City of Hampton, Virginia.

10. CONTRACTOR'S REGISTRATION:

Registered Virginia Contractor Class and No. ______________________________ (issued to Contractor by DPOR)

State Corporation Commission Registration No. _____________________________ (issued to Contractor by the SCC)

***In Accordance with 23 CFR 635.110 of the Code of Federal Regulations, Bidder shall provide a copy of Contractors License upon Notice of Intent (NOI) of Award of contract.***

(NOTE: FAILURE TO PROVIDE CONTRACTOR’S REGISTRATION NUMBER AT NOI TO AWARD IS GROUNDS

FOR REJECTION OF THE BID)

B-5

D. BIDDER SIGNATURE

Name of Contractor:

Authorized Signature:

Printed Name:

Title:

Date: (NOTE:

If Bidder is a corporation, write state of incorporation next to Name of Contractor.)

Vendor / Federal ID Number (FIN):

DUNS Number:

Is Bidder SWaM certified? Yes No Is Bidder DBE certified? Yes No

Is Bidder a Minority-Owned Business? Yes No

If yes, please indicate the “minority” classification below:

African American Hispanic American Native American Asian American Other: _________________

Please Explain:

Is Bidder Woman Owned? Yes No Is Bidder a Small Business? Yes No Is Bidder a Faith-Based Organization? Yes No

B-6

E. BIDDER CONTACT INFORMATION

MAILING ADDRESS, TELEPHONE NUMBER, FAX NUMBER & EMAIL ADDRESS OF BIDDER:

IF CORPORATION, PROVIDE NAME AND MAILING ADDRESS AS REQUIRED BELOW:

PRESIDENT SECRETARY TREASURER

IF PARTNERSHIP, PROPRIETORSHIP, LIMITED LIABILITY COMPANY OR OTHER FIRM, PROVIDE

NAME AND MAILING ADDRESS OF EACH PARTNER, PROPRIETOR, OR MEMBER OF FIRM.

B-7

II. VIRGINIA CONTRACTOR’S LICENSE

This Federally funded project shall be in accordance with 23 CFR 635: requiring the Contractor to provide its Contractors License upon award of contract. This, however, is not intended to preclude requirements for the licensing of a contractor subsequent to the award of the contract.

NOW, THEREFORE,

(a) If said BID shall be accepted, the Principal shall deliver a copy of Contractors License, or

(b) If said BID shall be rejected then this obligation shall be void, otherwise the same shall remain in force and effect.

IN WITNESS WHEREOF, the Principal and the Surety have here unto set their hands and seals, and such of them as are corporations have caused their corporate seals to be hereto affixed and these presents to be signed by their proper officers, the day and year set forth above.

Principal

By:

Attorney-in-Fact

B-8

III. BID BOND

KNOW ALL MEN BY THESE PRESENTS, that we, the undersigned, _______________as Principal, and __________________________________as Surety, are hereby held and firmly bound unto City of Hampton, Virginia as OWNER in the penal sum of ___________(Five Percent) for the payment of which, well and truly to be made, we hereby jointly and severally bind ourselves, successors and assigns.

Signed, this day of , 20 .

The Condition of the above obligation is such that whereas the Principal has submitted to the OWNER a certain BID, attached hereto and hereby made a part hereof to enter into a Contract in writing, for the project entitled: N.

Mallory Street Bicycle Lane Improvements, VDOT Project No: EN20-114-363/ UPC 117120.

NOW, THEREFORE,

(a) If said BID shall be rejected, or

(b) If said BID shall be accepted and the Principal shall execute and deliver a Contract in the attachment hereto (properly completed in accordance with said BID) and shall furnish a BOND for faithful performance of said Contract, and for the payment of all persons performing labor or furnishing materials in connection therewith, then this obligation shall be void, otherwise the same shall remain in force and effect; it being expressly understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed the penal amount of this obligation as herein stated.

The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its BOND shall be in no way impaired or affected by any extension of the time within which the OWNER may accept such BID; and said Surety does hereby waive notice of any such extension.

IN WITNESS WHEREOF, the Principal and the Surety have hereunto set their hands and seals, and such of them as are corporations have caused their corporate seals to be hereto affixed and these presents to be signed by their proper officers, the day and year set forth above.

Principal

Surety

By:

Attorney-in-Fact

IMPORTANT -Surety companies executing BONDS shall appear on the Treasury Department's most current list (Circular 570 as amended) and be authorized to transact business in the Commonwealth of Virginia.

B-9

IV. CERTIFICATION REGARDING DEBARMENT

This is to certify that this person/firm/corporation is not now debarred by the Federal Government or by the Commonwealth of Virginia or by any other state, or by any town, city, or county, from submitting Bids on contracts for construction covered by this solicitation, nor are they an agent of any person or entity that is now so debarred.

Each covered contractor must also screen each of its covered subcontractors. In this certification “contractor” refers to both contractor and subcontractor; “contract” refers to both contract and subcontract.

Signature of Official

Name of Official

Title

Firm or Corporation

Date

B-10

V. ANTI-COLLUSION/NON-DISCRIMINATION/DRUG-FREE

WORKPLACE REQUIREMENTS STATEMENT

ANTI-COLLUSION CLAUSE:

IN THE PREPARATION AND SUBMISSION OF THIS PROPOSAL, SAID BIDDER DID NOT EITHER

DIRECTLY OR INDIRECTLY ENTER INTO ANY COMBINATION OR ARRANGEMENT WITH ANY

PERSON, FIRM OR CORPORATION, OR ENTER INTO ANY AGREEMENT, PARTICIPATE IN ANY

COLLUSION, OR OTHERWISE TAKE ANY ACTION IN VIOLATION OF THE SHERMAN ACT (15 U.S.C.

SECTION 1), SECTIONS 59.1-9.1 THROUGH 59.1-9.17 OR SECTIONS 59.1-68.6 THROUGH 59.1-68.8 OF

THE CODE OF VIRGINIA.

THE UNDERSIGNED BIDDER HEREBY CERTIFIES THAT THIS AGREEMENT, OR ANY CLAIMS

RESULTING THEREFROM, IS NOT THE RESULT OF, OR AFFECTED BY, ANY ACT OF COLLUSION

WITH, OR ANY ACT OF, ANOTHER PERSON OR PERSONS, FIRM OR CORPORATION ENGAGED IN

THE SAME LINE OF BUSINESS OR COMMERCE; AND, THAT NO PERSON ACTING FOR, OR

EMPLOYED BY, HAS AN INTEREST IN, OR IS CONCERNED WITH, THIS PROPOSAL; AND, THAT NO

PERSON OR PERSONS, FIRM OR CORPORATION OTHER THAN THE UNDERSIGNED, HAVE, OR ARE,

INTERESTED IN THIS PROPOSAL.

DRUG-FREE WORKPLACE:

DURING THE PERFORMANCE OF THIS CONTRACT, THE SUCCESSFUL BIDDER AGREES TO (I)

PROVIDE A DRUG-FREE WORKPLACE FOR THE SUCCESSFUL BIDDER’S EMPLOYEES; (II) POST IN

CONSPICUOUS PLACES, AVAILABLE TO EMPLOYEES AND APPLICANTS FOR EMPLOYMENT, A

STATEMENT NOTIFYING EMPLOYEES THAT THE UNLAWFUL MANUFACTURE, SALE,

DISTRIBUTION, DISPENSATION, POSSESSION, OR USE OF A CONTROLLED SUBSTANCE OR

MARIJUANA IS PROHIBITED IN THE SUCCESSFUL BIDDER’S WORKPLACE AND SPECIFYING THE

ACTIONS THAT WILL BE TAKEN AGAINST EMPLOYEES FOR VIOLATIONS OF SUCH PROHIBITION;

(III) STATE IN ALL SOLICITATIONS OR ADVERTISEMENTS FOR EMPLOYEES PLACED BY OR ON

BEHALF OF THE SUCCESSFUL BIDDER THAT THE SUCCESSFUL BIDDER MAINTAINS A DRUG-FREE

WORKPLACE; AND (IV) INCLUDE THE PROVISIONS OF THE FOREGOING CLAUSES IN EVERY

SUBCONTRACT OR PURCHASE ORDER OF OVER $10,000, SO THAT THE PROVISIONS WILL BE

BINDING UPON EACH SUCCESSFUL BIDDER OR VENDOR.

FOR THE PURPOSE OF THIS SECTION, “DRUG-FREE WORKPLACE” MEANS A SITE FOR THE

PERFORMANCE OR WORK DONE IN CONNECTION WITH A SPECIFIC CONTRACT AWARDED TO A

SUCCESSFUL BIDDER IN ACCORDANCE WITH FEDERAL LAW, THE EMPLOYEES OF WHOM ARE

PROHIBITED FROM ENGAGING IN THE UNLAWFUL MANUFACTURE, SALE, DISTRIBUTION,

DISPENSATION, POSSESSION OR USE OF ANY CONTROLLED SUBSTANCE OR MARIJUANA DURING

THE PERFORMANCE OF THE CONTRACT.

EMPLOYMENT DISCRIMINATION BY THE SUCCESSFUL BIDDER SHALL BE PROHIBITED:

1. DURING THE PERFORMANCE OF THIS CONTRACT, THE SUCCESSFUL BIDDER AGREES AS

FOLLOWS:

a. THE BIDDER SHALL NOT DISCRIMINATE AGAINST ANY EMPLOYEE OR APPLICANT

FOR EMPLOYMENT BECAUSE OF RACE, RELIGION, COLOR, SEX, NATIONAL ORIGIN,

AGE, DISABILITY, OR ANY OTHER BASIS PROHIBITED BY STATE LAW RELATING TO

DISCRIMINATION IN EMPLOYMENT, EXCEPT WHERE THERE IS A BONA FIDE

OCCUPATIONAL QUALIFICATION REASONABLY NECESSARY TO THE NORMAL

OPERATION OF THE SUCCESSFUL BIDDER. THE SUCCESSFUL BIDDER AGREES TO

B-11

POST IN CONSPICUOUS PLACES, AVAILABLE TO EMPLOYEES AND APPLICANTS FOR

EMPLOYMENT, NOTICES SETTING FORTH THE PROVISIONS OF THIS

NONDISCRIMINATION CLAUSE.

b. THE SUCCESSFUL BIDDER, IN ALL SOLICITATIONS OR ADVERTISEMENTS FOR

EMPLOYEES PLACED BY OR ON BEHALF OF THE SUCCESSFUL BIDDER, SHALL

STATE THAT SUCH SUCCESSFUL BIDDER IS AN EQUAL OPPORTUNITY EMPLOYER.

c. NOTICES, ADVERTISEMENTS, AND SOLICITATIONS PLACED IN ACCORDANCE WITH

FEDERAL LAW, RULE OR REGULATION SHALL BE DEEMED SUFFICIENT FOR THE

PURPOSE OF MEETING THE REQUIREMENTS OF THIS SECTION.

2. THE SUCCESSFUL BIDDER WILL INCLUDE THE PROVISIONS OF THE FOREGOING

PARAGRAPHS A, B, AND C IN EVERY SUBCONTRACT OR PURCHASE ORDER OF OVER

$10,000, SO THAT THE PROVISIONS WILL BE BINDING UPON EACH SUBCONTRACTOR OR

VENDOR.

Name of Contractor:

Authorized Signature:

Printed Name:

Title:

Date:

VI. VDOT FORMS

B-12

It is the policy of the Virginia Department of Transportation that Disadvantaged

Business Enterprises (DBE) as defined in 49 CFR Part 26 must have the maximum opportunity to participate in the performance of federally funded contracts. A list of

DBE firms certified by the SBSD and MWAA is maintained on SBSD’s website

(http://www.SBSD.virginia.gov ) under the DBE Directory of Certified Vendors.

Contractors/consultants are encouraged to take all necessary and reasonable steps to ensure that DBE firms have the maximum opportunity to compete for and perform services on contract, including participation in any subsequent supplement contracts.

If the contractor/consultant intends to subcontract a portion of the services on the project, the contractor/consultant is encouraged to seek out and consider DBEs as potential Sub-contractors/sub-consultants. The contractor/Sub-contractor is encouraged to contact DBEs to solicit their interest, capability and qualifications. Any agreement between a contractor/consultant and a DBE whereby the DBE promises not to provide services to other contractors/consultants is prohibited.

[Include the following wording on federally funded projects with DBE goals:]

• The DBE contract goal for this procurement is %

[Include the following wording on federally funded projects without DBE goals:]

• DBE contract goals have not been established on this contract; however, contractors/consultants are still encouraged to employ reasonable means to obtain DBE participation.

If portions of the services are subcontracted to a DBE, the following needs to be submitted with the bid:

• Written documents of the prime’s commitment to the DBE to subcontract a portion of the services, a description of the services to be performed and the percent of participation. (See Section 17.3.4 for required forms)

• Written confirmation from the DBE that is participating, including a description of the services to be performed and the percent of participation. (See Section 17.3.4 for required forms)

B-13

Form C-48

Rev. 2-23-11

COMMONWEALTH OF VIRGINIA

DEPARTMENT OF TRANSPORTATION

SUBCONTRACTOR/SUPPLIER SOLICITATION AND UTILIZATION FORM (ALL BIDDERS)

PROJECT NO. CONTRACT I.D. NO.

FHWA NO. DATE SUBMITTED

All bidders, including DBEs bidding as Prime Contractors, shall complete and submit the following information as requested in this form within ten (10) business days after the opening of bids.

The bidder certifies this form accurately represents its solicitation and utilization or non-utilization, as indicated, of the firms listed below for performance of work on this contract. The bidder also certifies he/she has had direct contact with the named firms regarding participation on this project.

TITLE

SUBCONTRACTOR/SUPPLIER SOLICITATION AND UTILIZATION (ALL)

VENDOR

NUMBER NAME OF SUBCONTRACTOR/SUPPLIER

TELEPHONE

NUMBER

DBE OR

NON-DBE

UTILIZED

(Y/N)

NOTE: ATTACH ADDITIONAL PAGES, IF NECESSARY.

BIDDER MUST SIGN EACH ADDITIONAL SHEET TO CERTIFY ITS CONTENT AND COMPLETION OF FORM.

BIDDER SIGNATURE

ITB 24-35TM - UPC 117120 - Mellen Street Bike and Pedestrian Improvements

B-14

34028

EN20-114-363

Form C-49 2-24-14

Sheet 1 of 10

COMM0NWEALTH OF VIRGINIA

DEPARTMENT OF TRANSPORTATION

DBE GOOD FAITH EFFORTS DOCUMENTATION

CONTRACT I.D. NUMBER________________________________

PROJECT NUMBER_____________________________________

FHWA NUMBER________________________________________

DISTRICT______________________________________________

DATE BID SUBMITTED___________________________________

BIDDER’S NAME________________________________________

SIGNATURE____________________________________________

TITLE_________________________________________________

VENDOR NUMBER______________________________________

DBE GOAL FROM BID PROPOSAL____________________________

--DO NOT DETACH--

THIS INFORMATION MUST BE SUBMITTED

WITHIN 2 DAYS AFTER BID OPENING IF YOUR

BID DOES NOT MEET THE PROJECT DBE

REQUIREMENTS, OR

WHEN REQUESTED BY VDOT

ITB 24-35TM - UPC 117120 - Mellen Street Bike and Pedestrian Improvements

B-15

EN20-114-363

34028

Hampton Roads

8%

Sheet 2 of 10

COMM0NWEALTH OF VIRGINIA

DEPARTMENT OF TRANSPORTATION

DBE GOOD FAITH EFFORTS DOCUMENTATION

CONTRACT I.D. NO.________________________________DATE SUBMITTED______________

IF THE DBE GOAL ESTABLISHED FOR THIS CONTRACT HAS NOT BEEN MET OR VDOT

REQUESTS THE SUBMITTAL THEREOF, THE BIDDER IS REQUIRED TO SUBMIT GOOD

FAITH EFFORTS AS OUTLINED IN THIS DOCUMENT.

THE BIDDER ACKNOWLEDGES AND CERTIFIES THAT THIS FORM ACCURATELY

REPRESENTS THE INFORMATION CONTAINED HEREIN.

BIDDER SIGNATURE ____

TITLE________________________________________________________________________________________

NAMES OF CERTIFIED DBEs AND THE DATES ON WHICH THEY WERE SOLICITED TO BID

ON THIS PROJECT

INCLUDE THE ITEMS OF WORK OFFERED AND THE DATES AND METHODS USED FOR

FOLLOWING UP INITIAL SOLICITATIONS TO DETERMINE WHETHER OR NOT DBEs WERE

INTERESTED.

NAMES AND VENDOR

NUMBERS OF DBEs

SOLICITED

DATE OF INITIAL

SOLICITATION

ITEM(S) OF WORK FOLLOW-UP METHODS

AND DATES

NOTE: ATTACH ADDITIONAL PAGES IF NECESSARY

ATTACH COPIES OF SOLICITATIONS, TELEPHONE RECORDS, FAX CONFIRMATIONS,

ELECTRONIC INFORMATION, ETC.

B-16

Sheet 3 of 10

COMM0NWEALTH OF VIRGINIA

DEPARTMENT OF TRANSPORTATION

DBE GOOD FAITH EFFORTS DOCUMENTATION

CONTRACT I.D. NO._________________DATE SUBMITTED___________________________

IF THE DBE GOAL ESTABLISHED FOR THIS CONTRACT HAS NOT BEEN MET OR VDOT

REQUESTS THE SUBMITTAL THEREOF, THE BIDDER IS REQUIRED TO SUBMIT GOOD

FAITH EFFORTS AS OUTLINED IN THIS DOCUMENT.

THE BIDDER ACKNOWLEDGES AND CERTIFIES THAT THIS FORM ACCURATELY

REPRESENTS THE INFORMATION CONTAINED HEREIN.

BIDDER_____________________________________SIGNATURE______________________________________

TITLE________________________________________________________________________________________

TELEPHONE LOG

DBE(s) CALLED

TELEPHONE

NUMBER

DATE

CALLED

TIME

CALLED

CONTACT PERSON OR

VOICE MAIL STATUS

NOTE: ATTACH ADDITIONAL PAGES IF NECESSARY

B-17

Sheet 4 of 10

COMM0NWEALTH OF VIRGINIA

DEPARTMENT OF TRANSPORTATION

DBE GOOD FAITH EFFORTS DOCUMENTATION

CONTRACT I.D. NO._________________DATE SUBMITTED___________________________

IF THE DBE GOAL ESTABLISHED FOR THIS CONTRACT HAS NOT BEEN MET OR VDOT

REQUESTS THE SUBMITTAL THEREOF, THE BIDDER IS REQUIRED TO SUBMIT GOOD

FAITH EFFORTS AS OUTLINED IN THIS DOCUMENT.

THE BIDDER ACKNOWLEDGES AND CERTIFIES THAT THIS FORM ACCURATELY

REPRESENTS THE INFORMATION CONTAINED HEREIN.

BIDDER SIGNATURE ____

TITLE________________________________________________________________________________________

ITEM(S) OF WORK THAT THE BIDDER MADE AVAILABLE TO DBE FIRMS

IDENTIFY THOSE ITEM(S) OF WORK THAT THE BIDDER MADE AVAILABLE TO DBE

FIRMS OR THOSE ITEM(S) THE BIDDER IDENTIFIED AND DETERMINED TO SUBDIVIDE

INTO ECONOMICALLY FEASIBLE UNITS TO FACILITATE DBE PARTICIPATION. FOR

EACH ITEM LISTED, SHOW THE DOLLAR VALUE AND PERCENTAGE OF THE TOTAL

CONTRACT AMOUNT. IT IS THE BIDDER’S RESPONSIBILITY TO DEMONSTRATE THAT

SUFFICIENT WORK TO MEET THE GOAL WAS MADE AVAILABLE TO DBE FIRMS.

ITEM(S) OF WORK

MADE AVAILABLE

BIDDER

NORMALLY

PERFORMS ITEM(S)

(Y/N)

ITEM(S) BROKEN

DOWN TO

FACILITATE

PARTICIPATION

(Y/N)

AMOUNT IN

DOLLARS

PERCENTAGE

OF

CONTRACT

NOTE: INFORMATION REQUIRED FOR THIS SECTION CONTINUED ON SHEET 5

ATTACH ADDITIONAL PAGES IF NECESSARY

B-18

Sheet 5 of 10

COMM0NWEALTH OF VIRGINIA

DEPARTMENT OF TRANSPORTATION

DBE GOOD FAITH EFFORTS DOCUMENTATION

CONTRACT I.D. NO._________________DATE SUBMITTED___________________________

IF THE DBE GOAL ESTABLISHED FOR THIS CONTRACT HAS NOT BEEN MET OR VDOT

REQUESTS THE SUBMITTAL THEREOF, THE BIDDER IS REQUIRED TO SUBMIT GOOD

FAITH EFFORTS AS OUTLINED IN THIS DOCUMENT.

THE BIDDER ACKNOWLEDGES AND CERTIFIES THAT THIS FORM ACCURATELY

REPRESENTS THE INFORMATION CONTAINED HEREIN.

BIDDER SIGNATURE ____

TITLE________________________________________________________________________________________

ADDITIONAL INFORMATION REGARDING ITEM(S) OF WORK THAT THE

BIDDER MADE AVAILABLE TO DBE FIRMS (Continued From Sheet 4)

ITEM(S) OF WORK MADE AVAILABLE, NAMES OF SELECTED FIRMS AND DBE STATUS,

DBEs THAT PROVIDED QUOTES, PRICE QUOTE FOR EACH FIRM, AND THE PRICE

DIFFERENCE FOR EACH DBE IF THE SELECTED FIRM IS NOT A DBE.

ITEM(S) OF WORK

MADE

AVAILABLE(CONT.)

NAME OF

SELECTED

FIRM AND

VENDOR

NUMBER

DBE OR

NON-DBE

NAME OF

REJECTED

FIRM(S)

QUOTE IN

DOLLARS

PRICE

DIFFERENCE IN

DOLLARS

NOTE: ATTACH ADDITIONAL PAGES IF NECESSARY.

IF THE FIRM SELECTED FOR THE ITEM IS NOT A DBE, PROVIDE THE REASON(S) FOR

THE SELECTION ON A SEPARATE PAGE AND ATTACH.

PROVIDE NAMES, ADDRESSES, AND TELEPHONE NUMBERS FOR THE FIRMS LISTED

ABOVE.

B-19

Sheet 6 of 10

COMM0NWEALTH OF VIRGINIA

DEPARTMENT OF TRANSPORTATION

DBE GOOD FAITH EFFORTS DOCUMENTATION

CONTRACT I.D. NO._________________DATE SUBMITTED___________________________

IF THE DBE GOAL ESTABLISHED FOR THIS CONTRACT HAS NOT BEEN MET OR VDOT

REQUESTS THE SUBMITTAL THEREOF, THE BIDDER IS REQUIRED TO SUBMIT GOOD

FAITH EFFORTS AS OUTLINED IN THIS DOCUMENT.

THE BIDDER ACKNOWLEDGES AND CERTIFIES THAT THIS FORM ACCURATELY

REPRESENTS THE INFORMATION CONTAINED HEREIN.

BIDDER SIGNATURE ____

TITLE________________________________________________________________________________________

ADVERTISEMENTS OR PROOFS OF PUBLICATION.

NAMES AND DATES OF EACH PUBLICATION IN WHCH A REQUEST FOR DBE

PARTICIPATION FOR THE PROJECT WAS PLACED BY THE BIDDER. ATTACH COPIES OF

PUBLISHED ADVERTISEMENTS OR PROOFS OF PUBLICATION.

PUBLICATIONS DATES OF ADVERTISEMENT

NOTE: ATTACH ADDITIONAL PAGES IF NECESSARY

B-20

COMM0NWEALTH OF VIRGINIA

DEPARTMENT OF TRANSPORTATION

DBE GOOD FAITH EFFORTS DOCUMENTATION

CONTRACT I.D. NO._________________DATE SUBMITTED___________________________

IF THE DBE GOAL ESTABLISHED FOR THIS CONTRACT HAS NOT BEEN MET OR VDOT

REQUESTS THE SUBMITTAL THEREOF, THE BIDDER IS REQUIRED TO SUBMIT GOOD

FAITH EFFORTS AS OUTLINED IN THIS DOCUMENT.

THE BIDDER ACKNOWLEDGES AND CERTIFIES THAT THIS FORM ACCURATELY

REPRESENTS THE INFORMATION CONTAINED HEREIN.

BIDDER SIGNATURE ____

TITLE________________________________________________________________________________________

NAMES OF AGENCIES CONTACTED TO PROVIDE ASSISTANCE

NAMES OF AGENCIES (SEE SPECIAL PROVISION FOR 107.15) AND THE DATES THESE

AGENCIES WERE CONTACTED TO PROVIDE ASSISTANCE IN CONTACTING,

RECRUITING, AND USING DBE FIRMS. IF THE AGENCIES WERE CONTACTED IN

WRITING, ATTACH COPIES OF SUPPORTING DOCUMENTS.

NAME OF AGENCY

METHOD AND DATE OF

CONTACT RESULTS

NOTE: ATTACH ADDITIONAL PAGES IF NECESSARY.

B-21

Sheet 8 of 10

COMM0NWEALTH OF VIRGINIA

DEPARTMENT OF TRANSPORTATION

DBE GOOD FAITH EFFORTS DOCUMENTATION

CONTRACT I.D. NO._________________DATE SUBMITTED___________________________

IF THE DBE GOAL ESTABLISHED FOR THIS CONTRACT HAS NOT BEEN MET OR VDOT

REQUESTS THE SUBMITTAL THEREOF, THE BIDDER IS REQUIRED TO SUBMIT GOOD

FAITH EFFORTS AS OUTLINED IN THIS DOCUMENT.

THE BIDDER ACKNOWLEDGES AND CERTIFIES THAT THIS FORM ACCURATELY

REPRESENTS THE INFORMATION CONTAINED HEREIN.

BIDDER SIGNATURE ____

TITLE________________________________________________________________________________________

TECHNICAL ASSISTANCE AND INFORMATION PROVIDED TO DBEs

EFFORTS MADE TO PROVIDE INTERESTED DBEs WITH ADEQUATE INFORMATION

ABOUT THE PLANS, SPECIFICATIONS, AND REQUIREMENTS OF THE BID DOCUMENTS

TO ASSIST THE DBEs IN RESPONDING TO A SOLICITATION.

IDENTIFY THE DBEs ASSISTED, THE INFORMATION PROVIDED, AND THE DATE OF

CONTACT. ATTACH COPIES OF SUPPORTING DOCUMENTS.

DBEs ASSISTED INFORMATION PROVIDED DATE OF CONTACT

NOTE: ATTACH ADDITIONAL PAGES IF NECESSARY.

B-22

Sheet 9 of 10

COMM0NWEALTH OF VIRGINIA

DEPARTMENT OF TRANSPORTATION

DBE GOOD FAITH EFFORTS DOCUMENTATION

CONTRACT I.D. NO._________________DATE SUBMITTED___________________________

IF THE DBE GOAL ESTABLISHED FOR THIS CONTRACT HAS NOT BEEN MET OR VDOT

REQUESTS THE SUBMITTAL THEREOF, THE BIDDER IS REQUIRED TO SUBMIT GOOD

FAITH EFFORTS AS OUTLINED IN THIS DOCUMENT.

THE BIDDER ACKNOWLEDGES AND CERTIFIES THAT THIS FORM ACCURATELY

REPRESENTS THE INFORMATION CONTAINED HEREIN.

BIDDER SIGNATURE ____

TITLE________________________________________________________________________________________

EFFORTS MADE TO ASSIST DBEs OBTAIN BONDING, LINES OF CREDIT, INSURANCE, ETC.

EFFORTS MADE TO PROVIDE INTERESTED DBEs IN OBTAINING BONDING, LINES OF

CREDIT, INSURANCE, NECESSARY EQUIPMENT, SUPPLIES, MATERIALS, OR RELATED

ASSISTANCE OR SERVICES, EXCLUDING SUPPLIES AND EQUIPMENT THE

SUBCONTRACTOR PURCHASES OR LEASES FROM THE PRIME CONTRACTOR OR ITS

AFFILIATES.

IDENTIFY THE DBEs ASSISTED, THE ASSISTANCE OFFERED, AND THE DATES OF

SERVICES OFFERED AND PROVIDED. ATTACH COPIES OF SUPPORTING DOCUMENTS.

DBEs ASSISTED ASSISTANCE OFFERED DATES SERVICES OFFERED

AND/OR PROVIDED

NOTE: ATTACH ADDITIONAL PAGES IF NECESSARY.

B-23

Sheet 10 of 10

COMM0NWEALTH OF VIRGINIA

DEPARTMENT OF TRANSPORTATION

DBE GOOD FAITH EFFORTS DOCUMENTATION

CONTRACT I.D. NO._________________DATE SUBMITTED___________________________

IF THE DBE GOAL ESTABLISHED FOR THIS CONTRACT HAS NOT BEEN MET OR VDOT

REQUESTS THE SUBMITTAL THEREOF, THE BIDDER IS REQUIRED TO SUBMIT GOOD

FAITH EFFORTS AS OUTLINED IN THIS DOCUMENT.

THE BIDDER ACKNOWLEDGES AND CERTIFIES THAT THIS FORM ACCURATELY

REPRESENTS THE INFORMATION CONTAINED HEREIN.

BIDDER SIGNATURE ____

TITLE________________________________________________________________________________________

ADDITIONAL DATA TO SUPPORT DEMONSTRATION OF GOOD FAITH EFFORTS

ADDITIONAL DATA TO SUPPORT DEMONSTRATION OF GOOD FAITH EFFORTS

NOTE: ATTACH ADDITIONAL PAGES, IF NECESSARY

B-24

Form C-104 Rev. 7-13-05

COMMONWEALTH OF VIRGINIA

DEPARTMENT OF TRANSPORTATION

PROJECT:

FHWA:

This form must be completed, signed and returned with bid; and failure to do so may result in the rejection of your bid. THE CONTRACTOR SHALL AFFIRM THE FOLLOWIN G STATEMENT EITHER BY SIGNING

THE AFFIDAVIT AND HA VING IT NOTARIZED OR BY SIGNING THE UNSWORN DECLARATION

UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE UNITED STATES. A SEPARATE FORM

MUST BE SUBMITTED BY EACH PRINCIPAL OF A JOINT VENTURE BID.

STATEMENT, In preparation and submission of this bid, I, the firm, corporation or officers, agents or employees thereof did not, either directly or indirectly, enter into any combination or arrangement with any persons, firm or corporation or enter into any agreement, participate in any collusion, or otherwise take any action in the restraint of free, competitive bidding in violation of the Sherman Act (15 U.S.C. Section 1) or Article 1.1 or Chapter 12 of Title 18.2 (Virginia Governmental Frauds Act), Sections 59.1-9.1 through 59.1-

9.17 or Sections 59.1-68.6 through 59.1-68.8 of the Code of Virginia.

AFFIDAVIT

The undersigned is duly authorized by the bidder to make the foregoing statement to be filed with bids submitted on behalf of the bidder for contracts to be let by the Commonwealth Transportation Board.

Signed at , this day of , 20 County (City), STATE

By:

(Name of Firm) (Signature) Title (print)

STATE of COUNTY (CITY) of To-wit:

I , a Notary Public in and for the State and County(City) aforesaid, hereby certify that this day personally appeared before me and made oath that he is duly authorized to make the above statements and that such statements are true and correct.

Subscribed and sworn to before me this day of , 20

My Commission expires Notary Public

OR

UNSWORN DECLARATION

The undersigned is duly authorized by the bidder to make the foregoing statement to be filed with bids submitted on behalf of the bidder for contracts to be let by the Commonwealth Transportation Board.

Signed at , this day of , 20 County (City), STATE

By:

(Name of Firm) (Signature) Title (print)

ITB 24-35TM - UPC 117120 - Mellen Street Bike and Pedestrian Improvements

B-25

ORDER NO.:

CONTRACT ID. NO.:

Form C-105 Rev. 7-13-05

COMMONWEALTH OF VIRGINIA

DEPARTMENT OF TRANSPORTATION

AFFIDAVIT

PROJECT:

FHWA:

This form must be completed, signed, notarized and returned with bid; and failure to do so, may result in the rejection of your bid. A separate form must be submitted by each principal of a joint venture bid.

1. I, the firm, corporation or officers, agents or employees thereof have neither directly nor indirectly entered into any combination or arrangement with any person, firm or corporation or entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive bidding in connection with such contract, the effect of which is to prevent competition or increase the cost of construction or maintenance of roads or bridges.

During the preceding twelve months, I (we) have been a member of the following Highway Contractor's Associations, as defined in Section 33.1-336 of the Code of Virginia (1970). (If none, so state).

NAME Location of Principal Office

2. I (we) have _____, have not _____, participated in a previous contract or subcontract subject to the equal opportunity clause, as required by Executive Orders 10925, 11114, or 11246, and that I/We have _____, have not _____, filed with the joint Reporting Committee, the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the former President's Committee on Equal Employment Opportunity, all reports due under the applicable filing requirements.

Note: The above certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor [41 CFR 60-1.7(b)(1)], and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60-1.5. (Generally only contract or subcontracts of $10,000 or under are exempt.)

Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations.

Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60-1.7(b) (1) prevents the award of contract and subcontract unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor.

(Continued)

ITB 24-35TM - UPC 117120 - Mellen Street Bike and Pedestrian Improvements

B-26

ORDER NO.:

CONTRACT ID. NO.:

Form C-105

3. The bidder certifies to the best of its knowledge and belief, that it and its principals:

(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from covered transactions by any Federal department or agency;

(b) Have not within a three year period preceding this proposal been convicted of or had a civil judgement rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

(c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated above; and

(d) Where the bidders is unable to certify to any of the statements in this certification, the bidder shall show an explanation below.

Explanations will not necessarily result in denial of award, but will be considered in determining bidder responsibility. For any explanation noted, indicate below to whom it applies, initiating agency, and dates of action. Providing false information may result in federal criminal prosecution or administration sanctions. The bidder shall provide immediate written notice to the Department if at any time the bidder learns that its certification was erroneous when submitted or has become erroneous by reason of change circumstances.

The undersigned is duly authorized by the bidder to make the foregoing statements to be filed with bids submitted on behalf of the bidder for contracts to be let by the Commonwealth Transportation Board.

Signed at , this day of , 20 County (City), STATE

By:

(Name of Firm) (Signature) Title (print)

STATE of COUNTY (CITY) of To-wit:

I , a Notary Public in and for the State and County(City) aforesaid, hereby certify that this day personally appeared before me and made oath that he is duly authorized to make the above statements and that such statements are true and correct.

Subscribed and sworn to before me this day of , 20

My Commission expires Notary Public

B-27

Form C-111 Rev. 2-15-11

COMMONWEALTH OF VIRGINIA

DEPARTMENT OF TRANSPORTATION

MINIMUM DBE REQUIREMENTS

PROJECT NO.

FHWA NO.

* * * INSTRUCTIONS * * *

THIS FORM CAN BE USED BY THE CONTRACTOR TO SUBMIT THE NAMES OF DBE FIRMS TO BE UTILIZED ON THE PROJECT. THE CONTRACTOR SHALL INDICATE THE DESCRIPTION OF THE CATEGORY (S, M, SP or H) AND THE TYPE OF WORK THAT EACH DBE WILL PERFORM AND THE ALLOWABLE CREDIT PER ITEM(S). ADDITIONAL SHEETS TO SHOW THE ALLOWABLE CREDIT PER ITEM MAY BE ATTACHED IF NECESSARY. PLEASE NOTE: THE AMOUNT OF ALLOWABLE CREDIT FOR A DBE SUPPLIER IS 60% OF THE TOTAL COST OF THE MATERIALS OR SUPPLIES OBTAINED AND 100% FOR A DBE MANUFACTURER OF THE MATERIALS AND SUPPLIES OBTAINED.

A CONTRACTOR MAY COUNT 100% OF THE FEES PAID TO A DBE HAULER FOR THE DELIVERY OF MATERIALS AND SUPPLIES TO THE

PROJECT SITE, BUT NOT FOR THE COST OF THE MATERIALS AND SUPPLIES THEMSELVES.

DBE REQUIREMENT %

PERCENT ATTAINED BY BIDDER %

NAMES(S) AND CERTIFICATION NO.

OF DBE(S) TO BE USED

USED AS

SUBCONTR. (S)

MFG. (M)

SUPPLIER (SP)

HAULER (H)

TYPE OF WORK AND ITEM

NO(S)

$ AMOUNT OF

ALLOWABLE

CREDIT PER ITEM

TOTAL $

TOTAL CONTRACT VALUE $ x REQUIRED DBE % = $

I/WE CERTIFY THAT THE PROPOSED DBE(S) SUBMITTED WILL BE USED ON THIS CONTRACT AS STATED HEREON AND ASSURE THAT DURING THE LIFE OF THE CONTRACT. I/WE WILL MEET OR EXCEED THE PARTICIPATION ESTABLISHED HEREON BY THE

DEPARTMENT.

BY

BIDDER SIGNATURE

BY

TITLE DATE

ITB 24-35TM - UPC 117120 - Mellen Street Bike and Pedestrian Improvements

B-28

3 4 0 2 8

Form C-112 Rev. 3-1-11

COMMONWEALTH OF VIRGINIA

DEPARTMENT OF TRANSPORTATION

CERTIFICATION OF BINDING AGREEMENT

WITH

DISADVANTAGED BUSINESS ENTERPRISE FIRMS

Project No.:

Federal Project No.:

This form is to be submitted in accordance with the Department’s Special Provision for Section 107.15.

It is hereby certified by the below signed Contractors that there exists a written quote, acceptable to the parties involved preliminary to a binding subcontract agreement stating the details concerning the work to be performed and the price which will be paid for the aforementioned work. This document is not intended to, nor should it be construed to, contain the entire text of the agreement between the contracting parties. This document does not take the place of, nor may it be substituted for, an official subcontracting agreement in those situations that may require such an agreement. A copy of the fully executed subcontract agreement shall be submitted to the Engineer within fourteen (14) business days after contract execution.

It is further certified that the aforementioned mutually acceptable quote and fully executed subcontract agreement represent the entire agreement between the parties involved and that no conversations, verbal agreements, or other forms of non-written representations shall serve to add to, delete, or modify the terms as stated.

The prime Contractor further represents that the aforementioned mutually acceptable quote and fully executed subcontract agreement shall remain on file for a period of not less than one year following completion of the prime's contract with the Department or for such longer period as provisions of governing Federal or State law or regulations may require. For purposes of this form, the term Prime Contractor shall refer to any Contractor utilizing a DBE subcontractor, regardless of tier, in which they are claiming DBE credit toward the contract goal.

Contractors further jointly and severally represent that said binding agreement is for the performance of a "commercially useful function" as that term is employed in 49 C.F.R. Part 26.55 (c), (d).

TO BE SIGNED BY THE SUBCONTRACTOR TO THE PRIME CONTRACTOR, AND ANY LOWER TIER

SUBCONTRACTORS HAVING A CONTRACT WITH THE BELOW NAMED DBE FIRM

Prime Contractor

By:

Signature Title

Date:

First Tier Subcontractor if Applicable

By:

Signature Title

Date:

ITB 24-35TM - UPC 117120 - Mellen Street Bike and Pedestrian Improvements

B-29

Form C-112 Rev. 3-1-11

Second Tier Subcontractor if Applicable

By:

Signature Title

Date:

Third Tier Subcontractor if Applicable

By:

Signature Title

Date:

DBE Contractor

By:

Signature Title

Date:

B-30

C-1 SP2023-0004

I. PRE-BID QUESTION FORM

N. Mallory Street Bicycle Lane Improvements VDOT Project No.: UPC 117120

DATE: ______________________________

NAME: ______________________________

COMPANY: ______________________________________

SPECIFICATION SECTION ____________ PARAGRAPH __________

NOTE:

All questions regarding this solicitation shall be in writing using this question form. A separate form must be used for each question. Submit all Pre-Bid Question Forms to the City of Hampton Procurement Office via fax or via email. It shall be the responsibility of the sender to verify receipt of all transmissions. The City of Hampton shall not be responsible for missed transmissions.

All questions are due in the Procurement Office no later than Error! Reference source not found.. NO

EXCEPTIONS.

Final addendum and answers to pre-bid questions will be available from the Procurement Office and on eVA.

It shall be the responsibility of prospective bidders to verify, prior to turning in a response, if an addendum was issued. Bidders should check www.hampton.gov/bids-contracts for any addenda issued no later than 12 hours prior to bid receipt deadline.

C-2 SP2023-0004

II. CONTRACTOR QUESTIONNAIRE FORM

If requested by the City, the following questions shall be answered in full by the Bidder, and returned to the

City within seventy-two (72) hours.

1. Name of Company:

Trade Name (if different from Company Name):

Principal Office Address:

Telephone No(s).

Fax No(s).

Email Address(es)

a. If a Corporation, answer the following:

When Incorporated:

What State:

Virginia State Corporation Commission No.

b. If an Unincorporated Organization, answer the following:

Date of Organization:

Names and Addresses of or Members:

Type and State of Organization:

c. If a Partnership, state whether the Partnership is General or Limited:

Names and Addresses of Partners:

C-3 SP2023-0004

2. Experience:

a. How many years has this Bidder been in business as a Contractor under its present Business name?

b. List the prior names of this Bidder, if any.

3. How many years of experience in this type of construction work does this Bidder have?

a. As a Contractor?

b. As a Subcontractor?

4. Provide a list of uncompleted Contracts/Projects presently held by this Bidder (attach supplemental sheets if necessary):

Contract/Project Type of Work Amount % Complete

5. List this Bidder’s crew foremen and supervisors…