MontCo Debris RFP Attachments _.pdf

Attachment A

BID & ADDENDA ACKNOWLEDGEMENT

Addenda Acknowledgement

As required by this solicitation, the undersigned Bidder hereby acknowledges receipt of all Addenda through and including:

Addendum Number Dated Signature

No addenda were received

Bid Acknowledgement

This acknowledgment shall be signed, in ink, by a corporate officer, partner, or proprietor:

I certify that this Bid is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a Bid for the same construction, service, or material and is in all respects fair and without collusion or fraud. I am authorized to sign this bid for the Bidder and agreed to abide by all conditions of this Invitation for Bid and certify that I have read and understand the bidding documents in their entirety. In signing this Acknowledgement, I attest that under this Bid I shall provide the goods and/or services requested in this Invitation for Bids according to the published provisions of this IFB. I confirm the Pricing provided to the County under this IFB and certify that all statements made are true, complete and correct.

Authorized Signature Date

Authorized Representative Name (First & Last):

Company Name:

Company Address:

Bidder DUNS Number:

Telephone:________________________ Fax:____________________e-mail:_____________________________

Date:__________________________

FOR INTERNAL USE

Accepted by:________________________________________

Attachment B

BID SCHEDULE / PRICING FORM

PRICING

Bidder must provide pricing in the units requested within this IFB. Any quantities provided are based on estimates, and Bidder acknowledges that Montgomery County may require more or less. Where unit pricing and extended pricing differ, unit pricing governs.

Prices for all goods and/or services shall be firm for the duration of this contract. Prices shall be all inclusive. No price changes, additions, or subsequent qualifications will be honored during the course of the contract. All prices must be written in ink or typed. Pricing on all transportation, freight, drayage and other charges are to be prepaid by the successful Bidder and included in the Bid prices. If there are any additional charges of any kind, other than those mentioned above, specified or unspecified, Bidder MUST indicate the items required and attendant costs or forfeit the right to payment for such items.

MAINTENANCE

If applicable, maintenance required for equipment proposed should be available in Montgomery County by a manufacturer-authorized maintenance facility. Costs for this service shall be shown on the Bid Schedule / Pricing Form. If Montgomery County opts to include maintenance, it shall be so stated in the Scope of Work and resulting contract, and said cost shall be included. Service will commence only upon expiration of applicable warranties and should be priced accordingly, if applicable.

https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fharriscountytx.bonfirehub.com%2Fportal%2F&data=04%7C01%7COwais.Badat%40us.hctx.net%7C24866352b92f437705e308d8f3a3304e%7C0d9bc79c581b4477acf78d70dd3e555a%7C0%7C0%7C637527229497223924%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=WeBfCVeqFx54cm8LIzZasFLa7hiiPNuRTbuPdn7k0aA%3D&reserved=0

Attachment C

CERTIFICATION REGARDING LOBBYING

(To be submitted with each bid exceeding $100,000)

The undersigned [Bidder] certifies, to the best of his or her knowledge, that:

(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form- LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31 U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

Bidders are required to complete Form SF-LLL - Disclosure of Lobbying Activities to disclose lobbying activities pursuant to 31 U.S.C. 1352.

Bidder, ___________________________, certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, Bidder understands and agrees that the provisions of 31 U.S.C. § 3801 et seq., apply to this certification and disclosure, if any.

Print Name and Title of Bidder’s Authorized Official

Signature of Bidder’s Authorized Official Date

Attachment C

CERTIFICATION REGARDING LOBBYING

1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:

a. contract a. bid/offer/application a. initial filing

b. grant b. initial award b. material change

c. cooperative agreement c. post-award

d. loan For material change only:

e. loan guarantee Year quarter

f. loan insurance Date of last report

4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter Prime Name and Address of Prime:

Subawardee Tier If Known:

Congressional District, if known: Congressional District, if known:

6. Federal Department/Agency: 7. Federal Program Name/Description:

CFDA Number, if applicable

8. Federal Action Number, if known: 9. Award Amount, if known:

10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including (if individual, last name, first name, MI): address if different from No. 10a)

(last name, first name, MI):

11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This Signature:

disclosure of lobbying activities is a material representation of fact upon which reliance was placed Print Name:

by tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 Title:

U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public Telephone No.: Date:

inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure

Federal Use Only Authorized for Local Reproduction Standard Form – LLL (Rev. 7-97)

Attachment D

STATEMENT OF BIDDER QUALIFICATIONS

This Statement of Bidder Qualifications requests information about Bidder that will be used in the evaluation of Bidder responsibility. All Bidders must complete this form in its entirety and submit with the Bid. Answers should be as thorough and definitive as possible and include all pertinent data. Failure to fully and truthfully disclose the information required may result in the disqualification of your Bid from consideration or termination of the contract, once awarded. Supplemental materials, additional pages, or requested lists providing additional information may be attached to further clarify answers.

General Information

1. Name of company/organization: _______________________________________________

2. Address of company/organization:

3. Home office address (if other than above):

4. Telephone No: Fax No.:

5. Type of business entity (corporation, partnership, sole proprietorship, etc.):

A. If your organization is a corporation, please provide on a separate sheet(s), detailing the following: Date of incorporation, State of incorporation, Names of President, Vice-president, Secretary, and Treasurer.

B. If your organization is a partnership or individually owned, please attach a list detailing the following: Date of organization, Name of owner(s) or partners.

6. Place of incorporation (if applicable):

7. Type of work performed by your company:

8. Year founded/established:

9. Has your organization been in business under its present name for at least five (5) years? ☐ YES ☐ NO

A. If not, please explain why.

10. Primary individual to contact:

Litigation Record

Have you or any member of your organization or team brought any claim, litigation, or arbitration against Montgomery County or any other Federal, State or Local Government during the last five (5) years?

☐ YES ☐ NO

If yes, attach a list of any claims, lawsuits, or requested arbitrations and their final outcome.

Has Montgomery County or any other Federal, State or Local brought any claim or litigation against you or any member of your organization or team during the last five (5) years?

☐ YES ☐ NO

If yes, attach a list of any claims, lawsuits, or requested arbitrations and their final outcome.

Has you or any member of your organization or team filed any lawsuits or requested arbitration with regards to any contracts within the last five (5) years?

☐ YES ☐ NO

If yes, attach a list of any lawsuits or requested arbitrations and their final outcome.

Are there any administrative proceedings, claims, lawsuits, or other exposures pending against you or any member of your organization or team?

☐ YES ☐ NO

If yes, explain:

Have any subcontractors, in which your organization has some ownership, filed any lawsuits or requested arbitration with regards to any contracts within the last five (5) years?

☐ YES ☐ NO

If yes, explain:

Have you or any member of your organization or team to be assigned to this engagement been terminated (for cause or otherwise) from any work being performed for Montgomery County or any other Federal, State or Local Government, or Private Entity?

☐ YES ☐ NO

If yes, explain:

Have you ever failed to complete any work awarded to you? ☐ YES ☐ NO

If yes, explain, indicating what was not completed and the reasoning:

Have you ever defaulted on a contract? ☐ YES ☐ NO

If yes, explain:

Experience Record

How many years has your organization been providing the services identified in this IFB to the following types of entities?

Government (Public) Entities: ____________

Private (Commercial) Entities: ____________

List three to five (3-5) similar projects as the one specified in this solicitation that your organization has completed over the last five (5) years. For each project, as applicable, provide the name, nature of the project, size (SF), location, cost, completion date, owner and architect. Attach additional pages as necessary:

1. _____________________________________________________________________________________________________________

2. _____________________________________________________________________________________________________________

3. _____________________________________________________________________________________________________________

4. _____________________________________________________________________________________________________________

5. _____________________________________________________________________________________________________________

List the major projects your organization has in progress, giving the name and location of the project as well as nature of the type of services you are providing. Provide dollar amount of contract, type of work, percent complete, estimated completion date, and owner information for each project:

$ Amount of Contract Type of Work Est. Date of Name and Address

Completion of Owner

1. _____________________________________________________________________________________________________________

2. _____________________________________________________________________________________________________________

3. _____________________________________________________________________________________________________________

4. _____________________________________________________________________________________________________________

Describe your organization’s concepts for working in a team relationship with the owner and user groups during the completion of projects similar to that identified in this IFB. Identify which of the project(s) listed on Attachment F, References, best exemplify these concepts and experiences. Attach additional pages as necessary:

Please list categories of work that your organization normally performs with its own forces.

1. _____________________________________________________________________________________________________________

2. _____________________________________________________________________________________________________________

3. _____________________________________________________________________________________________________________

4. _____________________________________________________________________________________________________________

Please list subcontractors in which your organization has some ownership or relationship and list the categories of work those subcontractors normally perform.

1. _____________________________________________________________________________________________________________

2. _____________________________________________________________________________________________________________

3. _____________________________________________________________________________________________________________

4. _____________________________________________________________________________________________________________

Portions of work Bidder proposes to sublet in case of award of contract, including amount and type:

1. ______________________________________________________________________________________________________________

2. ______________________________________________________________________________________________________________

3. ______________________________________________________________________________________________________________

List of Surety Bonds in Force on the above incomplete work:

$ Amount of Contract Amount of Bond Name of Surety Company

1. _____________________________________________________________________________________________________________

2. _____________________________________________________________________________________________________________

3. _____________________________________________________________________________________________________________

4. _____________________________________________________________________________________________________________

Equipment Schedule (if applicable)

List of equipment owned by Bidder that is in serviceable condition and available for use:

1. _____________________________________________________________________________________________________________

2. _____________________________________________________________________________________________________________

3. _____________________________________________________________________________________________________________

4. _____________________________________________________________________________________________________________

5. _____________________________________________________________________________________________________________

6. _____________________________________________________________________________________________________________

7. _____________________________________________________________________________________________________________

8. _____________________________________________________________________________________________________________

Dated this day _________ of _______________ 20___ (Name of Organization)

By:_______________________________________ (Title)

Submitted by______________________________ an individual a partnership a corporation with principal office at ________________________________________________________ (Full Address or City, State)

To be filled in by Corporation: To be filled in by Partnership Date incorporated _____________ Date formed ________________ Under the laws of _____________State. State whether partnership is general, limited or associated

Executive Officer ___________________ List Members:

State of ___________________

County of _________________

_________________________________________, being duly sworn, deposes and attests that he/she is (Name of Bidder’s Representative)

____________________________________ of ____________________________________________, (Position Title) (Name of Organization) and that: (1) the Bidder bidding this work and the contractors / subcontractors anticipated to perform the work are properly licensed, as applicable, and shall provide proof of said licensure needed to complete the scope of work; (2) the answers to the foregoing questions on the attached/associated forms and all statements therein are correct to the best of their knowledge; (3) the experience record and the schedule of equipment are made part of this affidavit as though written in full herein; and (4) all statements and answers to the questions given in the above-mentioned experience record and schedule of equipment are true and correct.

_______________________________________________________, sworn to before me this _____ day (Name of Bidder’s Representative) of ______________, 20__.

____________________________ (Seal) Notary Public My Commission expires

MINORITY- AND WOMAN-OWNED BUSINESS ENTERPRISE

UTILIZATION COMMITMENT FORM

The undersigned has satisfied the requirements of the specifications in the following manner (please check the appropriate space):

The proposer is committed to M/WBE participation on this project equal to or greater than the goal stated in the bid and has submitted WITH ITS BID and attached hereto a Letter of Intent for each M/WBE listed on the utilization form.

OR –

The proposer is unable to meet the goal, is committed to a minimum of ______% M/WBE participation on this contract, and has submitted WITH ITS BID and attached hereto documentation of the proposer’s efforts with respect to each of the good faith effort actions listed in the Good Faith Efforts Checklist. Vendors shall also provide a Letter of Intent for the minimum M/WBE participation they are able to meet.

Proposer:

By:

Signature Date

Address:

Zip Code:

Telephone No.:

Email address:

mmccord Typewritten Text **Vendors that are M/WBE and completing the percentage of the goal as the prime for this project shall submit this completed form, a Letter of Intent and their certification(s).

**Vendors may utilize the Letter of Intent form provided within this package or may submit vendors own letterhead.

mmccord Typewritten Text mmccord Typewritten Text mmccord Typewritten Text mmccord Typewritten Text mmccord Typewritten Text mmccord Typewritten Text mmccord Typewritten Text mmccord Typewritten Text mmccord Typewritten Text mmccord Typewritten Text mmccord Typewritten Text mmccord Typewritten Text mmccord Typewritten Text mmccord Typewritten Text mmccord Typewritten Text mmccord Typewritten Text mmccord Typewritten Text

M/WBE UTILIZATION PLAN

The M/WBE Utilization Plan must be completed and submitted by the time specified in the solicitation documents. If the goal was not achieved, good faith efforts documentation must be submitted with the M/WBE Utilization Plan. All questions in the Good Faith Efforts Checklist MUST be completed and submitted with the M/WBE Utilization Plan if the goal is not met. Attach additional sheets as necessary.

Section I — Project Identification and Goal

Project Name

Solicitation Number

Project Goal

M/WBE %

Section II — Prime Company Information

Name of Company Address City, State Zip Phone Name of Contact Person Email address for Contract Person

Telephone number for Contract Person Is prime company M/WBE certified? (MBE/WBE, DBE, HUB, or 8(a))

Yes No MBE/WBE Joint Venture

I certify that the information included in this Utilization Plan is true and complete to the best of my knowledge and belief. I further understand and agree that this Utilization Plan shall become a part of my contract with Montgomery County.

Name and Title of Authorized Representative

Signature Date

For County Use Only:

I have reviewed this Utilization Plan and found that the Proposer HAS or HAS NOT complied as per the County M/WBE Policy.

Reviewer Date:

Tips: Use the name of the firm as listed in the directory.

Ensure the firm is certified in the area in which they are participating on this project.

Ensure the firm’s participation is in line with the scope and germane to the project.

Section III — Utilization Plan Summary

Goals: Proposed Participation

Proposer’s own participation in project %

M/WBE(s): (MBE/WBE, DBE, HUB, or 8(a)) %

Non-Certified Subcontractor(s) %

Total Participation (must equal 100%) %

Is the stated M/WBE goal of the solicitation met? (If no, provide an explanation below, attach the Good Faith Efforts checklist, and documentation of good faith efforts)

Yes No

Explanation for not meeting the M/WBE Goal:

For County Use Only:

Verified Goal Attainment:

M/WBE %

Name of MBE/WBE Certified Firm

Certified by:

Address/ City / State / Zip

Name of Contact Person

Email address for Contract Person

Telephone number for Contract Person

Percent of Subcontract

Description of services

6-digit NAICS code for work to be performed

Name of MBE/WBE Certified Firm

Certified by:

Address/ City / State / Zip

Name of Contact Person

Email address for Contract Person

Telephone number for Contract Person

Percent of Subcontract

Description of services

6-digit NAICS code for work to be performed

Name of MBE/WBE Certified Firm

Certified by:

Address/ City / State / Zip

Name of Contact Person

Email address for Contract Person

Telephone number for Contract Person

Percent of Subcontract

Description of services

6-digit NAICS code for work to be performed

Tips: Use the name of the firm as listed in the directory.

Ensure the firm is certified in the area in which they are participating on this project.

Ensure the firm’s participation is in line with the scope and germane to the project.

Section IV — Disclosure of M/WBE Participation Please list all M/WBE subcontractors below & Duplicate as Needed

Name of Non-Certified Firm

Address/ City / State / Zip

Name of Contact Person

Email address for Contract Person

Telephone number for Contract Person

Percent of Subcontract

Description of services

6-digit NAICS code for work to be performed

Name of Non-Certified Firm

Address/ City / State / Zip

Name of Contact Person

Email address for Contract Person

Telephone number for Contract Person

Percent of Subcontract

Description of services

6-digit NAICS code for work to be performed

Name of Non-Certified Firm

Address/ City / State / Zip

Name of Contact Person

Email address for Contract Person

Telephone number for Contract Person

Percent of Subcontract

Description of services

6-digit NAICS code for work to be performed

SECTION V — Disclosure of Non-Certified Sub-consultants

Duplicate As Needed

SECTION VI — GOOD FAITH EFFORTS CHECK LIST

If the M/WBE goal was not achieved, this good faith efforts checklist and supporting documents must be submitted with the bid. Failure to do so will render the bid non-responsive and cause it to be rejected.

Additional efforts after bid submission will not be considered in determining award of this contract.

Attach additional sheets as necessary.

___Attended pre-bid or pre-proposal meetings scheduled by the County to acquaint Contractors with M/WBEs available to provide relevant goods and services and to inform M/WBEs of subcontracting opportunities.

___Solicited through reasonable and available means (e.g., written notices, advertisements) M/WBEs certified in the anticipated scopes of subcontracting of the contract, within sufficient time to allow them to respond. Attach detailed Contacts Log, including date, method of contact, person contacted and contact information, and the result of the contact.

___Provided timely and adequate information about the plans, specifications and requirements of the contract. Followed up initial solicitations to answer questions and encourage M/WBEs to submit bids or proposals. Attach evidence of information provided, including the date, e.g., letters, emails, telephone logs, etc.

___Negotiated in good faith with interested M/WBEs that have submitted bids or proposals and thoroughly investigated their capabilities. Evidence of such negotiations includes the names, addresses and telephone numbers of M/WBEs with whom the vendor negotiated; a description of the information provided to M/WBEs regarding the work selected for subcontracting; and explanations as to why agreements could not be reached with M/WBEs to perform the work.

___Selected those portions of the contract consistent with the available M/WBEs, including, where appropriate, breaking out contract work items into economically feasible units to facilitate M/WBE participation even when the proposer would prefer to perform those scopes with its own forces. Provide description of work selected.

___Made efforts to assist interested M/WBEs in obtaining bonding, lines of credit, or insurance as required by the County or the vendor for performance of the contract (if applicable).

___Made efforts to assist interested M/WBEs obtain necessary equipment, supplies, materials, or access to manufacturer’s pricing, where appropriate.

___Effectively used the services of M/WBE assistance groups; local, state, and federal minority or women business assistance offices; and other organizations to provide assistance in the recruitment and placement of M/WBEs.

https://deeo.harriscountytx.gov/Vendor-Diversity

Revised October 2024

LETTER OF INTENT TO SUBCONTRACT

Project Number

Project Title

______________________________________ (“Contractor”) agrees to enter a contractual agreement with ________________________________________ (“M/WBE Subcontractor”), who will provide the following goods/services in connection with the above-referenced contract:

Pursuant to Montgomery County’s M/WBE policy, only M/WBE firms which are currently certified with one of Montgomery County’s recognized certifying agencies may be counted towards meeting the M/WBE goal at the subcontracting level.

Insert a brief narrative describing the goods/services to be provided. Broad categorizations (e.g., “electrical,”

“plumbing,” etc.) or the listing of the NAICS Codes in which M/WBE Subcontractor is certified are insufficient and may result in this Letter of Intent to Subcontract not being accepted.

for an estimated amount of $_____________________ or _______________% of the total estimated contract value.

The parties acknowledge that any obligation of the prime contractor to enter into a subcontract agreement or purchase order with the subcontractor is expressly contingent upon the prime contractor entering into a contract with Montgomery County for the work as defined in the bid/proposal.

This document must be completed in its entirety by the Contractor and signed by both the Contractor and the

M/WBE Subcontractor.

Contractor agrees to utilize M/WBE Subcontractor in the capacities indicated herein, and M/WBE

Subcontractor agrees to work on the above-referenced contract in the capacities indicated herein, contingent upon award of the contract to Contractor.

Signature: Contractor Signature: M/WBE Subcontractor

Print Name Print Name

Title Date Title Date

Attachment F

REFERENCES

Reference #1 Organization Name:

Contact Name/Telephone No.:

E-mail Address:

Address:

Services provided:

Reference #2 Organization Name:

Contact Name/Telephone No.:

E-mail Address:

Address:

Services provided:

Reference #3

Organization Name:

Contact Name/Telephone No.:

E-mail Address:

Address:

Services provided:

Attachment F

REFERENCES

Reference #4

Organization Name:

Contact Name/Telephone No.:

E-mail Address:

Address:

Services provided:

Reference #5 Organization Name:

Contact Name/Telephone No.:

E-mail Address:

Address:

Services provided:

Reference #6 Organization Name:

Contact Name/Telephone No.:

E-mail Address:

Address:

Services provided:

SSttuummpp CCoonnvveerrssiioonn TTaabbllee

Diameter to Volume Capacity

The quantification of the cubic yards of debris for each size of stump in the following table was derived from FEMA field studies conducted throughout the State of Florida during the debris removal operations following Hurricanes Charley, Frances, Ivan and Jeanne. The following formula is used to derive cubic yards:

[(Stump Diameter2 x 0.7854) x Stump Length] + [(Root Ball Diameter2 x 0.7854) x Root Ball Height] 46656

0.7854 is one-fourth Pi and is a constant.

46656 is used to convert cubic inches to cubic yards and is a constant

The formula used to calculate the cubic yardage used the following factors, based upon findings in the field:

• Stump diameter measured two feet up from ground

• Stump diameter to root ball diameter ratio of 1:3.6

• Root ball height of 31”

Stump Diameter (Inches)

Debris Volume (Cubic Yards)

Stump Diameter (Inches)

Debris Volume (Cubic Yards)

6 0.3 46 15.2 7 0.4 47 15.8 8 0.5 48 16.5 9 0.6 49 17.2 10 0.7 50 17.9 11 0.9 51 18.6 12 1 52 19.4 13 1.2 53 20.1 14 1.4 54 20.9 15 1.6 55 21.7 16 1.8 56 22.5 17 2.1 57 23.3 18 2.3 58 24.1 19 2.6 59 24.9 20 2.9 60 25.8 21 3.2 61 26.7 22 3.5 62 27.6 23 3.8 63 28.4 24 4.1 64 29.4 25 4.5 65 30.3 26 4.8 66 31.2 27 5.2 67 32.2 28 5.6 68 33.1 29 6 69 34.1 30 6.5 70 35.1 31 6.9 71 36.1 32 7.3 72 37.2 33 7.8 73 38.2 34 8.3 74 39.2 35 8.8 75 40.3 36 9.3 76 41.4 37 9.8 77 42.5 38 10.3 78 43.6 39 10.9 79 44.7 40 11.5 80 45.9 41 12 81 47 42 12.6 82 48.2 43 13.3 83 49.4 44 13.9 84 50.6 45 14.5

Attachment G

CONTRACTOR PROFILE

(To be submitted within fifteen (15) working days after being notified as apparent low bidder.)

Project Name: _______________________________________________ Project No. __________

Name of Contractor ____________________ Contractor’s FED Tax ID# ___________ DUNS # _______

Name of Subcontractor _________________ Subcontractor's FED Tax ID# _________ DUNS # _______

Category of Trade (e.g. Carpentry, Electrical, Plumbing, etc.)

Type of Contract:

Construction Professional Non-professional Services Supplies Equipment Architectural / Engineering

Name of Principle Owner(s) _______________________________________________

Name of Contact Person __________________________________________________

Company Address

________________________________________________________________________ Phone

Email _______________________________________________

Estimated Amount of Contract or Subcontract:

$________________________________________________ Women Owned: Yes No

Minority Owned: Yes No

Section 3 Business: Yes No (if yes, must attach the Montgomery County Section 3 Business

Concern Self-Certification form)

Signature of Contractor Date

FHWA-1273 -- Revised July 5, 2022

REQUIRED CONTRACT PROVISIONS

FEDERAL-AID CONSTRUCTION CONTRACTS

I. General II. Nondiscrimination III. Non-segregated Facilities IV. Davis-Bacon and Related Act Provisions V. Contract Work Hours and Safety Standards Act

Provisions VI. Subletting or Assigning the Contract VII. Safety: Accident Prevention VIII. False Statements Concerning Highway Projects IX. Implementation of Clean Air Act and Federal Water

Pollution Control Act X. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion XI. Certification Regarding Use of Contract Funds for

Lobbying XII. Use of United States-Flag Vessels:

ATTACHMENTS

A. Employment and Materials Preference for Appalachian Development Highway System or Appalachian Local Access Road Contracts (included in Appalachian contracts only)

I. GENERAL

1. Form FHWA-1273 must be physically incorporated in each construction contract funded under title 23, United States Code, as required in 23 CFR 633.102(b) (excluding emergency contracts solely intended for debris removal). The contractor (or subcontractor) must insert this form in each subcontract and further require its inclusion in all lower tier subcontracts (excluding purchase orders, rental agreements and other agreements for supplies or services). 23 CFR 633.102(e).

The applicable requirements of Form FHWA-1273 are incorporated by reference for work done under any purchase order, rental agreement or agreement for other services. The prime contractor shall be responsible for compliance by any subcontractor, lower-tier subcontractor or service provider. 23 CFR 633.102(e).

Form FHWA-1273 must be included in all Federal-aid design-build contracts, in all subcontracts and in lower tier subcontracts (excluding subcontracts for design services, purchase orders, rental agreements and other agreements for supplies or services) in accordance with 23 CFR 633.102. The design-builder shall be responsible for compliance by any subcontractor, lower-tier subcontractor or service provider.

Contracting agencies may reference Form FHWA-1273 in solicitation-for-bids or request-for-proposals documents, however, the Form FHWA-1273 must be physically incorporated (not referenced) in all contracts, subcontracts and lower-tier subcontracts (excluding purchase orders, rental agreements and other agreements for supplies or services related to a construction contract). 23 CFR 633.102(b).

2. Subject to the applicability criteria noted in the following sections, these contract provisions shall apply to all work performed on the contract by the contractor's own organization and with the assistance of workers under the contractor's immediate superintendence and to all work performed on the contract by piecework, station work, or by subcontract. 23 CFR 633.102(d).

3. A breach of any of the stipulations contained in these Required Contract Provisions may be sufficient grounds for withholding of progress payments, withholding of final payment, termination of the contract, suspension / debarment or any other action determined to be appropriate by the contracting agency and FHWA.

4. Selection of Labor: During the performance of this contract, the contractor shall not use convict labor for any purpose within the limits of a construction project on a Federal-aid highway unless it is labor performed by convicts who are on parole, supervised release, or probation. 23 U.S.C. 114(b).

The term Federal-aid highway does not include roadways functionally classified as local roads or rural minor collectors.

23 U.S.C. 101(a).

II. NONDISCRIMINATION (23 CFR 230.107(a); 23 CFR Part 230, Subpart A, Appendix A; EO 11246)

The provisions of this section related to 23 CFR Part 230, Subpart A, Appendix A are applicable to all Federal-aid construction contracts and to all related construction subcontracts of $10,000 or more. The provisions of 23 CFR Part 230 are not applicable to material supply, engineering, or architectural service contracts.

In addition, the contractor and all subcontractors must comply with the following policies: Executive Order 11246, 41 CFR Part 60, 29 CFR Parts 1625-1627, 23 U.S.C. 140, Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), Title VI of the Civil Rights Act of 1964, as amended (42 U.S.C.

2000d et seq.), and related regulations including 49 CFR Parts 21, 26, and 27; and 23 CFR Parts 200, 230, and 633.

The contractor and all subcontractors must comply with: the requirements of the Equal Opportunity Clause in 41 CFR 60- 1.4(b) and, for all construction contracts exceeding $10,000, the Standard Federal Equal Employment Opportunity Construction Contract Specifications in 41 CFR 60-4.3.

Note: The U.S. Department of Labor has exclusive authority to determine compliance with Executive Order 11246 and the policies of the Secretary of Labor including 41 CFR Part 60, and 29 CFR Parts 1625-1627. The contracting agency and the FHWA have the authority and the responsibility to ensure compliance with 23 U.S.C. 140, Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), and Title VI of the Civil Rights Act of 1964, as amended (42 U.S.C.

2000d et seq.), and related regulations including 49 CFR Parts 21, 26, and 27; and 23 CFR Parts 200, 230, and 633.

The following provision is adopted from 23 CFR Part 230, Subpart A, Appendix A, with appropriate revisions to conform to the U.S. Department of Labor (US DOL) and FHWA requirements.

1. Equal Employment Opportunity: Equal Employment Opportunity (EEO) requirements not to discriminate and to take affirmative action to assure equal opportunity as set forth under laws, executive orders, rules, regulations (see 28 CFR Part 35, 29 CFR Part 1630, 29 CFR Parts 1625-1627, 41 CFR Part 60 and 49 CFR Part 27) and orders of the Secretary of Labor as modified by the provisions prescribed herein, and imposed pursuant to 23 U.S.C. 140, shall constitute the EEO and specific affirmative action standards for the contractor's project activities under this contract. The provisions of the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) set forth under 28 CFR Part 35 and 29 CFR Part 1630 are incorporated by reference in this contract. In the execution of this contract, the contractor agrees to comply with the following minimum specific requirement activities of EEO:

a. The contractor will work with the contracting agency and the Federal Government to ensure that it has made every good faith effort to provide equal opportunity with respect to all of its terms and conditions of employment and in their review of activities under the contract. 23 CFR 230.409 (g)(4) & (5).

b. The contractor will accept as its operating policy the following statement:

"It is the policy of this Company to assure that applicants are employed, and that employees are treated during employment, without regard to their race, religion, sex, sexual orientation, gender identity, color, national origin, age or disability. Such action shall include: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship, pre-apprenticeship, and/or on-the-job training."

2. EEO Officer: The contractor will designate and make known to the contracting officers an EEO Officer who will have the responsibility for and must be capable of effectively administering and promoting an active EEO program and who must be assigned adequate authority and responsibility to do so.

3. Dissemination of Policy: All members of the contractor's staff who are authorized to hire, supervise, promote, and discharge employees, or who recommend such action or are substantially involved in such action, will be made fully cognizant of and will implement the contractor's EEO policy and contractual responsibilities to provide EEO in each grade and classification of employment. To ensure that the above agreement will be met, the following actions will be taken as a minimum:

a. Periodic meetings of supervisory and personnel office employees will be conducted before the start of work and then not less often than once every six months, at which time the contractor's EEO policy and its implementation will be reviewed and explained. The meetings will be conducted by the EEO Officer or other knowledgeable company official.

b. All new supervisory or personnel office employees will be given a thorough indoctrination by the EEO Officer, covering all major aspects of the contractor's EEO obligations within thirty days following their reporting for duty with the contractor.

c. All personnel who are engaged in direct recruitment for the project will be instructed by the EEO Officer in the contractor's procedures for locating and hiring minorities and women.

d. Notices and posters setting forth the contractor's EEO policy will be placed in areas readily accessible to employees, applicants for employment and potential employees.

e. The contractor's EEO policy and the procedures to implement such policy will be brought to the attention of employees by means of meetings, employee handbooks, or other appropriate means.

4. Recruitment: When advertising for employees, the contractor will include in all advertisements for employees the notation: "An Equal Opportunity Employer." All such advertisements will be placed in publications having a large circulation among minorities and women in the area from which the project work force would normally be derived.

a. The contractor will, unless precluded by a valid bargaining agreement, conduct systematic and direct recruitment through public and private employee referral sources likely to yield qualified minorities and women. To meet this requirement, the contractor will identify sources of potential minority group employees and establish with such identified sources procedures whereby minority and women applicants may be referred to the contractor for employment consideration.

b. In the event the contractor has a valid bargaining agreement providing for exclusive hiring hall referrals, the contractor is expected to observe the provisions of that agreement to the extent that the system meets the contractor's compliance with EEO contract provisions. Where implementation of such an agreement has the effect of discriminating against minorities or women, or obligates the contractor to do the same, such implementation violates Federal nondiscrimination provisions.

c. The contractor will encourage its present employees to refer minorities and women as applicants for employment.

Information and procedures with regard to referring such applicants will be discussed with employees.

5. Personnel Actions: Wages, working conditions, and employee benefits shall be established and administered, and personnel actions of every type, including hiring, upgrading, promotion, transfer, demotion, layoff, and termination, shall be taken without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or disability.

The following procedures shall be followed:

a. The contractor will conduct periodic inspections of project sites to ensure that working conditions and employee facilities do not indicate discriminatory treatment of project site personnel.

b. The contractor will periodically evaluate the spread of wages paid within each classification to determine any evidence of discriminatory wage practices.

c. The contractor will periodically review selected personnel actions in depth to determine whether there is evidence of discrimination. Where evidence is found, the contractor will promptly take corrective action. If the review indicates that the discrimination may extend beyond the actions reviewed, such corrective action shall include all affected persons.

d. The contractor will promptly investigate all complaints of alleged discrimination made to the contractor in connection with its obligations under this contract, will attempt to resolve such complaints, and will take appropriate corrective action within a reasonable time. If the investigation indicates that the discrimination may affect persons other than the complainant, such corrective action shall include such other persons. Upon completion of each investigation, the contractor will inform every complainant of all of their avenues of appeal.

6. Training and Promotion:

a. The contractor will assist in locating, qualifying, and increasing the skills of minorities and women who are applicants for employment or current employees. Such efforts should be aimed at developing full journey level status employees in the type of trade or job classification involved.

b. Consistent with the contractor's work force requirements and as permissible under Federal and State regulations, the contractor shall make full use of training programs (i.e., apprenticeship and on-the-job training programs for the geographical area of contract performance). In the event a special provision for training is provided under this contract, this subparagraph will be superseded as indicated in the special provision. The contracting agency may reserve training positions for persons who receive welfare assistance in accordance with 23 U.S.C. 140(a).

c. The contractor will advise employees and applicants for employment of available training programs and entrance requirements for each.

d. The contractor will periodically review the training and promotion potential of employees who are minorities and women and will encourage eligible employees to apply for such training and promotion.

7. Unions: If the contractor relies in whole or in part upon unions as a source of employees, the contractor will use good faith efforts to obtain the cooperation of such unions to increase opportunities for minorities and women. 23 CFR

230.409. Actions by the contractor, either directly or through a contractor's association acting as agent, will include the procedures set forth below:

a. The contractor will use good faith efforts to develop, in cooperation with the unions, joint training programs aimed toward qualifying more minorities and women for membership in the unions and increasing the skills of minorities and women so that they may qualify for higher paying employment.

b. The contractor will use good faith efforts to incorporate an EEO clause into each union agreement to the end that such union will be contractually bound to refer applicants without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, age, or disability.

c. The contractor is to obtain information as to the referral practices and policies of the labor union except that to the extent such information is within the exclusive possession of the labor union and such labor union refuses to furnish such information to the contractor, the contractor shall so certify to the contracting agency and shall set forth what efforts have been made to obtain such information.

d. In the event the union is unable to provide the contractor with a reasonable flow of referrals within the time limit set forth in the collective bargaining agreement, the contractor will, through independent recruitment efforts, fill the employment vacancies without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, or disability;

making full efforts to obtain qualified and/or qualifiable minorities and women. The failure of a union to provide sufficient referrals (even though it is obligated to provide exclusive referrals under the terms of a collective bargaining agreement) does not relieve the contractor from the requirements of this paragraph. In the event the union referral practice prevents the contractor from meeting the obligations pursuant to Executive Order 11246, as amended, and these special provisions, such contractor shall immediately notify the contracting agency.

8. Reasonable Accommodation for Applicants / Employees with Disabilities: The contractor must be familiar with the requirements for and comply with the Americans with Disabilities Act and all rules and regulations established thereunder. Employers must provide reasonable accommodation in all employment activities unless to do so would cause an undue hardship.

9. Selection of Subcontractors, Procurement of Materials and Leasing of Equipment: The contractor shall not discriminate on the grounds of race, color, religion, sex, sexual orientation, gender identity, national origin, age, or disability in the selection and retention of subcontractors, including procurement of materials and leases of equipment. The contractor shall take all necessary and reasonable steps to ensure nondiscrimination in the administration of this contract.

a. The contractor shall notify all potential subcontractors, suppliers, and lessors of their EEO obligations under this contract.

b. The contractor will use good faith efforts to ensure subcontractor compliance with their EEO obligations.

10. Assurances Required:

a. The requirements of 49 CFR Part 26 and the State DOT’s FHWA-approved Disadvantaged Business Enterprise (DBE) program are incorporated by reference.

b. The contractor, subrecipient or subcontractor shall not discriminate on the basis of race, color, national origin, or sex in the performance of this contract. The contractor shall carry out applicable requirements of 49 CFR part 26 in the award and administration of DOT-assisted contracts. Failure by the contractor to carry out these requirements is a material breach of this contract, which may result in the termination of this contract or such other remedy as the recipient deems appropriate, which may include, but is not limited to:

(1) Withholding monthly progress payments;

(2) Assessing sanctions;

(3) Liquidated damages; and/or

(4) Disqualifying the contractor from future bidding as non-responsible.

c. The Title VI and nondiscrimination provisions of U.S.

DOT Order 1050.2A at Appendixes A and E are incorporated by reference. 49 CFR Part 21.

11. Records and Reports: The contractor shall keep such records as necessary to document compliance with the EEO requirements. Such records shall be retained for a period of three years following the date of the final payment to the contractor for all contract work and shall be available at reasonable times and places for inspection by authorized representatives of the contracting agency and the FHWA.

a. The records kept by the contractor shall document the following:

(1) The number and work hours of minority and non-minority group members and women employed in each work classification on the project;

(2) The progress and efforts being made in cooperation with unions, when applicable, to increase employment opportunities for minorities and women; and

(3) The progress and efforts being…