PPCC DQ 16-779, Art Classroom HVAC CC & DTS.pdf

DOCUMENTED QUOTE

Date 9/17/2015

Quote Number: PPCC DQ 16-779

Return all Quotes to:

Pikes Peak Community College

Purchasing Office 5675 S. Academy Blvd., Box C2

Colorado Springs, Colorado 80906 Fax Number: 719-502-2009

Procurement@ppcc.edu

Purchasing Agent:

Shae Farrar

719-502-2008

Quote Due Date: 10/15/2015

Quote Due Time: 10:00am

LATE BIDS WILL NOT BE ACCEPTED

Quotes properly marked with Quote No., Date and Hour of Opening will be accepted in the Purchasing

Department, Room B229, via fax or email prior to the opening date and hour.

PIKES PEAK COMMUNITY COLLEGE (PPCC) IS SOLICITING QUOTES

FOR (TWO) ART CLASSROOM VENTILATION PROJECTS

FOR THE FACILITIES DEPARTMENT

PROJECTS ARE LOCATED AT THE

CENTENNIAL CAMPUS, 5675 S. ACADEMY BLVD., COLORADO SPRINGS, COLORADO 80906 AND THE

DOWNTOWN STUDIO CAMPUS, 100 W. PIKES PEAK AVE., COLORADO SPRINGS, COLORADO 80903

I. General Information

1. All questions regarding this bid must be directed to the PPCC Purchasing Agent identified above.

2. Price quote must include all shipping, handling and delivery charges to our Centennial Campus, 5675 S. Academy

Blvd., Colorado Springs, CO 80906 and The Downtown Studio Campus, 100 W. Pikes Peak Ave., Colorado Springs, Colorado 80903 and be FOB Destination. No additional charges for packing, drayage, or any other purpose will be allowed

3. Awarded vendor will contact the department prior to delivery to make arrangements for installation.

4. Pricing to remain firm for 90 days.

5. A Purchase Order will be issued to the awarded Contractor as needed. Costs that exceed $100,000 will be procured using a State of Colorado contract.

6. Payment will be made in full after the service has been received and accepted by Pikes Peak Community College personnel. NET: 45 days

7. This solicitation is published using the Colorado Operations Resource Engine (CORE). ColoradoVSS is the vendor facing side and will be where most competitive bid opportunities will be posted. Vendors must be registered on CORE to be considered responsive at the time of award of the response. CORE and its registration information may be linked through the State Purchasing Office link at www.colorado.gov/vss To become a registered supplier on ColoradoVSS: https://codpa-vss.hostams.com/webapp/PRDVSS1X1/AltSelfService http://www.colorado.gov/vss

8. Quotes must be in accordance with specifications set forth and subject to conditions herein and/or attached. All respondents are responsible for checking ColoradoVSS system for award; no other notification will be provided.

9. PPCC is required to have a W-9 on file for every company it does business with. Complete the W-9 located at Attachment A.

10. Reciprocity is mandated by statute. CRS 8-18-101 states, “When a contract for commodities or services is to be awarded to a bidder, a resident bidder…shall be allowed a preference against a nonresident bidder equal to the preference given or required by the state in which the nonresident bidder is a resident.”

11. All bids must be submitted on the quote form provided; no substitute forms will be accepted. Quote form must be signed by an individual with express authority to bind company.

12. Multiple bids will not be accepted. Each vendor is to submit one best offer bid.

13. PPCC reserves the right to award each item/project to separate vendors, or award all of the items/projects to a single vendor.

14. In accordance with Procurement Code, CRS 24-103-207.5 titled Purchasing Preference for Environmentally

Preferable Products; bidders responding to this solicitation may seek to qualify for the preference and governmental bodies conducting this solicitation shall award a contract to a bidder who offers environmentally preferable products subject to the conditions in the Code and Procurement Rules.

15. A Contractor that operates as a sole proprietor hereby swears or affirms under penalty of perjury that the Contractor (i) is a citizen of the United States or otherwise lawfully present in the United States pursuant to federal law, (ii) shall comply with the provisions of CRS 24-76.5-101 et seq, and (iii) shall produce one of the forms of identification required by CRS 24-76.5-103 prior to the effective date of this Contract. Except where exempted by federal law and except as provided in CRS 24-76.5-103(3), a Contractor that receives federal or state funds under this contract must confirm that any individual natural person eighteen years of age or older is lawfully present in the United States pursuant to CRS 24-76.5-103(4) if such individual applies for public benefits provided under this contract. Attachment B

16. Contract performance outside of the United States or Colorado, 24-102-206. Prior to contracting or as a requirement for the solicitation of any contract from the State for services, as appropriate, any prospective vendor shall disclose in a statement of work where services will be performed under the contract, including subcontracts, and whether any services under the contract or subcontracts are anticipated to be performed outside of the United States or the State. If the prospective vendor anticipates services under the contract or any subcontracts will be performed outside the United States or the State, the vendor shall provide in its statement of work a provision setting forth why it is necessary or advantageous to go outside the United States or the State to perform the contract or any subcontracts.

17. ILLEGAL ALIENS–PUBLIC CONTRACTS FOR SERVICES. CRS 8-17.5-101 and 24-76.5-101. The Contractor certifies that the Contractor shall comply with the provisions of CRS 8-17.5-101 et seq. The Contractor shall not knowingly employ or contract with an illegal alien to perform work under this contract or enter into a contract with a subcontractor that fails to certify to the Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this contract. The Contractor represents, warrants, and agrees that it (i) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (ii) otherwise will comply with the requirements of CRS 8-17.5-102(2)(b). The Contractor shall comply with all reasonable requests made in the course of an investigation under CRS 8-17.5- 102 by the Colorado Department of Labor and Employment. If the Contractor fails to comply with any requirement of this provision or CRS 8-17.5-101 et seq., the State may terminate this contract for breach and the Contractor shall be liable for actual and consequential damages to the State. Attachment C

18. PERA. PPCC is a Colorado PERA affiliated employer. Pursuant to Colorado SB06-235 and C.R.S. 24-51-1101(2), PPCC is requiring the vendor to complete the PERA form located at Attachment D.

II. Service-Disabled Veteran Owned Small Business (SDVOSB). An SDVOSB preference will be given, if applicable.

SDVOBs must be incorporated or organized in Colorado or they must maintain a place of business or have an office in Colorado. In order to be given preference, the bidder must submit documentation of SDVOSB certification issued through the U.S. Department of Veterans Affairs with their response to the solicitation. Preference shall be applied in the form of a 5% deduction of the total bid, once the deduction has been applied if the SDVOSB is the low bidder they will receive the award. College will pay the total bid without the deduction.

III. Licenses and Permits: The contractor and any sub-contractors performing work on this project must be licensed to perform such work in the City of Colorado Springs and El Paso County Colorado. The contractor shall provide all required permits. Copies of all permits with approval signatures shall be submitted to Pikes Peak Community College Purchasing Office, Centennial Campus, 5675 S. Academy Blvd., Colorado Springs, Colorado 80911, Room B229, prior to start date.

IV. Project Schedule: A start and completion date will be mutually agreed upon by both parties with an approximate start date of October 19th, 2015 and a no later than completion date of January 19th, 2016. The work schedule MUST be coordinated and approved with the designated Facilities Representative.

V. Insurance and Bonds: Awarded contractor must execute the required agreement and furnish a Certificate of Insurance on Accord form that meets the state requirements. Construction costs that are $50,000 or more must be accompanied by a Bid Bond. If total bid exceeds $100,000 contractor will be required to provide a Performance Bond (SC-6.22) AND a Labor and Material Payment Bond (SC-6.221) with limits of each equal to 100% of the accepted bid with power of attorney.

VI. Sub-Contractors: Contractor must provide the Facilities Department and the Purchasing Office with a list of sub-contractors, if applicable, prior to commencing work.

VII. Acceptance: The designated Facilities Representative and A/E will inspect the work site(s) for acceptance upon completion of each project.

VIII. Mandatory Site Walk Through: There will be a Mandatory site walk-thru on Friday October 2nd 10:00am located at the Centennial Campus in the Breckenridge Building, Room B232 . Be prepared to travel to the Downtown Studio immediately after the Centennial walk through.

Please allow sufficient time to get to the room by the meeting time. Late vendors will not be accepted; the door will be closed and locked.

IX. Questions: All questions must be addressed to the Purchasing Office and hand delivered, sent via fax to 719-502-2009, or e-mailed to Procurement@ppcc.edu by Wednesday October 7th, 2015. Questions will not be accepted after this date. All questions and answers will be posted on the CORE website on Monday October 12th, 2015.

Product substitution requests for the Air Handling and Air Conditioning Units will be handled during the question and answer period. Refer to the Project Manual 230500-03 Section 1.5 for guidance.

X. General Considerations

1. Contractor will comply with all current building codes.

2. Disposal of waste is the responsibility of the Contractor. Contractor is responsible for providing their own dumpsters and sanitary facilities.

3. Contractor shall perform daily clean up and removal of construction debris and will perform a final cleaning of all surfaces prior to acceptance of work.

4. Contractor shall tape/fence off work area and provide proper signage as needed to direct foot traffic to maximize the safety of College employees and students.

5. Do not include overtime costs in your quote. Work shall be conducted during normal business hours: Centennial

Campus, Mon-Fri 8am – 11pm, Sat-Sun 8am – 8pm; The Downtown Studio Campus, Mon-Fri 8am-10pm, Sat-Sun 8am – 5pm.

6. Products should contain the lowest amount of volatile organic compounds (VOCs) including low or formaldehyde-free and should not contain polyvinyl chloride if applicable.

7. Recycled content packaging that does not use PVC film should be used if feasible.

8. Project Number/Title: Projects CON 1573, DTS Art Classroom HVAC Renovation and CON 1574, CC Art Classroom HVAC Renovation

9. (Per Project) The Principal Representative has determined that the entire project shall be substantially complete within 90 calendar days from the date of the Notice to Proceed, and the project shall be finally complete, including the delivery of any or all guarantees and warranties, the submittal of sales and use tax payment forms, the completion of the final punch list and the calling for final inspection, within 14 calendar days, if applicable, from the date of substantial completion. In accordance with Article 46 of the General Conditions of the Contract, Time of Completion and Liquidated Damages, failure to complete the work within the agreed number of calendar days shall be considered breach of contract and subject the bidder to liquidated damages to the extent specified in Article 7D of the Contractor’s Agreement Design/Bid/Build (SC-6.21).

10. The right is reserved to waive informalities or irregularities and to reject any and all Bids.

11. Bidders may procure Bidding Documents from:

Bridgers & Paxton Steven Taylor 1365 Garden of the Gods Rd., Suite 130 Colorado Springs, Colorado 80907 719-630-3350

12. Project Manual/Site Area Maps/Drawings can be obtained at https://apps.ppcc.edu/upload-purchasing/?key=1c70c5322cf293f702aa5afa444333c2

13. A Deposit of 0 will be required for each complete set of Contract Documents. This deposit shall be a guaranty that the documents will be returned in good condition. Such deposits will be returned to (1) Actual Bidders who return the documents before the termination of five (5) business days after the opening of the Bids, (2) Other interested parties who return the documents within five (5) business days after checking them out. Additional copies of any documents, drawings, or specifications will be supplied at the actual cost of reproduction. Bidders desiring the Architect/Engineer to mail bid documents will be required to pay the full cost of mailing. Such expenses will be non-refundable.

14. Each Bid shall be submitted on the required Bid Form and must be accompanied by a Bid Bond on State Buildings Programs Bid Bond Form Sc-6.14 in an amount not less than 5% of the total Bid. The Bid Bond may also be (1) a cashier's check or (2) a certified check made payable to the Treasurer of the State of Colorado in an amount not less than 5% of the total Bid. The Bid Bond is submitted as a guaranty that the Bid will be maintained in full force and effect for a period of thirty (30) days after the opening of the Bids for the project.

15. The Bidder promises, in submitting his Bid, that if issued a Notice of Award, he will, within the prescribed time, execute the required Agreement, furnish the required Performance Bond, Labor and Material Payment Bond, Insurance Policy and Certificates of Insurance, or forfeit his Bid Guaranty as Liquidated Damages.

16. For State Public Works, not less than eighty percent (80%) of the labor employed on such projects shall consist of Colorado labor. Colorado labor means any person who is a resident of the state of Colorado at the time of employment.

17. Bid Preference shall be applied per Procurement Rule R24-111-102-02(c). A comparable percentage https://apps.ppcc.edu/upload-purchasing/?key=1c70c5322cf293f702aa5afa444333c2 disadvantage will be applied to the bid of Nonresident bidders from a state that provides a percentage bidding preference to bidders from that state. Additional information may be obtained from the Department of Personnel and Administration’s (DPA) web site.

18. Contractor must provide a written statement of work to the state agency if it anticipates subcontracting any services outside the United States or Colorado. The written statement is a requirement of the bid or proposal submittal and must include the types of services that will be performed, the location, and the reason why it is necessary or advantageous to do so. Per Procurement Rules R24-102-206-01 and R24-102-206-02.

X. Product/Service Specifications

SCOPE OF WORK

Furnish all labor, materials, equipment, implements, parts and supplies necessary to:

1. CON 1573, DTS Art Classroom HVAC Renovation (see project manual)

Demolition of existing art classroom fume hood

Demolition of existing art classroom fume hood.

Installation of new evaporative cooled, gas fired makeup unit, kiln room exhaust hood, and kiln room exhaust fan including:

Ductwork, air devices, natural gas piping, domestic water piping, drain piping, control wiring, and electrical modifications

New duct enclosure on second floor for duct from rooftop makeup air unit down to art classroom Patch and paint

Warranty: Minimum One Year Labor and Materials

2. CON 1574, CC Art Classroom HVAC Renovation (see project manual)

Demolition of existing kiln room fume hood Installation of new evaporative cooled, gas fired makeup unit, kiln room exhaust hood, and kiln room exhaust fan including:

Ductwork, air devices, natural gas piping, domestic water piping, control wiring, and electrical modifications Patch and paint

Warranty: Minimum One Year Labor and Materials

STATE OF COLORADO

OFFICE OF THE STATE ARCHITECT

STATE BUILDINGS PROGRAMS

BID

Institution/Agency: Pikes Peak Community College/GJJA

Project No./Name: CON 1573, DTS Art Classroom HVAC Renovation

Bidder Acknowledges Receipt of Addenda Numbers:

Bidder Anticipates Services outside the United States or Colorado: No Yes If Yes see 3A below

Bidder will comply with 80% Colorado Labor on project above $500,000: Yes No If No see 3B below

Bidder is a Service-Disabled Veteran Owned Small Business: No Yes If Yes see 3C below

Base Bid $

(Refer to Bid Alternate Form SC-6.13.1 Attached, If Applicable)

Bidder’s Time of Completion

a. Time Period from Notice to Proceed to Substantial Completion:

b. Time Period from Substantial Completion to Final Acceptance:

c. Total Time of Completion of Entire Project (a + b):

1. BID: Pursuant to the advertisement by the State of Colorado dated the undersigned bidder hereby proposes to furnish all the labor and materials and to perform all the work required for the complete and prompt execution of everything described or shown in or reasonably implied from the Bidding Documents, including the Drawings and Specifications, for the work and for the base bid indicated above. Bidders should include all taxes that are applicable.

2. EXAMINATION OF DOCUMENTS AND SITE: The bidder has carefully examined the Bidding Documents, including the Drawings and Specifications, and has examined the site of the Work, so as to make certain of the conditions at the site and to gain a clear understanding of the work to be done.

3. PARTIES INTERESTED IN BID: The bidder hereby certifies that the only persons or parties interested in this Bid are those named herein, and that no other bidder or prospective bidder has given any information concerning this Bid.

A. If the bidder anticipates services under the contract or any subcontracts will be performed outside the United States or Colorado, the bidder shall provide in a written statement which must include, but need not be limited to the type of services that will be performed at a location outside the United States or Colorado and the reason why it is necessary or advantageous to go outside the United States or Colorado to perform such services. (Does not apply to any project that receives federal moneys)

B. For State Public Works projects per C.R.S. 8-17-101, Colorado labor shall be employed to perform at least 80% of the work. Colorado Labor means any person who is a resident of the state of Colorado at the time of the Public Works project. Bidders indicating that their bid proposal will not comply with the 80% Colorado Labor requirement are required to submit written justification along with the bid submission. (Does not apply to any project that receives federal moneys–

C. A Service-Disabled Veteran Owned Small Business (SDVOSB) per C.R.S. 24-103-211, means a business that is incorporated or organized in Colorado or maintains a place of business or has an office in Colorado and is officially registered and verified by the Center for Veteran Enterprise within the U.S. Department of Veteran Affairs. Attach proof of certification along with the bid submission.

4. BID GUARANTEE: This Bid is accompanied by the required Bid Guarantee. You are authorized to hold said Bid Guarantee for a period of not more than thirty (30) days after the opening of the Bids for the work above indicated, unless the undersigned bidder is awarded the Contract, within said period, in which event the Director, State Buildings Programs, may retain said Bid Guarantee, until the undersigned bidder has executed the required Agreement and furnished the required Performance Bond, Labor and Material Payment Bond, Insurance Policy and Certificates of Insurance and Affidavit Regarding Unauthorized Immigrants.

5. TIME OF COMPLETION: The bidder agrees to achieve Substantial Completion of the Project from the date of the Notice to Proceed within the number of calendar days entered above, and in addition, further agrees that the period between Substantial Completion and Final Acceptance of the Project will not exceed the number of calendar days noted above. If awarded the Work, the bidder agrees to begin performance within ten (10) days from

OFFICE OF THE STATE ARCHITECT

STATE BUILDINGS PROGRAMS

BID

Institution/Agency: Pikes Peak Community College/GJJA

Project No./Name: CON 1574, CC Art Classroom HVAC Renovation

Bidder Acknowledges Receipt of Addenda Numbers:

Bidder Anticipates Services outside the United States or Colorado: No Yes If Yes see 3A below

Bidder will comply with 80% Colorado Labor on project above $500,000: Yes No If No see 3B below

Bidder is a Service-Disabled Veteran Owned Small Business: No Yes If Yes see 3C below

Base Bid $

(Refer to Bid Alternate Form SC-6.13.1 Attached, If Applicable)

Bidder’s Time of Completion

a. Time Period from Notice to Proceed to Substantial Completion:

b. Time Period from Substantial Completion to Final Acceptance:

c. Total Time of Completion of Entire Project (a + b):

1. BID: Pursuant to the advertisement by the State of Colorado dated the undersigned bidder hereby proposes to furnish all the labor and materials and to perform all the work required for the complete and prompt execution of everything described or shown in or reasonably implied from the Bidding Documents, including the Drawings and Specifications, for the work and for the base bid indicated above. Bidders should include all taxes that are applicable.

2. EXAMINATION OF DOCUMENTS AND SITE: The bidder has carefully examined the Bidding Documents, including the Drawings and Specifications, and has examined the site of the Work, so as to make certain of the conditions at the site and to gain a clear understanding of the work to be done.

3. PARTIES INTERESTED IN BID: The bidder hereby certifies that the only persons or parties interested in this Bid are those named herein, and that no other bidder or prospective bidder has given any information concerning this Bid.

A. If the bidder anticipates services under the contract or any subcontracts will be performed outside the United States or Colorado, the bidder shall provide in a written statement which must include, but need not be limited to the type of services that will be performed at a location outside the United States or Colorado and the reason why it is necessary or advantageous to go outside the United States or Colorado to perform such services. (Does not apply to any project that receives federal moneys)

B. For State Public Works projects per C.R.S. 8-17-101, Colorado labor shall be employed to perform at least 80% of the work. Colorado Labor means any person who is a resident of the state of Colorado at the time of the Public Works project. Bidders indicating that their bid proposal will not comply with the 80% Colorado Labor requirement are required to submit written justification along with the bid submission. (Does not apply to any project that receives federal moneys–

C. A Service-Disabled Veteran Owned Small Business (SDVOSB) per C.R.S. 24-103-211, means a business that is incorporated or organized in Colorado or maintains a place of business or has an office in Colorado and is officially registered and verified by the Center for Veteran Enterprise within the U.S. Department of Veteran Affairs. Attach proof of certification along with the bid submission.

4. BID GUARANTEE: This Bid is accompanied by the required Bid Guarantee. You are authorized to hold said Bid Guarantee for a period of not more than thirty (30) days after the opening of the Bids for the work above indicated, unless the undersigned bidder is awarded the Contract, within said period, in which event the Director, State Buildings Programs, may retain said Bid Guarantee, until the undersigned bidder has executed the required Agreement and furnished the required Performance Bond, Labor and Material Payment Bond, Insurance Policy and Certificates of Insurance and Affidavit Regarding Unauthorized Immigrants.

5. TIME OF COMPLETION: The bidder agrees to achieve Substantial Completion of the Project from the date of the Notice to Proceed within the number of calendar days entered above, and in addition, further agrees that the period between Substantial Completion and Final Acceptance of the Project will not exceed the number of calendar days noted above. If awarded the Work, the bidder agrees to begin performance within ten (10) days from

Attachment A

Form W-9

Substitute Form

State of Colorado 8-2007

Request for Taxpayer Identification Number and Certification

Give form to the requester. Do not send to the IRS.

P ri n t o r

T y p e

S ee

S p ec if ic I n st ru ct io n s o n p ag e

Name

Business name, if different from above

Check appropriate box:

Individual/ Sole Proprietor Corporation Partnership Other

Exempt from backup withholding

Address (number, street, and apt. or suite no.) Requester:

City, state, and ZIP code.

List Account number(s) here (optional)

Phone Number:

Part I Taxpayer Identification Number (TIN)

Enter your TIN in the appropriate box. For individuals, this is your social security number (SSN) However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.

Social Security number

Note: If the account is in more than one name, see the chart on page 3 for guidelines on whose number to enter.

Employer identification number

Part II Certification

Minority and Women-owned Businesses (M/WBEs) Self Certification (Please check all boxes that apply)

In an effort to track levels of participation by women and minorities doing business with the State of Colorado, the followin g information is requested. Please indicate the appropriate category of ownership for your company. “Owned” in this context means a business that is at least 51 percent owned by an individual(s) who also control(s) and operate(s) it. “Control” in this context means exercising the po wer to make policy decisions. “Operate” means actively involved in the day-to-day management. If you business is jointly owned by both men and women or is a large publicly held corporation, please check the box labeled “Not Applicable.”

Gender Information:

□ Female-Owned □ Male-Owned □ Not Applicable

Owner Ethnicity Information

□ African American □ Asian/Pacific American □ White (non-Hispanic) □ Not Applicable

□ Hispanic American □ Native American □ Other: _____________________________

Small Business Information

Small Business (a business that is organized for profit, is independently owned and operated, and has 25 or fewer full time equival ent employees.)

□ Yes □ No

Sign Here

Signature of U.S. person ► Date ►

Attachment B

HOUSE BILL 1023 IDENTIFICATION REQUIREMENT

As required by C.R.S. 24-76.5-103

FOR SOLE PROPRIETOR’S ONLY (see paragraph II, 7)

Signature of Document Holder Date

Printed Name of Document Holder Social Security Number

Place Notary Stamp or Seal above

Signature of Authorized Notary Date

Printed Name of Authorized Notary (Faxed copies must be notarized in order to be considered acceptable)

PLEASE PLACE AN ENLARGED COPY OF ONE OF THE FOLLOWING IN THIS SPACE:

A valid state issued Driver’s License that is considered to be an official form of identification by the issuing state; or

A United States military card or a military dependents identification card; or

A United States Coast Guard Merchant Mariner Card; or

A Native American Tribal Document

Attachment C

CERTIFICATION AND AFFIDAVIT

REGARDING UNAUTHORIZED IMMIGRANTS

(Ref paragraph II, 9)

The Vendor, whose name and signature appear below, certifies and agrees as follows:

1. The Vendor shall comply with the provisions of Public Contracts for Services Law CRS 8-17.5-101 et seq.

The Vendor shall not knowingly employ or contract with an unauthorized immigrant to perform work for the State or enter into a contract with a subcontractor that knowingly employs or contracts with an unauthorized immigrant.

2. The Vendor certifies that it does not employ or contract with an unauthorized immigrant who will perform work under this contract, and that they will participate in either (i) the “E-verify Program” jointly administered by the United States Department of Homeland Security and the Social Security Administration, or (ii) the “Department Program” administered by the Colorado Department of Labor and Employment, in order to confirm the employment eligibility of all employees who are newly hired to perform work under this contract.

3. The Vendor shall comply with all reasonable requests made in the course of an investigation under CRS 8- 17.5-102 by the Colorado Department of Labor and Employment. If the Vendor fails to comply with any requirement of this provision or CRS 8-17.5-101 et seq., the State may terminate work for breach and the Vendor shall be liable for actual for damages to the State.

4. If the Vendor is a sole proprietor, the undersigned hereby swears or affirms under penalty of perjury under the laws of the State of Colorado that (check one):

___ I am a United States citizen, or

___ I am a Permanent Resident of the United States, or

___ I am lawfully present in the United States pursuant to Federal law.

I understand that this sworn statement is required by law because I am a sole proprietor entering into a contract to perform work for the State of Colorado. I understand that state law requires me to provide proof that I am lawfully present in the United States prior to starting work for the State. I further acknowledge that I will comply with the requirements of CRS 24-76.5-101 et seq. and will produce the required form of identification prior to starting work. I acknowledge that making a false, fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the criminal laws of Colorado as perjury in the second degree under CRS 18-8- 503 and it shall constitute a separate criminal offense each time a public benefit is fraudulently received.

CERTIFIED and AGREED to this ______ day of _________________, 20___.

VENDOR:

(Vendor Full Legal Name) FEIN or Social Security Number

BY: _______________________________________ __________________________

Signature of Authorized Representative Title

Attachment D

PERA RETIREE QUESTIONNAIRE FOR PERSONAL SERVICES CONTRACT

Pikes Peak Community College (PPCC) is required to pay an employer contribution to the Colorado Public Employees’ Retirement Association (PERA) based on the amount paid to any PERA retiree. Therefore, please assist PPCC in identifying any PERA retirees associated with this contract by completing the following:

Is this business entity owned or operated by a PERA retiree or an affiliated party of the

PERA retiree? _____YES _____NO

Are any individuals working with this contract PERA retirees?

_____YES _____NO

If you answered yes to either question above, please list the name, address, telephone number, and social security number of the PERA retiree and explain in what capacity the PERA retiree is involved with this contract.

Name: ________________________________________________________________

Address: ______________________________________________________________

Telephone # ___________________________________________________________

In what capacity is the PERA retiree involved with this contract?

Print Vendor Name: ___________________________________________________________________

Vendor Signature: _____________________________________________ Date: _____________