FAS Rev Aug 28, 2024

The City of Seattle

Department of Finance and Administrative Services

BID FORMS

Leschi South Moorage Facility Upland Utility Installation

Administering Department:

Seattle Parks and Recreation

PW # 2025-045

Ordinance # 123177, 123442 & 124349

Prepared by:

Reid Middleton

Contact: Blaine McRae Phone: 425-290-2721

Address: 728 134th Street SW Suite 200, Everett, WA 98204

BIDDER NAME:__________________________________________

BID FORM SECTION 00 41 00

Leschi South Moorage Facility Upland Utility Installation

DEA Rev Aug 28, 2024

1.01 - BID

TO THE DIRECTOR OF PURCHASING AND CONTRACTING FOR THE CITY OF

SEATTLE:

A. The undersigned Bidder hereby certifies to have personally and carefully examined the Bid Documents issued for: Leschi South Moorage Facility Upland Utility Installation as authorized under Ordinance

No. 123177, 123442 & 124349

B. The Bidder has examined the site where the Work is to be performed and the conditions affecting the Work;

C. The Bidder has attached a Bid Guaranty in the amount of five percent (5%) of the

Total Bid that could be awarded including additives and retail sales tax if applicable in the form of cashier's check, certified check, or bid bond;

D. The Bidder hereby proposes to furnish all material and labor and to perform all work which may be required, and to complete the work within the time fixed and upon the terms and conditions provided in the Bid Documents for the price provided on the OpenGov Bid Form:

BIDDERS MUST COMPLETE PRICING TABLE IN OPENGOV

BID FORM

SECTION 00 41 00

1.02 DECLARATION

I DECLARE, UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON,

AS FOLLOWS:

A. BID: I agree to perform the Work in compliance with the Bid Documents, for the prices stated in OpenGov Bid Form to be incorporated into Section 00 41 00, Paragraph 1.01 of the Contract.

B. NON-DISCRIMINATION: I agree to ensure equal opportunity for employment and to engage in Affirmative Efforts in the solicitation of women and minorities and WMBE firms for participation on this Contract in accordance with SMC Ch.

20.42 and RCW 35.22.650.

C. NON-COLLUSION: I have not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free, competitive bidding in the preparation and submission of a Bid to the Owner for consideration in the award of a contract on the improvement described in the Bid Documents.

D. My bid takes into account the requirements imposed by Section 00 73 16, Article 1.09, which waives, with respect to the Owner only, the Contractor’s immunity under RCW Title 51, (Industrial Insurance) of the Revised Code of Washington.

E. I agree to comply with the requirements regarding subcontracting, and the purchase of supplies or materials from firms that are not debarred or otherwise disqualified from doing business with the City under the provisions of SMC Ch.

20.42 or SMC Ch. 20.70.

F. Responsible Bidder Requirements: My bid acknowledges that I am in compliance with all of the responsible bidder requirements under RCW 39.04.350, including:

having a certificate of registration under RCW 18.27 prior to bidding; a UBI number; industrial insurance coverage if required under Title 51 RCW; an employment security number under Title 50; and a state excise tax registration number under Title 82 and have received training on requirements related to public works and prevailing wage by Labor and Industries or approved training provider under RCW 39.04.350, and chapter 39.12 or are exempted by Labor and Industries. https://secure.lni.wa.gov/verify. I affirm I am not disqualified from bidding on any public works contract under RCW 39.06 or RCW 39.12.065(3) or on the System for Award Management, (sam.gov). I will provide proof of these requirements if requested.

G. SUSPENSION and DEBARMENT: The Bidder certifies compliance with federal regulations regarding “Debarment and Suspension (NONPROCUREMENT),” 2 C.F.R. part 180 (see Section 00 73 01, Article 1.14 for more information). This certification is a material representation of fact relied upon by the City of

BID FORM

SECTION 00 41 00

Seattle. If it is later determined by the City of Seattle that the bidder or proposer knowingly rendered an erroneous certification, in addition to remedies available to the City of Seattle, the City of Seattle and the Federal Government may pursue available remedies, including but not limited to suspension and/or debarment. The bidder or proposer agrees to comply with the requirements of 2 C.F.R. part 180, subpart C, while this offer is valid throughout the period of any contract that may arise from this offer. The bidder or proposer further agrees to include a provision requiring such compliance in its lower-tier-covered transactions.

H. ANTI-LOBBYING: The Bidder certifies compliance with the provisions of 31 USC 1352 concerning lobbying activities by signing and submitting the appropriate certification form(s). (see section 00 73 01, Article 1.12 for more information.)

GENERAL BUSINESS INFORMATION

Business Name:

Business Street Address:

Business Mailing Address:

Business Phone, general: Business Fax:

If the above address is not in the State of Washington please fill in the following:

Washington State Office Address:

State in which the Company is formed:

Please complete the following:

State of WA UBI No.:

State of WA Contractor Registration No.:

Employment Security Department No.

City of Seattle Business License No.:

CONTACT INFORMATION

Primary Contact for Award (Name and Title):

Primary Contact Phone: Email:

Administration Contact (Name and Title):

Administration Contact Phone: Email:

Social Equity Contact (Name and Title):

Social Equity Phone: Email:

INSURANCE INFORMATION

Name of Insurance Company:

Name of Insurance Contact:

Insurance Contact Phone: Email:

FAS Rev. July 2024

OFFICIAL AUTHORIZED TO SIGN FOR BIDDER:

I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct:

Location or Place Executed (City, State): Print Name and Title:

Date:

Signature:

End of Section 00 41 00

Form_Certificate of Compliance_2 CFR 200.321 FAS Revised 01/08/2025

FORM_CERTIFICATE OF COMPLIANCE

WITH 2 CFR §200.321

Contracting with small businesses, minority businesses, women’s business enterprises, veteran-owned businesses and labor surplus area firms.

By signing below, the Contractor certifies that, when possible, it ensures that small businesses, minority businesses, women's business enterprises, veteran-owned businesses, and labor surplus area firms (See U.S.

Department of Labor's list) are considered as set forth below:

1. The referenced business types are included on solicitation lists;

2. These business types are solicited whenever they are deemed eligible as potential sources;

3. Dividing procurement transactions into separate procurements to permit maximum participation by these business types;

4. Establishing delivery schedules (for example, the percentage of an order to be delivered by a given date of each month) that encourage participation by these business types;

5. Utilizing organizations such as the Small Business Administration and the Minority Business Development Agency of the Department of Commerce; and

6. Applying the requirements to subcontracts.

The Contractor understands that, should the Contractor be the awarded the contract, this certificate will continue to be binding for the duration of the project. The Contractor understands that the City may request additional documentation at any time to verify Contractor compliance with these requirements.

The Contractor swears and affirms that the above and foregoing representations are true and correct to the best of its information, knowledge, and belief.

Date:

Company Name:

Printed Name of Contractor’s Authorized Representative:

Signature of Contractor’s Authorized Representative:

CERTIFICATION REGARDING LOBBYING SECTION 00 41 00, ATTACHMENT @@

[PROJECT NAME]

FAS-Purchasing and Contracting Rev: 8/27/25

CERTIFICATION REGARDING LOBBYING

Certification for Contracts, Grants, Loans, and Cooperative Agreements

The undersigned certifies, to the best of his or her knowledge and belief, 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 section 1352, title 31, U.S. Code. 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.

The Contractor certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. Chap. 38, Administrative Remedies for False Claims and Statements, apply to this certification and disclosure, if any.

Signature of Contractor’s Authorized Representative:

Printed Name & Title of Contractor’s Authorized Representative:

Date:

DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046

(See reverse for public burden disclosure.)

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 For Material Change Only:

d. loan year _________ quarter _________

e. loan guarantee date of last report ______________

f. loan insurance

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

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 address if ( if individual, last name, first name, MI): different from No. 10a )

(last name, first name, MI ):

11. Signature:

Print Name:

Title:

Telephone No.: _______________________

Authorized for Local Reproduction

Standard Form LLL (Rev. 7-97)

Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be available for public inspection.

required disclosure shall be subject to a not more than $100,000 for each such failure.

Prime Subawardee

Federal Use Only:

Date:

who fails to file the Any person $10,000 and than civil penalty of not less

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employeeof any agency, a Member of Congress, an officer or employeeof Congress, or an employeeof a Member of Congress in connectionwith a coveredFederalaction. Completeall items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

2. Identify the status of the covered Federal action.

3. Identify the appropriateclassification of this report. If this is a followup report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action.

4. Enter the full name, address, city, State and zip code of the reporting entity. Include CongressionalDistrict, if known. Check the appropriateclassification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee,e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

5. If the organization filing the report in item 4 checks "Subawardee," then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known.

6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizationallevel below agency name, if known. For example, Department of Transportation, United States Coast Guard.

7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance

(CFDA) number for grants, cooperative agreements, loans, and loan commitments.

8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number;

Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001."

9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.

10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action.

(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name, and Middle Initial (MI).

11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.

According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB Control Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503.

BUILD AMERICA, BUY AMERICA (BABA) CERTIFICATION SECTION 00 41 00, ATTACHMENT @@

[PROJECT NAME]

FAS-Purchasing and Contracting Rev: 8/27/25

Build America, Buy America (BABA) Certification

The bidder must submit certification of compliance with the Infrastructure Investment and Jobs Act (117th Congress 2021-2022) Section 70914 and part 184 of 2 CFR which provide that any steel, iron, manufactured products, and construction materials, and materials identified in section 70917(c) of BABA are used in this project and are produced in the United States, unless a waiver has been granted. Failure to submit this certification will result in a bid being declared non-responsive.

I hereby certify that I will meet the requirements of the Infrastructure Investment and Jobs Act (117th Congress 2021-2022) Section 70914 and part 184 of 2 CFR.

Signature Date

Title: