Required Bid Forms Packet.pdf

Required Forms

REQUIRED BID FORMS

The bidder must include the following completed checklist items or their bid proposal may be deemed non responsive. Horry County reserves the right to accept or reject any and all bids, in whole or in part, that are deemed to be in the best interest of the County at its sole discretion.

CHECKLIST of REQUIRED FORMS/ITEMS

□ Completed and Signed Bid Submittal Form

□ Electronic Bid Proposal item pricing (to be completed within the ebidding software)

□ Addendum Acknowledgment

□ Signed Non-Collusion Affidavit

□ Completed Legal Litigation Form

□ Bid Bond (if applicable, will be stated on the cover sheet)

□ Signed Anti-Lobbying Form

□ Signed Debarment, Suspension, and Other Responsibility Matters

□ Signed S.C. Drug-Free Workplace Form

□ Copies of Active License(s)/Business License(s)-including State of SC General Contractor's License

□ Sample Certificate of Insurance (COI)

□ Nonresident Taxpayer Registration Form (applicable if business is located outside the State of South Carolina)

Required Form

BID SUBMITTAL FORM

Home Rehabilitation for

BID FORMSUBMITTAL OF:

(hereinafter called "BIDDER"), organized and existing under the laws of the State of

South Carolina). TO: Horry County (herein after called "OWNER")

In compliance with your Invitation for Bids, BIDDER hereby proposes to perform all WORK for the construction of the improvements as shown and called for in the CONSTRUCTION DOCUMENTS in strict accordance with the CONTRACT DOCUMENTS, within the time set forth and for the TOTAL BID AMOUNT stated in electronic bid submittal.

By submission of this BID, each BIDDER certifies that this BID has been arrived at independently, without consultation, communication, or agreement as to any matter relating to the BID with any other BIDDER or with any competitor.

BIDDER agrees to provide faithful performance of all work described in the CONTRACT DOCUMENTS and proper fulfillment of such Contract for the TOTAL BID AMOUNT as presented in electronic bid submittal.

Bidder hereby acknowledges receipt of all Addenda published in Horry County’s ebidding software.

NOTE: Bids shall include sales tax and all other applicable taxes and fees. Any work required as identified in the specifications not specifically listed below shall be included in the most closely related work item listed.

It is the responsibility of the Contractor to verify all quantity take-offs, and to bid the work appropriately.

Any discrepancy and resulting cost adjustments should be noted in comments section when entering the unit price into the ebidding software.

Signature Line:

Authorized Signing Officer (Printed Name) Authorized Signing Officer Signature

Title Email address

Address: _ _

Company:

Phone #: Fax #:

Required Form ACKNOWLEDGEMENT OF ADDENDA

Offeror hereby acknowledges receipt of all Addenda through and including:

Addendum No. , dated .

Company

Authorized Signature

Print Name

FORM OF NONCOLLUSION AFFIDAVIT

(This Affidavit is Part of the Bid Submittal)

STATEOF )

COUNTYOF

being first duly sworn, deposes and says that he/she is

(Sole owner, a partner, president, secretary, etc.)

of _ the party making the foregoing Bid Proposal that such Bid Proposal is genuine and not collusive or sham; that said Bidder has not colluded, conspired, connived, or agreed directly or indirectly, with any Bidder or person to put in a sham Bid Proposal, or that such other person shall refrain from offering and has not in any manner, directly or indirectly sought by agreement or collusion, or communication of conference, with any person, to fix the bid proposal price of affiant or any other Bidder, or to fix any overhead, profit or cost element of said bid proposal price, or that of any other Bidder to secure any advantage against OWNER any person interested in the proposed Contract; and that all statements in said Bid Proposal are true; and further, that such Bidder has not, directly or indirectly submitted this bid proposal, or the contents thereof, or divulged information or date relative thereto to any association or to any member or agent thereof.

(Bidder)

Sworn to and subscribed before me this day of , 20 .

State _County

Notary Public in and for

My commission expires , 20 .

Legal / Litigation Statement Form

Disclose any litigation within the last five (5) years in which a claim has been made against any team member (individual or company) asserting a cause of action other than Employment issues or Contracts not related to your professional work. Explain the issues in these cases (or the fact there are none) as part of your submittal:

Required Form (If Applicable)

BID BOND

KNOW ALL MEN BY THESE PRESENTS, that we the undersigned, as PRINCIPLE, and as SURETY are held and firmly bound unto , hereinafter called the “OWNER”, in the penal sum of Dollars ($ ), lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents.

THE CONDITION OF THIS OBLIGATION IS SUCH, that Whereas the Principal has submitted the Accompanying Bid, dated , 20 , for

NOW, THEREFORE, if the Principle shall not withdraw said Bid within the period specified therein after the opening of the same, or, if no period be specified, within thirty (30) days after the said opening, and shall within the period specified therefore, or if no period be specified, within ten (10) days after the prescribed forms are presented to him for signature, enter into a written Contract with the Owner in accordance with the Bid as accepted, and give bond with good and sufficient surety or sureties, as may be required, for the faithful performance and proper fulfillment of such Contract; or in the event of the withdrawal of said Bid within the period specified, or the failure to enter into such Contract and give such bond within the time specified, if the Principal shall pay the Owner the difference between the amount specified in said Bid and the amount for which the Owner may procure the required work or supplies or both, if the latter be in excess of the former, then the above obligation shall be void and of no effect, otherwise to remain in full force and virtue.

IN WITNESS WHEREOF, the above-bounded parties have executed this instrument under their several seals this day of , 20 , the name and corporate seal of each corporate party being hereto affixed and these presents signed by its undersigned representative, pursuant to authority of its governing body.

(SEAL)

(SEAL)

Attest: By:

Affix By: Corporate

Seal

ANTI-LOBBYING FORM

CERTIFICATION OF RESTRICTIONS ON LOBBYING

I, , hereby certify on

(name and title of bidder's official) behalf of that:

(name of bidder)

(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 any 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 sub awards at all tiers (including subcontracts, sub grants, and contracts under grants, loans, and cooperative agreements) and that all sub recipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance is 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.

Executed this day of , .

By (signature of authorized official)

(title of authorized official)

CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND OTHER

RESPONSIBILITY MATTERS

As required by Executive Order 12549, Debarment and Suspension, and implemented under the applicable CFR, for prospective participants in covered transactions, as defined in the applicable CFR

A. The applicant certifies that it and its principals:

(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any Federal department or agency;

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

(c) Are not presently indicted for or otherwise criminally or civilly charged by a government entity

(Federal State or local) with commission of any of these offenses enumerated in paragraph (1) (b) of this certification; and

(d) Have not within a three-year period preceding this application had one or more public transactions

(Federal, State or local) terminated for cause or default; and

B. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an explanation to this application.

Address:

Contractor’s Signature

Printed or Typed Name

Title

Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants should also review the instructions for certification included in the regulations before completing this form. Signature of this form provides for compliance with certification requirements under the applicable CFR covering New Restrictions on Government-wide Debarment and Suspension (Non-procurement). The certification shall be treated as a material representation of fact upon which reliance will be placed when the Agency determines to award the covered transaction or cooperative agreement.

BB. S.C. DRUG-FREE WORKPLACE (CONTRACTORS OTHER THAN INDIVIDUALS) -

APPLICABLE TO CONTRACTORS RECEIVING $50,000 OR MORE FROM A STATE

AGENCY AND ALL STATE AGENCIES REGARDLESS OF CONTRACT AMOUNT.

As required by the S.C. Drug-Free Workplace Act #593 of 1990 and the Federal Drug-Free Workplace Act of 1988 and implemented under the applicable CFR –

A. The applicant certifies that it will or will continue to provide a drug-free workplace by:

(a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the contractor’s workplace and specifying the actions that will be taken against employees for violation of such prohibition;

(b) Establishing an on-going drug-free awareness program to inform employees about-

(1) The dangers of drug abuse in the workplace;

(2) The contractor’s policy of maintaining a drug-free workplace;

(3) Any available drug counseling, rehabilitation and employee assistance programs; and,

(4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;

(c) Making it a requirement that each employee to be engaged in the performance of the contract be given a copy of the statement required by paragraph(a);

(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the contract, the employee will –

(1) Abide by the terms of the statement; and

(2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction;

(d) Notifying the agency, in writing, within 10 calendar days after receiving notice under subparagraph (d) (2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to the State Funding Agency. Notice shall include the identification number(s) of each affected contract;

(f) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (d) (2), with respect to any employee who is soconvicted-

(1) Taking appropriate personnel action against such an employee up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or

(2) Requiring such employees to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency;

(g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e) and (f).

B. DRUG-FREE WORKPLACE (CONTRACTORS WHO ARE INDIVIDUALS) -APPLICABLE

TO CONTRACTORS RECEIVING $50,000 or MORE FROM A STATE AGENCY.

As required by the S.C. Drug-Free Workplace #593 of 1990 –

(a) As a condition of the contract I certify that I will not engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance in conducting any activity with the contract; and

(b) If convicted of a criminal drug offense resulting from a violation occurring during the conduct of any contract activity, I will report the conviction, in writing, within 10 calendar days of the conviction to the State Funding Agency.

Signature of Contractor Typed Name and Title

Required Form (if applicable)

Mail to: The company or individual you are contracting with.

The undersigned nonresident taxpayer on oath, being first duly sworn, hereby certifies as follows:

1. Name of Nonresident Taxpayer:

2. Trade Name, if applicable (doing business as):

3. Mailing Address:

4. Federal Employer Identification Number (FEIN):

5. Hiring or Contracting with:

Name:

Address:

Receiving Rentals or Royalties From:

Name:

Address:

6. I hereby certify that the above named nonresident taxpayer is currently registered with (check the appropriate box):

The South Carolina Secretary of State or The South Carolina Department of Revenue:

Date of Registration:

7. I understand that by this registration, the above named nonresident taxpayer has agreed to be subject to the jurisdiction of the South Carolina Department of Revenue and the courts of South Carolina to determine its South Carolina tax liability, including estimated taxes, together with any related interest and penalties.

8. I understand the South Carolina Department of Revenue may revoke the withholding exemption granted under Code

Section 12-8-550 (temporarily doing business or professional services in South Carolina) or Code Section 12-8-540 (rentals) at any time it determines that the above named nonresident taxpayer is not cooperating with the Department in the determination of its correct South Carolina tax liability.

The undersigned understands that any false statement contained herein could be punished by fine, imprisonment or both.

Recognizing that I am subject to the criminal penalties under Code Section 12-54-44(B)(6)(a)(i), I declare that I have examined this affidavit and to the best of my knowledge and belief, it is true, correct and complete.

(Seal) Signature of Nonresident Taxpayer (Owner, Partner or Corporate Officer, when relevant) Date

If Corporate officer, state title:

(Name - Please Print)

33231028

1350 STATE OF SOUTH CAROLINA

DEPARTMENT OF REVENUE I-312

NONRESIDENT TAXPAYER REGISTRATION (Rev. 5/18/15)

AFFIDAVIT INCOME TAX WITHHOLDING 3323

INFORMATION

NONRESIDENT TAXPAYER REGISTRATION AFFIDAVIT

Submit this form to the company or individual you are contracting with.

Do not submit this form to South Carolina Department of Revenue.

PURPOSE OF AFFIDAVIT

A person is not required to withhold taxes for a nonresident taxpayer who submits an affidavit certifying that they are registered with either the South Carolina Secretary of State or the South Carolina Department of Revenue.

REQUIREMENTS TO MAKE WITHHOLDING PAYMENTS

Code Section 12-8-550 requires persons hiring or contracting with a nonresident taxpayer to withhold 2% of each payment made to the nonresident where the payments under the contract exceed $10,000. However, this section does not apply to payments on purchase orders for tangible personal property when those payments are not accompanied by services to be performed in this state.

Code Section 12-8-540 requires persons making payment to a nonresident taxpayer of rentals or royalties at a rate of $1,200 or more a year for the use of or for the privilege of using property in South Carolina to withhold 7% of the total of each payment made to a nonresident taxpayer who is not a corporation and 5% if the payment is made to a corporation.

Our Internet address is: www.dor.sc.gov

33232026 http://www.dor.sc.gov/