RFB-2025-015 - General Highway Requirements - Bid Package.pdf

BROOME COUNTY HIGHWAY DIVISION - 2025 GENERAL HIGHWAY REQUIREMENTS

2025 General Highway Requirements - 116

PROPOSAL SHEETS

2025 GENERAL

HIGHWAY

REQUIREMENTS

RFB 2025-015

2025 General Highway Requirements - 117

PROPOSAL FORM INSTRUCTIONS

Enter price bid opposite each item in the proposal. SUBJECT TO THE CONDITIONS AND

SPECIFICATIONS CONTAINED HEREIN.

THIS PROPOSAL IS SIGNED BY THE BIDDER WITH FULL KNOWLEDGE AND ACCEPTANCE OF ALL THE

PROVISIONS OF THE PROPOSAL AND THE SPECIFICATIONS.

BID MUST BE SUBMITTED ON FORMS ATTACHED IN ENVELOPE, RETURN PROPOSAL FORMS IN

DUPLICATE TOGETHER WITH ALL OTHER PARTS.

EACH ITEM THAT A PROPOSAL SHEET IS SUBMITTED MUST BE PLACED IN SEPARATE SEALED

ENVELOPES, CLEARLY MARKING ON THE OUTSIDE THE ITEM TITLE BEING BID. EXAMPLE: ASPHALT PRODUCTS, SERVICE CONTRACTS, AGGREGATES, EACH ARE TO BE PLACED IN SEPARATE ENVELOPES.

ALTHOUGH IF MORE THAN ONE PRODUCT IS BID UNDER THE SAME ITEM TITLE SUCH AS

AGGREGATES, THEY MAY ALL BE PLACED IN THE SAME SEALED ENVELOPE.

COMPLIANCE WITH INSTRUCTIONS AND WITH LAWS:

The bidder shall comply with the lawful directions of the officials, agents or representatives of the Superintendent of Highways of the County of Broome and with provisions of the State Finance Law, the Labor Law, the General Business Law, the Workmen's Compensation Law and all other statutes relating to or affecting contracts with the County of Broome.

NO LIABILITY BEYOND AVAILABLE APPROPRIATIONS:

By nothing herein contained shall the County of Broome be made to incur any liability beyond monies available for the purpose herein, or otherwise to be in violation of Section 41 of the State Finance Law.

QUALIFICATIONS FOR BIDDERS

1. Bids received later than the date and time specified will not be considered.

2. The bidder will be required to show, to the satisfaction of the Superintendent of Highways that he is a responsible contractor experienced in the kind of work to be performed; that he is financially able to execute the contract; that he has adequate equipment and fixed storage facilities to satisfactorily and efficiently perform the work as directed within the specified time limits. The bidder must state exact location of plant.

3. The Contractor bidding on asphaltic material must own or have arrangements with a plant that has available permanent heated storage units located within a sixty mile radius of Broome County to supply the quantities specified. He must maintain and have available at all times approved asphalt pressure distributors to apply the asphalt in the manner specified.

PROPOSAL SHEETS

2025 General Highway Requirements P-1

ASPHALT PRODUCTS

ITEM AS-1 37.5 F9 BASE COURSE HMA, 80 SERIES COMP Price per Ton: $

ITEM AS-2 25 F9 BINDER COURSE HMA, 80 SERIES COMP Price per Ton: $

ITEM AS-3 19 F9 BINDER COURSE HMA, 80 SERIES COMP Price per Ton: $

ITEM AS-4 12.5 F2 TOP COURSE HMA, 80 SERIES COMP Price per Ton: $

ITEM AS-5 9.5 F2 TOP COURSE HMA, 80 SERIES COMP Price per Ton: $

ITEM AS-6 6.3 F2 TOP COURSE HMA, w PG 64V-22

80 SERIES COMP

Price per Ton: $

ITEM AS-7 37.5 F9 BASE COURSE WMA, 80 SERIES COMP Price per Ton: $

ITEM AS-8 25 F9 BINDER COURSE WMA, 80 SERIES COMP Price per Ton: $

ITEM AS-9 19 F9 BINDER COURSE WMA, 80 SERIES COMP Price per Ton: $

ITEM AS-10 12.5 F2 TOP COURSE WMA, 80 SERIES COMP Price per Ton: $

ITEM AS-11 9.5 F2 TOP COURSE WMA, 80 SERIES COMP Price per Ton: $

ITEM AS-12 6.3 F2 TOP COURSE WMA, w PG 64V-22

80 SERIES COMP

Price per Ton: $

ITEM AS-13 MODIFIED STOCKPILE PATCHING MATERIAL

Item 15402.2030 - Modified Stockpile Patching Mat'l

Item 15402.2050 - Fiber-Reinforced Stockpile Patching Mat'l

Price per Ton:

Price per Ton:

ITEM AS-14 MISCELANEOUS PATCHING MATERIAL Price per Ton: $

ITEM AS-15 HOT MIX ASPHALT CURB Price per Ton: $

LIQUID ASPHALT PRODUCTS

ITEM LA-1 702-3102P (HFRS-2P) SURFACE TREATMENT Price per Gallon: $

ITEM LA-2 702-4101P (CRS-2P) SURFACE TREATMENT Price per Gallon $

2025 General Highway Requirements P-2

LIQUID CALCIUM CHLORIDE

ITEM LC-1 LIQUID CALCIUM CHLORIDE

Item LC-1 - Delivered in Bulk and Placed in Tank Price per Gallon: $

Item LC-1 - Delivered and Applied at Site Price per Gallon: $

AGGREGATES/STONE

ITEM AGG-1 SELECT GRANULAR FILL

Item 203.07 - Pick-up Price per Ton: $

Item 203.07 - Delivery

ITEM AGG-2 SUBBASE

Price per Ton: $

Item 304.12 - Type 2, Pick-up Price per Ton: $

Item 304.12 - Type 2, Delivery Price per Ton: $

Item 304.14 - Type 4, Pick-up Price per Ton: $

Item 304.14 - Type 4, Delivery Price per Ton: $

ITEM AGG-3 UNDERDRAIN FILTER, TYPE I

Item 605.0901 - Type I, Pick-up Price per Ton: $

Item 605.0901 - Type I, Delivered Price per Ton: $

ITEM AGG-4 STONE FILL

Item 620.02 - Fine Stone Fill, Pick-up Price per Ton: $

Item 620.02 - Fine Stone Fill, Delivered Price per Ton: $

2025 General Highway Requirements P-3

AGGREGATES/STONE, CON’T

ITEM AGG-4 STONE FILL(Continued)

Item 620.03 - Light Stone Fill, Pick-up

Item 620.03 - Light Stone Fill, Delivered

Price per Ton:

Price per Ton:

Item 620.04 - Medium Stone Fill, Pick-up Price per Ton: $

Item 620.04 - Medium Stone Fill, Delivered Price per Ton: $

Item 620.05 - Heavy Stone Fill, Pick-up Price per Ton: $

Item 620.05 - Heavy Stone Fill, Delivered Price per Ton: $

Item 620.06 - Rip Rap Stone, Pick-up Price per Ton: $

Item 620.06 - Rip Rap Stone, Delivered Price per Ton: $

Item 620.08 -Bedding Material, Pick-up Price per Ton: $

Item 620.08 - Bedding Material, Delivered Price per Ton: $

ITEM AGG-5 CRUSHED STONE

Size 1A - Pick-up Price per Ton: $

Size 1A - Delivered Price per Ton: $

Size 1ST - Pick-up Price per Ton: $

Size 1ST - Delivered Price per Ton: $

Size 1 - Pick-up Price per Ton: $

Size 1 - Delivered Price per Ton: $

2025 General Highway Requirements P-4

AGGREGATES/STONE, CON’T

ITEM AGG-5 CRUSHED STONE (Continued)

Size 2 - Pick-up Price per Ton: $

Size 2 - Delivered Price per Ton: $

ITEM AGG-6 CRUSHED GRAVEL

Size 1A - Pick-up

Size 1A - Delivered

Price per Ton:

Price per Ton:

Size 1ST - Pick-up Price per Ton: $

Size 1ST - Delivered Price per Ton: $

Size 1 - Pick-up Price per Ton: $

Size 1 - Delivered Price per Ton: $

Size 2 - Pick-up Price per Ton: $

Size 2 - Delivered Price per Ton: $

ITEM AGG-7 ROAD SAND

Pick-up

Delivered

Price per Ton:

Price per Ton:

2025 General Highway Requirements P-5

AGGREGATES/STONE, CON’T

ITEM AGG-8 TOPSOIL

Pick-up Price per Ton: $

Delivered

ITEM AGG-9

EXTRA HEAVY STONE

Price per Ton: $

Type A - Pick-up Price per Ton: $

Type A - Delivered Price per Ton: $

Type B - Pick-up Price per Ton: $

Type B - Delivered Price per Ton: $

ITEM AGG-10 EXTRA HEAVY STACKABLE STONE

Pick-up Price per Ton: $

Delivered Price per Ton: $

CONCRETE PRODUCTS

ITEM CP-1 FLOWABLE FILL Price per CY: $

ITEM CP-2 PORTLAND CEMENT CONCRETE

Class A Concrete Price per CY: $

Class D Concrete Price per CY: $

Class E Concrete Price per CY: $

Class F Concrete Price per CY: $

Class HP Concrete Price per CY: $

2025 General Highway Requirements P-6

CONCRETE PRODUCTS, CON’T.

ITEM CP-3 CONCRETE BOX CULVERTS

4' x 4' Price per LF: $

5' x 5' Price per LF: $

6' x 6' Price per LF: $

8' x 8' Price per LF: $

8' x 12' Price per LF: $

8' x 16' Price per LF: $

8' x 20' Price per LF: $

10' x 10' Price per LF: $

10' x 14' Price per LF: $

10' x 18' Price per LF: $

10' x 20' Price per LF: $

Precast Concrete Toe Wall {Head Wall) Price per LF: $

Precast Concrete Wing Walls Price per SF: $

ITEM CP-4 CONCRETE PRESTRESSED BEAMS

Prestressed Concrete Hollow Slab Units

16' x 36" Price per SF: $

18' x 36" Price per SF: $

20' x 36" Price per SF: $

22' x 36" Price per SF: $

24' x 36" Price per SF: $

26' x 36"

28'x36"

Price per SF:

Price per SF:

30' x 36" Price per SF: $

2025 General Highway Requirements P-7

Prestressed Concrete Solid Slab Units

16'

18'

20'

22'

24'

26'

28'

30' x x x x x x x x

48"

48"

48"

48"

48"

48"

48"

48"

Price per SF:

Price per SF:

Price per SF:

Price per SF:

Price per SF:

Price per SF:

Price per SF:

Price per SF:

ITEM CP-5 PRECAST CONCRETE DRAINAGE UNITS

Frames/Grates/Covers

Round Price per EA: $

Square Price per EA: $

Rectangular Price per EA: $

Pre-Cast Concrete Catch Basin (LxWxD)

24" x 24" x 36" Price per EA: $

24" x 24" x 48" Price per EA: $

Additional Vertical Linear Foot Price per LF: $

24" x 30" x 36" Price per EA: $

24" x 30" x 48" Price per EA: $

Additional Vertical Linear Foot Price per LF: $

24" x 36" x 36" Price per EA: $

24" x 36" x 48" Price per EA: $

Additional Vertical Linear Foot Price per LF: $

2025 General Highway Requirements P-8

CONCRETE PRODUCTS, CON’T

ITEM CP-5 PRECAST CONCRETE DRAINAGE UNITS(Continued)

Pre-Cast Concrete Drywell (Dia. x H)

48" ID Cover Price per EA: $

48" x 2-ft Vertical Section Price per EA: $

48" x 3-ft Vertical Section Price per EA: $

48" x 4-ft Vertical Section Price per EA: $

Base Price per EA: $

72" ID Cover Price per EA: $

72" x 2-ft Vertical Section Price per EA: $

72" x 3-ft Vertical Section Price per EA: $

72" x 4-ft Vertical Section Price per EA: $

Base Price per EA: $

Pre-Cast Manhole (Dia. x H)

48" x 24" Cover Price per EA: $

48" x 12" Riser Price per EA: $

48" x 24" Riser Price per EA: $

48" x 48" Base Price per EA: $

60" x 24" Cover Price per EA: $

60" x 12" Riser Price per EA: $

60" x 24" Riser Price per EA: $

60" x 60" Base Price per EA: $

72" x 24" Cover Price per EA: $

72" x 12" Riser Price per EA: $

72" x 24" Riser Price per EA: $

CONCRETE PRODUCTS, CON’T

ITEM CP-5 PRECAST CONCRETE DRAINAGE UNITS(Continued)

72" x 72" Base Price per EA: $

Adjustment Rings 24" x 3" Price per EA: $

Retaining Wall Blocks and Caps (HxWxL)

18" x 24" x 24" Blocks Price per EA: $

18" x 24" x 48" Blocks Price per EA: $

18" x 24" x 72" Blocks Price per EA: $

Unit Caps Price per EA: $

MISC. MATERIALS

ITEM MAT-1 SMOOTH INTERIOR CORRUGATED PLASTIC PIPE

PIPE

2025 General Highway Requirements P-9

12" Dia. SICPP 12" Dia. SICPP

- Plain End

- Bell End

Price per LF: $

15" Dia. SICPP 15" Dia. SICPP

- Plain End

- Bell End

Price per LF: $

18" Dia. SICPP 18" Dia. SICPP

- Plain End

- Bell End

Price per LF: $

24" Dia. SICPP 24" Dia. SICPP

- Plain End

- Bell End

Price per LF: $

30" Dia. SICPP 30" Dia. SICPP

- Plain End

- Bell End

Price per LF: $

36" Dia. SICPP 36" Dia. SICPP

- Plain End

- Bell End

Price per LF: $

42" Dia. SICPP 42" Dia. SICPP

- Plain End

- Bell End

Price per LF: $

48" Dia. SICPP 48" Dia. SICPP

- Plain End

- Bell End

Price per LF: $

60" Dia. SICPP 60" Dia. SICPP

- Plain End

- Bell End

Price per LF: $

2025 General Highway Requirements P-10

MISC. MATERIALS, CON’T

ITEM MAT-1 SMOOTH INTERIOR CORRUGATED PLASTIC PIPE(Continued)

COUPLERS

EQUIPMENT RENTAL

ITEM ER-1 ROLLERS

Single Drum Roller

Dual Drum Roller

Price per Day: $

Price per Week: $

Price per Month: $

Mobilization: $

Price per Day: $

Price per Week: $

Price per Month: $

Mobilization: $

12" Coupler Price per Ea. $

15" Coupler Price per Ea. $

18" Coupler Price per Ea. $

24" Coupler Price per Ea. $

30" Coupler Price per Ea. $

36" Coupler Price per Ea. $

42" Coupler Price per Ea. $

48" Coupler Price per Ea. $

60" Coupler Price per Ea. $

2025 General Highway Requirements P-11

EQUIPMENT RENTAL, CON’T

ITEM ER-2 COLD MILLING MACHINE

4' WIDE - Down-cut Drum Price per Day:

Price per Week:

Price per Month:

Mobilization:

6' WIDE - Down-cut Drum

Price per Day:

Price per Month:

Mobilization:

7' WIDE - Down-cut Drum Price per Day:

Price per Month:

Mobilization:

10' WIDE - Down-cut Drum Price per Day:

Price per Week: $

Price per Month: $

Mobilization: $

4' WIDE - Up-cut Drum Price per Day:

Price per Week: $

2025 General Highway Requirements P-12

EQUIPMENT RENTAL, CON’T

ITEM ER-2 COLD MILLING MACHINE(Continued)

6' WIDE - Up-cut Drum Price per Day: $

Price per Week: $

Price per Month: $

Mobilization: $

7' WIDE - Up-cut Drum Price per Day:

Price per Week:

Price per Month:

Mobilization:

10' WIDE - Up-cut Drum Price per Day:

Price per Week:

Price per Month:

Mobilization:

ITEM ER-3 RUBBER TIRE HYDRAULIC EXCAVTOR

Rubber Tire Excavator Price per Month: $

Mobilization: $

ITEM ER-4 BITUMINOUS PAVER

BITUMINOUS PAVER Price per Day: $

Price per Week: $

2025 General Highway Requirements P-13

EQUIPMENT RENTAL, CON’T

ITEM ER-5 TRACK-TYPE DOZER

100 HP Minimum {CAT D5M or equal) Price per Day:

Price per Week:

Price per Month:

Mobilization:

165 HP Minimum {CAT D6R or equal) Price per Day:

Price per Week:

Price per Month:

Mobilization:

ITEM ER-6 ROAD WIDENER

Widener {Midland SP 10 or equal) Price per Day:

Price per Week:

Price per Month:

Mobilization:

ITEM ER-7 PORTABLE CRUSHING PLANT

Portable Crushing Plant Price per Day:

Price per Week:

Price per Month:

Mobilization:

2025 General Highway Requirements P-14

EQUIPMENT RENTAL, CON’T

ITEM ER-8 TELEHANDLER

Telehandler {Skyjack SJ 519 or Equal) Price per Day: $

Price per Week: $

SERVICE CONTRACTS

ITEM SER-1 COLD RECYCLING ASPHALT CONCRETE

Central Plant Mixing

3" in Depth Price per Sq. Yard: $

4" in Depth Price per Sq. Yard: $

HFRS-2 Price per Gallon: $

HFMS-2 Price per Gallon: $

HFRA Price per Gallon: $

Fog Seal Polymer Price per Gallon: $

Modifier Price per Gallon: $

Work Zone Traffic Control Price per Sq. Yard: $

Additional Aggregate Price per Ton: $

In-Place Recycling Train

3" in Depth Price per Sq. Yard: $

4" in Depth Price per Sq. Yard: $

HFRS-2 Price per Gallon: $

2025 General Highway Requirements P-15

SERVICE CONTRACTS, CON’T

ITEM SER-1 COLD RECYCLING ASPHALT CONCRETE(Continued)

HFMS-2 Price per Gallon: $

HFRA Price per Gallon: $

Fog Seal Polymer Price per Gallon: $

Modifier Price per Gallon: $

Work Zone Traffic Control Price per Sq. Yard: $

Additional Aggregate Price per Ton: $

ITEM SER-2 COLD MILLING

0" - 2" Depth Price per Sq. Yard: $

2 1/16" to 4" Depth Price per Sq. Yard: $

4 1/16" to 6" Depth Price per Sq. Yard: $

ITEM SER-3 FULL DEPTH RECLAMATION OF ASPHALT PAVEMENT

Item 304.6000017, Thickness Recycled {6-8 inches)

0 - 12,320 SY Price per Sq. Yard: $

12,321 - 36,960 SY Price per Sq. Yard: $

36,961 - 73,920 SY Price per Sq. Yard: $

Item 304.6000017, Thickness Recycled {8-10 inches)

0 - 12,320 SY Price per Sq. Yard: $

12,321 - 36, 960 SY Price per Sq. Yard: $

36,961 - 73,920 SY Price per Sq. Yard: $

Chemical Stabilizing Agent Price per Gallon: $

Bituminous Stabilizing Agent Price per Gallon: $

Aggregate Price per Ton: $

2025 General Highway Requirements P-16

SERVICE CONTRACTS, CON’T

ITEM SER-4 MICRO-SURFACING

Item 413.02020118 - Microsurfacing Type III, F2

0-150 TN Price per Ton: $

151-300 TN Price per Ton: $

301-500 TN Price per Ton: $

500+ TN Price per Ton: $

Item 413.02020118 - Microsurfacing Type II, F2

0-150 TN Price per Ton: $

151-300 TN Price per Ton: $

301-500 TN Price per Ton: $

500+ TN Price per Ton: $

Rut Filling Price per Ton: $

Fog Seal Price per Gallon: $

ITEM SER-5 COLD MIX BITUMINOUS PAVEMENT

Type I Including Agg. And WZTC Price per Ton: $

Excluding Agg. And WZTC Price per Ton: $

Type II Including Agg. And WZTC Price per Ton: $

Excluding Agg. And WZTC Price per Ton: $

Type III Including Agg. And WZTC Price per Ton: $

Excluding Agg. And WZTC Price per Ton: $

ITEM SER-6 CLEANING AND SEALING CRACKS

Including WZTC Price per Gallon: $

Excluding WZTC Price per Gallon: $

2025 General Highway Requirements P-17

ITEM SER-7 HOT MIX ASPHALT USING RECYCLING TREATMENTS

Including WZTC Price per SY: $

Excluding WZTC Price per SY: $

ITEM SER-8 QUICK SET SLURRY

Type II, F3 - Item 414.02030118

0-150 TN Price per Ton: $

151-300 TN Price per Ton: $

301-500 TN Price per Ton: $

500+ TN

Type III, F3 - Item 414.03030118

Price per Ton: $

0-150 TN Price per Ton: $

151-300 TN Price per Ton: $

301-500 TN Price per Ton: $

500+ TN Price per Ton: $

ITEM SER-9 VEGETATION CONTROL

Roadside Mileage Price per Mile: $

Applied Material Price per Gallon: $

ITEM SER-10 SUBBASE COURSE, OPTIONAL TYPE

Including WZTC Price per CY: $

Excluding WZTC Price per CY: $

2025 General Highway Requirements P-18

SERVICE CONTRACTS, CON’T

ITEM SER-11 37.5 F9 BASE COURSE, 80 SERIES COMPACTION

Item 402.378904 - w/PG 64S-22 including WZTC

0-500 TON

OVER 500 TON

Item 402.378904 - w/PG 64S-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

Price per Ton: $

Item 402.378904 - w/PG 64V-22 including WZTC

0-500 TON

OVER 500 TON

Item 402.378904 - w/PG 64V-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

Price per Ton: $

Item 404.378901 - w/PG 64S-22 including WZTC

0-500 TON

OVER 500 TON

Item 404.378901 - w/PG 64S-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

Price per Ton: $

Item 404.378901 - w/PG 64V-22 including WZTC

0-500 TON

OVER 500 TON

Item 404.378901 - w/PG 64V-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

2025 General Highway Requirements P-19

SERVICE CONTRACTS, CON’T

ITEM SER-12 25 F9 BINDER COURSE, 80 SERIES COMPACTION

Item 402.258904 - w/PG 64S-22 including WZTC

0-500 TON

OVER 500 TON

Item 402.258904 - w/PG 64S-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

Price per Ton: $

Item 402.258904 - w/PG 64V-22 including WZTC

0-500 TON

OVER 500 TON

Item 402.258904 - w/PG 64V-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

Price per Ton: $

Item 404.258901 - w/PG 64S-22 including WZTC

0-500 TON

OVER 500 TON

Item 404.258901 - w/PG 64S-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

Price per Ton: $

Item 404.258901- w/PG 64V-22 including WZTC

0-500 TON

OVER 500 TON

Item 404.258901 - w/PG 64V-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

2025 General Highway Requirements P-20

ITEM SER-13 19 F9 BINDER COURSE, 80 SERIES COMPACTION

Item 402.198904 - w/PG 64S-22 including WZTC

0-500 TON

OVER 500 TON

Item 402.198904 - w/PG 64S-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

Price per Ton: $

Item 402.198904 - w/PG 64V-22 including WZTC

0-500 TON

OVER 500 TON

Item 402.198904 - w/PG 64V-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

Price per Ton: $

Item 404.198901- w/PG 64S-22 including WZTC

0-500 TON

OVER 500 TON

Item 404.198901 - w/PG 64S-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

Price per Ton: $

Item 404.198901- w/PG 64V-22 including WZTC

0-500 TON

OVER 500 TON

Item 404.198901 - w/PG 64V-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

2025 General Highway Requirements P-21

ITEM SER-14 12.5 F2 TOP COURSE, 80 SERIES COMPACTION

Item 402.128204 - w/PG 64S-22 including WZTC

0-500 TON

OVER 500 TON

Item 402.128204 - w/PG 64S-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

Price per Ton: $

Item 402.128204 - w/PG 64V-22 including WZTC

0-500 TON

OVER 500 TON

Item 402.128204 - w/PG 64V-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

Price per Ton: $

Item 404.128201- w/PG 64S-22 including WZTC

0-500 TON

OVER 500 TON

Item 404.128201 - w/PG 64S-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

Price per Ton: $

Item 404.128201- w/PG 64V-22 including WZTC

0-500 TON

OVER 500 TON

Item 404.128201 - w/PG 64V-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

2025 General Highway Requirements P-22

SERVICE CONTRACTS, CON’T

ITEM SER-15 9.5 F2 TOP COURSE, 80 SERIES COMPACTION

Item 402.098204 - w/PG 64S-22 including WZTC

0-500 TON

OVER 500 TON

Item 402.098204- w/PG 64S-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

Price per Ton: $

Item 402.098204 - w/PG 64V-22 including WZTC

0-500 TON

OVER 500 TON

Item402.098204 - w/PG 64V-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

Price per Ton: $

Item 404.098201- w/PG 64S-22 including WZTC

0-500 TON

OVER 500 TON

Item 404.098201- w/PG 64S-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

Price per Ton: $

Item 404.098201- w/PG 64V-22 including WZTC

0-500 TON

OVER 500 TON

Item 404.098201 - w/PG 64V-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

2025 General Highway Requirements P-23

ITEM SER-16 6.3 F2 TOP COURSE, 80 SERIES COMPACTION

Item 402.068204 - w/PG 64V-22 including WZTC

0-500 TON

OVER 500 TON

Item 402.068204 - w/PG 64V-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

Price per Ton: $

Item 404.068201- w/PG 64V-22 including WZTC

0-500 TON

OVER 500 TON

Item 404.068201 - w/PG 64V-22 exluding WZTC

0-500 TON

OVER 500 TON

Price per Ton:

Price per Ton: $

Price per Ton: $

Price per Ton: $

ITEM SER-17 CHIP SEAL

Option A - Chip Seal w/ WZTC w/1A Aggregate Price per SY: $ w/1ST Aggregate Price per SY: $

Option B - Chip Seal with Fog Deal w/ WZTC w/1A Aggregate w/1ST Aggregate

Fog Seal

Cover Sand

Price per SY: $

Price per SY: $

Price per Gallon: $

Price per SY: $

Option C - Chip Seal

Excluding Aggregate and WZTC Price per SY: $

2025 General Highway Requirements P-24

SERVICE CONTRACTS, CON’T

ITEM SER-18 TACK COAT APPLICATION

Item 407.0102 - Diluted Tack Coat

Item 407.0103 - Straight Tack Coat

Price per Gallon: $

Price per Gallon: $

ITEM SER-19 LOW-DENSITY CELLULAR CONCRETE

Item 204.03 - 0-10 CY including WZTC Price per CY: $

Item 204.03 - 0-10 CY excluding WZTC Price per CY: $

Item 204.03 - 10+ CY including WZTC Price per CY: $

Item 204.03 - 10+ CY excluding WZTC Price per CY: $

ITEM SER-20 SHOTCRETE

Item 583.02 - Removal, Replacement w/o Rebar Encasement Price per SF: $

Item 583.02 - Removal, Replacement w/ Rebar Encasement Price per SF: $

ITEM SER-21 ASPHALT PLANT INSPECTION FOR QUALITY ASSURANCE

Regular Time Price per Hour: $

Overtime/Weekends Price per Hour: $

ITEM SER-22

ITEM SER-23

MISCELLANEOUS STEEL FABRICATION - SHOP

Steel Fabrication

MISCELLAENOUS STEEL GALVANIZATION - SHOP

Steel Galvanization

Price per Hour: $

Price per LB: $

ITEM SER-24 REFLECTORIZED PAVEMENT MARKING PAINTS

Item 640.10 - White Paint Reflectorized Pavement Stripes Price per LF: $

Item 640.11 - Yellow Paint Reflectorized Pavement Stripes Price per LF: $

2025 General Highway Requirements - 118

PROPOSAL SHEET

BROOME COUNTY

DIVISION OF PURCHASE

FOR

2025 GENERAL HIGHWAY REQUIREMENTS

The undersigned proposes and offers to furnish, deliver, and install for Broome County, 2025 GENERAL HIGHWAY REQUIREMENTS the specifications for which are attached. This proposal and offer is guaranteed to fulfill the minimum specifications as prepared by Broome County.

This submission constitutes a certification that no Broome County officer or employee has any interest herein. In the event that any Broome County Officer or employee has any such interest, the full nature thereof shall be disclosed.

NAME OF COMPANY:

ADDRESS OF COMPANY:

NAME & TITLE OF

OFFICER OR PERSON

SIGNING THIS BID:

SIGNATURE:

DATE:

TELEPHONE NUMBER:

FAX NUMBER:

EMAIL:

NOTICE: THE PROPOSAL SHALL BE ENCLOSED IN A SEALED ENVELOPE WITH COMPANY

NAME AND CLEARLY MARKED WITH THE TITLE OF EACH ITEM MARKED ON

ENVELOPE: I.E. ASPHALT PRODUCTS, LIQUID ASPHALT PRODUCTS, SERVICE

CONTRACTS, ITEM AS-1, SER-1, ETC.

BIDDERS MUST SUBMIT THIS ORIGINAL SHEET AND AN EXACT CLEAR DUPLICATE.

2025 General Highway Requirements - 119

NON-COLLUSION BIDDING CERTIFICATE

NON-COLLUSIVE BIDDING CERTIFICATION:

"{a) By submission of this bid, each bidder and each person signing on behalf of any bidder certifies, and in the case of a joint bit, each party thereto certifies as to its own organization, under penalty of perjury, that to the best of knowledge and belief:

{1) The prices in this bid have been arrived at independently without collusion, consultation, communication, or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any other bidder or with any competitor;

{2) Unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the bidder and will not knowingly be disclosed by the bidder prior to opening, directly or indirectly, to any other bidder or to any competitor; and

{3) No attempt has been made or will be made by the bidder to induce any other person, partnership or corporation to submit or not to submit a bid for the purpose of restricting competition."

NAME OF COMPANY

SIGNATURE & TITLE OF SIGNER

NOTE:

A bid shall not be considered for award nor shall any award be made where {a) {1), {2) and {3) above have not been complied with; provided, however, that if in any case the bidder cannot make the foregoing certification, the bidder shall so state and shall furnish with the bid a signed statement which sets forth in detail the reason therefore. Where {a) {1), {2) and {3) above have not been complied with, the bid shall not be considered for award nor shall any award be made unless the head of the purchasing unit of the political subdivision, public department, agency or official thereof to which the bid is made, or his designee, determines that such disclosure was not made for the purpose of restricting competition.

The fact that a bidder {a) has published price lists, rates or tariffs covering items being procured, {b) has informed prospective customers of proposed or pending publication of new or revised price lists for such Items, or {c) has sold the same Items to other customers at the same prices being bid, does not constitute, without more, a disclosure within the meaning of subparagraph one {a).

BIDDERS MUST SUBMIT THIS ORIGINAL SHEET AND AN EXACT, CLEAR DUPLICATE.

2025 General Highway Requirements - 120

ELECTION LAW STATEMENT

I state that I am the of {Type or print name of {Position)

. In the calendar year immediately preceding the date of this {Vendor)

Statement, has not made a contribution which exceeded {Vendor) the permitted thresholds {thresholds limits are available at the Broome County Board of

Elections) set forth in Article 14 of the Election Law of the State of New York.

Dated:

By:

{Signature of individual)

2025 General Highway Requirements - 121

GIFTS STATEMENT

Gifts signed statement: The County shall require a signed statement for any contact or agreement that requires formal bidding under the New York State General Municipal Law, the Broome County Charter or Local Law of Broome county that discloses all gifts given, if any, by the bidding professional business entity {the bidder) to any officer or employee of the County of Broome.

CERTIFICATION

I, state that I am the of {Print or type name of individual) {Position)

. In the calendar year immediately preceding {Vendor) the date of this Statement, has made the following gifts {Vendor) to Officers and / or Employees of the County of Broome:

Name of County Officer / Employee and Item description Value of Gift

{add additional sheets if necessary)

I did not provide gifts to Officers or Employees of Broome County.

Dated:

By:

{Signature of individual)

2025 General Highway Requirements - 122

IRANIAN ENERGY DIVESTMENT CERTIFICATION

Pursuant to Section 103-g of the

New York State General municipal Law

A. By submission of this bid/proposal, each bidder/proposer and each person signing on behalf of any bidder/proposer certifies, and in the case of a joint bid, each party thereto certifies as to its own organization, under penalty of perjury, that to the best of its knowledge and belief that each bidder is not on the list created pursuant to paragraph {b) of subdivision 3 of Section 165-a of the New York State Finance Law.

B. A Bid/Proposal shall not be considered for award, nor shall any award be made where the condition set forth in Paragraph A above has not been complied with; provided, however, that in any case the bidder/proposer cannot make the foregoing certification set forth in Paragraph A above, the bidder/proposer shall so state and shall furnish with the bid a signed statement which sets forth in detail the reasons therefore. Where Paragraph A above cannot be complied with, the Purchasing Unit to the political subdivision, public department, agency or official thereof to which the bid/proposal is made, or his designee, may award a bid/proposal, on a case by case business under the following circumstances:

1. The investment activities in Iran were made before April 12, 2012, the investment activities in Iran have not been expanded or renewed after April 12, 2012, and the Bidder/Proposer has adopted, publicized and is implementing a formal plan to cease the investment activities in Iran and to refrain from engaging in any new investments in Iran; or

2. The political subdivision makes a determination that the goods or services are necessary for the political subdivision to perform its functions and that, absent such an exemption, the political subdivision would be unable to obtain the goods or services for which the contract is offered. Such determination shall be made in writing and shall be a public document.

{Signature)

Title

2025 General Highway Bid Requirements - 123

OFFEROR’S CERTIFICATION OF ADHERENCE TO EXECUTIVE ORDER 177

REGARDING ANTI-DISCRIMINATORY POLICIES AND PRACTICES

The New York State Human Rights Law, Article 15 of the Executive Law, prohibits discrimination and harassment based on age, race, creed, color, national origin, sex, pregnancy or pregnancy-related conditions, sexual orientation, gender identity, disability, marital status, familial status, domestic violence victim status, prior arrest or conviction record, military status or predisposing genetic characteristics.

The Human Rights Law may also require reasonable accommodation for persons with disabilities and pregnancy-related conditions. A reasonable accommodation is an adjustment to a job or work environment that enables a person with a disability to perform the essential functions of a job in a reasonable manner. The Human Rights Law may also require reasonable accommodation in employment on the basis of Sabbath observance or religious practices.

Generally, the Human Rights Law applies to:

• all employers of four or more people, employment agencies, labor organizations and apprenticeship training programs in all instances of discrimination or harassment;

• employers with fewer than four employees in all cases involving sexual harassment; and,

• any employer of domestic workers in cases involving sexual harassment or harassment based on gender, race, religion or national origin.

In accordance with Executive Order No. 177, the Bidder hereby certifies that it does not have institutional policies or practices that fail to address the harassment and discrimination of individuals on the basis of their age, race, creed, color, national origin, sex, sexual orientation, gender identity, disability, marital status, military status, or other protected status under the Human Rights Law.

Executive Order No. 177 and this certification do not affect institutional policies or practices that are protected by existing law, including but not limited to the First Amendment of the United States Constitution, Article 1, Section 3 of the New York State Constitution, and Section 296{11) of the New York State Human Rights Law.

Offeror Certification:

I certify adherence to Executive Order No. 177.

Signature: Date:

Printed Name:

Title:

Contractor Name:

Address:

General Highway Requirements - 124

BROOME COUNTY HIGHWAY DIVISION - 2025 GENERAL HIGHWAY REQUIREMENTS

INSURANCE ACKNOWLEDGEMENT

THE FOLLOWING INSURANCE ACKNOWLEDGEMENT MUST BE COMPLETED, SIGNED AND

SUBMITTED WITH BID. HOWEVER, THE CERTIFICATE OF INSURANCE AND RELATED

ENDORSEMENT(S) MUST BE PROVIDED BY THE AWARDED BIDDER PRIOR TO THE ISSUANCE

OF A CONTRACT OR PURCHASE ORDER.

The , if a successful bidder, agrees to {Company Name) provide an insurance certificate w/endorsement, in compliance with the insurance requirements set forth in this bid:

2025 General Highway Requirements

Authorized Signature

Name & Title of Authorized Signer

Date

Insurance Agency

Address of Agency

Contact Person at Agency

Phone Number of Agency

Form W-9 (Rev. March 2024)

Request for Taxpayer Identification Number and Certification

Department of the Treasury Internal Revenue Service Go to www.irs.gov/FormW9 for instructions and the latest information.

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

Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below.

P ri nt o r ty p e.

S ee S p ec if ic

In st ru ct io n s on p ag e 3.

1 Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner’s name on line 1, and enter the business/disregarded entity’s name on line 2.)

2 Business name/disregarded entity name, if different from above.

3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Check only one of the following seven boxes.

Individual/sole proprietor C corporation S corporation Partnership Trust/estate

LLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership) Note: Check the “LLC” box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate box for the tax classification of its owner.

Other (see instructions)

3b If on line 3a you checked “Partnership” or “Trust/estate,” or checked “LLC” and entered “P” as its tax classification, and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check this box if you have any foreign partners, owners, or beneficiaries. See instructions

4 Exemptions (codes apply only to certain entities, not individuals;

see instructions on page 3):

Exempt payee code (if any)

Exemption from Foreign Account Tax Compliance Act (FATCA) reporting code (if any)

(Applies to accounts maintained outside the United States.)

5 Address (number, street, and apt. or suite no.). See instructions.

6 City, state, and ZIP code

Requester’s name and address (optional)

7 List account number(s) here (optional)

Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later.

Note: If the account is in more than one name, see the instructions for line 1. See also What Name and Number To Give the Requester for guidelines on whose number to enter.

Social security number or Employer identification number

Part II Certification Under penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and

2. I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue

Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and

3. I am a U.S. citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.

Sign Here

Signature of U.S. person Date

General Instructions Section references are to the Internal Revenue Code unless otherwise noted.

Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9.

What’s New Line 3a has been modified to clarify how a disregarded entity completes this line. An LLC that is a disregarded entity should check the appropriate box for the tax classification of its owner. Otherwise, it should check the “LLC” box and enter its appropriate tax classification.

New line 3b has been added to this form. A flow-through entity is required to complete this line to indicate that it has direct or indirect foreign partners, owners, or beneficiaries when it provides the Form W-9 to another flow-through entity in which it has an ownership interest. This change is intended to provide a flow-through entity with information regarding the status of its indirect foreign partners, owners, or beneficiaries, so that it can satisfy any applicable reporting requirements. For example, a partnership that has any indirect foreign partners may be required to complete Schedules K-2 and K-3. See the Partnership Instructions for Schedules K-2 and K-3 (Form 1065).

Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS is giving you this form because they

Cat. No. 10231X Form W-9 (Rev. 3-2024)

2025 General Highway Requirements - 125

Form W-9 (Rev. 3-2024) Page 2 must obtain your correct taxpayer identification number (TIN), which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following.

• Form 1099-INT (interest earned or paid).

• Form 1099-DIV (dividends, including those from stocks or mutual funds).

• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds).

• Form 1099-NEC (nonemployee compensation).

• Form 1099-B (stock or mutual fund sales and certain other transactions by brokers).

• Form 1099-S (proceeds from real estate transactions).

• Form 1099-K (merchant card and third-party network transactions).

• Form 1098 (home mortgage interest), 1098-E (student loan interest), and 1098-T (tuition).

• Form 1099-C (canceled debt).

• Form 1099-A (acquisition or abandonment of secured property).

Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.

Caution: If you don’t return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later.

By signing the filled-out form, you:

1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued);

2. Certify that you are not subject to backup withholding; or

3. Claim exemption from backup withholding if you are a U.S. exempt payee; and

4. Certify to your non-foreign status for purposes of withholding under chapter 3 or 4 of the Code (if applicable); and

5. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting is correct. See What Is FATCA Reporting, later, for further information.

Note: If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.

Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are:

• An individual who is a U.S. citizen or U.S. resident alien;

• A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States;

• An estate (other than a foreign estate); or

• A domestic trust (as defined in Regulations section 301.7701-7).

Establishing U.S. status for purposes of chapter 3 and chapter 4 withholding. Payments made to foreign persons, including certain distributions, allocations of income, or transfers of sales proceeds, may be subject to withholding under chapter 3 or chapter 4 of the Code (sections 1441–1474). Under those rules, if a Form W-9 or other certification of non-foreign status has not been received, a withholding agent, transferee, or partnership (payor) generally applies presumption rules that may require the payor to withhold applicable tax from the recipient, owner, transferor, or partner (payee). See Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities.

The following persons must provide Form W-9 to the payor for purposes of establishing its non-foreign status.

• In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the disregarded entity.

• In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the grantor trust.

• In the case of a U.S. trust (other than a grantor trust), the U.S. trust and not the beneficiaries of the trust.

See Pub. 515 for more information on providing a Form W-9 or a certification of non-foreign status to avoid withholding.

Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person (under Regulations section 1.1441-1(b)(2)(iv) or other applicable section for chapter 3 or 4 purposes), do not use Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Pub. 515). If you are a qualified foreign pension fund under Regulations section 1.897(l)-1(d), or a partnership that is wholly owned by qualified foreign pension funds, that is treated as a non-foreign person for purposes of section 1445 withholding, do not use Form W-9. Instead, use Form W-8EXP (or other certification of non-foreign status).

Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a saving clause. Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes.

If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items.

1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien.

2. The treaty article addressing the income.

3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions.

4. The type and amount of income that qualifies for the exemption from tax.

5. Sufficient facts to justify the exemption from tax under the terms of the treaty article.

Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if their stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first Protocol) and is relying on this exception to claim an exemption from tax on their scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption.

If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W-8 or Form 8233.

Backup Withholding What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 24% of such payments. This is called “backup withholding.” Payments that may be subject to backup withholding include, but are not limited to, interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made in settlement of payment card and third-party network transactions, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding.

You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return.

Payments you receive will be subject to backup withholding if:

1. You do not furnish your TIN to the requester;

2. You do not certify your TIN when required (see the instructions for Part II for details);

3. The IRS tells the requester that you furnished an incorrect TIN;

4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only); or

5. You do not certify to the requester that you are not subject to backup withholding, as described in item 4 under “By signing the filled-out form” above (for reportable interest and dividend accounts opened after 1983 only).

2025 General Highway Requirements - 126

Form W-9 (Rev. 3-2024) Page 3

Certain payees and payments are exempt from backup withholding.

See Exempt payee code, later, and the separate Instructions for the Requester of Form W-9 for more information.

See also Establishing U.S. status for purposes of chapter 3 and chapter 4 withholding, earlier.

What Is FATCA Reporting?

The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all U.S. account holders that are specified U.S. persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code, later, and the Instructions for the Requester of Form W-9 for more information.

Updating Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you are no longer tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account, for example, if the grantor of a grantor trust dies.

Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect.

Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty.

Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.

Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties.

Specific Instructions Line 1 You must enter one of the following on this line; do not leave this line blank. The name should match the name on your tax return.

If this Form W-9 is for a joint account (other than an account maintained by a foreign financial institution (FFI)), list first, and then circle, the name of the person or entity whose number you entered in Part I of Form W-9. If you are providing Form W-9 to an FFI to document a joint account, each holder of the account that is a U.S. person must provide a Form W-9.

• Individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name.

Note for ITIN applicant: Enter your individual name as it was entered on your Form W-7 application, line 1a. This should also be the same as the name you entered on the Form 1040 you filed with your application.

• Sole proprietor. Enter your individual name as shown on your Form 1040 on line 1. Enter your business, trade, or “doing business as” (DBA) name on line 2.

• Partnership, C corporation, S corporation, or LLC, other than a disregarded entity. Enter the entity’s name as shown on the entity’s tax return on line 1 and any business, trade, or DBA name on line 2.

• Other entities. Enter your name as shown on required U.S. federal tax documents on line 1. This name should match the name shown on the charter or other legal document creating the entity. Enter any business, trade, or DBA name on line 2.

• Disregarded entity. In general, a business entity that has a single owner, including an LLC, and is not a corporation, is disregarded as an entity separate from its owner (a disregarded entity). See Regulations section 301.7701-2(c)(2). A disregarded entity should check the appropriate box for the tax classification of its owner. Enter the owner’s name on line 1. The name of the owner entered on line 1 should never be a disregarded entity. The name on line 1 should be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S.

federal tax purposes has a single owner that is a U.S. person, the U.S.

owner’s name is required to be provided on line 1. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity’s name on line 2. If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN.

Line 2 If you have a business name, trade name, DBA name, or disregarded entity name, enter it on line 2.

Line 3a Check the appropriate box on line 3a for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box on line 3a.

IF the entity/individual on line 1 is a(n) . . .

THEN check the box for . . .

• Corporation Corporation.

• Individual or

• Sole proprietorship

Individual/sole proprietor.

• LLC classified as a partnership for U.S.