SCSD Quote Documents.pdf

HOLD HARMLESS AGREEMENT

In accordance with Article 12 of the General Conditions (“Indemnification”), the Contractor agrees as follows to the following indemnification obligations under its Agreement with the Owner:

A. The Contractor and its SubContractors shall defend, indemnify and hold harmless: (1) the Owner, its consultants, employees, officers, members of the Board and agents; and (2) the Architect and its consultants, employees, officers and agents; from and against any and all claims, damages, losses, suits, obligations, fines, penalties, costs, charges, and expenses, including but not limited to attorney’s fees, which may be imposed upon or incurred by or asserted against any of them by reason of any act or omission of such contractor or any of its subcontractors or any person or firm directly or indirectly employed by such contractor, for the act(s) and/or omission(s) of any contractor or subcontractor in connection with the work of the Project.

B. To the fullest extent permitted by law, the Contractor and its SubContractors shall defend, indemnify and hold harmless: (1) the Owner, its consultants, employees, officers, members of the Board, and agents; and (2) the Architect and its consultants, employees, officers, and agents from and against claims, damages, losses, and expenses, including but not limited to attorney’s fees, arising out of or resulting from performance of its work, provided that such claim, damage, loss or expense is attributable to bodily injury, sickness, disease, or death, or to injury to or destruction, of tangible property including loss of use resulting therefrom, but only to the extent caused in whole or in part by negligent acts or omissions of the Contractor, a SubContractor, anyone directly or indirectly employed by them or anyone for whose acts they may be liable, regardless of whether or not such claim, damage, loss, or expense is caused in part by a party indemnified hereunder. Such obligation shall not be construed to negate, abridge, or reduce other rights or obligations of indemnity which would otherwise exist as to a party or person described in this Paragraph B. The Contractor’s indemnity obligations under this Paragraph B shall, but not by way of limitation, specifically include all claims and judgments which may be made against the Owner, the Architect, the Architect's consultants and agents and employees of any of them under any applicable statute, rule or regulation including the New York Statute, Occupational Safety and Hazardous Act, and the Federal Occupational Safety and Hazardous Act. In claims against any person or entity indemnified under this Paragraph B by an employee of the Contractor, a SubContractor, anyone directly or indirectly employed by them or anyone for whose acts they may be liable, the indemnification obligation under this Paragraph B shall not be limited by a limitation on amount or type of damages, compensation or benefits payable by or for the Contractor or a SubContractor under workers’ or workmen’s compensation acts, disability benefit acts, or other employee benefit acts.

C. The Contractor and its SubContractors shall defend, indemnify and hold harmless: (1) the Owner, its consultants, employees, officers, members of the Board, and its agents; and (2) the Architect and its consultants, employees, officers, and agents from and against any fines, penalties, judgments, or damages, including reasonable attorney’s fees, imposed on or incurred by the parties indemnified hereunder which are incurred as a result of the Contractor’s failure to give the notices required by Article 6(T) of the General Conditions of the Contract for Construction.

D. The Contractor and its SubContractors shall defend, indemnify and hold harmless: (1) the Owner, its consultants, employees, officers, members of the Board and agents; and (2) the

Architect and its consultants, employees, officers and agents from and against any actions, lawsuits or proceedings or claims of liens brought against each or any of them as a result of liens filed against the Contractor’s Project funds, including all the cost and expense of said liens, and including but not limited to attorney’s fees incurred by each or any of them.

E. The Contractor and its SubContractors shall defend, indemnify and hold harmless: (1) the Owner, its consultants, employees, officers, members of the Board and agents; and (2) the Architect and its consultants, employees, officers, and agents from and against any and all liability for violation of all federal, state, and local laws, ordinances, regulations, rules, codes, orders, and policies applicable to the Contractor’s work and shall defend any claims or actions which may be brought against the Owner as the result thereof.

F. The Contractor and its SubContractors shall defend, indemnify and hold harmless: (1) the Owner, its consultants, employees, officers, members of the Board and agents; and (2) the Architect and its consultants, employees, officers and agents from and against any and all liability for claims made by third parties, including SubContractors, in connection with this Agreement and shall defend any claims or actions which may be brought against the Owner as the result thereof.

G. The Contractor shall defend, indemnify and hold harmless (1) the Owner, its consultants, employees, officers, members of the Board and agents; and (2) the Architect and its consultants, employees, officers and agents from and against any and all claims, damages, losses, suits, obligations, fines, penalties, costs, charges, and expenses which may be imposed upon or incurred by or asserted against any of them by reason of any act or omission of such contractor or any subcontractor or any person or firm directly or indirectly or indirectly employed by such contractor, with respect to violations of OSHA requirements, rules, and/or regulations.

H. The indemnification obligations set forth herein shall become effective upon the Owner’s or the Architect’s receipt of a claim for which the Contractor is required to provide indemnification to the Owner or the Architect. In the event that the Contractor shall fail to refuse to defend any such action, the Contractor shall be liable to the Owner for all costs of the Owner in defending such claim or action and all costs of the Owner, including attorney’s fees, in recovering such defense costs from the Contractor. In the event the Owner or the Architect is required to bring an action to enforce the indemnification obligation, the Contractor shall be liable to the Owner and/or the Architect for all costs associated with said action including attorney’s fees.

By: _________________________________________________ Signature of Authorized Representative of Contractor

(Print Name and Title)

(Date)

Smithtown Central School District 26 New York Avenue, Smithtown, New York 11787

NON-COLLUSIVE CERTIFICATION

Firm Name: _______________________________________________________________________

Business Address: ____________________________________________________________________

Telephone Number: _________________________________________________________________

I. General Proposal/Proposal Certification

The bidder certifies that he/she will furnish, at the prices herein quoted, the materials, equipment and/or services proposed on this bid.

II. Non-Collusive Certification

By submission of this bid proposal, the bidder certifies that he/she is complying with Section 103-d of the General Municipal Law as follows:

1) Statement of non-collusion in bids and proposals to political subdivision oftheState.

Every bid orproposalhereaftermadetoapoliticalsubdivisionoftheStateoranypublic department, agency or official thereof where competitive bidding is required bystatute, rule,regulation,orlocallaw,forworkorservicesperformedortobeperformedorgoods sold or to be sold, shall contain the following statement subscribed by the bidder and affirmed by such bidder as true under the penalties of perjury.

A. By submission of this bid, each bidder and each person signing on behalf of thebidder certifies, and in the case of a joint proposal, each party thereto certifies as to its own organization, under penalty of perjury, that tothebestoftheproposer’sknowledgeand belief:

1. The prices in this bid have been arrived at independently without collusion, consultation, communication, or agreement for the purpose of restricting competitionastoanymatterrelatingtosuchpriceswithanyotherbidderorwith any competitor;

2. Unless otherwise required by law, the prices which have beenquotedinthisbid have not been knowingly disclosed by the bidder and will not knowingly be disclosedbythebidderpriortoopening,directlyorindirectly,toanyotherbidder or to any competitor;

3. No attempt has been made or will be made by the bidder to induce any other person partnership or corporation to submit a bid for the purpose of restricting competition.

B. A bid shall not be consideredforawardnorshallanyawardbemadewhere(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

#25/26-09 Climate Pro K12 (Or Equal) Portable Air Conditioners with the bid a signed statement which sets forth in detail the reasons therefore. Where (A)(1),(2),and(3)abovehavenotbeencompliedwith,thebidshallnotbeconsideredfor award nor shall any award be made unless the head of purchasing unit of the political subdivision,publicdepartment,agency,orofficialthereoftowhichthebidismade,orhis designee, determines that such disclosure was not made for the purpose of restricting competition.

Thefactthattheabidder(a)haspublishedpricelists,rates,ortariffscoveringitemsbeing procured, (b) has informedprospectivecustomersofproposedorpendingpublicationof neworrevisedpricelistsforsuchitems,or(c)hassoldthesameitemstoothercustomers at the same prices being bid does not constitute, without more, a disclosure within the meaning of paragraph A above.

C. AnybidhereaftermadetoanypoliticalsubdivisionoftheStateoranypublicdepartment, agency or official thereof by a corporate bidder for work or servicesperformedortobe performedorgoodssoldortobesold,wherecompetitivesubmittingbiddingisrequired by statute, rule, regulation, or local law, and where such bid contains the certification referredtoinsubdivisiononeofthesection,shallbedeemedtohavebeenauthorizedby theboardofdirectorsofthebidderandsuchauthorizationshallbedeemedtoincludethe signing and submission of the bid and the inclusion therein of the certificate as to non-collusion as the act and deed of the corporation.

The bidder affirms the above statement as true under the penalties of perjury.

(SEAL OF CORPORATION)

Corporate or Company Name

Signature of Bidder: ____________________________________________________________ (Signature of Bidder or authorized representative of a corporation)

Title:_________________________________________________________________________

Subscribed and sworn to before me this ________ day of ________ ,20___

Notary Public

FORM OF DISCLOSURE

THEUNDERSIGNEDAFFIRMSTHATTHEFOLLOWINGCONSTITUTEALLOFFICERS,DIRECTORS,

PARTNERS, OR CONTROLLING PRINCIPALS OF THE FIRM:

Name Title

1. Does any Smithtown Board Member, administrator, or employee possess any financial interest, directly orindirectly,inthefirm?__________Ifyes,setforthbelowthebasisuponwhichafinancialinterestexistsin the firm:

2. Has the firm or any of its officers, directors, partners, or controlling principals possessed any interest in transaction heretofore entered into with Smithtown Schools? __________ If yes, please describe the transactions(s):

3. Does any direct relative of a member of the Board, administration, or staff possess any financial interest, directly or indirectly, in the firm (for purposes of their inquiry a direct relative is to be defined as a parent, spouse, child or sibling)? __________ If yes, set forth below the Smithtown School Board Member, administrator, or staff member whose relation possesses an interest and the relationship:

THE UNDERSIGNED AFFIRMS THAT THE ABOVE STATEMENTSARETRUEANDUNDERSTANDS

THAT ANY FALSE STATEMENT SHALL CONSTITUTE A VIOLATION OF THE PENAL LAW OR

GENERAL MUNICIPAL LAW, AS APPLICABLE.

Firm: ______________________________________________________________

Signature: ______________________________________________________________

Print Name: ______________________________________________________________

Title: ______________________________________________________________

Date: ______________________________________________________________

CERTIFICATION OF COMPLIANCE WITH THE IRAN DIVESTMENT ACT

As a result of the Iran Divestment Act of 2012 (the “Act”), Chapter 1 of the 2012 Laws of New York, a new provision has been added to State Finance Law (SFL) § 165-a and New York General Municipal Law § 103-g, botheffectiveApril12,2012. UndertheAct,theCommissioneroftheOfficeofGeneralServices(OGS)will be developing a list of “persons” who are engaged in “investment activities in Iran” (both are defined terms in the law) (the “Prohibited Entities List"). Pursuant to SFL § 165-a(3)(b), the initial list is expected to be issued no later than 120 days after the Act’s effective date at which time it will be posted on the OGS website.

By submitting a bid in response to this solicitation or by assuming the responsibility of a Contract awarded hereunder, each Bidder/Contractor, any person signing on behalf of any Bidder/Contractor and any assignee or subcontractor and, in the case of a joint bid, each party thereto, certifies, under penalty of perjury, that once the Prohibited Entities List is posted on the OGS website, that to the best of its knowledge and belief, that each Bidder/Contractor and any subcontractor or assignee is not identified on the Prohibited Entities List created pursuant to SFL § 165-a(3)(b).

Additionally, Bidder/Contractor is advised that once the Prohibited Entities List is posted on the OGS Website, any Bidder/Contractor seeking to renew or extend a Contract or assume the responsibility of a Contract awarded in response to this solicitation must certify at the time the Contract is renewed, extended or assigned that it is not included on the Prohibited Entities List.

During the term of the Contract, should the School District receive information that a Bidder/Contractor is in violation of the above-referenced certification, the School District will offer the person or entity an opportunity to respond. If the person or entity fails to demonstrate that he/she/it has ceased engagement in the investment which is in violation of the Act within 90 days after the determination of such violation, then the School District shall take such action as may be appropriate including, but not limited to, imposing sanctions, seeking compliance, recovering damages or declaring the Bidder/Contractor in default. The School District reserves the right to reject any bid or request for assignment for a Bidder/Contractor that appears on the Prohibited Entities List prior to the award of a contract and to pursue a responsibility review with respect to any Bidder/Contractor that is awarded a contract and subsequently appears on the Prohibited Entities List.

I, ___________________________________________, being duly sworn, deposes and says that he/she is the

___________________________ of the __________________________________ Corporation and that neither the Bidder/ Contractor nor any proposed subcontractor is identified on the Prohibited Entities List.

SIGNED

SWORN to before me this

_______________ day of _______________, 20___

NotaryPublic: _________________________

DECLARATION OF BIDDER’S INABILITY TO PROVIDE CERTIFICATION OF COMPLIANCE

WITH THE IRAN DIVESTMENT ACT

Bidders shall complete this form if they cannot certify that the bidder /contractor or any proposed subcontractor is not identified on the Prohibited Entities List. The District reserves the right to undertake any investigation into the information provided herein or to request additional information from the bidder.

Name of the Bidder: ______________________________________________________________________________

Address of Bidder: ______________________________________________________________________________

Has bidder been involved in investment activities in Iran? ________________________________________________ Describe the type of activities including but not limited to the amounts and the nature of the investments (e.g. banking, energy, real estate)

If so, when did the first investment activity occur?_______________________________________________________ Have the investment activities ended? ________________________________________________________________

If so, what was the date of the last investment activity? ___________________________________________________

If not, have the investment activities increased or expanded since April 12, 2012? _____________________________

Has the bidder adopted, publicized, or implemented a formal plan to cease the investment activities in Iran and to refrain from engaging in any new investments in Iran? __________________________________________

If so, provide the date of the adoption of the plan by the bidder and proof of the adopted resolution, if any and a copy of the formal plan. ___________________________________________________________________

In detail, state the reasons why the bidder cannot provide the Certification of Compliance with the Iran Divestment Act below (additional pages may be attached):

I, ____________________ being duly sworn, deposes and says that he/she is the _________________ of the __________________________________ Corporation and the foregoing is true and accurate.

SIGNED

SWORN to before me this

_______________ day of _______________, 20___

Notary Public: _________________________

Form W-9 (Rev. October 2018) Department of the Treasury Internal Revenue Service

Request for Taxpayer Identification Number and Certification

▶ Go to www.irs.gov/FormW9 for instructions and the latest information.

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

P ri nt o r ty p e.

S ee S p ec ifi c

In st ru ct io ns o n p ag e 3.

1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.

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

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

Individual/sole proprietor or single-member LLC

C Corporation S Corporation Partnership Trust/estate

Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ▶

Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner.

Other (see instructions) ▶

4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):

Exempt payee code (if any)

Exemption from FATCA reporting code (if any)

(Applies to accounts maintained outside the U.S.)

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. Also see 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.

Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS 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-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), 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.

If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later.

Cat. No. 10231X Form W-9 (Rev. 10-2018)