HomeMy Public PortalAbout159-2017 - Mikesell Excavating - Demolition - BEPAGREEMENT
THIS AGREEMENT made and entered into this ✓C day of &VII&i 2017, and referred to as
Contract No. 159-2017 by and between the City of Richmond, Indiana, a municipal corporation
acting by and through its Board of Public Works and Safety (hereinafter referred to as the "City")
and Mikesell Excavating, Inc., 652 New Garden Road, New Paris, Ohio, 45347 (hereinafter referred
to as the "Contractor").
SECTION I. STATEMENT AND SUBJECT OF WORK
City hereby retains Contractor to perform services in connection with the demolition and removal of
certain unsafe structures located in Richmond, Indiana, for the Blight Elimination Program (Round 1,
Bid 7) Project (the "Project"), which services shall include demolition, removal of debris, and
restoration of the sites as more specifically set forth in the Notice to Bidders. The structures are as
follows:
Round 1, Bid 7:
Group 23:
77 NW I Street
$9,600.00
79 NW I Street
$8,700.00
121 S loth Street
$13,800.00
132 Richmond Ave.
$18,400.00
210 S 13th Street
$15,100.00
216 N 2 Is' Street
$13,900.00
237 S 14th Street
$13,900.00
407 S 61h Street
$8,100.00
409 N 18th Street
$9,800.00
421 S 9th Street
$10,400.00
632 S 8th Street
$8,500.00
1027 Sheridan Street
$8,200.00
1114 Crosshall Street
$8,000.00
2221 Glen Court
$8,400.00
TOTAL: $154,800.00
Certain Requests for Proposals (BEP Round 1, Bid 7) dated September 9, 2017, including any and all
addendums, has been made available for inspection by Contractor, is on file in the office of the
Director of the Department of Purchasing for the City, and is hereby incorporated by reference and
made a part of this Agreement. Contractor agrees to abide by the same.
Contract No. 159-2017
Page I of 10
dated October 9, 2017, are
Portions of the response of Contractor to said Request for 8) pages, and which Exhibit is hereby
attached hereto as Exhibit A, which portions consist of eight (8) pages,
incorporated by reference and made a part of this Agreement. Contractor agrees to abide by the
same.
re as fully a part of
This Agreement consists of the following ContractacheDocuments, here ond he same asan all particular become
Agreement as if set out verbatim herein or attache
the Agreement between the parties hereto in all matters and things set forth herein and described:
a. This Agreement;
b. All Addenda issued prior to receipt of Bids,
acknowledged by Contractor in its Bid;
C. General Conditions;
d. Special Conditions;
e. Technical Specifications;
f. City Standards and Specifications;
g. Instructions to Bidders;
h. Advertisement or Notice to Bidders;
i. Performance and Payment Bonds;
whether or not receipt thereof has been
j. Contractor's Itemized Proposal and Declarations.
In resolving conflicts, errors, discrepancies, and disputes concerning the nature, character, scope or
extent of Work to be performed or furnished by the Contrar, tor, ormore other
the rights
Contract obligations
of the h e
City and Contract, arising from or prescribe by oneo
following rules shall govern:
a. A requirement occurring in one Contract Document is as binding as though occurring in
all Contract Documents;
b. The Contract Documents shall be given precedence in the order as listed above.
The Contractor shall furnish all labor, material,
equipment, and services necessary which are
incidental to the proper completion of all work specified.
No performance of services shall commence until the following has been met:
1, The City is in receipt of any required certificates of insurance and/or
warranties;
Page 2 of 10
2. The City is in receipt of any required affidavit signed by Contractor in
accordance with Indiana Code 22-5-1.7-11(a)(2);and
3. A purchase order has been issued by the Purchasing Department.
SECTION II. STATUS OF CONTRACTOR
Contractor shall be deemed to be an independent contractor and is not an employee or agent of the
City of Richmond. The Contractor shall provide, at its own expense, competent supervision of the
work.
SECTION III. COMPENSATION
City shall pay Contractor an amount not to exceed the total amount of One Hundred Fifty-four
Thousand Eight Hundred Dollars and Zero Cents ($154,800.00) for complete and satisfactory
performance of the work required hereunder. Demolition permit fees will be waived by the City and
Landfill fees will be discounted by Fifty Percent (50%).
SECTION IV. TERM OF AGREEMENT AND LIQUIDATED DAMAGES
This Agreement shall become effective when signed by all parties and shall continue in effect until
completion of the Project, which completion shall be within thirty (30) days of the date of receipt of
the purchase order by Contractor. A penalty will be assessed and deducted from Contractor's
retainage in the event services are still being performed by Contractor under this Agreement in the
amount of One Dollar ($1.00) per day and per structure (for each structure that remains un-
demolished and/or cleared as required by the Contract Documents beyond the date set forth above)
and the same for each day past the date for completion as set forth above.
It is hereby understood and mutually agreed, by and between the Contractor and the City that the date
of the time for completion of the Project as specified in the Contract documents are ESSENTIAL
CONDITIONS of this Agreement. The Contractor and City acknowledge and agree that the time
allotted by this Agreement for the performance and completion of the Project is reasonable and takes
into account any and all risks and adverse conditions assumed by Contractor hereunder.
The Contractor and Owner recognize and contemplate that unexcused failure by the Contractor to
complete the Work within the term set forth above will cause the City and the Public to suffer
financial losses or inconvenience, the full and exact extend and character of which cannot be
measured as a basis for recovery by the City of actual damages, and that liquidated damages as
prescribed in this Agreement represent a fair, reasonable, and appropriate estimate thereof.
Accordingly, the Contractor agrees that such liquidated damages may be assessed and recovered by
the City, as against Contractor and its Surety, in the event of delayed completion and without the City
being required to present any evidence of the amount or character of actual damages sustained by
reasons thereof.
Notwithstanding the term of this Agreement, City may terminate this Agreement in whole or in part,
for cause, at any time by giving at least five (5) working days written notice specifying the effective
date and the reasons for termination which shall include but not be limited to the following:
Page 3 of 10
a. failure, for any reason of the Contractor to fulfill in a timely and proper manner its
obligations under this Agreement;
b. submission by the Contractor to the City of reports that are incorrect or incomplete in any
material respect;
c. ineffective or improper use of funds provided under this Agreement;
d. suspension or termination of the grant funding to the City under which this Agreement is
made; or
e. unavailability of sufficient funds to make payment on this Agreement.
In the event of such termination, the City shall be required to make payment for all work performed
prior to the effective date by Contractor, but shall be relieved of any other responsibility herein.
This Agreement may also be terminated, in whole or in part, by mutual Agreement of the parties by
setting forth the reasons for such termination, the effective date, and in the case of partial
termination, the portion to be terminated.
SECTION V. INDEMNIFICATION AND INSURANCE
Contractor agrees to obtain insurance and to indemnify the City for any damage or injury to person or
property or any other claims which may arise from the Contractor's conduct or performance of this
Agreement, either intentionally or negligently; provided, however, that nothing contained in this
Agreement shall be construed as rendering the Contractor liable for acts of the City, its officers,
agents, or employees. Contractor shall as a prerequisite to this Agreement, purchase and thereafter
maintain such insurance as will protect it from the claims set forth below which may arise out of or
result from the Contractor's operations under this Agreement, whether such operations by the
Contractor or by any sub -contractors or by anyone directly or indirectly employed by any of them, or
by anyone for whose acts the Contractor may be held responsible.
Coverage
A. Worker's Compensation &
Disability Requirements
B. Employer's Liability
C. Comprehensive General Liability
Section I. Bodily Injury
Section 2. Property Damage
Limits
Statutory
$100,000
$1,000,000 each occurrence
$2,000,000 aggregate
$1,000,000 each occurrence
Page 4 of 10
D. Comprehensive Auto Liability
Section 1. Bodily Injury $1,000,000 each person
$1,000,000 each occurrence
Section 2. Property Damage $1,000,000 each occurrence
E. Comprehensive Umbrella Liability $1,000,000 each occurrence
$2,000,000 each aggregate
SECTION VI. COMPLIANCE WITH WORKER'S COMPENSATION LAW
Contractor shall comply with all provisions of the Indiana Worker's Compensation law, and shall,
before commencing work under this Agreement, provide the City a certificate of insurance, or a
certificate from the industrial board showing that the Contractor has complied with Indiana Code
Sections 22-3-2-5, 22-3-5-1 and 22-3-5-2. If Contractor is an out of state employer and therefore
subject to another state's worker's compensation law, Contractor may choose to comply with all
provisions of its home state's worker's compensation law and provide the City proof of such
compliance in lieu of complying with the provisions of the Indiana Worker's Compensation Law.
SECTION VII. COMPLIANCE WITH INDIANA E-VERIFY PROGRAM REQUIREMENTS
Pursuant to Indiana Code 22-5-1.7, Contractor is required to enroll in and verify the work eligibility
status of all newly hired employees of the contractor through the Indiana E-Verify program.
Contractor is not required to verify the work eligibility status of all newly hired employees of the
contractor through the Indiana E-Verify program if the Indiana E-Verify program no longer exists.
Prior to the performance of this Agreement, Contractor shall provide to the City its signed Affidavit
affirming that Contractor does not knowingly employ an unauthorized alien in accordance with IC
22-5-1.7-11 (a) (2). In the event Contractor violates IC 22-5-1.7 the Contractor shall be required to
remedy the violation not later than thirty (30) days after the City notifies the Contractor of the
violation. If Contractor fails to remedy the violation within the thirty (30) day period provided
above, the City shall consider the Contractor to be in breach of this Agreement and this Agreement
will be terminated. If the City determines that terminating this Agreement would be detrimental to
the public interest or public property, the City may allow this Agreement to remain in effect until the
City procures a new contractor. If this Agreement is terminated under this section, then pursuant to
IC 22-5-1.7-13 (c) the Contractor will remain liable to the City for actual damages.
SECTION IX. IRAN INVESTMENT ACTIVITIES
Pursuant to Indiana Code (IC) 5-22-16.5, Contractor certifies that Contractor is not engaged in
investment activities in Iran. In the event City determines during the course of this Agreement that
this certification is no longer valid, City shall notify Contractor in writing of said determination and
shall give contractor ninety (90) days within which to respond to the written notice. In the event
Contractor fails to demonstrate to the City that the Contractor has ceased investment activities in Iran
within ninety (90) days after the written notice is given to the Contractor, the City may proceed with
any remedies it may have pursuant to 1C 5-22-16.5. In the event the City determines during the
course of this Agreement that this certification is no longer valid and said determination is not
refuted by Contractor in the manner set forth in IC 5-22-16.5, the City reserves the right to consider
Page 5 of 10
the Contractor to be in breach of this Agreement and terminate the agreement upon the expiration of
the ninety (90) day period set forth above.
SECTION X. PROHIBITION AGAINST DISCRIMINATION
A. Pursuant to Indiana Code 22-9-1-10, Contractor, any sub -contractor, or any person acting on
behalf of Contractor or any sub -contractor shall not discriminate against any employee or applicant
for employment to be employed in the performance of this Agreement, with respect to hire, tenure,
terms, conditions or privileges of employment or any matter directly or indirectly related to
employment, because of race, religion, color, sex, disability, national origin, or ancestry.
B. Pursuant to Indiana Code 5-16-6-1, the Contractor agrees:
1. That in the hiring of employees for the performance of work under this Agreement of
any subcontract hereunder, Contractor, any subcontractor, or any person acting on behalf of
Contractor or any sub -contractor, shall not discriminate by reason of race, religion, color, sex,
national origin or ancestry against any citizen of the State of Indiana who is qualified and
available to perform the work to which the employment relates;
2. That Contractor, any sub -contractor, or any person acting on behalf of Contractor or
any sub -contractor shall in no manner discriminate against or intimidate any employee hired
for the performance of work under this Agreement on account of race, religion, color, sex,
national origin or ancestry;
3. That there may be deducted from the amount payable to Contractor by the City under
this Agreement, a penalty of five dollars ($5.00) for each person for each calendar day during
which such person was discriminated against or intimidated in violation of the provisions of
the Agreement; and
4. That this Agreement may be canceled or terminated by the City and all monies due or
to become due hereunder may be forfeited, for a second or any subsequent violation of the
terms or conditions of this section of the Agreement.
C. Violation of the terms or conditions of this Agreement relating to discrimination or
intimidation shall be considered a material breach of this Agreement.
SECTION XI. RELEASE OF LIABILITY
Contractor hereby agrees to release and hold harmless the City and all officers, employees, or agents
of the same from all liability for negligence which may arise in the course of Contractor's
performance of its obligations pursuant to this Agreement.
SECTION XII. ADDITIONAL PROGRAM PROVISIONS
The City of Richmond is entering into this Agreement with Contractor with the understanding that
City has been or will be allocated certain funding from the Indiana Housing and Community
Development Authority ("IHCDA") in order that the City can participate in the IHCDA's Blight
Elimination Program ("BEP"). As a result, the following provisions as applicable to City as the
Page 6 of 10
"Program Recipient" and/or as applicable to Contractor are set forth in this Section. Contractor
agrees that in the event the IHCDA notifies the City and submits any additional applicable laws,
statutes, or guidelines applicable to this Agreement under IHCDA's Program Guidelines for BEP,
said additional provisions shall be attached to this Agreement as an Addendum and executed by the
parties.
A. The Recipient shall carry out the Project in accordance with the conflict of interest provisions
prescribed in 24 CFR 92.356(f).
B. The Recipient and Contractor and any principals of the Recipient and Contractor certify that
(A) it, except for de minimis and nonsystematic violations, has not violated the terms of (i)
IC 24-4.7 (Telephone Solicitation Of Consumers), (ii) IC 24-5-12 (Telephone Solicitations),
or (iii) IC 24-5-14 (Regulation of Automatic Dialing Machines) in the previous three hundred
sixty-five (365) days, even if IC 24-4.7 is preempted by Federal law; and (B) it will not
violate the terms of IC 24-4.7 for the duration of this Agreement, even if IC 24-4.7 is
preempted by Federal law.
C. The Recipient and Contractor and any principals of the Recipient and Contractor certify that
an affiliate or principal of the it and any agent acting on behalf of the it or on behalf of an
affiliate or principal of the Recipient (A) except for de minimis and nonsystematic violations,
has not violated the terms of IC 24-4.7 in the previous three hundred sixty-five (365) days,
even if IC 24-4.7 is preempted by Federal law; and (B) will not violate the terms of IC 24-4.7
for the duration of this Agreement, even if IC 24-4.7 is preempted by Federal law.
D. Meaningful Access for Limited English Proficient Persons. Persons who, as a result of
national origin, do not speak English as their primary language and who have limited ability
to speak, read, write, or understand English ("limited English proficient persons" or "LEP")
may be entitled to language assistance under Title VI of the Civil Rights Act of 1964 ("Title
VI") in order to receive a particular service, benefit, or encounter. In accordance with Title
VI and its implementing regulations, the Recipient and Contractor agree to take reasonable
steps to ensure meaningful access to activities funded with BEP Funds by LEP persons. Any
of the following actions could constitute "reasonable steps", depending on the circumstances:
acquiring translators to translate vital documents, advertisements, or notices, acquiring
interpreters for face to face interviews with LEP persons, placing advertisements and notices
in newspapers that serve LEP persons, partnering with other organizations that serve LEP
populations to provide interpretation, translation, or dissemination of information regarding
the project, hiring bilingual employees or volunteers for outreach and intake activities,
contracting with a telephone line interpreter service, etc.
E. Lobbying Activities. Pursuant to 5 U.S.C. § 1502 and 31 U.S.C. § 1352, as amended from
time to time , and any regulations promulgated thereunder, the Recipient and Contractor
hereby certify that no Federally appropriated funds have been paid or will be paid by or on
behalf of the Recipient or Contractor 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 award, the making of any Federal loan, the
entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment to, or modification of any Federal contract, award, loan, or cooperative
Page 7 of 10
agreement. If any funds other than Federally 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, the Recipient and/or Contractor shall complete and submit Standard
Form-LLL, "Disclosure Form to Report Lobbying".
F. Non -Discrimination Clause. Pursuant to the Indiana Civil Rights Law, specifically including
Indiana Code § 22-9-1-10, and in keeping with the purposes of the federal Civil Rights Act of
1964, the Age Discrimination in Employment Act, and the American with Disabilities Act,
the Recipient and Contractor covenant that they shall not discriminate against any employee
or applicant for employment relating to this Agreement with respect to hire, tenure, terns,
conditions or privileges of employment or any matter directly or indirectly related to
employment because of the employee or applicant's race, age, color, religion, sex, disability,
national origin, ancestry, or status as a veteran, or any other characteristic protected by
federal, state, or local law ("Protected Characteristics"). Furthermore, the Recipient and
Contractor certify compliance with applicable federal laws, regulations, and executive orders
prohibiting discrimination based on the Protected Characteristics in the provision of services.
Recipient and Contractor understand that IHCDA is a recipient of federal funds, and
therefore, where applicable, the Recipient, Contractor and subcontractors of both agree to
comply with requisite affirmative action requirements, including reporting pursuant to 41
C.F.R. Chapter 60, as amended and Section 202 of Executive Order 11246.
G. Maintaining a Drug -Free Workplace (Executive Order No. 90-5). Pursuant to Executive
Order No. 90-5, April 12, 1994, issued by Governor Evan Bayh, the Indiana Department of
Administration requires the inclusion of this certification in all contracts with and grants from
the State of Indiana in excess of $25,000. No award of a contract or grant shall be made, and
no contract, purchase order or agreement, the total of which amount exceeds $25,000, shall
be valid unless and until this certification has been fully executed by the Recipient and
Contractor and attached to the contract or agreement as part of the contract documents. False
certification or violation of the certification may result in sanctions including, but not limited
to, suspension of contract payments, termination of the contract payments, termination of the
contract or agreement and/or debarment of contracting opportunities with the State for up to
three (3) years.
The Recipient and Contractor certify and agree that each will provide a drug -free workplace
by:
1. Publishing and providing to all of its employees a statement notifying
employees that the unlawful manufacture, distribution, dispensing, possession or use of a
controlled substance is prohibited in the Recipient's and Contractor's workplaces and
specifying the actions that will be taken against employees for violations of such prohibition;
and
2. Establishing a drug -free awareness program to inform employees about (1)
the dangers of drug abuse in the workplace; (2) the Recipient's and Contractor's policies 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 an employee
for drug abuse violation occurring in the workplace;
Page 8 of 10
3. Notifying all employees in the statement required by subparagraph (a) above
that as a condition of continued employment the employee will (1) abide by the terms of the
statement; and (2) notify the employer of any criminal drug use conviction for a violation
occurring in the workplace no later than five (5) days after such a conviction;
4. Notifying in writing the contracting State Agency and the Indiana Department
of Administration within ten (10) days after receiving notice from an employee under
subdivision (c)-(2) above, or otherwise receiving actual notice of a conviction;
5. Within thirty (30) days after receiving notice under subdivision (c)-(2) above
of a conviction, imposing the following sanctions or remedial measures on any employee
who is convicted of drug abuse violations occurring in the workplace: (1) take appropriate
personnel action against the employee, up to and including termination; or (2) require such
employee to satisfactorily participate 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; and
6. Making a good faith effort to maintain a drug -free workplace through the
implementation of subparagraphs (a) through (e) above.
SECTION XIII. MISCELLANEOUS
This Agreement is personal to the parties hereto and neither party may assign or delegate any of its
rights or obligations hereunder without the prior written consent of the other party. It shall be
controlled by Indiana law and shall be binding upon the parties, their successors and assigns. It
constitutes the entire Agreement between the parties, although it may be altered or amended in whole
or in part at any time by filing with the Agreement a written instrument setting forth such changes
signed by both parties.
This Agreement may be simultaneously executed in several counterparts, each of which shall be an
original and all of which shall constitute but one and the same instrument.
The parties hereto submit to jurisdiction of the courts of Wayne County, Indiana, and suit arising
under this Contract, if any, must be filed in said courts. The parties specifically agree that no
arbitration or mediation shall be required prior to the commencement of legal proceedings in said
Courts.
Any person executing this Contract in a representative capacity hereby warrants that he has been duly
authorized by his or her principal to execute this Contract.
In the event of any breach of this Agreement by Contractor, and in addition to any other damages or
remedies, Contractor shall be liable for all costs incurred by City due to the enforcement of this
Agreement, including but not limited to City's reasonable attorney's fees, whether or not suit is filed.
In the event that an ambiguity or question of intent or a need for interpretation of this Agreement
arises, this Agreement shall be construed as if drafted jointly by the parties, and no presumption or
Page 9 of 10
burden of proof shall arise favoring or disfavoring any party by virtue of the authorship of any of the
provisions of this Agreement.
IN WITNESS WHEREOF, the parties have executed this Agreement at Richmond, Indiana, as of the
day and year first written above, although signatures may be affixed on different dates.
"CITY"
THE CITY OF RICHMOND, INDIANA BY
AND THROUGH ITS BOARD OF PUBLIC
WORKS AND SAFETY
i
By:
Vicki Robinson, President
am
Richard Foore. Member
Date:
APPROVI
Date:
"CONTRACTOR"
MIKESELL EXCAVATING, INC.
652 New Garden Road
New Paris, OH 45347
r
By: -�eA-Lk
Printed: A C,-r4
•i - [EM TWO a
Date: � t I d-1 I I 1
Page 10 of 10
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ITEMIZED BID PROPOSAL AND DECLARATIONS
Instructions To Bidders:
This form shall be utilized by all Bidders Except as otherwise specifically provided, all parts shall
be fully and accurately filled in and completed and notarized
Bid Proposal for: Blight Elimination Program (BEP) Demolition
Date: 101cp i l -1
To: City of Richmond
PART 1
BIDDER INFORMATION
tint
1.1 Bidder Name:
1.2 Bidder Address: Street Address: to 52 !y t } Cam,_ —den
City. 2-1 1) R"f- 5 State:_ Zip: 4U�4_.
Phone Number: Ft3i) Fax Number: (�31) �-
1.3 Bidder is a/an [markoneJ:
Individual _ Partnership — Indiana Corporation
X Foreign (Out of State) Corporation
_ Joint Venture _
_ MBE WBE VBE
Other:
[The following must be answered if the Bidder or any of its partners or joint venture parties is a
foreign corporation Note: To do business in or with City of Richmond Indiana, foreign corporations
must register with the Secretary of the State of Indiana as required by the `Indiana Code 23-1-49 et
seq " General Corporation Act as stated therein and expressed in the Attorney General's Opinion #2,
dated January 13, 1958.1 _
1. Corporation Name: B-COLU Cb-i nq �c .
2. Address: LD 52 f - i C)-O bardc r) L?d M cw ne s . o ti LI G3q 7
3. Date registered with State of Indiana: q %(!E>
4. Indiana Regisir Agent: �1re � Ci.SSOICL
Name: YtCJOt'lf C- n
Address: CA 1 1 Shff S cc-A-Wt Dr.
Cone � �.Ot��oGl8�1�1
PART 2
BID PROPOSAL and MYVIDUAL STRUCTURE AMOUNTS
2.1 The undersigned Bidder proposes to furnish all necessary labor, machinery, tools,
apparatus, materials, equipment, service and other necessary supplies, and to perform and fulfill
all obligations incident thereto in strict accordance with and within the time(s) provided by the
terms and conditions of the Contract Documents for the above described Work and Project,
including any and all addenda thereto, for the total sum as follows:
Round 1 Bid 7
Demo Group 23
1.
77 NW IT, St.
$ 91pW b Qj(
2.
79 N W " I" St.
$ P>-100 , CY-)
3.
121 S 10'h St.
$ (?, i �[X>
4.
132 Richmond Ave.
$ j S, i MC,, �)
5.
210 S 13'h St.
$ 1 �511 00 ()O
6.
216 N 21s` St.
$ i o, 9 00.00
7.
237S 141'St.
$ 1,�,GOOC�
8.
407 S 61h St.
$
9.
409 N le St.
$ Q
10.
421 S 9 h St.
$ j Q, !—j W
11.
632 S 8`" St.
$ 115Lb
12.
1027 Sheridan St.
$
13.
1114 Crosshall St.
$ B000. �Q
14.
2221 Glen Ct.
$ '6 l 4oO .oc,
For the total lump sum of $ for Demo Group 23..
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IVIA
OH
K YQU fvtf�rrd± b suiwat acn pmftm of IDe wneli� SbA-z lbe crave and at&ens af fir, sw�c�, � ,
equspm, ent ft be used 1w Me and wbolteir ym will reWm a haV�- HbwevAw, iF ym are
urebfie %2 axw%* pmwde a fisdirM4, waderstwd a fistaig nwfst The pnmded r to owVrcm±
aPppanad- UaU the caffiVelm of itte pivposed pMeojoi2 am under, a cDrj4mv%g dVfga6an to
irmwdatelly nuffy *a-- gpoeurnmenUl uzx'h iiT Me evkmt tvRf yeu stbse4mody debam, he Mat 14m wdC use a
sub,rjwftacW en Ve pgzpcsed prqecL
Wh4 eqjFmaql da ym hme aumfebi-a to ws, fix the pacpasEd Pr APTW equpment lb be used by,
submn*acbms nvq at* be weqjmd re be Sisted ty the gmemmea&l LwxL
CIA: F-)(Col toc �?22 P-)L-.,
Haue yeu entmed mto owkmcft cr mmve;-A offems W au' Fadecats vAmd1b sw� #me pnms used. in:
PrePRrhg e Yowl It mdt� pkmsa mplan the ratmmh� used wbch wmM arrobwat&e pmes
ks�
OWINSIUM-WI duiI mak
SECTM 0 COUTRACTOWS, F(NMCtAL STATEMENT
�4 OF bdda-s bwmxgi skaftwmt is mart dagxy Any W submthad wdwrtt said Wmx-ef
543b3venft as re cared by 5L-MNa s h(a t be rendemd wvwabdt noWl slaberomt pmmded bea"sdLmir ba
the %oweming body, awmdng Me mmtact must be spaiNc eta�gi`s in 6W, 5a trim swd qtwemmg W4 cm wokl--
a proper d&WmmmadmT Qf te biideW, capabAq/ liar, mmpleUrtig The pr4pvt C awarded.
SECTION IV CONTRACTOR'S NON — COLLUSION AFFIDAVIT
The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other
member, representative, or agent of the firm, company, corporation or partnership represented by him, entered
into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such
letting nor to prevent any person from bidding nor to include anyone to refrain from bidding, and that this bid is
made without reference to any other bid and without any agreement, understanding or combination with any other
person in reference to such bidding.
He further says that no person or persons, firms, or corporation has, have or will receive directly or
indirectly, any rebate, fee, gift, commission or thing of value on account of such sale.
SECTION V OATH AND AFFIRMATION
I HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS AND INFORMATION
CONTAINED IN THE FOREGOING BID FOR PUBLIC WORKS ARE TRUE AND CORRECT.
Datedat�1��j,j' S O�� this ' day of -20
(Title of Person Signing)
ACKNOWLEDGEMENT
STATE OF Oh I b
COUNTY OF (��` )SS
Before me, a Notary Public, personally appeared the above -named � fl� and
swore that the statements contained in the foregoing document are true and correct.
Subscribed and sworn to before me this day ofy�}t.. l0
fary Pubhc
My Commission Expires:
County of Residence:__1