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Danella Utility Construction Inc.
SECTION 00300 - BID FORM (REVISED —ADDENDUM 3) p8161101 BID TO: The City of Sunny Isles Beach Sunny Isles Beach, Florida 33025 1. The undersigned Bidder proposes and agrees, if this Bid is accepted,to enter into an Agreement with the OWNER in the form included in the Contract Documents (as defined in Article 6 of the Agreement) to perform the Work as specified or indicated in said Contract Documents entitled: City of Sunny Isles Beach Construction of Underground Utility Conduits. 2. Bidder accepts all of the terms and conditions of the Contract Documents, including without limitation those in the Notice Inviting Bids and Instructions to Bidders,dealing with the disposition of the Bid Security. 3. This Bid will remain open for the period stated in the"Notice Inviting Bids" unless otherwise required by law. Bidder will enter into an Agreement within the time and in the manner required in the"Notice Inviting Bids" and the "Instructions to Bidders", and will furnish the insurance certificates, Payment Bond, and Performance Bond required by the Contract Documents prior to Bid Award, and within the time frame indicated by City. 4. Bidder has examined copies of all the Contract Documents including the following addenda(receipt of all of which is hereby acknowledged): Number A Lidenkitnn Date 12/03/201 S A,keniUM 2 121117/ 2.015 Addeo:tom3 12/2812015 Addendum 4 12/22/2QIs 5. Bidder has familiarized itself with the nature and extent of the Contract Documents, Work, site, locality where the Work is to be performed,the legal requirements(federal,state and local laws,ordinances,rules, and regulations), and the conditions affecting cost, progress or performance of the Work and has made such independent investigations as Bidder deems necessary. 6. This Bid is genuine and not made in the interest of or on behalf of any undisclosed person, firm or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization or corporation; Bidder has not directly or indirectly induced or solicited any other Bidder to submit a false or sham Bid; Bidder has not solicited or induced any person, firm or corporation to refrain from bidding; and Bidder has not sought by collusion to obtain for itself any advantage over any other Bidder or over OWNER. 7. Contractor must submit an initial/preliminary construction schedule to undertake and complete this project based on the following information; Notice to Proceed to be issued on February 4, 2016 with a completion date of March 1, 2017. 00300- 1/26 To all the foregoing, and including all Bid Schedule(s)and Information Required of Bidder contained in this Bid Form, said Bidder further agrees to complete the Work required under the Contract Documents within the Contract Time stipulated in said Contract Documents, and to accept in full payment therefore the Contract Price based on the Total Bid Price(s) named in the aforementioned Bidding Schedule(s). All representations made by Bidder in this Bid are made under penalty of perjury. C/'�' 1' DATED: 1/ilia BIDDER: i dlS vill (;OM-I(Uaiici O BY: /' I (Signature) TITLE: O2t AR._s .J -n Sworn to and subscribed to before me in Miami-Dade County, Florida on the 7 dayof(,...—..L.y 20 /o Notary ublic, State o Florida-at-Large: (i My Commission Expires: • ,n p;';.a� LEONA ANN ODIN � SP t•s Notary Public .State al Florida _ •• my comm.Expires nog 29.2018 ii ..• Commission 0 FF 118289 Bonded Though National Notary Assn 0 it .. .- v It .. v w .t -.., e v v i 00300-2/26 • City of Sunny Isles Beach Construction of Underground Utility Conduit Collins & off Collins Avenue SCHEDULE OF BID PRICES PAY ITEM PER 01020 Quantity Unit Unit Costs Base Price 1 Bonds and Insurance 3 % '10000,00 210,000.00 2 Mobilization 1 LS GI135. 01 iei1 ,- 5. 50 3 Maintenance of Traffic 15 MONTH 214/19)5.00 I Si1, 57)0, (O 4 Testing, Surveying and Miscellaneous 1 LS 11.051561),(01 20 S 5550,(DO 5 Indemnification Allowance 1 LS $100 $100 SUBTOTAL DIVISION 1 Install only one(1)-6 inch PVC schedule 40 6 conduit bundled in one main trench with 5,778 LF 45.3 5 '7192,0-32.3o others for FPL Utility (FPL to furnish material) Install only two (2)-6 inch PVC schedule 40 ;f, 7 conduit bundled in one main trench with 1,708 LF 4l,.X15 eo kQ, (pO others for FPL Utility (FPL to furnish material) Install only three (3)-6 inch PVC schedule 40 8 conduit bundled in one main trench with 91 LF Orb.d c 4,454. ,tor, _ others for FPL Utility (FPL to furnish material) Install only one (1)-2 inch PVC schedule 40 9 conduit bundled in one main trench with 691 LF 31,20 25,105,20 others for FPL Utility (FPL to furnish material) Install only two (2)-2 inch PVC schedule 40 10 conduit bundled in one main trench with 286 LF 361st 1 I, ?Al. 00 others for FPL Utility (FPL to furnish material) Install only three (3)-2 inch PVC schedule 40 11 conduit bundled in one main trench with 5,300 LF 14.4 1415 lId, (4095-.CO others for FPL Utility (FPL to furnish material) Install only six(6)-2 inch PVC schedule 40 12 conduit bundled in one main trench with 1539 LF 4-B.4i 5 16.,334.36 others for FPL Utility (FPL to furnish material) Install only nine (9)-2 inch PVC schedule 40 13 conduit bundled in one main trench with 75 LF 51,2.0 3, S40.00 others for FPL Utility (FPL to furnish material) Install only one (1)-6 inch PVC schedule 40 14 lateral conduit bundled in one lateral trench 913 LF -61,40 52, Tl (x•-0 with others for FPL Utility(FPL to furnish material) Install only two(2)-6 inch PVC schedule 40 15 lateral conduit bundled in one lateral trench 659 LF 5c1,co 00 with others for FPL Utility (FPL to furnish material) 00300-3/26 PAY ITEM Quantity Unit Unit Costs I Base Price PER 01020 Install only three (3)-6 inch PVC schedule 40 16 lateral conduit bundled in one lateral trench 327 LF (44 .00 16041. 00 with others for FPL Utility (FPL to furnish material) Install only one (1)-2 inch PVC schedule 40 17 lateral conduit bundled in one lateral trench 1A77 LF IL3, 13, 42-015 with others for FPL Utility (FPL to furnish material) Install only two (2)-2 inch PVC schedule 40 / , 18 lateral conduit bundled in one lateral trench 495 LF 6.3, Z 5 31, 8.75 with others for FPL Utility(PL to furnish material) Install only three (3)-2 inch PVC schedule 40 /' 19 lateral conduit bundled in one lateral trench 1,397 LF (iy.0(7 �f(( (3.8° with others for FPL Utility (FPL to furnish material) Install only six (6)-2 inch PVC schedule 40 20 lateral conduit bundled in one lateral trench 1,388 LF '73a 101 , 324,00 with others for FPL Utility (FPL to furnish material) Install only one (1)-6 inch PVC schedule 40 21 lateral conduit in one lateral trench exclusive 720 LF 1ll. 15 gj1 (o(p(j.00 for FPL Utility (FPL to furnish material) Install only two (2)-4 inch PVC schedule 40 22 lateral conduit in one lateral trench exclusive 63 LF 12115 I T&,p, '2-5 for FPL Utility(FPL to furnish material) Install only three (3)-4 inch PVC schedule 40 23 lateral conduit in one lateral trench exclusive 215 LF 12,15 /L(a,115, 25 for FPL Utility(FPL to furnish material) Install only six(6)-4 inch PVC schedule 40 24 lateral conduit in one lateral trench exclusive 351 LF 151.0053,&I •co for FPL Utility(FPL to furnish material) Install only one (1)-2 inch PVC schedule 40 25 lateral conduit in one lateral trench exclusive 129 LF 12,50 1( 14 32.c for FPL Utility(FPL to furnish material) 26 Install only feeder splice box for FPL Utility 11 EA (FPL to furnish material) Z31� �� 110,I Z�'OD Install only concrete pad for vista switch 27 cabinets for FPL Utility (FPL to furnish 18 EA 2353,00 LI.'coo.in material) 28 Install only 50° splice box for FPL Utility(FPL 20 EA 1115,00 I '3 905.00 to furnish material) 29 Install only 48"handhole for FPL Utility (FPL to 2 EA 1140 ©() `Z,350,Q7 furnish material) 30 Install only 30"handhole for FPL Utility (FPL to 2 EA (ppl, CO I ( i 20n furnish material) 31 Install only 24"handhole for FPL Utility (FPL to 18 EA (oQO.t 0 I (o , eco 00 furnish material) 32 Install only 12'x8' manhole for FPL Utility(FPL 1 EA S065.061 6,''b5.co to furnish material) Install only concrete pad for transformers, r1n 33 capacitor banks and fuse cabinets for FPL 26 EA ' 1�J•( ) 31 `t , .GO Utility(FPL to furnish material) 00300-4/26 Proposal From: Danella Utility Construction Inc. Project: COLLINS AVE UTILITY UNDERGR 170 Commerce Rd Description: OH/UG CONVERSION ON COLLINS Unit 5 AVE IN SUNNY ISLES FL Boynton Beach, FL 33426 Phone: 561-327-5320 Fax: 561-327-5319 ITEM DESCRIPTION BID QTY U/M UNIT BID AMOUNT General Items 1 Bonds and Insurance 3.000 % 70,000.00 5210,000.00 2 Mobilization 1.000 LS 61,735.50 $61,735.50 3 Maintenance of Traffi 15.000 Month 26,500.00 $397,500.00 4 Testing, Surveying a 1.000 LS 205,550.00 5205,550.00 5 Indemnification Allow 1.000 LS 100.00 $100.00 General Items Section Total: $874,885.50 Labor and Equipment 6 One 6" PVC SCH 40 5,778.000 LF 45.35 $262,032.30 7 Two 6" PVC SCH 40 1,708.000 LF 46.95 580,190.60 8 Three 6" PVC SCH 4 91.000 LF 48.95 $4,454.45 9 One 2" PVC SCH 40 691.000 LF 37.20 525,705.20 10 Two 2" PVC SCH 40 286.000 LF 39.50 511,297.00 11 Three 2" PVC SCH 4 5,300.000 LF 41.45 5219,685.00 12 Six 2" PVC SCH 40 1,539.000 LF 48.95 $75,334.05 13 Nine 2" PVC SCH 40 75.000 LF 51.20 53,840.00 14 One 6" PVC SCH 40 913.000 LF 57.40 $52,406.20 15 Two 6" PVC SCH 40 659.000 LF 59.00 538,881.00 16 Three 6" PVC SCH 4 327.000 LF 61.00 $19,947.00 17 One 2" PVC SCH 40 1,477.000 LF 63.25 $93,420.25 18 Two 2" PVC SCH 40 495.000 LF 63.25 $31,308.75 19 Three 2" PVC SCH 4 1,397.000 LF 69.00 596,393.00 20 Six 2" PVC SCH 40 L 1,388.000 LF 73.00 $101,324.00 21 One 6" PVC SCH 40 720.000 LF 121.75 $87,660.00 22 Two 4" PVC SCH 40 63.000 LF 121.75 $7,670.25 23 Three 4" PVC SCH 215.000 LF 121.75 $26,176.25 24 Six 4" PVC SCH 40 351.000 LF 151.00 $53,001.00 25 One 2" PVC SCH 40 129.000 LF 92.50 $11,932.50 26 Install Feeder Splice 11.000 EA 2,375.00 $26,125.00 27 Install Concrete Pad 4.000 EA 2,350.00 $9,400.00 28 Install 50" Splice Box 20.000 EA 1,775.00 $35,500.00 29 Install 48" Handhole 2.000 EA 1,190.00 $2,380.00 30 Install 30" Handhole 2.000 EA 601.00 $1,202.00 31 Install 24" Handhole 18.000 EA 600.00 $10,800.00 32 Install 12'x8' Manhole 1.000 EA 8,885.00 $8,885.00 33 Set Concrete Pad for 40.000 EA 785.00 $31,400.00 34 Two 4" PVC SCH 40 2,524.000 LF 39.50 $99,698.00 35 Three 4" PVC SCH 4 4,532.000 LF 41.30 $187,171.60 36 Five 4" PVC SCH 40 1,181.000 LF 44.80 $52,908.80 Danella Utility Construction Inc. PAY ITEM Quantity Unit Unit Costs Base Price PER 01020 Supply and install only two (2 )-4 inch PVC 34 schedule 40 conduit bundled in one main 2,524 LF 3Cj,5 ��(, (.0%.00 trench with others for Atlantic Broadband Supply and install only three (3 )-4 inch PVC 35 schedule 40 conduit bundled in one main 4,532 LF 41. 30 10'1 1-1 I.(pc trench with others for Atlantic Broadband Supply and install only five (5)-4 inch PVC 36 schedule 40 conduit bundled in one main 1,181 LF 44.So 52A,Cj 06,‘60 trench with others for Atlantic Broadband Supply and install only six (6 )-4 inch PVC 37 schedule 40 conduit bundled in one main 4,573 LF 4u 55 2121 513.15 trench with others for Atlantic Broadband Supply and install nine (9)-4 inch PVC 38 schedule 40 conduit bundled in one main 111 LF 5373 35 (0 i )I{-3,S j trench with others for Atlantic Broadband Supply and Install three (3)-4inch PVC schedule 40 lateral conduit bundled in one 39 lateral trench with others for Atlantic 1013 LF (,%.5 D Coq,3qo,5D Broadband Supply and Install four(4)-4inch PVC schedule 40 40 lateral conduit bundled in one lateral trench 397 LF '70.30 0:1,409. 10 with others for Atlantic Broadband Supply and Install five (5)-4inch PVC schedule 41 40 lateral conduit bundled in one lateral trench 36 LF 11.Cj0 28x4, 41-0 with others for Atlantic Broadband Supply and Install six (6)-4inch PVC schedule �e !� G 42 40 lateral conduit bundled in one lateral trench 2,290 LF 1-I.(16 14j' 2,3"1D(1 SCI with others for Atlantic Broadband Supply and Install seven (7)-4inch PVC schedule 40 lateral conduit bundled in one 43 lateral trench with others for Atlantic 42 LF Si 5-1) 3 i�23,(� Broadband Supply and Install eight (8)-4inch PVC 44schedule 40 lateral conduit bundled in one lateral trench with others for Atlantic 231 LF �j7J 2fj 2,0,2 0 Broadband Supply and Install nine (9)-4inch PVC schedule 45 40 lateral conduit bundled in one lateral trench 528 LF 5,C0 44, Se0•OQ with others for Atlantic Broadband Supply and install twelve (12)-4 inch PVC 46 schedule 40 lateral conduit in one lateral 38 LF cN'00 3,1(02,.cc trench for Atlantic Broadband Supply and install two (2)4 inch PVC schedule 47 40 lateral conduit in one lateral trench 65 LF q I ,ST) 5 ,Gly 7. 50 exclusive for Atlantic Broadband Supply and install three (3)-4 inch PVC �^ 48 schedule 40 lateral conduit in one lateral 163 LF 111, (N 15IGi 41. 40 trench exclusive for Atlantic Broadband Supply and install six(6)4 inch PVC schedule 49 40 lateral conduit in one lateral trench 99 LF 114.80 11 13(15, 20 exclusive for Atlantic Broadband 00300-5/26 PAY ITEM Quantity Unit Unit Costs Base Price PER 01020 • 50 Supply and install 30"x 48"x36" handhole for 73 EA 1530.00 16I ,lA0.00 Atlantic Broadband Supply and install two (2 )-4 inch PVC schedule 51 40 conduit bundled in one main trench with 1,154 LF 39.(e0 /1.5 1(.M ,y-Q others for AT&T Supply and Install two (2)-4inch PVC schedule 52 40 lateral conduit bundled in one lateral trench 198 LF (g0.el 0 (2105(6.20 with others for AT&T Supply and install one (1)-4 inch PVC schedule 53 40 lateral conduit in one lateral trench 142 LF 77 (D5 1 1 1 0 L(p,/R) exclusive for AT&T Supply and install two (2)4 inch PVC schedule 54 40 lateral conduit in one lateral trench 99 LF q(o,w 4 1 5134.(D exclusive for AT&T 55 Supply and install 30"x 48"x36" handhole for 9 EA 1530,00 13,110.00 AT&T Supply and install two (2 )-4 inch PVC schedule _ 56 40 conduit bundled in one main trench with 4,435 LF ,SD 175, 182.50 others for Comcast Supply and install three (3 )-4 inch PVC 57 schedule 40 conduit bundled in one main 5,381 LF LFI 25 221 , 9.(4. 25 trench with others for Comcast Supply and install four(4 )-4inch PVC schedule 58 40 conduit bundled in one main trench with 322 LF 1440.5 114-/q 2)C). (0 others for Comcast Supply and Install two (2)-4inch PVC schedule 59 40 lateral conduit bundled in one lateral trench 909 LF ( i4.,SD 5S,(03 015C with others for Comcast Supply and Install three (3)-4inch PVC 60 schedule 40 lateral conduit bundled in one 316 LF S5O 21 , 64(.0.00 lateral trench with others for Comcast Supply and Install four(4)-4inch PVC schedule 61 40 lateral conduit bundled in one lateral trench 905 LF 1(p.(` ' LoB,i SO,op with others for Comcast Supply and Install five (5)-4inch PVC schedule 62 40 lateral conduit bundled in one lateral trench 39 LF ig.00 31 C I2.a3 with other for Comcast Supply and Install six (6)-4inch PVC schedule 63 40 lateral conduit bundled in one lateral trench 631 LF 431+,OD 53,co4-00 with other for Comcast Supply and Install eight(8)-4inch PVC 64 schedule 40 lateral conduit bundled in one 62 LF 81 CO 51 361'- .M lateral trench with other for Comcast Supply and install two (2)-4 inch PVC schedule 65 40 lateral conduit in one lateral trench 54 LF t 02,5D 51 J exclusive for Comcast Supply and install six (6)4 inch PVC schedule 66 40 lateral conduit in one lateral trench 103 LF [(0 .00 101(OM do exclusive for Comcast 67 Supply and install 24"x 48"x36" handhole for 54 EA 1530.00 t 2,(c2O Ob Comcast 00300-6/26 PAY ITEM Quantity Unit Unit Costs Base Price PER 01020 Supply and install two (2)-2 inch PVC schedule 68 40 conduit bundled in one main trench with 78 LF (-1.D.10 3,(042--50 others for Hotwire Supply and Install two (2)-2 inch PVC schedule 69 40 lateral conduit bundled in one lateral trench 344 LF 'SB 15 20,210 .00 with other for Hotwire Supply and install two (2)-2 inch PVC schedule �^ 4 70 40 lateral conduit in one lateral trench 33 LF q 4. w 3,102.00 exclusive for Hotwire Supply and install directionally bored two (2)- 71 2" HDPE for Hotwire including profile 5,287 LF 24-.00 I2k,,ess.cc construction drawings 72 Supply and install 24"x 36"x18" handhole for 11 EA 11153.00 I (Q Z50.00 Hotwire 73 Supply and install 30"x 48"x24" handhole for 1 EA n5D.00 1 ,150. 00 Hotwire Supply and install one (1)-2 inch PVC schedule 74 40 conduit bundled in one main trench with 9,003 LF ,(0.(,5 3Z9),156I.(DC J others for Street Lighting Supply and install two (2)-2 inch PVC schedule p 75 40 conduit bundled in one main trench with 98 LF 51.95 x,081 . 30 others for Street Lighting Supply and Install one (1)-2 inch PVC schedule 76 40 lateral conduit bundled in one lateral trench 115 LF 64.00 3(9o. with other for Street Lighting Supply and Install two (2)-2 inch PVC schedule 77 40 lateral conduit bundled in one lateral trench 706 LF C14,DO OBJ,3104.00 with other for Street Lighting Supply and Install three (3)-2 inch PVC 78 schedule 40 lateral conduit bundled in one 54 LF 14-00 5,0r1(Q,e0 lateral trench with others for Street Lightinq Supply and install one (1)-2 inch PVC schedule 79 40 lateral conduit in one lateral trench 581 LF I 36)-CO SO 11 -CX) exclusive for Street Lighting Supply and install two (2)-2 inch PVC schedule 80 40 lateral conduit in one lateral trench 1,113 LF 206.00 226,((pS,W exclusive for Street Lighting Supply and install one (1)-2 inch PVC schedule 81 40 conduit in a separate trench exclusive for 13,569 LF '5 ,Q(, ( ,0(1 , (045400 Street Lighting 82 Supply and install 271/2°X18"X12" pull box for 154 EA Sis .00 126,5 10.00 Street Lighting Supply and install 30" diameter concrete 83 foundation for Street Lighting as per sheet L- 111 EA 21/30.00 2.Cj 1, i 30.CO 30 of FOOT Lighting Plans Supply and install concrete spread footer 84 foundation for Street Lighting as per sheet L- 3 EA (050.CO 3,150 .00 31 of FOOT Lighting Plans Supply and install four(4)-2 inch PVC schedule 85 40 conduit bundled in one main trench with 13,069 LF Z21,10 505,110 .30 others for City conduit 00300-7/26 • PAY ITEM • Quantity Unit Unit Costs Base Price PER 01020 Supply and Install four(4)-2 inch PVC schedule 86 40 lateral conduit bundled in one lateral trench 407 LF 66,10 2(G,13A-I0 with other for City conduit Supply and Install eight(8)-2 inch PVC 87 schedule 40 lateral conduit bundled in one 316 LF 63,1'5 2C0, 3 01.00 lateral trench with other for City conduit Supply and Install twelve (12)-2 inch PVC 88 schedule 40 lateral conduit bundled in one 81 LFCI 5 (✓,C( (01.6K lateral trench with other for City conduit Supply and install four (4)-2 inch PVC 89 schedule 40 lateral conduit in one lateral 144 LF 0,(00 ( I U 0(r.cj-0 trench exclusive for City conduit Supply and install eight (8)-2 inch PVC 90 schedule 40 lateral conduit in one lateral 785 LF g 3, Z4) 1/2,351. 26 trench exclusive for City conduit Supply and install twelve (12)-2 inch PVC 91 schedule 40 lateral conduit in one lateral 49 LF CO, (.OD 4-1-1q 261.40 trench exclusive for City conduit 92 Supply and install 24°X13°X12° pull box for 45 EA 1110 .00 2-4-,203.03 City conduit 93 Flowable fill 1000 CF 4, („+Q I 4,(o00.OD Milling of existing asphalt pavement (2 '/z" 94 average depth) 8,606 SY 4.10 40,44412D 95 Superpave Asphaltic Conc, Traffic C (1 %) 702 TN 161'5 .0O I (3(v,V11O,00 96 Asphalt Concrete Friction Course, Traffic C, 468 TN 2k0.00121 ,(oel�•() FC-9.5 (1°) TOTAL BID PRICE (BID ITEMS 1 THROUGH 96) $ $� yfg5 5'15,071 Note unit prices for items 6 to 92 shall include: the cost of roadway, driveways, pavement markings, landscaping, sod, curb and sidewalk restoration associated with this work. Asphalt restoration to be completed in two lifts, minimum 3/4" each. BASE BID PRICE $ 1 ,+5 , 5115.00 rw (li o& , fowl ntk + Klat fl `14-cAec _ ; biue v1kr dnoo( sv �ut c1 2 e'to C U 1) (WRITE AMOUNT IN WORDS) 00300-8/26 AMOUNT SHALL BE SHOWN IN BOTH,WORDS AND FIGURES. IN CASE OF DISCREPANCIES,THE AMOUNT SHOWN IN WORDS SHALL GOVERN. TOTAL AMOUNTS SHALL BE SHOWN ON BOTH WORDS AND FIGURES. IN CASE OF DISCREPANCIES, THE AMOUNT SHOWN IN WORDS SHALL GOVERN FOR EACH BID ITEM AND TOTAL BASE BID OR TOTAL ALTERNATE BID. Bidder acknowledges that included in the various items of the bid proposal and the TOTAL BASE BID PRICE and ALTERNATE BID PRICE, are costs for complying with the Florida Trench Safety Act, F.S. 553.60 et. Seq. The Bidder by signing and submitting the trench Safety Act Compliance Statement is, in writing, assuring that it will perform any trench excavation in accordance with applicable trench safety standards. 00300-9126 INFORMATION REQUIRED OF BIDDER LIST OF SUBCONTRACTORS: The Bidder shall list below the name and the location of the place of business of each subcontractor who will perform work or labor or render service to the prime contractor in or about the construction of the work or improvement, or a subcontractor licensed by the State who, under subcontract to the prime contractor, specially fabricates and installs a portion of the work or improvement according to detailed drawings contained in the plans and specifications, in an amount in excess of one-half of 1 percent of the prime contractor's total bid. The Bidder shall also list below the portion of the work, which will be done by each subcontractor under this Contract. The prime contractor shall list only one subcontractor for each portion as is defined by the prime contractor in its bid. The Bidder's attention is directed to the provisions of Paragraph entitled"Subcontract Limitations,"of the Supplementary General Conditions which stipulates the percent of the Work to be performed with the Bidders'own forces. Failure to comply with this requirement will render the Bid non-responsive and may cause its rejection. Subcontract Percent of Subcontractor's Name Work to be Performed or License Total Contract & Address Number M �l t Over(Qy °7o i—Tett 1 cov Cft e 54r i 049 GSsO GrigiA ed.itioz Traciic Lis Q,vie ,FL- 33314 2. D;ceV-t'onAI Drilli q &curet Drill,^gSya-ierv6 U Po. Qox 303S' Lc+bell1?.,FL 339x75 3. Ccx,cfc(-c / (awcr a 04 Naiest e4i- (muck de + holt Rtsk .cc l on ac \ SW L14'' Ave .At 'I }c, ,cs4cat-, FL &30 4. ACI r1A`1I I lAGu1io3 Tck Tcc sr�r� Coro J 9830 SR &M -Sulk io 1)cnic. &r•Gck1 FL ?,'3 ja 5. /OCT 3% Roodp$a TCa41,c Sysacrks 1305 ifJE 1i9kk S4 M Ifir^i , fl- 3316_( 6. Note: Attach additional sheets if required. 00300- 11/26 NAMED EQUIPMENT / MATERIAL SUPPLIER LIST: The Contract Documents are based upon the equipment or products available from the suppliers listed below. Provisions are made in the Contract Documents for alternate suppliers in certain instances whose equipment or products may be deemed equivalent in quality (reference Article 6.4 of the General Conditions). However, the Bidder must indicate in its Bid which named supplier the Bidder intends to use (in the event an alternate is not accepted)for each item of equipment/material item listed on this form by circling one of the listed Suppliers below for each type of equipment/material noted. Should a Bidder fail to circle a named item in any category it hereby agrees to furnish the first supplier listed (denoted by the letter A). Should a Bidder circle more than one named item in any category it hereby agrees to furnish the first supplier circled. In addition,where noted on the list,the Bidder must provide a price for the equipment/material item circled exclusive of installation cost. The value referenced is included in the Total Base Bid Price. Where"or equal"is specified in the technical specifications,the Bidder may write in the proposed"or equal" Supplier name in the"OR EQUAL"SUPPLIER/MATERIAL SUPPLIER LIST, but it must nevertheless also circle one of the listed Suppliers below. If the proposed"or equal"Supplier is not accepted by the ENGINEER, the Bidder must furnish the circled Supplier as noted above. Equipment/ Material Item Supplier PVC, OPE/ unvdholes A. Gatto1 bco f B. A. B. A. B. A. B. 00300- 12/26 "OR EQUAL" SUPPLIER/ MATERIAL SUPPLIER LIST: The Bidder proposes the following "or equal" Suppliers for the equipment or material categories so identified: Equipment or Material Alternate Supplier Item Specification Section (list one only per item) ,. 1141 N/A N /A 2. 3. 4. 5. The acceptance of equipment or materials by the proposed "or equal" Suppliers shall be at the sole discretion of the OWNER based on the SUBSTITUTES OR "OR EQUAL" ITEMS requirements of the General Conditions. Note that only one "or equal" Supplier may be proposed per Equipment or Material Item. In the event that the single proposed "or equal" item is not ultimately accepted by the OWNER, the CONTRACTOR shall furnish the named equipment / material item per the NAMED EQUIPMENT / MATERIAL SUPPLIER LIST. 00300- 13/26 N mo $ " m e E e m n e e em n n 102-' E c =` c n E p m p - 0 c = a c pug E.m E c-7 c c o _ z o 0 0 - e ma =OE < o a• _ 3 .aoos mol mos .mmoE J°' s mr- " .ala _ns n a Q� .fir b - c mm m we wg_ .p-® m - .Don ee 3 m- rom = wN a bN n - °N 'gym �{y goE `m'® 3mo® Sm® biaL nell �® o�® E^® ^® 30® c^®_ r®_ nm°O� m e a c aEE 'I'-2.3> a 5 c moo a= =, 3° a a 9 a E E 0-22 a 0 _ °-0-8. 7= = :-ES a _ O a a 0� vQ E a > - o-r - om a- a O - 9U n og0 vim^. E .CG C �(J U aN J 2 C� UK �Q Oa Cci -209„ o- `o °mom 20 > _203 a _ _ o �, Eat o=a o: EJ o E _I c ° o LL'Ya 3 LL O o LL K LL 3 3 L O o LL¢ LL W a LL O? g° oz o ^ V° 00 v 0 0 o 0i a co o 0 u m _ v ± o ,om P. o C o 8 m E w E E m U J E m = m m a m ° 0 0 ° _ _ a - _ _ t - o c x e ..a n m U 'o e > > > �. _ _ o p O 9 O q q - O C O _ v OV-. a m m m m m 0 m 0 0 0 2 m C O a O O_ O O O_ O W O 0 o 0 o LL `o L_ 9 0 - V2 a 'a C LL LL LL a a LL LL - U- LL 2 a -_ C 4 S O O S S O g g g 0 0 m g - C 0 m o m �Irj - �O y, •m E O N Vg O m 0 g O t° t0 0 N m N 0 E of vi p- e - N a q m 0 Q N m m0 0 m `7 o r n 0 r - v0i O o 45 45 w w w w '^ w w '" w 4' O e G ' 9 a N N NO- N S 0 9 = H-'-o e N-_o u ?a v . 6. Nom -4 N B N 0 r N m mm N m g E m e n EN ° oN N oN "' EN NDN N^-N N° E E E2 N`= - N •` 0 Nm 0C%1 - m o oU `o nee, cuc`o aoc`o 30 `o moa =�01 0 0 £ o EQ `2 '0� .2 Ug 'o, Igo -$E a- E Q 918 f of T E f '2a 518 - vo 09 ¢_ za 188 gc z9 U6 Jam aOo 0 g OLLO LC LO QOLO O ac-o Oa-O 90 a Oa9 m Cu a � ^ cm. ao mEZ meO Z _ Z muC NOZ 0o0 t00 Va m Vit UaNQVQ Q ,Q U o No U V U U U U 0 m -O 0 3 c o on V v v U 0 0 8 C mm `a _, c -to ° E 'mc o ov " mm'o c=m , ..a r a " o E-o` n 9 m= 9 c a a 9 !'6,-) E2 > w v 3 2,30E2-2 n 0 g a m 2f o 6 P v ac a 9 d ^ c o ^ d ^ c a a a w , e2-.7, 042=_ = m- o '0 m- E ^ u m0 �°9 LL :: U qQ and Na 2g2 =,4 3O E _ e 5Ca m0 o c2oa 3 vc u `0I a„ 3 _ acv 67-,E o = n$u) o C 30 No3 . 0t r5=de - '00 o E c o-rE $ - 9 ao ao$c 0018 ga E Ln `3dc 'ew.v 0 -cc F . . =o °mo a ,0 0 0 3°u j`O2_a0°o¢ ov ° ro= oca_ eao a � ° 0v nh Zou oa a 18LLs E < = I- `o b co- 'og - 03 UOV nmV 00 .2 033 co 2 psg=oo °SE Eqc e8 2 18 -2 c g E o 00 o ° o a `Q a E E o 0g 8' m - -m„ ° 9a a'C 90g uoo 0 0 m9 Mc 0=3 as ooa0 = AS - e = - mE 3c _ Ea _ o nv 2aa c o: c 2 9n go= 2 V o aa -t1 cv° ma 20 cd wnE >ooE noPO °-2 a- o 3'c° o.cc 0 Z 0 n o o ' not cTO ° ocg O c c ^ a Ba o g: 42 ''' '88 o e . `o 9e ^ EQ? En Qom EE o 18.0 2 `c£ 4 oc o 2000 b ^ c° gm g goy _a6 60, C. Zaa= 0 ;E6= 900 00z °oc 94 300 m .0 -0', m E Ee n� 9 um o Ea ELz= =moo m rQ m.u .°� 'D.- :E29 o u? - gN mgr E a3 ^ •r, 4a m o q oo� wag =''g o m Sap < N 12 - LL 3< =o2an 3g : 9u oQ E 2222 ma - ocac lett c- o= = oa ° v 1n>9 ° 32 _ °uu Qo mq - a § s ="' ° ev �m m 18`318 3 m' o b6 >- m m 2 4420 -^18 218 u of 000 E -u ' - mG 0m.oE $ o `uE mmU-` 3n a ii n° �a 2ry599p Eo ^ tag vg _`o o'9V gm mo o £j- 3a m- om>g o _ 2m m_ mE 0 - 3m -a 3 ^ 3 ^ a gN n o = oa - vi > actin- 9 o m0 m Som 7 2 m ?E _-__ `o = S2 E Q 3 - 9 3 &" e0 „ - N n _ g v o ^ 3 age '-2.°- m o =ow - - - _ 0 E o 9 u o E E a. H w an UI m CO to 20 U - _co S - _ -c. _ a eS _ S - - - o 0 0 o u 0 2 0 0 0 0 - a 9 9 m V V 8 88 Q Q Q Q Q Q Q C a o ° E rm � E0 ^ 3 9 = _� 9 > 0 o c 0- q ' 0 4 = coo 0 m m O U a 0 a 0 LL a' 2 0 0 N v J g O U g0 W g 5 a o _ G Ca U o H 0 — Z Q Ell G y ° ^ to W N q � ^ 9 2 5a- 0 0=0- S 0 = m e °o � o ma z a o mn o 0 00 ' m° ° co_ m° oo °= v w ¢ v 2- E = t20 f2 a0 C() w 9 cc 0 02 0 Ofta3 p a' C a �° mo 0 " c ° Srclia ” w 0 S= ' G£ o ra ew a` m m 0 oz 0 fou 1800 ' m a 0, O 0 / !| !{} /\? \! oi ei 0 O }}; !!7 o° ( : §\ \(} »{} \ti { !o °/! } ) } \ \ \ - \) a� §!; = ti co 0 0 co in 40] §{ (0 - 82o2 00 60 i0 co 0 :- So _ »\_ pa \ \ t \\ ƒ t / `a � ) i _ _ - 02 - , — - 0 / °-§U ! !} / ] (` E- /2 13 5 / _ I . 5 8 2 2 / \)G ) ) • e -!5 { /\ -„ BIDDER'S GENERAL INFORMATION: The Bidder shall furnish the following information. Additional sheets shall be attached as required. Failure to complete Item Nos. 1, 3, and 8, will cause the bid to be non-responsive and may cause its rejection. In any event, no award will be made until all of the Bidder's General Information (i.e., items 1 through 8, inclusive) is delivered to the OWNER. (1) CONTRACTOR's name nd address: Dav dIA U4 14y C�onMFrLt ion (jo CAMivte c9 (?oad, \ni-1 5 Goyv>.-lon Beatin ,FL- 3342C, (2) CONTRACTOR's telephone number: (cGt)-32fl —532° (3) CONTRACTOR's license: Primary classification: &Oft-A CcrrkenCkor State License No. and Expiration Date: (GC 15/S 19x AU F 31`t ,g0tCo Supplemental classification held, if any: Name of Licensee, if different from (1) above: (4) Name of person who inspected site of proposed Work for your firm: Name: Fmk, B Date of Inspection: I2I�1115 (5) Name, address, and telephone number of surety company and agent who will provide the required bonds on this contract:SlMki55 krAl ,tnL• 2 Pool I Utt jCQ,Rick Pool;jPA Ig13o1 (blo) 727—S351-I (6) ATTACH TO THIS BID the experience resume of the person who will be designated chief construction superintendent or on-site construction manager. (7) ATTACH TO THIS BID a financial statement, references, and other information, sufficiently comprehensive to permit an appraisal of CONTRACTOR's current financial condition. (8) List four projects completed as of recent date, involving work of similar type and complexity (Use separate sheet if required): Contract Name, address and tele- Project Price phone number of OWNER 1. Mar aariiavi Ile, PPI_ t 2,4`15;83960 FJoc'idA RD,Jer tL�a� el74-41S--9433 2. Col1ie16004-lyO1It•03 324oln91013`7 CohjewCouMy(L34)-252-383(, 3.MOrorail Extension SGTI Z,4s3.q(o Fla-iagfL+ercLAi j1305)-& 1-144q 4.-TJI 5&4)00 i4 f t,862,G36.6I Tov+n TSkxT'J (_992)-9-15-01W UndLC6nafindiu1 See, 44140 For More.. 00300- 14/26 • BID BOND • STATE OF Pennsylvania COUNTY OF Chester ) SS: • KNOW ALL MEN BY THESE PRESENTS, that we, Danella uti litiy Construction, INc. Liberty Mutual Insurance Company , as principal, and • , as Surety, are held and firmly bound unto the City of Sunny Isles Beach, (hereinafter called "the City"), a municipal corporation of the State of Florida in the penal sum of Five Percent (55%) of Total Bid Amount Dollars($ ),lawful money of the United States,for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators and successors jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION IS SUCH that whereas the principal has submitted the accompanying bid, dated January 7, 20 16 Collins Avenue Utility Undergrounding, Bid No. 15-12-02 For: NOW, THEREFORE, (a) if said bid shall be rejected, or (b) if said bid shall be accepted and the Principal shall properly execute and deliver to said City the appropriate Contract Documents, and shall in all respeds fulfill all terms and conditions attributable to the acceptance of said bid, Then this obligation shall be void. Otherwise, it shall remain in force and in effect, being expressly understood and agreed that the liability of the Surety for any and all claims hereunder shall in no event exceed the amount of this obligation as herein stated. The Surety,for value received, hereby agrees that the obligations of said Surety and/or its bond shall in no way be impaired or affected by any extension of time within which the City may accept such bid; and said Surety does hereby waive notice of any extension. IN WITNESS HEREOF,the above bonded parties have executed this instrument under their several seals this 7th day of January 20=16, the name and the corporate seal of each corporate party being hereto affixed and these presents being duly signed by its undersigned representative. 00300-15!25 • • IN PRESENCE F: !Sanel la 0 i aiNviiv�(SE )the Wrtne (Individual or Partnership Principal) C)--- • (10 COW1M h& Pt Witness (Business Address) • &tintAv 6atin, F(, 3N4z.0 • (City, State, Zip) 5101 - 321 . 5320 (Business Phone) ATTE n oari —J DANELLA UTILITY CONSTRUCTION, INC. S etary (Corporate Principal)' By:K</-1/4'Jr Y - m' (Title) A I LIBERTY MUTUAL INSURANCE COMPANY Stve?eigy Theresa Bassett, witness (Corporate S • )' Impress Corporate Seal - �_ D� ipan, Atte .ey in Facc � � - IMPORTANT: Surety companies executing bonds must appear on the Treasury Department's-most current list(circular 570 as amended) and be authorized to transact business in the State of Florida. • 00300-16/26 • THIS POWER OF ATTORNEYIS NOT VALID UNLESS IT IS:PRINTED ON RED-BACKGROUND:. - -This Power,of Attorney limits the acts of those named herein;and they have no authority to bind the_Company except in_the manner and_to the extent herein stated.-3_ " _ _ No.,se9asel - Amenc,an Fire`and_Casualty Company _ _Liberty Mutual Insurance Company- , _ _ - - r- .L -,_ _ _ -The Ohio Casualty!nsurance Company - _ -West American Insurance Company 7 - POWER OFATTdRNEY - --:,--',,,:KNOWN ALE PERSONS BY-THESE PRESENTS:-That Ameninan Fire&Casualty Company and The OhioCasualty Insurance Companyare corporations duly organized under the laysof-= - - _, the State of New Hampshire_that Liberty Insurance Company is a coryo don dbly mgan¢ed under the laws`of the Safe of Massadlusebs;and West Anerican Insurance Company, is a corporation duly organized under the laws of the State of Indiana(herein colleCJvely called the'Compaoies7),pursuant to and by authority set fonh=does hereby.name;constitute- _- -17-3E-_and appomt,2 EBrian.C.Block;Daniell P.Dunigar,1James L.Hahn Joseph:W:.Kookr, ,J .Richard J..Decker-William.F Simlbss = _1= - - - _ = - . - C' - - --, - - - - ▪ all"ot the oily of Peofi a- =-=sate of%PA ch uximdually if there be more man one named,its-Cu-lend lawful attorney fecttomake,exeare seal;scknevAedge : 7and deliver;for and on its behalf as surety and as its act and deed;any and all inderakings bonds recognizances and other."surety obligations;m pursuance of these presents and shatl-= - - be as binding upon the Companies as if theyhave beenduly sgned by"the president and attested by.the seaetary of the Companies in thea own proper persons= 7 t - - _ .7 7 - - _ . .7,- IN WITNESS WHEREORsthis Power:of Attomey.hal been subscribed byanauthorized-Officer or official of the Companies and the ro ra a seals of the Companies have been aff ed: - - _ _ there Ws"4tn:==.dyy o{=.Mardi �%��-2015 _ _ • " :i-_ ;v-r:� _ - - -— _ i. vp,o c-tr _ �1v 1Nsr �1Nsuq _ 1ew _- American Fire and Casualty Company - ID 4,v„ - -,/,.....` ▪ ..7",.014/29.1_r, �t off° 4 re. tt,;(7 3w3Z°F _ -. The Ohio Casualty Insurance Company y li---c-: S ° 147--„-;,-1.), m a- 171971.21 ° a — o - - West .Mutual Insurance Company -y. a 190fi 1919 - �+ O = - -= S - r _ 3 _ - " West en canlnsurance_Company - N 6.4 tit ldT 147-- a' rsi` -e i= ^-,,- :77- O. c • - - Byr ' - i a. m STATE OE PENNSYLVANIA_ - = ss - - _ David M Care;Assistant Se&etary - - _ -c -4" COUNTY O MONTGOMERY - - -- - _ A - LI! 0 On tis 4th ddf Match _ 2015 be premie PersonauY appeared.David M.-Carey,who acanov edged-himself to.be the Assistant Secretary of American Fire and u F. O m CasualyCompany,:Llbery.Weill IrissbrintiCompany Thhe Ohio Casualy,lnsurance Company,and Wes Am ericininsurance Company ard.that rte assurh"beug auJ,onze_d so than': :TN. p?. "exec a tire,foregoing instrument for tie purposes therein conainedby sgrang on behalf of the corporations by himself as adult'auMnzed-officer - - " - _- 41.1'1: f E or? IN WITNESS WHEREOF,I hive-hire-unit subscribed name aindiffaid-Ply:notarial seal at Ptymous Meeting,Pennsytariia on the day and year first above wn an. - _ - - 0=o: T+ O - ' ' ' — p4 C. c -COMMONWEALTH OF=Nutaria15ePE1 NNSYLVANIA -_ ����q 11 �- _ - _ - t O . � - -• - QCr): Twesa Psietla Notal Pubik gy• / NMI O_ . R d - - - ' - - OF = - - -PtYMOOin T"9.M0=aJ°"ffin eWnry — - Teresa_ Pastena.Notary Public -_ '" _ O _ _ . : .My Commission Expms Matti 2e;2011 - d C O.m _ = Ma er.Penisylvat A sooa:bn of Naanaa - - - _ a co " :C'..115 This Power otAftoTey a made and er ea,epuau d pursuant to and by coniy df fiveo fo0amg By laws and Authorizatons ofAmencen Fie and CasulyalCompany:The Oho Casualty Insurancein p O 'Company;Libery Mutual Insurance Company;and Wes American Insurance Company which resolutions are:now in lull for-re-arid effect reading as follows- __ _ _ mss :ARTICLE IV` on as=OFFICERS Seddon 12-Power of Attorney.Anyofficer or oaierofiaal of the Corporation authorized fortat e in purposwrung by the Chairman Or or the Preslden and sublet- :0;e C.m. -to such luniatiJ1e.Chaimandr tae Pressideni may.presrribe;shall_appointsuit a:omeys-in-fact as may be necessary-to act n Sehatf;ofthe Comwatron to make exeche seal y O a -acknadeoge and deliver as surety any and all undertaungs bonds;recogruzances and other—surety obligations:I Surhattorneysin-fact sutteatothellmhatbns set fontintt irrespective -0i3 E mposers ole piney,snag have fu07pw+er 5bind-the CorporalonTby theu-sigr 1i a and exea'uort of anysuch:insuumens and toatachthere,o theseal'of,he Corporebon When so' .=15 8,1-, executed suai instruments shall be as bindug as if signed by:the Presiders and ahested to by the Seaeary:Anypower or autlxinkganted to any esenrtawitr attorney in fact under -.>-- "` the provisions of this arttide may.be revoked at any,ume by tie Board;theCtialfman3 the President or. _by_the officer w officers granunig suchpower or au'Jonty.- = -_ _ .m y A E ;ARTICLE XIII Exeiu-uon of Cahats l7E SECTION 5 an Surety Bonds d Underaangs-Any ofrcerof tie Company iut honed for thate i pur osn writing by.the chairman or the president, E tap i> m and au subject to sudi fumuonsas the chairmn o arthe president may prescribe-shall appoint such attore= rneys act:as may be necessary to ct ui behalf of the Company to make;exeate, -t-00 O seal acfimb Ledge,and deliver.as,surey any;and all underaki gs,-.bonds rec gnizancesIand other:surety oblgauons_Such attorneys-in-fact suble=t to the set forth intheir !ES?, u r spegve pvve`rs of a.omey;shia9 Have lull power io bud the Company by heir sign ehire ri exewbon of any such instruments and le Mach thereto to seal of the Company.;When so 0 o- ezecu'ed such insrumens shall be as binding as if signbyt ed he presdent and afiesad by are seaearyn. - �' - _ a I?- Cerhfitate of Designation=ThePresident of the Company acting pursuant to the Bylaws of the Company autonzes David M:Carey-Assistant Secreary.to appoint such-aborneys-in • -fait as may be_necessary toad on behalf of theCompany.to make execute,seal;acknowledge and deliver as surety any.and all undenakugs;tonds recogni arks and other surety _ -obligations-s= _ _ _ _ _ _ - f l .7-F_ • Authoniation=By unanimous consent of die Cotnpanys Board of Directors,the Company Consents that farsunde or mchanically reproduced signature of any assistant secretary of the- -r Company wherever appearing upon a certified copy of any:pvwer of attorney isssued by.ale Company m connecuo`n vnth surety iondlShall be-valid and dug upon the Company vaJi • :the samefoncearideect asthoughmanuaiyaffoied - __- c' - - - - - r '�==" :r- - _=!-mss-v✓ J;Gregory W^Davenport'tris undersgned Asslsan Seaeary;of American Eire and Casually Comppany The Ohio CasualtyInsurance Company,Libehy Mutual lnsura&e Company and ^-_ West American insurance Company do here cerfi that the-origin-al_ er of attome of which:t e f bY. fly _ pow y oregoing Is a full-.hue a_c - _-_t copy"ot the Power of Atomeyexeaited.by sad -- _ Companies_lo in full force and effect and has not been revoked. - - - - _ .- _E-- - _ _ /'_ ▪ - ItI:TESTIMONY WHEREOF 1 havehereun o set my hand and affixed the seals of said Companies this ! ' day of -JO/(u 2 - J - 20/bv� :�= -_ft>GlfL'C JPtSY 1Ns6,ti *JNSURq o INSHpi.vr _ _ l .L. /- ' < 1906 _ of 0 =1919= m a 1912 ° c 3 cJ, -✓',aa o e o - - tai „ s _Gregory_W:Davenport Assistant Secretary • _ _c = __ - - _ - - - _ 7�of 5o0W _ _.-LMS,12ar33_122013 _ - - _ _ _ _ .nMf `MlV ANTI-KICKBACK AFFIDAVIT STATE OF FlorI J4 p ) SS: COUNTY OF Palm r. ccs I, the undersigned hereby duly sworn, depose and say that no portion of the sum herein bid will be paid to any employees of the City of Sunny Isles Beach and its elected officials, as a commission, kickback, reward or gift, directly or indirectly by me or any member of my firm or by an officer of the corporation. By: / /1 \Rub Preside/Ai (Title) Sworn and subscribed before me this �/ !61=> day of WEL _.�, , 20 / 10 � NOTARY PUBLIC State of Florida at ,, LEONA ANN ODEN •.--•r ,-��,�^ / t%✓ ' Notary Public-state of Florida t F My Comm.Expires Aug 29.2018 .",;•—, 4. Commission r FF 118289 = -My Comission pine „8' Assn. 00300- 17/26 PUBLIC ENTITY CRIMES SWORN STATEMENT PURSUANT TO SECTION 287.133(3)(a), FLORIDA STATUTES ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS. 1. This sworn statement is submitted to submitted g CI I OY SU ri1.1 1 1 t SIe byT�nPRocs / for DQYULIIq U-I i11.1-111 Con4-14X-4 ion whose business address is ('10 Colhvltcct Rd ,115 , ft6y " rvi &ace\ 1 (IL 3342C, and (if applicable its Federal Employer Identification Number (FEIN) is �-01t2oo5 (If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement: 2 I understand that a "public entity crime" as defined in Paragraph 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or of the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 3 I understand that "convicted" or "conviction" as defined in Paragraph 283.133(1)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, non-jury trial, or entry of a plea of guilty or nolo contendere. 4 I understand that an "affiliate" as defined in Paragraph 287.133(1)(a), Florida Statutes means: 1. A predecessor or successor of a person convicted of a public entity crime; or 2. An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm's length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 5 I understand that a "person" as defined in Paragraph 287.133(1)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal 00300- 18/26 power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity. 6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement (Indicate which statement applies). Vt..-Neither the entity submitting this sworn statement, nor any of its officers,directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. _The entity submitting this sworn statement,or one or more of its officers, directors,executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. _The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989. However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list (Attach a copy of the final order). I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE)ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND,THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION 287.017, FLORIDA STATUTES FOR CATEGORY TWO OF ANY CHAN E IN THE INFORMATION CONTAINED IN THIS FORM. / (Signature) Sworn Sworn to and subscribed before me this �_ day o•i , 20/4. �idP Personally known jr ' / OR Produced Identification Notary Public, State of Florida-At-Large My commission expires 0-0/2-o/l (Printe• •,•!.• - -•••-• Comm..sipawc(;t)ame ofuSOtsary+pODFk) ;:', .'Fs Notary Public -State of Florida : + : •_ My Comm.Expires Aug 29.2018 t Commission x FF 118289 -N •�.L - Bonded Uri*Nalicnal Notary Assn. t. 00300-19126 TRENCH SAFETY ACT COMPLIANCE STATEMENT Project Name: City of Sunny Isles Beach-Construction of Underground Utility Conduits Project Number: City Bid No. Project Location: Work is located in the street segments as shown on the Key Sheet of the Drawing Set, and is Collins Avenue and off Collins in the City of Sunny Isles, Florida. Instructions: Chapter 90-96 of the Laws of Florida requires all contractors engaged by the City of Sunny Isles Beach, Florida to comply with Occupational Safety and Health Administration Standard 29 C.F.R.s. 1926.650 Subpart P. All prospective contractors are required to sign the compliance statement and provide compliance cost information where indicated below. The costs for complying with the Trench Safety Act must be incorporated into this project's base bid as shown on page 1 of this document. Certify this form in the presence of a notary public or other officer authorized to administer oaths. CERTIFICATION 1. I understand that Chapter 90-96 of the Laws of Florida (The Trench Safety Act) requires me to comply with OSHA Standard, Standard 29 C.F.R.s. 1926.650 Subpart P. I will comply with the Trench Safety Act, and I will design and provide safety systems at all trench excavations in excess of five feet in depth for this project. 2. The estimated\_ cost imposed by compliance with the Trench Safety Act will be: JT til X lOUSc C\CL Dollars S 6 t dco (Written) (Figures) 3. The amount listed above has been included within the Base Bid as listed on this Proposal Form. Certified: (Company actor) By: (P d tIPrincipal's Signature) l )o( , /Sc cs ( residenit/i Principal's Type or Print Name) r/ S to and subscribed to before me in Miami-Dade County, Florida on the / 14__ day of , 20 /x . Notary Public, State of Florida-at-Large: �- My Commission Expires: d� .2_0(.o'.;';.e„r, LEONA ANN ODEN °, -•: Notary Public-State of Florida �,,��U::/\ ; My Comm.(spites Aug 29.2018 Pc Commission • FF 118289 ,,,,,.••" Boroed Through National Natar sn. O126 NON-COLLUSIVE AFFIDAVIT STATE OF F lonc4q FAA Q_ ) SS: Fbh COUNTY OF 4 &7 Ch ) P5 being first duly sworn,deposes and says that: (1) He/she is the, (Owner, Partner,Offs.DRepresentative or Agent) of raY19,t)o U-11 'H I C0II4nitl lo%1 the Bidder that has submitted the attached Bid; (2) He/she is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such Bid; (3) Such Bid is genuine and is not a collusive or sham Bid; (4) Neither the said Bidder nor any of its officers, partners,owners,agents, representatives,employees or parties in interest, including this affidavit, have in any way colluded, conspired, connived or agreed, directly or indirectly,with any other Bidder, firm,or person to submit a collusive or sham Bid in connection with the Work for which the attached Bid has been submitted; or to refrain from bidding in connection with such Work; or have in any manner, directly or indirectly, sought by agreement or collusion, or communication, or conference with any Bidder, firm, or person to fix the price or prices in the attached Bid or of any other Bidder, or to fix any overhead, profit, or cost elements of the Bid price or the Bid price of any other Bidder, or to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against (Recipient), or any person interested in the proposed Work; (5) The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance, or unlawful agreement on the part of the Bidder or any other of its agents, representatives, owners, employees or parties in interest, including this affidavit. 00300-21/26 Signed, sealed - d •-livered In the presence AP Witn ss / / / A--- ,off.,, P• ss Witness (Print Name) 1/P (Title) ACKNOWLEDGEMENT STATE OF FfOric ) SS: COUNTY OF Palm (Sea,c2n ) f OR /SME, the undersigned authority, personally appeared �JOI.✓ / 74 SS to me well known and known by me to be the person described here�i nd who cuted the foregoing Affidavit and acknowledged to and before me that 4..../044, ]3, c, -ss executed said Affidavit for the purpose therein expressed. WITNESS, my hand and official seal this /1-C- day of 9 , 20/4. By: /� 41/14(—) (Title) N• ARY PUBLIC State of Florida-at-Large y My Commission Expires: 0th/�4y 00300-22/26 DRUG FREE WORKPLACE (Tie Bid Form) FLORIDA STATE STATUTE 287.087 Identical Tie Bids: Preference shall be given to business with drug-free workplace programs. Whenever two or more bids,which are equal with respect to price,quality, and service are received by the State or by any political subdivision for the procurement of commodities or contractual services, a bid received from a business that certifies that it has implemented a drug-free workplace program shall be given preference in the award process. Established procedures for processing tie bids will be followed if none of the tied vendors have a drug-free workplace program. In order to have a drug-free workplace program,a business shall: 1. Publish a statement notifying employees that the unlawful manufacture,distribution,dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation,and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the commodities or contractual services that are under Bid a copy of the statement specified in subsection (1). 4. In the statement specified in subsection(1), notify the employees that, as a condition of working on the commodities or contractual services that are under Bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Impose a sanction on, or require the satisfactoryparticipation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, by any employee who is so convicted. 6. Make a good faith effort to continue to maintain a drug-free workplace through the implementation of this section. As the,person authorized to sign the statement, I certify that this firm complies fully with the above requirements. /7/16 Bid 'stSignature Date 00300-23/26 NON-DISCRIMINATION AFFIDAVIT I, the undersigned, hereby duly sworn, depose and say that the organization, business or entity represented herein shall not discriminate against any person in its operations, activities or delivery of services under any agreement it enters into with the City of Sunny Isles Beach.The same shall affirmatively comply with all applicable provisions of federal, state and local equal employment laws and shall not engage in or commit any discriminatory practice against any person based on race, age, religion, color, gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation or any other factor which cannot be lawfully used as a basis for service delivery. By: yy Title: ole.F— • b,.� Sworn and subscribed before me this 7.4, day oqt.,,.r7 , 20 /s- cary ublic, State of Florida • — (Printed Narng.katnLEONA ANN ODEN 1 _>> t _ Notary Public -State of Florida r. ••' •- MY Comm.Expires Aug 29.2018 My commisR`. =s. a „ r IT 11e2e3 ,, 4 . ."� Bade011rough National Nctary Assn. / 00300-24/26 FAILURE TO COMPLETE, SIGN AND RETURN THIS FORM MAY DEEM YOUR BID NON-RESPONSIVE BUSINESSNENDOR� PROFILE SURVEY Name of Business: Dov&lQ �L4((t}h4y C, v 4ri-Vion Address: I l° WM at Ksa ,'1TSl epriov1 &non 1cL 3-311X Phone No.: CS-6)-329 -5320 Contact Person (Regarding This Form): ire-die Brady Type of Business (check the appropriate type): ,, CONSTRUCTION SERVICES - Firms involved in the process of building, altering, repairing, improving or demolishing any structure, building or real property. ❑ ARCHITECTURE AND ENGINEERING (A&E) SERVICES - Firms involved in architectural design, engineering services, inspections and environmental consulting (materials and soil testing) and surveying. o PROFESSIONAL SERVICES - Includes those services that require special licensing, educational degrees, and unusually highly specialized expertise. o BUSINESS SERVICES - Involves any services that are labor intensive and not a construction related or professional service. o COMMODITIES - Includes all tangible personal property services, including equipment, leases of equipment, printing, food, building materials, office supplies. A Small Disadvantaged Business Enterprise (SDBE) is defined as a small business concern that is at least fifty-one (51) percent beneficially owned and which is routinely managed by one or more of the following (Please identify your respective SDBE category): African-American Hispanic Asian-Indian American Asian-Pacific American Native American Any Woman not included among the aforementioned categories 00300-25/26 Form W-9 Request for Taxpayer Give Form to the (Rev.December2014) requester. Do not Department of the Treasury send Number and Certification send to the IRS. Internal Revenue Service 1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank. Danella Utility Construction, Inc. ri 2 Business name/disregarded entity name,if different from above m at n 3 Check appropriate box for federal tax(W55ification;check only one of the following seven boxes: 4 Exemptions(codes apply only to certain entities,not individuals;see o D IntlivitluaVsole proprietor or C Corporation ❑ S Corporation ❑ Partnership ❑ TrusVestate instructions on page 3): C o single-member LLC Exempt payee code(if any) L,y ❑Umited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)► u `p Note.For a single-member LLC that is disregarded,do not check LLC;check the appropriate box in the line above for Exemption from FATCA reporting the tax classification of the single-member owner. code(if any) 4 0 ❑Other(see instructions) Woks e.avr3 mvre.mmaee 4e us) 5 Address(number,street,and apt.or suite no.) Requester's name and address(optional) U a 170 Commerce Road Unit 5 6 City,state,and ZIP code 0n Boynton Beach, FL 33426 7 List account number(s)here(optional) Part L Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid i Social security number backup withholding.For individuals,this is generally your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other - - entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN on page 3. or Note.If the account is in more than one name,see the instructions for line 1 and the chart on page 4 for Employer identification number guidelines on whose number to enter. 7 7 — 0 7 1 2 0 0 5 • j 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 on page 3. Sign Signature /7A Here U.S.pen► _ _ w J� Date►General Instruction •Form 1098(home mortgage interest),10ent loan interest),1098-T (tuition) Section references are to the Internal Revenue Code unless otherwise noted. •Form 1099-C(canceled debt) Future developments.Information about developments affecting Form W-9(such •Form 1099-A(acquisition or abandonment of secured property) as legislation enacted after we releases it)is at www.irs.gov/1w9. Use Form W-9 only if you are a U.S.person(including a resident alien),to Purpose of Form provide your correct TIN. An individual or entity(Form W-9 requester)who is required to file an information If you do not return Form W-9 to the requester with a TIN.you might be subject retum with the IRS must obtain your correct taxpayer identification number(TIN) to backup withholding.See What is backup withholding?on page 2. which may be your social security number(SSM,individual taxpayer identification By signing the filled-out foram,you: number(ITIN),adoption taxpayer identification number(ATIN),or employer 1.Certify that the TIN you are giving is correct(or you are waiting for a number identification number(EIN),to report on an information return the amount paid to to be issued), you,or other amount reportable on an information retum.Examples of information returns include,but are not limited to,the following: 2.Certify that you are not subject to backup withholding,or •Form 1099-INT(interest earned or paid) 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If •Form 1099-DIV(dividends,including those from stocks or mutual funds) applicable,you are also certifying that as a U.S.person,your allocable share of any partnership income from a U.S.trade or business is not subject to the •Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected income,and •Form 1099-B(stock or mutual fund sales and certain other transactions by 4.Certify that FATCA code(s)entered on this form Of any)indicating that you are brokers) exempt from the FATCA reporting,is correct.See What is FATCA reporting?on •Form 1099-S(proceeds from real estate transactions) page 2 for further information. •Form 1099-K(merchant card and third party network transactions) Cat.No.10231X Form W-9(Rev.12-2014)