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HomeMy WebLinkAboutSection 00300 - Bid Forms-F 00300 - 1/26 SECTION 00300 - BID FORM 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 Date 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. 00300 - 2/26 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. DATED: BIDDER: BY: (Signature) TITLE: Sworn to and subscribed to before me in Miami-Dade County, Florida on the _____ day of _______________ 20_____ Notary Public, State of Florida-at-Large: __________________________________ My Commission Expires: __________________________________ _______________________ 00300 - 3/26 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 % 2 Mobilization 1 LS 3 Maintenance of Traffic 15 MONTH 4 Testing, Surveying and Miscellaneous 1 LS 5 Indemnification Allowance 1 LS $100 $100 SUBTOTAL DIVISION 1 6 Install only one(1)-6 inch PVC schedule 80 conduit bundled in one main trench with others for FPL Utility (FPL to furnish material) 5,778 LF 7 Install only two (2)-6 inch PVC schedule 80 conduit bundled in one main trench with others for FPL Utility (FPL to furnish material) 1,708 LF 8 Install only three (3)-6 inch PVC schedule 80 conduit bundled in one main trench with others for FPL Utility (FPL to furnish material) 91 LF 9 Install only one (1)-2 inch PVC schedule 80 conduit bundled in one main trench with others for FPL Utility (FPL to furnish material) 691 LF 10 Install only two (2)-2 inch PVC schedule 80 conduit bundled in one main trench with others for FPL Utility (FPL to furnish material) 286 LF 11 Install only three (3)-2 inch PVC schedule 80 conduit bundled in one main trench with others for FPL Utility (FPL to furnish material) 5,300 LF 12 Install only six (6)-2 inch PVC schedule 80 conduit bundled in one main trench with others for FPL Utility (FPL to furnish material) 1539 LF 13 Install only nine (9)-2 inch PVC schedule 80 conduit bundled in one main trench with others for FPL Utility (FPL to furnish material) 75 LF 14 Install only one (1)-6 inch PVC schedule 80 lateral conduit bundled in one lateral trench with others for FPL Utility (FPL to furnish material) 913 LF 15 Install only two (2)-6 inch PVC schedule 80 lateral conduit bundled in one lateral trench with others for FPL Utility (FPL to furnish material) 659 LF 00300 - 4/26 PAY ITEM PER 01020 Quantity Unit Unit Costs Base Price 16 Install only three (3)-6 inch PVC schedule 80 lateral conduit bundled in one lateral trench with others for FPL Utility (FPL to furnish material) 327 LF 17 Install only one (1)-2 inch PVC schedule 80 lateral conduit bundled in one lateral trench with others for FPL Utility (FPL to furnish material) 1,477 LF 18 Install only two (2)-2 inch PVC schedule 80 lateral conduit bundled in one lateral trench with others for FPL Utility (PL to furnish material) 495 LF 19 Install only three (3)-2 inch PVC schedule 80 lateral conduit bundled in one lateral trench with others for FPL Utility (FPL to furnish material) 1,397 LF 20 Install only six (6)-2 inch PVC schedule 80 lateral conduit bundled in one lateral trench with others for FPL Utility (FPL to furnish material) 1,388 LF 21 Install only one (1)-6 inch PVC schedule 80 lateral conduit in one lateral trench exclusive for FPL Utility (FPL to furnish material) 720 LF 22 Install only two (2)-4 inch PVC schedule 80 lateral conduit in one lateral trench exclusive for FPL Utility (FPL to furnish material) 63 LF 23 Install only three (3)-4 inch PVC schedule 80 lateral conduit in one lateral trench exclusive for FPL Utility (FPL to furnish material) 215 LF 24 Install only six (6)-4 inch PVC schedule 80 lateral conduit in one lateral trench exclusive for FPL Utility (FPL to furnish material) 351 LF 25 Install only one (1)-2 inch PVC schedule 80 lateral conduit in one lateral trench exclusive for FPL Utility (FPL to furnish material) 129 LF 26 Install only feeder splice box for FPL Utility (FPL to furnish material) 11 EA 27 Install only concrete pad for capacitor bank for FPL Utility (FPL to furnish material) 4 EA 28 Install only 50” splice box for FPL Utility (FPL to furnish material) 20 EA 29 Install only 48’’handhole for FPL Utility (FPL to furnish material) 2 EA 30 Install only 30’’handhole for FPL Utility (FPL to furnish material) 2 EA 31 Install only 24’’handhole for FPL Utility (FPL to furnish material) 18 EA 32 Install only 12’x8’ manhole for FPL Utility (FPL to furnish material) 1 EA 33 Install only concrete pad for FPL transformers, switch cabinets and fuse cabinets(FPL to furnish material) 40 EA 00300 - 5/26 PAY ITEM PER 01020 Quantity Unit Unit Costs Base Price 34 Supply and install only two (2 )-4 inch PVC schedule 80 conduit bundled in one main trench with others for Atlantic Broadband 2,524 LF 35 Supply and install only three (3 )-4 inch PVC schedule 80 conduit bundled in one main trench with others for Atlantic Broadband 4,532 LF 36 Supply and install only five (5 )-4 inch PVC schedule 80 conduit bundled in one main trench with others for Atlantic Broadband 1,181 LF 37 Supply and install only six (6 )-4 inch PVC schedule 80 conduit bundled in one main trench with others for Atlantic Broadband 4,573 LF 38 Supply and install nine (9 )-4 inch PVC schedule 80 conduit bundled in one main trench with others for Atlantic Broadband 111 LF 39 Supply and Install three (3)-4inch PVC schedule 80 lateral conduit bundled in one lateral trench with others for Atlantic Broadband 1013 LF 40 Supply and Install four (4)-4inch PVC schedule 80 lateral conduit bundled in one lateral trench with others for Atlantic Broadband 397 LF 41 Supply and Install five (5)-4inch PVC schedule 80 lateral conduit bundled in one lateral trench with others for Atlantic Broadband 36 LF 42 Supply and Install six (6)-4inch PVC schedule 80 lateral conduit bundled in one lateral trench with others for Atlantic Broadband 2,290 LF 43 Supply and Install seven (7)-4inch PVC schedule 80 lateral conduit bundled in one lateral trench with others for Atlantic Broadband 42 LF 44 Supply and Install eight (8)-4inch PVC schedule 80 lateral conduit bundled in one lateral trench with others for Atlantic Broadband 231 LF 45 Supply and Install nine (9)-4inch PVC schedule 80 lateral conduit bundled in one lateral trench with others for Atlantic Broadband 528 LF 46 Supply and install twelve (12)-4 inch PVC schedule 80 lateral conduit in one lateral trench for Atlantic Broadband 38 LF 47 Supply and install two (2)-4 inch PVC schedule 80 lateral conduit in one lateral trench exclusive for Atlantic Broadband 65 LF 48 Supply and install three (3)-4 inch PVC schedule 80 lateral conduit in one lateral trench exclusive for Atlantic Broadband 163 LF 49 Supply and install six (6)-4 inch PVC schedule 80 lateral conduit in one lateral trench exclusive for Atlantic Broadband 99 LF 00300 - 6/26 PAY ITEM PER 01020 Quantity Unit Unit Costs Base Price 50 Supply and install 30’’x 36’’x48’’ handhole for Atlantic Broadband 73 EA 51 Supply and install two (2 )-4 inch PVC schedule 80 conduit bundled in one main trench with others for AT&T 1,154 LF 52 Supply and Install two (2)-4inch PVC schedule 80 lateral conduit bundled in one lateral trench with others for AT&T 198 LF 53 Supply and install one (1)-4 inch PVC schedule 80 lateral conduit in one lateral trench exclusive for AT&T 142 LF 54 Supply and install two (2)-4 inch PVC schedule 80 lateral conduit in one lateral trench exclusive for AT&T 99 LF 55 Supply and install 30’’x 36’’x48’’ handhole for AT&T 9 EA 56 Supply and install two (2 )-4 inch PVC schedule 80 conduit bundled in one main trench with others for Comcast 4,435 LF 57 Supply and install three (3 )-4 inch PVC schedule 80 conduit bundled in one main trench with others for Comcast 5,381 LF 58 Supply and install four (4 )-4inch PVC schedule 80 conduit bundled in one main trench with others for Comcast 322 LF 59 Supply and Install two (2)-4inch PVC schedule 80 lateral conduit bundled in one lateral trench with others for Comcast 909 LF 60 Supply and Install three (3)-4inch PVC schedule 80 lateral conduit bundled in one lateral trench with others for Comcast 316 LF 61 Supply and Install four (4)-4inch PVC schedule 80 lateral conduit bundled in one lateral trench with others for Comcast 905 LF 62 Supply and Install five (5)-4inch PVC schedule 80 lateral conduit bundled in one lateral trench with other for Comcast 39 LF 63 Supply and Install six (6)-4inch PVC schedule 80 lateral conduit bundled in one lateral trench with other for Comcast 631 LF 64 Supply and Install eight (8)-4inch PVC schedule 80 lateral conduit bundled in one lateral trench with other for Comcast 62 LF 65 Supply and install two (2)-4 inch PVC schedule 80 lateral conduit in one lateral trench exclusive for Comcast 54 LF 66 Supply and install six (6)-4 inch PVC schedule 80 lateral conduit in one lateral trench exclusive for Comcast 103 LF 67 Supply and install 24’’x 36’’x48’’ handhole for Comcast 54 EA 00300 - 7/26 PAY ITEM PER 01020 Quantity Unit Unit Costs Base Price 68 Supply and install two (2 )-2 inch PVC schedule 80 conduit bundled in one main trench with others for Hotwire 78 LF 69 Supply and Install two (2)-2 inch PVC schedule 80 lateral conduit bundled in one lateral trench with other for Hotwire 344 LF 70 Supply and install two (2)-2 inch PVC schedule 80 lateral conduit in one lateral trench exclusive for Hotwire 33 LF 71 Supply and install directionally bored two (2)- 2’’ HDPE for Hotwire including profile construction drawings 5,287 LF 72 Supply and install 24’’x 36’’x18’’ handhole for Hotwire 11 EA 73 Supply and install 30’’x 48’’x24’’ handhole for Hotwire 1 EA 74 Supply and install one (1)-2 inch PVC schedule 80 conduit bundled in one main trench with others for Street Lighting 9,003 LF 75 Supply and install two (2)-2 inch PVC schedule 80 conduit bundled in one main trench with others for Street Lighting 98 LF 76 Supply and Install one (1)-2 inch PVC schedule 80 lateral conduit bundled in one lateral trench with other for Street Lighting 115 LF 77 Supply and Install two (2)-2 inch PVC schedule 80 lateral conduit bundled in one lateral trench with other for Street Lighting 706 LF 78 Supply and Install three (3)-2 inch PVC schedule 80 lateral conduit bundled in one lateral trench with others for Street Lighting 54 LF 79 Supply and install one (1)-2 inch PVC schedule 80 lateral conduit in one lateral trench exclusive for Street Lighting 581 LF 80 Supply and install two (2)-2 inch PVC schedule 80 lateral conduit in one lateral trench exclusive for Street Lighting 1,113 LF 81 Supply and install one (1)-2 inch PVC schedule 80 conduit in a separate trench exclusive for Street Lighting 13,569 LF 82 Supply and install 271/2”X18”X12” pull box for Street Lighting 154 EA 83 Supply and install 30’’ diameter concrete foundation for Street Lighting as per sheet L- 30 of FDOT Lighting Plans 111 EA 84 Supply and install concrete spread footer foundation for Street Lighting as per sheet L- 31 of FDOT Lighting Plans 3 EA 85 Supply and install four (4)-2 inch PVC schedule 80 conduit bundled in one main trench with others for City conduit 13,069 LF 00300 - 8/26 PAY ITEM PER 01020 Quantity Unit Unit Costs Base Price 86 Supply and Install four (4)-2 inch PVC schedule 80 lateral conduit bundled in one lateral trench with other for City conduit 407 LF 87 Supply and Install eight (8)-2 inch PVC schedule 80 lateral conduit bundled in one lateral trench with other for City conduit 316 LF 88 Supply and Install twelve (12)-2 inch PVC schedule 80 lateral conduit bundled in one lateral trench with other for City conduit 81 LF 89 Supply and install four (4)-2 inch PVC schedule 80 lateral conduit in one lateral trench exclusive for City conduit 144 LF 90 Supply and install eight (8)-2 inch PVC schedule 80 lateral conduit in one lateral trench exclusive for City conduit 785 LF 91 Supply and install twelve (12)-2 inch PVC schedule 80 lateral conduit in one lateral trench exclusive for City conduit 49 LF 92 Supply and install 24”X13”X12” pull box for City conduit 45 EA 93 Flowable fill 1000 CF 94 Contingency allowance for conduit, boxes, and miscellaneous installation for duck bank work off Collins utilizing unit prices in this bid form. The construction plans for this work is forthcoming. LS TOTAL BID PRICE (BID ITEMS 1 THROUGH 92) $ $ Note unit prices for 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 $__________________________ (WRITE AMOUNT IN WORDS) 00300 - 9/26 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 - 10/26 ADDENDA PAGE The below text is provided only as an example of the typical layout of an addendum page. (Delete header and this line from an actual Addendum) Date of Issuance:______________________ CITY of SUNNY ISLES BEACH DEPARTMENT OF ENGINEERING SERVICES CONSTRUCTION MANAGEMENT DIVISION ADDENDUM NO. ______ For Sunny Isles Beach Underground Conduit Installation CITY BID NO. Bidders are hereby notified that this Addendum shall be attached to and made part of the above named Bidding and Contract Documents issued for bids on ___________________________, 2015. The following items are issued to, add to, delete from, modify and clarify the Bidding and Contract Documents. These items shall have full force and effect as the Bidding and Contract Documents, and cost involved shall be included in the bid prices. Bids to be submitted on the specified bid date shall conform to the additions and revisions listed. The Bidder shall acknowledge receipt of this Addendum by inserting its number and date on Page 00300-1, Item 4, of the Bid Form and by faxing a signed copy of this addendum to City of Sunny Isles Beach, Department of Engineering Services, Construction Management Division Fax: xxx xxx xxxxx. This addendum consists of ____ page(s). SECTION 00030 – PUBLIC NOTICE: The date of the Pre-Bid Conference shall be changed to ____________________________. All other information shall remain the same. NO OTHER CHANGES ARE REQUIRED. ALL OTHER TERMS AND CONDITIONS REMAIN THE SAME EXCEPT AS PREVIOUSLY AMENDED. ACKNOWLEDGEMENT OF RECEIPT OF ADDENDUM NO. ______ (PLEASE FAX TO: xxx-xxx-xxxx) AUTHORIZED SIGNATURE: COMPANY NAME: 00300 - 11/26 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. Work to be Performed Subcontract or License Number Percent of Total Contract Subcontractor's Name & Address 1. 2. 3. 4. 5. 6. Note: Attach additional sheets if required. 00300 - 12/26 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 _____________________________________ A. B. _____________________________________ A. B. _____________________________________ A. B. _____________________________________ A. B. 00300 - 13/26 "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 Item Specification Section Alternate Supplier (list one only per item) 1. 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 - 14/26 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 and address: (2) CONTRACTOR's telephone number: (3) CONTRACTOR's license: Primary classification: State License No. and Expiration Date: 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: Date of Inspection: (5) Name, address, and telephone number of surety company and agent who will provide the required bonds on this contract: (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): Project Contract Price Name, address and tele- phone number of OWNER 1. 2. 3. 4. 00300 - 15/26 BID BOND STATE OF _________________ ) ) SS: COUNTY OF _______________ ) KNOW ALL MEN BY THESE PRESENTS, that we,______________________________ _______________, 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 ______________________________________________________________________________ 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_____________________________, 20___. 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 respects 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____________ day of______________________, 20___, the name and the corporate seal of each corporate party being hereto affixed and these presents being duly signed by its undersigned representative. 00300 - 16/26 IN PRESENCE OF: ____________________________ ____________________(SEAL) Witness (Individual or Partnership Principal) _____________________________ __________________________ Witness (Business Address) __________________________ (City, State, Zip) __________________________ (Business Phone) ATTEST: _____________________________ ___________________________ Secretary (Corporate Principal)* By:________________________ _________________________ (Title) ATTEST: _____________________________ ____________________________ Secretary (Corporate Surety)* *Impress Corporate Seal By:_________________________ 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 - 17/26 ANTI-KICKBACK AFFIDAVIT STATE OF _________________ ) ) SS: COUNTY OF _______________ ) 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: (Title) Sworn and subscribed before me this day of , 20___ NOTARY PUBLIC State of Florida at Large My Commission Expires: 00300 - 18/26 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 by for whose business address is and (if applicable) its Federal Employer Identification Number (FEIN) is (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 - 19/26 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). ___ 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 CHANGE IN THE INFORMATION CONTAINED IN THIS FORM. (Signature) Sworn to and subscribed before me this ____________________day of_________________, 20___. Personally known OR Produced Identification Notary Public, State of Florida-At-Large My commission expires (Printed typed or stamped Commissioned name of notary public) 00300 - 20/26 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: Dollars $ (Written) (Figures) 3. The amount listed above has been included within the Base Bid as listed on this Proposal Form. Certified: (Company Contractor) By: (President/ Principal's Signature) (President/ Principal's Type or Print Name) Sworn to and subscribed to before me in Miami-Dade County, Florida on the day of , 20____. Notary Public, State of Florida-at-Large:________________________________ My Commission Expires: _______________________ 00300 - 21/26 NON-COLLUSIVE AFFIDAVIT STATE OF ) ) SS: COUNTY OF ) being first duly sworn, deposes and says that: (1) He/she is the, (Owner, Partner, Officer, Representative or Agent) of 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 - 22/26 Signed, sealed and delivered In the presence of: ____________________________ By: _______________________ Witness _____________________________ __________________________ Witness (Print Name) __________________________ (Title) ACKNOWLEDGEMENT STATE OF _________________ ) ) SS: COUNTY OF _______________ ) BEFORE ME, the undersigned authority, personally appeared ______________________________ to me well known and known by me to be the person described herein and who executed the foregoing Affidavit and acknowledged to and before me that __________________________________________ executed said Affidavit for the purpose therein expressed. WITNESS, my hand and official seal this ________ day of ____________________, 20___. By: _______________________________ (Title) NOTARY PUBLIC State of Florida-at-Large My Commission Expires: 00300 - 23/26 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 satisfactory participation 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. Bidder’s Signature Date 00300 - 24/26 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: Title: Sworn and subscribed before me this day of , 20____ Notary Public, State of Florida (Printed Name) My commission expires: 00300 - 25/26 FAILURE TO COMPLETE, SIGN AND RETURN THIS FORM MAY DEEM YOUR BID NON-RESPONSIVE BUSINESS/VENDOR PROFILE SURVEY Name of Business: _______________________________________________ Address: ________________________________________________________ Phone No.: ______________________________________________________ Contact Person (Regarding This Form): ______________________________ 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. ‰ PROFESSIONAL SERVICES - Includes those services that require special licensing, educational degrees, and unusually highly specialized expertise. ‰ BUSINESS SERVICES - Involves any services that are labor intensive and not a construction related or professional service. ‰ 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 - 26/26