Project 2017-03 Grandview Unit Conversion
Everett, Washington
SECTION 00 41 00 - BID FORMS
The following documents are attached to this section:
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List all forms that must be submitted with signature when bids are due.
00 41 01 Bid Bond Form
00 41 02 Certificate of Corporate Principal
00 41 03 Asbestos Free Materials Certification
00 41 04 Lead Based Paint Certification
00 41 05 Minority Business Report
00 41 06 Suspension & Debarment
00 41 07 Environmental Regulation
00 41 08 Non Collusive Affidavit
00 41 09 Contractor’s Statement of Qualifications
00 41 10 Bid Form
Notes:
END OF SECTION
BID FORMS
00 41 00 - 1
Project 2017-03 Grandview Unit Conversion
Everett, Washington
HOUSING AUTHORITY OF THE CITY OF EVERETT
BID BOND
We, the undersigned,
(Name of Principal)
as PRINCIPAL,
and
as SURETY are held
and firmly bound unto the Housing Authority of the City of Everett, hereinafter called the
“Authority”, 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, successors and assigns, jointly and severally, firmly by these
present.
THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has submitted
the accompanying Bid, dated
, 20
, for
.
NOW, THEREFORE, if the Principal shall not withdraw said bid within the period specified
therein after the opening of the same, or if no period be specified, within Ninety (90) days after
the said opening, and shall within the period specified therefore, or, if no period be specified
within Ten (10) days after acceptance of the bid, give bond with good and sufficient surety or
sureties as may be required, for the faithful performance and Proper fulfillment of such contract;
or the failure to give such bond within the time specified, if the Principal shall pay the Authority
the difference between the amount for which the Authority may procure the required work or
supplies or both, if the latter amount be in excess of the former, then the above obligation shall be
void and of no affect, otherwise to remain in full force and virtue.
The Surety must be Guaranty or Surety Company Acceptable to the Authority. Individual
Sureties shall not be considered. U.S. Treasury Circular No 570, published annually in the
Federal Register lists companies approved to act as Surety on bonds securing government
contracts, the maximum underwriting limits on such, contract bonded, and the states in which
each company is licensed to do business. Use of this Circular by writing directly to Audit Staff,
Bureau of Government Financial Operations, U.S. Treasury Department, Washington D.C.
20226.
Bid Bond Form
00 41 01 - 1
Project 2017-03 Grandview Unit Conversion
Everett, Washington
BID BOND
IN WITNESS WHEREOF, the above bounded parties have executed this instrument under their
several seals this
day of
, 20
, the name and corporate seal of each
corporate party being hereto affixed and these present duly signed by the undersigned
representative, pursuant to authority of its governing body.
In presence of:
(Individual Principal)
(SEAL)
(Business Address)
(Individual Principal)
(SEAL)
(Business Address)
ATTEST:
(Corporate Principal)
(Business Address)
Affix
Corporate
Seal
BY:
ATTEST:
(Corporate Principal)
(Business Address)
BY:
Affix
Corporate
Seal
(Power of Attorney for person signing for surety company must be attached to bond.)
Bid Bond Form
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Project 2017-03 Grandview Unit Conversion
Everett, Washington
CERTIFICATE AS TO CORPORATE PRINCIPAL
I,
, certify that I am the
Secretary of the corporation
named as Principal in the within bond; that
, who signed the said bond on behalf of the Principal was then
of said corporation; that I know his/her
signature, and his/her signature thereto is genuine, and that said bond was duly signed, and
attested to, for and in behalf of said corporation by authority of its governing body.
(Signed)
(Date)______________________
Certifiate of Corporate Principal
00 41 02 - 1
Project 2017-03 Grandview Unit Conversion
Everett, Washington
ASBESTOS-FREE MATERIALS CERTIFICATION
DATE:
COMPANY (OR INDIVIDUAL)
NAME:
STREET:
CITY:
PHONE:
FAX:
OWNER OR CONTRACTING OFFICER:
By signing below the bidder certifies that all materials to be used on this project
shall not contain any asbestos. This certification will apply to all contractors and
subcontractors hired or employed by this firm (individual). If materials are found
to violate this certification, this firm (individual) agrees to replace those materials
with acceptable materials of like quality and to hold the Owner harmless from any
costs or liabilities arising from such situations. It is understood that state law
requires that a licensed and certified asbestos abatement firm do the removal of
asbestos material.
SIGNATURE:
NAME:
TITLE:
Asbestos Fee Materials Certification
00 41 03 - 1
Project 2017-03 Grandview Unit Conversion
Everett, Washington
LEAD-BASED PAINT CERTIFICATION
DATE:
COMPANY (OR INDIVIDUAL)
NAME:
STREET:
CITY:
PHONE:
FAX:
OWNER OR CONTRACTING OFFICER:
Federal regulations (24 CFR Part 135) prohibits the use of lead-based paint in
any Federally-funded residential rehabilitation or construction. By signing below
the bidder certifies that no painting materials used on this project will contain lead
exceeding federal standards*. This certification will apply to all contractors and
subcontractors hired or employed by this firm (individual). If materials should be
found to violate this certification, this firm (individual) shall be subject to fines
and/or prosecution in accordance with Federal regulations.
SIGNATURE:
NAME:
TITLE:
* Paint products must contain no more than six one-hundredths (.06) of one percent (1%) by
weight in total nonvolatile content of the paint.
Lead-BasedPaintCertification
004104-1
Project 2017-03 Grandview Unit Conversion
Everett, Washington
Contractor’s Women And/or Minority Business Enterprise
1*
2*
3*
4*
5*
6*
7*
8*
Trade/Specialty
Name of Firm
WBE
MBE
Approx Dollar
Amount
Apparent Low Bid
Not Responsive
Expect to Award
Subcontract
Yes
Total dollar amount of bid expected to be performed by WBE:
Percentage of Total bid amount:
Total dollar amount of bid expected to be performed by MBE:
Percentage of total bid amount:
No
$___________________
_________________%
$___________________
_________________%
I hereby certify that the above information, to the best of my knowledge, is true and accurate, and that the subcontractors are Women Business Enterprises (WBE) or Minority Business
Enterprise (MBE) as defined on the next page.
Women and/or Minority Business Enterprise Statement of Intent Form
00 41 05 -1
Contractor: _____________________________________
Date: ________________________
(Instructions outlining the procedure to fill out this form appear on the next page)
Instructions for Completing
The following women and/or minority business enterprises have been contacted to submit a proposal for subcontracting in the performance of the contract work on
which this bid is based.
1.Trade/Specialty
List the trade/specialty for which the subcontractor or supplier is bidding (i.e. plumbing, electrical, etc.)
2.Name of Firm
List the full name of the firm.
3.WBE
The definition of Women’s Business Enterprise (WBE) states that: “WBE must have 50% women ownership and control of the management
and daily operations of business.
4.MBE
The definition of Minority Business Enterprise (MBE) states that: “MBE must have 50% minority ownership and control of the management and
daily operations of the business.
5.Approximate Dollar Amount
List the approximate dollar amount of the subcontractor’s bid.
6.Apparent Low Bid
________Yes
_________No
Check the “yes” column if the subcontractor’s bid appears to be the low bid in that trade. If there are two or more subcontractors listed for
a specific trade, check the “yes” column for only one subcontractor. All other subcontractors would be checked in the “no” column.
7.Non Responsive
Check the column only if the subcontractor’s bid is non-responsive for reasons other than the amount of the bid (i.e. failure to complete all
necessary information on which the bid is based, failure to respond, etc.)
8.Expect to Award Subcontract
Put a check in this column beside the subcontractor who would be reasonably expected to be awarded the bid. Again, check only one
subcontractor/supplier for a specific trade/specialty.
Women and/or Minority Business Enterprise Statement of Intent Form
00204-2
Project 2017-03 Grandview Unit Conversion
Everett, Washington
SUSPENSION & DEBARMENT COMPLIANCE
_____________________________________ certifies that neither it, nor any person or firm
which has an interest in the above named firm are debarred, suspended or ineligible from
involvement by any federal, state or local government. I furthermore certify that the above or
firm which has an interest in the above named firm shall not enter into any subcontract with any
subcontractor who has been temporarily denied participation from participating in contracting
programs by any agency of the United States Government or of the State of Washington, and
shall take full responsibility for the acts or omissions of its subcontractors, and of any person(s)
either directly or indirectly employed by the Contractor.
Signature
Name
Title
Date
SUSPENSION & DEBARMENT
00 41 06 - 1
Project 2017-03 Grandview Unit Conversion
Everett, Washington
ENVIRONMENTAL REGULATION COMPLIANCE
Certifies that neither it, nor any
person or firm which has an interest in the above named firm has any environmental sanctions in
effect and complies with the requirements of the Clean Air Act (42 U.S. C. 1857 (h)), section 508
of the Clean Water Act (33 U.S. C. 1368), Executive Order 11738, and Environmental Protection
Agency regulation (40 CFR Part 15).
Signature
Name
Title
Date
ENVIORMENTAL REGULATION COMPLIANCE
00 41 07 - 1
Project 2017-03 Grandview Unit Conversion
Everett, Washington
NON-COLLUSIVE AFFIDAVIT
(PRIME BIDDER)
State of .......
County of .....
NAME - Title
who is an authorized Agent of the firm of ____________________________________
being first duly sworn, on his/her oath, says that the bid herewith submitted is genuine and not a sham or
collusive bid, or made in the interest or on the behalf of any person not herein named; and he/she further
says that the said bidder has not directly or indirectly induced or solicited any bidder on the above work
or supplies to put in a sham bid, or any other person or corporation to refrain from bidding; and that said
bidder has not in any manner sought by collusion to secure him/herself an advantage over any other
bidder or bidders; or to secure any advantage against the Housing Authority of the City of Everett or any
person interested in the proposed contract; and that all statements in said proposal or bid are true and
correct.
Bidder (if individual)...
Partner (if partnership)….
Officer (if corporation…..
Subscribed and sworn to before me ________________________________________
Notary Public in and for the State of_______________________________________
residing at ___________________________.
this
day of
, 20
.
My Commission expires ............. ___________________________________________
NON-COLLUSIVE AFFIDAVIT
00 41 08 - 1
Project 2017-03 Grandview Unit Conversion
Everett, Washington
Contractor's Statement of Qualification
The Undersigned certifies that the additional information provided herein is true and sufficiently complete
so as not to be misleading.
Submitted to:
Address:
Housing Authority of the City of Everett
3107 Colby Avenue
Everett, WA 98201
Submitted by:
Address:
Principal Office:
Telephone Number
Fax Number
Tax Identification Number
UBI Number
Contractor’s License #
Corporation
Partnership
Individual
Joint Venture
Plumbing
(Please specify)
Electrical
Other
Name of Project:
General Construction
Other
HVAC
Roofing
1
1.a.
1.b
ORGANIZATION
Number of years in business as a Contractor?
How many years has your organization been in business under its present business name?
1.c.
Under what other or former names has your organization appeared?
1.d.
1.e.
1.f.
1.g.
1.h.
If your organization is a corporation, answer the following:
Date of Corporation:
State of incorporation:
President’s Name:
Vice President’s Name (s):
1.i.
1.j.
1.k.
1.l.
1.m.
1.n.
Secretary’s Name:
Treasurer’s Name:
If your organization is a partnership, answer the following:
Date of organization:
Type of partnership:
Name of general partner(s):
CONTRACTOR’S STATEMENT OF QUALIFICATIONS
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Project 2017-03 Grandview Unit Conversion
Everett, Washington
1.o.
1.p.
1.q
1.r.
If your organization is individually owned, answer the following:
Date of organization:
Name of owner:
If the form of your organization is other than those listed above, describe it and name the
principals:
2
2.1.
LICENSING
List jurisdictions and trade categories in which your organization is legally qualified to do
business and indicate registration or licenses numbers, if applicable.
2.2
List jurisdictions in which your organization's partnership or trade name is field.
3
3.1.
EXPERIENCE
List the categories of work that your organization normally performs with its own forces:
3.2.
Claims and Suite (if the answer to any of the questions is yes, please attach details)
3.3.
3.4.
Has your organization ever failed to complete any work awarded to it?
Are there any judgements, claims, arbitration proceedings or suite pending or outstanding against
your organization or its officers? (If yes, please give brief description)
3.5.
Has your organization filed any law suits or requested arbitration with regard to construction
contracts within the last five years? (If yes, please give brief description)
3.6.
Within the last five years, has any officer or principal of your organization ever been an officer
or principal of another organization when it failed to complete a construction contract? (If the
answer is yes, please attached details)
3.7.
On a separate sheet, list major construction projects your organization has in progress, giving the
name of the project, owner, architect, contract amount, percent complete and scheduled
completion date.
CONTRACTOR’S STATEMENT OF QUALIFICATIONS
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Project 2017-03 Grandview Unit Conversion
Everett, Washington
3.8.
3.9.
4
4.1
4.2
4.3
4.4
4.5
4.6
State total worth of work in progress and under contract:
On separate sheet, list the major projects your organization has completed in the past five years,
giving the name of project, owner, architect, contract amount, date of completion and percentage
of the cost of the work performed with your own forces:
State average annual dollar amount of construction work performed during the past five years;
On the next page, list the construction experience and present commitments of the key
individuals of your organization:
SECTION V: FINANCING
Financial Statement:
Attach a financial statement, preferably audited, including your organization's latest balance sheet
and income statement showing the following items:
a. Current Assets (e.g., cash, joint venture accounts, accounts receivable, notes
receivable, accrued income, deposit, materials inventory and prepaid expenses):
b. Net Fixed Assets:
c. Other Assets:
d. Current Liabilities (e.g., capital, capital stock, authorized and
outstanding
shares par values, earned surplus and retained earnings).
Name and address of firm preparing attached financial statement, and date thereof:
Is the attached financial statement for the identified organization named on Page 1?
If not, explain the relationship and financial responsibility of the organization whose financial
statement is provided (e.g., parent-subsidiary):
Will the organization whose financial statement is attached act as guarantor of the contract for
construction?
CONTRACTOR’S STATEMENT OF QUALIFICATIONS
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Project 2017-03 Grandview Unit Conversion
Everett, Washington
5 REFERENCES
Trade References: Current Contact Information
Company Name
Address
Phone #
Contact Person
Bank References:
Bank Name
Address
Phone #
Contact Person
Complete Project References:
Company Name
Address
Phone #
Contact Person
SURETY
Name of bonding company:
Name and address, telephone number of agent:
INSURANCE
Name of Insurance Company
Name and address, telephone number of agent
CONTRACTOR’S STATEMENT OF QUALIFICATIONS
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Project 2017-03 Grandview Unit Conversion
Everett, Washington
SIGNATURE
Dated this ___________ day of ____________________ , 200______.
Name of Organization:
By:
Title:
_____________________________ being duly sworn deposes and says that the information provided
herein is true and sufficiently complete so as not to be misleading.
Subscribed and sworn before me this ___________ day of ________________, 200____.
Notary Public:
My Commission Expires:
END OF SECTION 00209
CONTRACTOR’S STATEMENT OF QUALIFICATIONS
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Project 2017-03 Grandview Unit Conversion
Everett, Washington
BID FORM
Project Name: Project 2017-03 Grandview Unit Conversion
Everett, Washington
Bid To:
Everett Housing Authority
3107 Colby Avenue
Everett, WA 98201
Attention: Brenda McLeod
Bid From:
(Name of Contractor)
(Individual)
1.
Pursuant to and in compliance with the Invitation to Bid dated March 8, 2017 and other
documents related thereto, and subject to all conditions thereof, the undersigned hereby
proposes and agrees to furnish all labor, materials, equipment and testing necessary to
perform and furnish the Work as indicated in the Bidding Documents, and, in accordance
with the terms and conditions of the Contract Documents.
2.
In submitting this Bid, Bidder represents, as more fully set forth in the Agreement, that:
a.
This Bid will remain subject to acceptance for ninety (90) days after the day of the
bid opening;
b.
The Owner has the right to reject this Bid;
c.
The Bidder will sign and submit the Contract with Bonds, Insurance and other
documents required by the Bidding Requirements within seven (7) days after the
date of Owner’s Notice of Award;
d.
Bidder has examined copies of the Bidding Documents and has visited the
site and
become familiar with the general, local, and site conditions;
e.
The Undersigned agrees to pay the Owner as liquidated damages the sum insert
liquidated damages amount for each consecutive calendar day that is in default
after the Contract Time. Liquidated damages shall be deducted from the contract
by change order.
f.
Bidder accepts the provisions of and agrees bid is in strict accordance with the
Contract Documents consisting of:
1.
2.
3.
BID FORM
This Instrument, (Bid Form);
All documents as listed in the Table of Contents is a part of these Contract
Documents and is incorporated as fully as if bound herein.
All provisions required by law to be inserted in this contract whether actually
inserted or not;
00 41 09 - 1
Project 2017-03 Grandview Unit Conversion
Everett, Washington
3.
BIDDER will complete the Work in accordance with the Contract Documents for the
following price:
BASE BID: ____________________________________$________________
Estimated Sales Tax____________________
4.
BIDDER acknowledges receipt of Addenda(s) Number(s):
#
Date
#
Date
#
Date
5.
The Undersigned agrees if awarded the Contract, to complete it within insert contract
time days after the Notice to Proceed.
6.
Contractor must list the subcontractors he/she intends to utilize on this project. Changes
are allowed, subject to EHA approval.
LIST OF SUBCONTRACTORS TO BE USED
Name of Subcontractor
BID FORM
Type of Work
00 41 09 - 2
Project 2017-03 Grandview Unit Conversion
Everett, Washington
CONTRACTOR SIGNATURE AUTHORITY
Date Bid Submitted:
Company Name:
Signature of Authorized Person to Sign Bid
Printed Name and Title
Billing Address:
City State Zip:
Phone:
Fax:
Contact Person:
Email Address:
State of Washington Contractor’s License:
Federal ID #
Are you incorporated?
Yes
No
Unified Business ID # (UBI) Washington State Only:
Are you a minority contractor? Yes
No
On what basis are you a minority contractor? Please select one of the following:
If you are a women owned business, please also circle the ethnicity.
1
2
3
4
5
6
7
8
Caucasian
Black
Native
American
Hispanic
Asian
Pacific
Hasidic
Jew
Woman
Other; Please
describe:
END OF BID FORM
BID FORM
00 41 09 - 3