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00400. BID FORM: (Page 2 of 8)
Note: Bidders are bidding on a lump sum basis for the purpose of determining
the lowest responsive and responsible. bidders. However, Bidders will be paid
based on the line item breakdown, contained in the Bid Form, with payments
based on actual work performed.
Jam'• PROJECT PACKAGE I — Flagami/West End Storm Sewer Improvements B-50695
• t t Our LUMP SUM BID includes the total cost for the work specified in this bid, consisting
_Jr ko"%. f furnishing all materials, labor, equipment, supervision, mobilization, overhead & profit
required, in accordance with the Bid Specifications.
� ltag ooto.kC O. t Total Price Package I: $ S. 561)06.50
�04(1 i o n t► �( Lunde/cc/ 1 �� ��� n i .� A "til'�+l Ai
Written Amount
PROJE� CT-_CKAGE II — Fairlawn Storm Sewer Improvements IIB-50
Our LUMP SUM BID inc 11
_ •: the total cost for the work s
of furnishing all materials, labor, e• •'' • ent, supe _'•
required, in accordance with the Bid Speci «: •:•ns.
Total Price Package II:
4-wa
ied in this bid, consisting
, mobilization, overhead & profit
005,4 oo
- ti.rc t cl four huv)dract and
Written Amount
A CONTINGENCY ALLOWANCE may be established for this Agreement fo
unforeseen circumstances or City requested changes and shall be authorized at
the so discretion of the City.
Total Price Package I & II:
seve r i (l' 42iv�
S' 4, 594.50
-P t hand rS A e47
Few
DIRECTIONS: COMPLETE PART I OR PART II, WHICHEVER APPLIES, AND PARTS I11 AND IV.
'1r
Fovr
Written Amo nt
Part I: Listed below are the dates of issue for each Addendum received in connection
with this Bid:
Addendum No. 1, Dated
Addendum No. 2, Dated
Addendum No. 3, Dated
gl2'lIU-J
Addendum No. 4, Dated
Fianami/West End Phase II and Fairlawn Phase IIB Sewer Improvements
Bid No.: 06-07-012
Part 11:
00400. BID FORM: (Page 3 of 8)
1\0
No addendum was received in connection with this Bid.
Part III; Certifications
The Bidder, by virtue of signing the Bid Form, affirms that the Bidder is aware of the following,,,
and shall comply with all the stated requirements.
1. Affirmative Action Plan
Successful bidder(s) shall establish an Affirmative Action Plan or an Affirmative Action Policy
pursuant to Ordinance #10062 as amended. Effective date of implementation must be
indicated on the policy: and
2. First Source Hirinq
Bidder certifies that (s)he has read and understood the provisions of City of Miami
Ordinance Section 18-110, pertaining to the implementation of a "First Source Hiring
Agreement". Evaluation of bidder's responsiveness to Ordinance Section 18-110 may be a
consideration in the award of a contract.
3. Non -Collusion
Bidder certifies that the only persons interested in this Bid are named herein; that no other
person has any interest in this Bid or in the Contract to which this Bid pertains; that this Bid
is made without connection or arrangement with any other person; and
4. Druq Free Workplace
The undersigned Bidder hereby certifies that it will provide a drug -free workplace program
by:
(1) Publishing a statement notifying its employees that the unlawful manufacture,
distribution, dispensing, possession, or use of a controlled substance is prohibited in the
Bidder's workplace, and specifying the actions that will be taken against employees for
violations of such prohibition;
(2) Establishing a continuing drug -free awareness program to inform its employees
about:
(i) The dangers of drug abuse in the workplace;
(ii)The Bidder's policy of maintaining a drug -free workplace;
(iii )Any available drug counseling, rehabilitation, and employee assistance programs;
and
(iv) The penalties that may be imposed upon employees for drug abuse violations
occurring in the workplace;
(3) Giving all employees engaged in performance of the Contract a copy of the statement
required by subparagraph (1);
(4) Notifying all employees, in writing, of the statement required by subparagraph (1), that
as a condition of employment on a covered Contract, the employee shall:
(i) Abide by the terms of the statement; and
Flagami/West End Phase II and Fairlawn Phase IIB Sewer Improvements Bid No.: 06-07-012
Page 131
00400. BID FORM: (Page 4 of 8)
(ii) Notify the employer in writing of the employee's conviction under a criminal drug statute
for a violation occurring in the workplace no later than five (5) calendar days after such
conviction;
(5) Notifying the City in writing within ten (10) calendar days after receiving notice under
subdivision (4) (ii) above, from an employee or otherwise receiving actual notice of such
conviction. The notice shall include the position title of the employee;
(6) Within thirty (30) calendar days after receiving notice under subparagraph (4) of a
conviction, taking one of the following actions with respect to an employee who is convicted
of a drug abuse violation occurring in the workplace:
(i) Taking appropriate personnel action against such employee, up to and including
termination; or
(ii) Requiring such employee to participate satisfactorily in a drug abuse assistance or
rehabilitation program approved for such purposes by a federal, state, or local health,
law enforcement, or other appropriate agency; and
(7) Making a good faith effort to maintain a drug -free workplace program through
implementation of subparagraphs(1) through (6); and
5. Lobbying
The undersigned certifies to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid, or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee
of any agency, a Member of Congress, an officer or employee of Congress, or an employee
of a Member of Congress in connection with the awarding of any Federal contract, the
making of any Federal grant, the making of any Federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with this Federal contract, grant, loan, or cooperative agreement, the
undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report
Lobbying," in accordance with its instructions.
(3) This undersigned shall require that the language of this certification be included in the
award documents for "All" sub -awards at all tiers (including subcontracts, sub -grants, and
contracts under grants, loans, and cooperative agreements) and that all sub -recipients shall
certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when
this transaction was made or entered into. Submission of this certification is a pre -requisite
for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code.
Any person who fails to file the required certification shall be subject to a civil penalty of not
less than $10,000 and not more than $100,000 for each such failure; and
Note: In these instances, "All" in the Final Rule is expected to be clarified to show that it
applies to covered contract/grant transactions over $100,000 (per QMB).
Flagami/West End Phase II and Fairlawn Phase IIB Sewer Improvements Bid No.: 06-07-012
Page 132
00400. BID FORM: (Page 5 of 8)
6. Debarment, Suspension and Other Responsibility Matters
The Bidder certifies to the best of its knowledge and belief, that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transactions by any Federal department or agency.
b. Have not within a three-year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (Federal, State, or
local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or falsification or destruction of records, making false statements, or
receiving stolen property;
c. Are not presently indicted for or otherwise criminally or civilly charged by a government
entity (Federal, State, or local) with commission of any of the offenses enumerated in
paragraph 1.b of this certification; and
d. Have not within a three-year period preceding this application/proposal had one or more
public transactions (Federal, State, or local) terminated for cause or default.
Where the prospective Bidder is unable to certify to any of the statements in this certification,
such Bidder shall submit an explanation to the Gity of Miami.
Part IV; Certification — Trench Safety Act
The Bidder, by virtue of signing the Bid Form, affirms that the Bidder is aware of the Trench
Safety Act, and will comply with all applicable trench safety standards. Such assurance shall be
legally binding on all persons employed by the Bidder and subcontractors.
The Bidder is also obligated to identify the anticipated method and cost of compliance with the
applicable trench safety standards.
Bidder acknowledges that included in the various items of the proposal and in the total bid price
are costs for complying with the Florida Trench Safety Act. These items are a breakout of the
respective
items involving trenching and will not be paid separately. They are not to be confused with bid
items in the schedule of prices, nor be considered additional work.
The Bidder further identifies the costs and methods summarized below:
Quantity Unit
Description Unit Price Price Extended . Method
Scar; i S f Ieia00.`�- 10 Ic70.°= I[cnc� boy t
Total $ tti�G(jO•
Flagami/West End Phase II and Fairlawn Phase IIB Sewer Improvements Bid No.: 06-07-012
Page 133
00400. BID FORM: (Page 6 of 8)
Attached is a Bid Bond [ ], Cash [ ], Money Order [ ], Unconditional/Irrevocable Letter of
Credit [ ], Treasurer's Check [ ], Bank Draft [ ], Cashier's Check [ ], Bid Bond Voucher [ ] or
Certified Check [� ] No. Bank of
Ne jary for the sum of
Dollars .
Firm's Name:
The Bidder shall acknowledge this bid and certifies to the above stated in Part III and IV by
signing and comp!-ting the spaces providedow. len (4terct '.s, .
r ciin 01 ( Q. 4Ms)c
Heoh 9)7;01
Telephone No.: ✓ ? D - ,�`O SD
Facsimile No.( c2-`0 _OrE-Mail Address: 3o •EcineAg k i-u(")-C etc f • ( '
Social Security
No Fe er j jh I Dun and
LD.Noor.:o Bradstreet No.:
(if applicable)
Signature:
Printed Name/Title:
City/State/Zip:
If a partnership, names and addresses of partners:
Flagami/West End Phase II and Fairlawn Phase IIB Sewer Improvements Bid No.: 06-07-012
Page 134
00400. BID FORM: (Page 7 of 8)
CERTIFICATE OF AUTHORITY
(IF CORPORATION)
I HEREBY CERTIFY that at a meeting of the Board of Directors of
--0/'OC-'T5 4')--(AC a corporat" n or anized a existing under the laws
of the State of -4- ieeictc. held on the'3) day of a resolution was duly
passed `and adopted authorizing (Nan e) c� rYT_ SaChi2 as
(Title) :- of the corporation to execute bids on behalf of the corporation and
providing that his/her execution thereof, attested by the secretary of the corporation, shall be the official
act and deed of the corporation. i further certify that said resolution remains in full force and effect. "�
IN ^UVITNES,SV�,/HEREOF, I have hereunto set my hand this ,��''./ day of , 20 U
Secrets
Print:
.�r
CERTIFICATE OF AUTHORITY
(IF PARTNERSHIP)
1 HER : CERTIFY that at a meeting of the Board of Directors of
, a partnership organized and existing under the laws
of the State of
held on the _day of , a resolution was duly passed
and adopted authorizing (Name as (Title) of the to
execute bids on behalf of the pa -rship and provides that his/her execution thereof, attested by a
partner, shall be the official act and dee..f the partnership.
I further certify that said partnership agreemen -mains in full force and effect.
Partner:
Print:
IN WITNESS WHEREOF, I have hereunto set hand this , day of , 20
CERTIFICATE OF AUTHORITY
IF JOINT VENTURE)
Joint venturers must su it a joint venture agreement indicating that the person signing this bid is
authorized to sign bid documents n behalf of the joint venture. If there is no joint venture agreement
each member of the joint venture m 1 sign the bid and submit the appropriate Certificate of Authority
(corporate, partnership, or individual).
CERTIFICATE OF AUTHORITY
(IF INDIVIDUAL)
I HEREBY CERTIFY tha , (Name) , individually and doing business
as (d/b/a) (If Applicable) have executed and am bound
by the terms of the bid to which this -' estation is attached.
IN WITNESS WHEREOF, I have hereunto se •. hand this , day of , 20
Signed:
Print:
Flagami/West End Phase II and Fairlawn Phase IIB Sewer Improvements Bid No.: 06-07-012
Page 135
00400. BID FORM: (Page 8 of 8)
NOTARIZATION
STATE OF !-" p,e 1 19
COUNTY OF N/ 19 /-1 i - ✓,4 s�, �� .:�1
The foregoing instrument was a knowledged before me this ( it
of v[i
20 , by ()f9.. 7\4 !) i l--- who is personally known to me or who has
produced • - ' * JJ kJas identification and who (did / did not) take an oath.
SIGNATURE OF NOTARY PUBLIC
1 OBAO
Q` irt!SSMN Da:50254
July 14. MO
P--ff4AM-044TA P ' B�
NAME OF NOTARY PUBLIC
SS:
Flagami/West End Phase II and Fairlawn Phase JIB Sewer Improvements Bid No.: 06-07-012
Page 136