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HomeMy WebLinkAboutBid ResponseBID FORM {Page 1 of 9) SECTION 4 BID FORM Su bin Ur`f L#/ -n;it 1-F Date City of Miami, Florida Office of the City Clerk City Hall; 1`' Floor 3500 Pan American Drive Miami. Florida 33133-5504 The undersigned, as Bidder. hereby declares that the only persons interested in this Bid as principal are named herein and that no person other than herein mentioned has any interest in this bid or in the Contract to be entered into: that this Bid is made without connection with any other person, firm. or parties making a Bid; and that it is, in all respects. made fairly and in good faith without collusion or fraud. The Bidder further declares that it has examined the Site of the Work and informed itself fully of all conditions pertaining to the place where the Work is to be done; that it has examined the Contract Documents and all addenda thereto furnished before the opening of the Bids, as acknowledged below; and that it has satisfied itself about the Work to be performed; and that it has submitted the required Bid Guaranty; and all other required information with the Bid; and that this Bid is submitted voluntarily and willingly. The Bidder agrees. if this Bid is accepted. to contract with the City, a municipal corporation of the State of Florida, pursuant to the terms and conditions of the Contract Documents and to furnish all necessary materials, equipment, machinery, tools, apparatus, means of transportation, and all labor necessary to construct and complete within the time limits specified the Work covered by the Contract Documents for the Project(s) entitled. ITB No: 17-18-029 Title: Overtown Greenway at NW 11th Terrace — Phase 2 (from NW 3rd Avenue to Bth Avenue) The Bidder also agrees to furnish the required Performance Bond and Payment Bond or alternative form of security. if permitted by the City, each for not less than the total Bid price plus alternates, if any. and to furnish the required Certificate(s) of Insurance. The undersigned further agrees that the Bid Guaranty accompanying the Bid shall be forfeited if Bidder fails to execute said Contract, or fails to furnish the required Performance Bond and Payment Bond or fails to furnish the required Certificates) of Insurance within fifteen (15) calendar days after being notified of the award of the Contract. In the event of arithmetical errors, the Bidder agrees that these errors are errors which may be corrected by the City. Bidder agrees that any unit price listed in the Bid is to be multiplied by the stated quantity requirements in order to arrive at the total. Overtown Greenway at NW filth Terrace 4? Phase 2 - Project No,: B-30624 ITB No.: 17-18-029 BID FORM (Page 2 of 9) Form SU trust be submitted with Bidder's bid. The SU Form can be found posted on the webpage with the bid documents. The Bidder's Total Bid Construction Cost includes the total cost for the Work specified in this solicitation, consisting of furnishing all materials, labor, equipment. supervision, mobilization, overhead & profit required in accordance with the bid specifications. Bidder's Bid Amount Includes the total cost for the Work specified in this solicitation, consisting of furnishing all materials, labor, equipment. permits. supervision, mobilization, overhead & profit required in accordance with the Bid Specifications. Scope of Work: The Work consists of furnishing all materials, labor, and equipment necessary for road improvements such as drainage system installations, milling and resurfacing, new sidewalks replacement. striping. signs, landscaping. hardscape, decorative street and pedestrian lighting, and ADA compliant ramps, and compliance based on the Miami River Greenways Master Plan. BID: Phase 2 - TOTAL BID CONSTRUCTION COST: $ ' , e76)H. $ V 6' iK- Mai-64 h {vit1 t ► 101 1-- d k x---tt ov,L i t 4 jsWY�.f dr%'-vi �;`�. A"• 1.21(1 0L1.'L4L C. N.(E*{,41 Written Total Bid Construction Cost Overtown Greenway at NW llth Terrace 43 Phase 2 - Project No.: B-30624 ITB No.: 17-18-029 BID FORM (Page 3 of 9) The Excel Bid Form reflecting Unit Costs is required to be submitted within the Bid Submittal Forms. Bidders must download the required Excel Bid Form from the Project's webpage at: http://www.n iamigov.cornlMiamiCapital/NewBidsandProposais.html Failure to submit the required Excel Bid Form may result in the Bid being deemed non- responsive. The Excel Bid Form shall round all Bid prices to the second decimal. ITB 17-18-029 - Overtown Greenway at NW 11 th Terrace — FDOT LAP Project Line No Pay Item No. Pay Item Description Unit 1 Quantity Unit Cost Cost 1 2 3 2 3 4 4 5 5 6 6 7 7 8 8 9 9 10 10 TOTAL Overtown Greenway at NW 11th Terrace Sd Phase 2 - Project No.: B-30624 ITB No.: 17-18-029 City or Miami ProjocT B-30624 Overtown Greonway Phase It Bid Forrn OVERTOW (REENWAY ALONG NW 11 TERRACE FROM NW 3 AVENUE TO NW 6 AVENUE. PROJECT fB-30624 (FM 431501-1 8209 17-'I) SIGNING AND PAVEMENT MARKING (FM##420917-1) ITEM PAY ITEM PAY ITEM DESCRIPTION UNIT UNIT PRICE QUANTITY COST 0 0G 3 Reflective Pavement Markers (WY) EA $ 10.00 16 $160.00 0711 11121 6" Solid Traffic Stripe (White) L1= $ 2:00 2,010 $4,020 00 0711 11123 '12' Solid Traffic Stripe (White; LF $ 6,00 240 $1,440.00 0711 11125 24" Solid Traffic Stripe (White') I._F $ 20.00 56 $1,120.00 0711 11151 6" 2/4 Skip Traffic Stripe (White) LF $ 2.00 363 $726 00 0711 11160 BUS Pavement Message EA $ 500 00 2 $1,000 00 0711 11160 ONLY Pavement Message EA $ 50000 3 $1,500..00 0711 11160 BIKE Pavement Message ESA $ 350.00 10 $3,500.00 0711 11170 BIKE Thru Arrow Symbol EA $ 250.00 9 $2.250.00 0711 11170 BIKE right Arrow Symbol EA $ 500.00 1 $500.00 07'11 11170 Right Directional Arrow EA $ 300.00 2 $600 00 0711 11170 Sparrow (Share Lane) EA $ 300.00 2 $600.00 0711 11211 6" Solid Traffic Stripe (Yellow) LE $ 2.00 1,934 $3 868.00 0711 11224 16" Solid Traffic Stripe: (Yellow) LF $ 20.00 3 $60 00 0700 20 11 Sir2 le Post Sign, F&I, Less than 12 sf AS $ 300,00 22 $6,600.00 0700 20 12 Single Post Sign, F&I, 12-20 sf AS $ 500.00 5 $2,500 00 0700 20 40 Single Post Sign, Relocate AS $ 500.00 1 $500.00 0700 20 60 Single Post Sion, Remove AS `fi 100.00 13 $1,300 00 ' SUBTOTAL "A": $32,244.00 I-IARDSCAPE ITEM PAY ITEM PAY ITEM DESCRIPTION UNIT UNIT PRICE FLAN [QUANTITY COST -1-1 Trash Receptacle Surface Mounted EA $3_500.00 12 $42,000 00 H-2 Bench Surface Mounted EA $3,500.00 14 $49,000 00 11-3 Concretes Bollards EA $500.00 21 $10,500 00 11-4 Metal Bicycle racks LTA $3,500.00 1 $3,500.00 11-5 Pedestrian Colored Concrete 'SY $72.00 792 $57,027.34 H-6 Vehicular Concrete _ SY $63.00 837 $52,747 29 I-I-7 NOT USED H-8 NOT USED €1-9 Compressed Recycled Robber Mulch (Red) SY $45 00 503 S22,624.69 H-10 Compressed Recycled Rubber Mulch (Yellow) SY $35.00 332 S11,631.29 I-i-11 Compressed Recycled Rubber Mulch (Green) SY $30.00 449 S13.464.30 H-12 Gravel - 4 inch Deep SF $5.00 449 $2,244,05 H-13 Granite Chips with bonded aggregate coating (3" deep) SF $8.00 326 $2,608.96 11 14 Decorative.Fence 8' o.a.- Typical (Including Gates) I..F $100 00 194 $19,4.16,80 11.15 Decorative Gate G' EA $7,500.00 2 $15,000.00 H 16 Dbl Drive Gate 10' EA $10,000 00 1 $10,000.00 SUBTOTAL "13": $311,764.72 Page 1 or 3 City cI Miami Project B-30624 Overtown Greenway Phase II Bid Form LANDSCAPE ITEM PAY ITEM PAY ITEM DESCRIPTION UNIT UNIT PRICE PLAN QUANTITY COST 0-1-1 I-ICUS SP "GREEN ISLAND L., $9 00 790 57,1100 00 JASMINE VOLUBLE EA $5 00 1. 0 $950.00 SUBTOTAL "C": $8,060.00 580-1-2. ROYAL POINCIANA EA I,1.000.00 1 $1,000 00 E3ISMARK PALM EA $350.00 4 $1.400 00 GOLDEN SHOWER TREE EA $500 00 4 $2,000 00 POWDER PUFF EA $250.00 8 $2,00000 CABADA PALM EA $550.00 9 54,950.00 (}UE-TN'S CREPE MYR ELE EA $500 00 0 54,000 00 JABOT ICABA EA $100.00 10 $1,000 00 SIMPSON STOPPER EA $100.00 30 v3,000 00 LIVE OAK EA $1,500 00 23 $34.500.00 AFRICAN TULIP EA $750.00 4 $3 000 00 DADE COUNTY PINE EA 5200.00 97 $19.400 00 DADE COUNTY PINE EA $200.00 95 $19.000.00 SILVER SAW PALMETTO EA 5100.00 840 $84 000 00 GREEN THATCH PALM EA 535000 4 $1.400.00 GREEN THATCH PALM EA $500 00 1 $500 00 MONTGOMERY PALM EA 5750 00 60 545,000.00 SUI OTML "D": $226,150.00 Ruin. 2 of 3 City of Miami Project 8.30624 Ovcrtown Greonway Phase Bid Form ROADWAY FNItt420917-1 ITEM PAY ITEM PAY ITEM DESCRIPTION UNIT UNIT PRICE PLAN QUANTITY COST 1 1-1 Mobilization LS :.:-.(1,000.00 1 $50,000 00 7 102-1 Maintenance of. Traffic LS 526,000.00 1 9,000.00 3 110-1,1 Clearing and Grubbing_ LS $30,000 00 1 $30,000 00 4 154-4 - Type B Stabilization (for concrete pavement anti Sod areas) SY $2.00 1,416 S2,891.50 5 285-711 Optional Base Group 11 (8" Limerock LBR 100) SY $21,00 2,604 $54,679 10 6 327-70-6 Milling Exisiing Asphalt Pavement (1" Averagel SY $5.00 386 $1,927 9 7 334-1-13 Superpave Asphaltic Concrete, Traffic C (1101bsisy-in., 1" ave min., includes roadway and parking lanes) TN $180.00 21 83,1317 33 8 334-1-13 Superpave Asphaltic Concrete, Traffic C (119Ibs)sy-in., 2" ave. min., includes roaclway and parking lanes) TN $200.00 293 858,585 8F) 9 350-1-4 Cement Concrete Pavement Plain 9" SY $72.00 997 $71,779 68 10 425-1201 Catch Basin, Type 9 EA $4 500.00 1 $4.500 00 11 425-1205 Catch Resin Top, Type 9 Parital 84500.00 2 $9.000.00 12 425-1541 Catch Basin, Type D EA $5,000.00 1 $5.000 OC 13 425-1545 Catch Basin Top, Type D Partial EA $5,000 00 1 $5,000 0(-.: 14 15 425-1901 . Intel Curb, City of Miami Type F-3 EA $2,500 00 10 525,000.00 425-2-61 Manhole Type A (P-8) EA $5,000.00 'I $5,000.00 16 425-4 Inlet AdjList EA $1,000.00 7 $7,000.00 17 425-5 Manhole Adjust EA .$1,000.00 17 $17,000.00 18 425-6 Valve Adjust EA $750.00 14 $ 10, VT) . C70 .19 425-6A Pull boxAdjust EA $250.00 14 S3.500.00 20 430-175-115 Pipe Culvert, Optional Material, Round, i 5"S/CD LF $65.00 218 514.170.00 21 430-175-118 Pipe Culvert, Optional Material, Round Shape 18" S/CD LF $75.00 61 $4,575.00 22 443-70-4 French Drain, 18" HDPE IF $120 00 330 $3c.1,600.05 23 520-2-4 Concrete Curb Type "B" 1.1: 330.00 69 $7,070 00 24 520-2-4 Concrete Curb Type "D" LF $25.00 397 $9.925 00 25 520-3 Concrete Valley Gutter LF $30 00 45 $1,3:0 00 20 522-2 Sidewalk Concrete, 6" Thick SY $54.00 4,57 S247.071 0+1 27 26 527-2 Detectable Warnings SF $30 00 12 $360 00 570-1-2 Performance Turf, Sod SY $35 00 3 664 5128,240.00 20 580-1-1 Landscape Complete (see above Small Plants, SUBTOTAL "C") LS $8,060.00 1 58,060.00 30 580-1-2 Landscape Complete (see above Large Plants, SUBTOTAL "D") LS $226,150.00 1 $226,150.00 31 1 644 700 Fire hydrant, adjust & modify EA $4,500.00 3 $13.500 00 32 Lighting System Complete LS $150,000.00 1 $150,000.00 33 Signing and Pavement Marking Complete (See SUBTOTAL "A" above). LS 532,244.00 1 $32,244.00 34 Hardscape Complete (See SUBTOTAL "B" above) LS $311,764.72 1 $311,764.72 35 Permitting Allowance (Do Not Bid) LS $16,100.00 1 $16,100.00 TOTAL (FIM420917-1) $1,590,361.87 ROADWAY (SAFE ROUTES TO SCHOOL FM#431501-1) ITEM PAY IITEM PAY ITEM DESCRIPTION UNIT UNIT PRICE QUANTITY COST 'I 520-1-10 Concrete Curb Type "F" LF 33000 3.607 $108 060 00 2 522-1 Sidewalk Controte, 4" Thick SY $40 00 2 656 3106,245.92 TOTAL ( -1V9/43 501-1) $214.305.92 Phase 2 - TOTAL BID CONSTRUCTION COST $1,804,667.71) P39e 3 of 3 BID FORM (Page 4 of 9) DIRECTIONS: COMPLETE PART I OR PART II. AS APPLICABLE. AS WELL AS PARTS 1[I AND Iv Part 1; Listed below are the dates of issue for each/Addendum received in connection with this bid: Addendum No. 1, Dated 511 i i -26('S Addendum No 2. Dated 5..2`i 1Z: ih Addendum No. 3. Dated Addendum No. 4, Dated Part 11: No addenda was received in connection with this bid. Part II1: Certifications The Bidder. by virtue of signing the Bid Formaffirms that the Bidder is aware cif the following, and shall comply with all the stated requirements. 1. Non -Collusion The undersigned 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. Bidder certifies that the selected independent third -party verifier will verify and certify compliance data and reports honestly and accurately. 2_ Drug 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). Overtown Greenway at NW 11th Terrace S� Phase 2 - Project No.; B-30624 ITB No.: 17-18-029 Cite of 4Uiarni fix ADDENDUM NO. I May 17, 2018 INVITATION TO BID NO. 17-18-029 WAY AT I. -,, 1 n ;:; E:- ACE — PHASE 3rd AY'EN1;E TO Stir AVENUE) TO: ALL PROSPECTIVE BIDDERS: The failowina changes, additions, clarifications. and/ix deletions amend the above -captioned Invitation to Bid, and sha i become an inteora- part of the Bids submitted, and the Contracts to be executed or Overtown Greenway at NW llth Terrace - Phase 2 — Invitation To Bid ("ITB") No.: 17-18-029 (the "Project'). Please note the contents herein, and affix same to the documents you have on hand. All attachments (if any) are available on the Office of Capital Improvements' ("OCI") website, and are part of this Addendum. A. Requests for information received and the corresponding responses: Q1, Since Police Offices are practically mandatory. is it ecssibie to include an item or an a! owan ;e for off -duty police off:cers? Al. In lieu of an "allowance" for off -duty police, the City of Miami's Bid Form includes Pay item 102-1- Maintenance of Traffic to cover the cost of off -duty police and other related items. THIS ADDENDUM IS AN ESSENTIAL PORTION OF THE PROFESSIONAL SERVICES AGREEMENT AND SHALL BE MADE A PART THEREOF, i Annie Perez, CPPO, Director City of Miami Department of Procurement Overtown Greenway at NVV llth Terrace - ITB No.: 17-18-029 Phase 2 - Project No.: B-30624 it it of ? � ADDENDUM NO. 2 May 24, 2018 INVITATION TO BID NO. 17-18-029 , NW -� . (r-ROB, N 3 i ' 1 TO 8:" AVENUE) TO: ALL PROSPECTIVE BIDDERS: The following. changes, additions, clerrfications, and/or deletions amend the above -captioned invitation to Bid, and shall become an integral part of the Bids submitted; and the Contract to be executed for Overtown Greenway at NW 11th Terrace - Phase 2 — Invitation To Bid ("ITB") No.: 17-18-029 (the "Project"). Please nate the contents herein, and affix same to the tlocurnents you have on hand. All attachments (if any) are available on the Office of Capital Improvements' ("OCI') website, and are part of this Addendum. A. The deadline for receipt of Bids for tl?ls Project has been changed to Wednesday, June 6, 2013 .at 3:0O P.M. (local time). B. Requests for information received and the corresponding responses: Q1. Pay item description t# 334-1-13; 334-1-13; 52.2-2. quantities show on plans Sheet #5 is different than that on the proposal form. Please clarify. Al. Quantities an the Bid Form aro correct. Please disregard quantities on Sheet #5: Q2. There is atso 2 pay items on Sheet 6, 5.20-1-10, and 522.1, not shown on proposal form. Please clarify. A2. They are an the Bid Form under the items labeled "ROADWAY (SAFE ROUTES TO SCHOOL FM#431501-1}." Q3. Or Sheet #1 index of Sheets 26-44 shows traffic control phasing_ is this phasing applied to construction process? A3_ Yes. Overtown Greenway at NW 11th Terrace - ITB No.: 17-18-029 Phase 2 - Project No.: B-30624 Q4. Sheets 22-44 show stornwater pollution prevention plan. Where does the silt fence get placed? Where does the price get placed cn the proposal forrn? A4. See section 6.0 on page 24, the contractor is responsible for developing the plan. No expressed pay item will cover this. Erosion control is a responsibility of the contractor, and is incidental to the work. Q5. Sheet HS-1 talks about patina coating - where is this placed? A5. Sheet HS-1 should be disregarded. The use of patina coating was removed. Q6. Sheet 30-33 shows a pedestrian walkway and legend cads for temporary asphalt. Can a section be provided? A6. No. Q7. Proposal form item #9 calls for 9' concrete plain, Sheet HS-7 shows three different colors, please clarify Vv'here is color #3 placed? What does single soldier course stand for? I1 is difficult to determine iocat on of pedestrian concrete, and vehicle concrete. please clarify. A7. The 9" plain concrete is intended for use in the areas hatched as `Concrete Hardscape Area" on pages 7-10. The colors shown on Sheet HS-7 are to be applied to these areas as specified on Sheets HS-3 to HS-6. The pay items are intended to divide the actual concrete from the coloring. Item 9 is for the concrete, and Item H-6 is for the areas to be colored. Similarly, Sheets 7-10 and Sheets HS-3 to HS-6 show the pedestrian areas and sidewalks that are 4", 6", and to be colored. Again, one pay item is for the sidewalk, and one is for coloring certain areas. Q8. Where are de'ails for pay items #10 through 22 located" A8. City of Miami Standard Details, and FDQT Standard Indexes. Q9. The quantity of 6" sw bid item #26 seems to be wrong. Please clarify. A9. The quantity shown is correct. Q10. Bid item #27 there are 13 not 12 and the unit should be .'each.' not -sf.'. A10. Correct. THIS ADDENDUM IS AN ESSENTIAL PORTION OF THE PROFESSIONAL SERVICES AGREEMENT AND SHALL BE MADE A PART THEREOF. Annie Perez, CPPO, Director City of Miami Department of Procurement Overtown Greenway at NW 11th Terrace - ITB No.: 17-16-029 Phase 2 - Project No.: B-30624 BID FORM (Page 5 of 9) (4) Giving all employees engaged in performance of the Contract a copy of the statement required by subparagraph (1); (5) 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, (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; (6) 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; (7) 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. (8) Making a good faith effort to maintain a drug -free workplace program through implementation of subparagraphs(1) through (7). 5. Lobbying The undersigned Bidder certifies to the best of their 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 Four 375-030-34, "Disclosure of Lobbying Activities," 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. Overtown Greenway at NW 11th Terrace 86 Phase 2 - Project No.: B-30624 ITB No.: 17-18-029 BED FORM (Page 6 of 9) 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, "Ali" in the Final Rule is expected to be clarified to show that it applies to covered contract/grant transactions over $100.000 (per QMB). 6. Debarment. Suspension and Other Responsibility Matters The undersigned Bidder certifies to the best of its knowledge and belief, that it and its principals: (a) Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by any Federal department or agency. (b) Have not, within a three-year period preceding this Bid, 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; Are not presently indictedfor or otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph 6:b of this certification; and, (d) Have not, within a three-year period preceding this Bid, had one or more public transactions (Federal, State, or local) terminated for cause or default. Where the Bidder is unable to certify to any of the statements in this certification, such Bidder shall submit a written explanation to the City of Miami, (c) Part iV; Certification — Trench Safety Act The undersigned 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 Bid 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. Overtown Greenway at NW 11th Terrace 87 Phase 2 - Project No.: B-30624 LTB No.: 17-18-029 BID FORM (Page 7 of 9) The Bidder further identifies the costs and methods summarized below: Quantity Unit Description Unit Price Price Extended Method [c, -, 42-4.011 Total $ la()01) Attached is a Bid Bond [vr./Cash [ ]. Money Order [ 1. Unconditional/Irrevocable Letter of Credit [ Treasurer's Check [ J. Bank Draft [ ]. Cashiers Check [ ], Bid Bond Voucher [J or Certified Check [ No. Bank of for the sum of Dollars (S )• The Bidder acknowledges this Bid and certifies to the above stated in Part III and IV, by signing and completing the spaces provided below. Firm's Name: „ , ""-- • Signature: Printed NameiTitle: /-0,-0104 ,40.4?6(fa City/State/Zip: IC:_e?ji) Telephone No: Facsimile No: 1-1•Q E-Mail Address: r-AA-11-64:. ro-vidrA.€-01-4 Social Security No. or Federal Dun and .D.No.: &65 Bradstreet No.: (if applicable) If a partnership, names and addresses of partners: Dvertown Greenway at NW iith Terrace S Phase 2 - Project No.: B-30624 ITB No.: 17-18-029 BID FORM (Page 8 of 9) CERTIFICATE OF AUTHORITY (1F CORPORATION) HEREBY CERTIFY that at a meeting of the Bcard of Directors of Yti y ati;et `r ` . , a corporation organized and existing under the laws of the ' State of fd,V'->ck.6 " held on the ` '.day of ( --...i . a r solution wps duly passed and adopted authorizing (Name) !-S1a �: c.`u es (Title) IclziC- 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. if IN WITNESS WHEREOF, i have hereunto set my hand this (" : day of —hint , 20 r2 Secretary: Print: J'" A-m.PA .g-'.G-ft. CERTIFICATE OF AUTHORITY (IF PARTNERSHIP) HEREBY 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) to execute Bids on behalf of the partnership and provides that his/her execution thereof, &tested by a partner, shall be the official act and deed of the partnership. I further certify that said partnership agreement remains in full force and effect. Partner: Print. IN WITNESS WHEREOF. I have hereunto set my hand this , day of , 20 CERTIFICATE OF AUTHORITY (IF JOINT VENTURE) Joint ventures must submit a joint venture agreement indicating that the person signing this Bid is authorized to sign Bid documents on behalf of the joint venture. If there is no joint venture agreement each member of the joint venture must sign the Bid and submit the appropriate Certificate of Authority (corporate, partnership, or individual). CERTIFICATE OF AUTHORITY (IF INDIVIDUAL) I HEREBY CERTIFY that, I (Name) individually and doing business as (drib/a) (as applicable) have executed and am bound by the terms of the Bid to which this attestation is attached. IN WITNESS WHEREOF, 1 have hereunto set my hand this , day of , 20 Signed: Print: Overtown Greenway at NW llth Terrace f ) Phase 2 - Project No.: B-30624 ITB No.: 17-18-029 BID FORM (Page 9 of 9) NOTARIZATION STATE OF ) SS: COUNTY OF44-&-erlow The foregoing instrument was acknowledged before me this 104 day of 20 by eigarrifrv't , who is(personally known to m) or who has produced as identification and who (did / did not) take an oath. SIGNAT RE 0 NOTARY STATE OF FLORIDA PLf - E • • •J ° C:Zrrt'St' C1(:, • kJ, 5• ASE°. PRINTED, STAMPED OR TYPED NAME OF NOTARY PUBLIC Overtown Greenway at NW 11th Terrace 90 Phase 2 - Project No.; B-30624 ITB No.: 17-18-029 SUPPLEMENT TO BID FORM: QUESTIONNAIRE This Completed Form Must Be Submitted With The Bid. The City May, At Its Sole Discretion, Require That The Bidder Submit Additional Information Not Included In The Submitted Form. Such information Must Be Submitted Within Seven (7) Calendar Days Of The City's Request. Failure To Submit The Form Or Additional Information Upon Request By The City Shall Result In The Rejection Of The Bid As Non -Responsive, Additional Pages May Be Used Following The Same Format And Numbering. By submitting its Bid, the Bidder certifies the truth and accuracy of all information contained herein. A. Business Information 1. How many years has Bidder been in business under its current name and ownership? r-t a. Professional Licenses/Certifications (include name and number)' Issuance Date i ( Y14-10- — f U isieve.2. ?Ifs-1260c ('include active certifications of small or disadvantage business & name of certifying entity) b. Date Bidder was licensed by State of Florida. Dept. Of Professional Regulation: €C/2 /2ao1 c. Qualified Business License: L_-l'YesE % No if Yes, Date Issued: to'=loot d. Identify Bidder's primary business? .d- -tit Eo, (Th s answer should be specific. For example, paving, crainage. schools, intericr renbvaticns etc.) e, Name of Bidder's Qualifier, license number, and relationship to company: 1LLin,O 4-Q..Ytt k „E f. Names of previous Bidder Qualifiers during the past five (5) years including, license numbers, relationship to Bidder and years serving as qualifier. 2. Name and Licenses of any prior Bidder companies. Name of Company r License No. Issuance Date Type of Company::, E Corporation ice' CorporationELLCLSole Proprietorship, Other: (Corporations will be required to provide a copy of their corporate resolution prior to executing a contract) Overtown Greenway at NW 11th Terrace �)• Phase 2 - Project No.: B•30624 ITB No.: 17-18-029 4. Company Ownership a Identify all owners of the company Name Title % of ownership j�v.. b. Is any owner identified above an owner of another company? [ `Yes No If yes, identify the name of the owner, other company names, and % ownership for each /- ? r c. Identify all individuals authorized to sign for the Bidders company, indicating the level of their authority r check applicable boxes and for other provide specific U ve1s of a stnori1Y) Name Title ry, Signatory Authority All Cost No -Cost Other n Explaination for Other: (Note: "Ali" refers to any type of document including but not limited to contracts, amendment, change proposal requests (CPR), change orders (CO), notices, claims. disputes. etc. "Cost" refers to CPRs, COs. No -cost refers to RFls, Notices, and other similar documents). 5. Employee information Total No. of Employees: 16- Number of Managerial/Admin. Employees: 4 Number of Trades Personnel and total number per classification: (Apprentices must be listed separately for each classification) 3 { 3 , 3 t 5r ". . v �Tr� r ;- iZ-Qii)%f altla, p 4 Acsx-ct.A+ How many employees are working under H2B visas? ldek Overtown Greenway at NW l lth Terrace 95 Phase 2 - Project No.: B-30624 ITB No.: 17-18-029 6. Has any Owner or employee of the Bidder ever been convicted of a federal offense or moral turpitude? If yes, please explain_ Insurance & Bond Information a. Insurance Carrier name and address: Z4- G'lir+ .Er v ra p 7 s'g4kM `�-�►� , is. - 3'3114 b. Insurance Contact Name, telephone, and e-mail: 47;i_rf!-(F,` c. Insurance Experience Modification Rating (EMR): (If no EMR retina please explain wily) d. Number of insurance claims paid out by Bidder in Past 5 years and value of each: e. Bond Carrier name and address: t5&i Gtt w r1 ure.d- 60op — f. Bond Carrier Contact Name, telephone, and e-mail: Vita& eav 9• 5 C3 — t'e 2 — 3� 52, 41 f'L I 44. lam' incci,i62 -1 C>eri Number of Bond Claims paid out by Bidder in Past 5 years .and value: v't{_ 8 Have any claims lawsuits been file against Bidder in the past 5 years? If yes: identify all where Bidder has either settled or an adverse judgment has been issued against Bidder, Identify the year basis for the claim or judgment and settlement unless the value of the settlement is covered by a written. confidentiality agreement. 9. To the best of Bidder's knowledge, is Bidder or any officers of Bidder currently under investigation by any law enforcement agency or public entity? If yes, provide details: 10. Has Bidder been assessed liquidated damages or defaulted on a project in the past five .(5) years? R Yes Q No, (if yes, provide ar attachment that provides an explanation of the project and an explanation). /14 ?(4, . 11. Has Bidder been cited for any OSHA violations in the past five (5) years? If yes, please provide an attachment including all details on each citation. 40 Overtown Greenway at NW llth Terrace 96 Phase 2 - Project No.: B-30624 ITB No.: 17-18-029 12. Provide an attachment listing all of the equipment, with a value of 55,000 or greater. owned by the Bidder. 1-�1�. B. Project Management and Subcontract Details 1. Project Manager for this Project: a. Name. 12,z,.01-64 b. Years with Company: 44 4t,' c Licenses/Certifications: CPt .-2•19l 601 - For :,' F f d, Last 3 projects with the company including role. scope of work, and value of project: - „CKIrev . t j �( :ir`�� Ytlrfi ' '`r '� v — 3,243,2-a2-co P& l--CvyV1 (-5pWV P-(r, ryr, r at- 5!,z: 9. v� �✓` �ZL�' �J' X �1%lLt�, --- !f �i �-.2_12 U3.� f f` '.r 4 `{�afR.l) l�• {1i) J 2. Subcontractors: Name Trade % of Work License No. Certification* -it € ��t -ov-71r c 011E ! ( b . 2.044 o 6. w2 a -fit,., i.i i—. 17iActer• (•active cenifcations of snail or disadvantage business and name of certifying entity) How many Subcontractor employees are working under H2B visas? WA - Scope of physical construction labor to be self -performed by Bidder and the corresponding percentage of the Work: (This does net include such items as assurance bends, dunnpsters, trailers. anc other similar non -construction work items) C. Current and Prior Experience: 1. Detail current experience. including Projects currently under construction. recently awarded. or pending award. Provide an attachment to this Questionnaire that lists all such Projects. including the owner's name, title and value of project, scope of work, projected or actual start date, projected completion date, and number of company trades personnel assigned to the Project). 2... Prior Projects of a similar size, scope. Provide an attachment to this Questionnaire that includes completed Projects the Bidder considers of a similar, size. scope and complexity that the City should consider in determining the Bidder's responsiveness and responsibility. (This attachment must include the Project that meets the minimum number of projects identified by the Bid solicitation. Information provided must include the owners Overtown Greenway at NW llth Terrace 97 Phase 2 - Project No.: B-30624 ITB No.: 17-18-029 name. address and contact person. including telephone and e-mail, title aF Project, location of Project, scope, initial value and final cost of the project, projected and final timeframes for completion in calendar days, and the number of company trades personnel, by classification. that were assigned to the Project. The delivery method. including. but not limited to; design -build, CM@Risk. Design -Bid -Build, etc., is to be identified for each Project. If there is a difference between the initial and final cost or initial and actual tirneframe provide details on why the differences exist. A reference letter is to be completed by the owner of the Proect and submitted as part of the Bid submission. D. Bidder's References Bidders are to include a minimum of three (3) references from completed Projects listed in C.2 above. The attached form reference letter on page 99 must be used and is to be included with the Bid submission. The City, at its sole discretion may allow the Bidder to submit the references after the specified date for Bid submission, g A ''r liviLiCtej, ; a all ,! i a - (.,,"4 a.iso (/tCt tJck4 I r1 -fl1. - e)...}e,t. r l ro 'EA a/ j vJ k Ave..yyt O S÷ 4 ! ` - y aJ; VAA lift. r —rn t&-A. i Overtown Greenway at NW illth Terrace 9Y Phase 2 - Project No.: B-30624 ITB No.: 17-18-029 Emilio T. Gonzalez, Ph.D, City Manager To Whom It May Concern Subject: Reference Letter Name of Bidder: The above referenced Bidder is responding to a Bid that has been issued by the City of Miami, The City requires that the Bidder provide written references with their Bid submission. By providing you with this document, the Bidder is requesting that you provide the following reference information. The City would appreciate you providing the information requested below, as well as any other information you feel is pertinent: Narne of Referenced Project: Scope of Referenced Work: Did the Scope involve the construction, installation, repair and/or replacement of drainage system components. sidewalks, pedestrian lighting or ADA ramps? ❑ Yes ❑ No Value of Prefect: $ Date Completed: Percentage of physical construction labor self -performed by Bidder: °Ic Was project completed on time and within budget: ❑ Yes No If no, was the Bidder at fault or contribute to the delay(s) or increased cost? If yes, please provide details: Comments: Name of Project Owner: Date: Signature Yes n No of Project Owner's Representative: Title: Telephone: Sincerely, Annie Perez. CPPO, Director Department of Procurement E-mail: Overtown Greenway at NW l lth Terrace 99 Phase 2 - Project No.: B-30624 1TB No.: 17-18-029 Project No. B- 30624 CITY OF MIAMI CAPITAL IMPROVEMENTS PROGRAM SUBCONTRACTOR UTILIZATION FORM Project Title: Overtown Greenway at NW 1 1th Terrace - Phase 2 Sheet No. 1 of This Form should be submitted with a bidder's bid fonrr submittal. Failure to submit this Form with the bid may result in the bid being rejected as non -responsive. ,The City in its reasonable discretion may allow, in the interest of the competition, the Bidder to submit the Form after bids are due (as supplemental information). Provide the following information for each subcontractor regardless of tier.* Attach additional sheets if necessary. Name of Business Portion of Work Dollar Amount Percent Address/City/State/Zip License Information** Miami-DadeCertification* CBE CSBE N/A Type Number 0 n I l• • I• I II II I. CJ 17 I 1 Ci I. I1 I I] I 1 [mil L I 0 Li HI Cl I I I o o nI Cl C� I I 0 Cl Cl II E Must be certified by Miami -Dade County. All tiers must be shown, including multiple sub -tiers, it permitted by the Contract Documents. "List only those relevant to this Project. 'Check N/A if the listed SU does not have a CBE/CSBE certification (e.g., independent third party verifier) Form SU t se,.c/,-- k4fAC. STA': -wT>lE `F: BID OPPORTUNITY LIST FOR PROFESSIONAL CONSULTANT SERVICES, AND COMMODITIES & CONTRACTUAL SERVICES Prime Contractor/Prime Consultant: Address/Phone Number: 4 3t)t\tf1 ;;;4` , 1 4 ti,sue"., 33f — % ;v Ho5 Procurement Number/Advertisement Number: [3 fko. [7- P $' ._. t%:-G / - 300-4 49 CFR Part 26.11 The list is intended to be a listing of all firms .that are participating, or attempting to participate, on DOT -assisted contracts. The list must include all firms that bid on prime contracts, or bid or quote subcontracts and supplies materials on DOT -assisted projects: including both DBEs and non -DBEs. For consulting companies this list must include all subconsultants contacting you and expressing an interest in teaming with you on a specific DOT -assisted project. Prime contractors and consultants must provide information for Numbers 1, 2, 3 and 4, and should provide any information they have available on Numbers 5, 6, 7, and 8 for themselves, and their subcontractors and subconsultants. 1. Federal Tax ID Number: r 6. i 9' 2. Firm Name: 091..J/ GF( , . 3. Phone: k - u.' - v-C 4. Address: 443 . `ft-• 5. Year Firm Established: '60 6. aDBE ❑ Non -DBE 8, nnual Gross Receipts Less than 51 million ❑ Between 51 - 55 million ❑ Between $5 - $10 million 7, ❑ "ubcontractor ❑ Between $10 - $15 million ❑-.'Subconsultant ❑ More than 515 million 1. Federal Tax ID Number: 2. Firm Name: 3. Phone: 4. Address: 5. Year Firm Established: 6. ❑ DBE ❑ Non -DBE ❑ Subcontractor • Subconsultant 8. Annual Gross Receipts 0 Less than 51 million O Between 51 - $5 million ❑ Between 55 - 810 million • Between $10 - 515 million ❑ More than 515 million 1. Federal Tax ID Number. 2. Firm Narne: 3. Phone: 4. Address: 5. Year Firm Established: 6. ❑ DBE 8, Annual Gross Receipts ❑ Non -DBE ❑ Less than 51 million O Between 51 - 55 million ❑ Between $5 - 510 million 7. 0 Subcontractor ❑ Between 510 - 515 million O Subconsultant 0 More than S15 million 1. Federal Tax ID Number: 2, Firm Name: 3. Phone: 4. Address: 5. Year Firm Established; 6. ❑ DBE ❑ Non -DBE 7. ❑ Subcontractor 0 Subconsultant 8, Annual Gross Receipts 0 Less than $1 million ❑ Between 51 - 55 Million ❑ Between S5 - $10 million ❑ Between $10 - $15 million ❑ More than $15 million AS APPLICABLE, PLEASE SUBMIT THIS FORM WITH YOUR: BID SHEET (Invitation to Bid - ITB) LETTERS OF RESPONSE (LOR) PRICE PROPOSAL (Request. for Proposal - RFP) REPLY (Invitation to Negotiate - ITN) LAP CERTIFICATION OF CURRENT CAPACITY CONFIDENTIAL For bids to be received on 1 %� ! ',Letting Date) VF 8, 5 E 6' Fill in your FDOT Vordor Number Only applicable to FDOT ore -qualified contractors) CERTIFICATE I hereby certify that the amount of any proposal submitted by this bidder for the above letting does not exceed the amount of the Firm's CJRRENT CAPACITY (maximum capacity rating less total uncompleted work). The total uncompleted work as shown on the "Status of Contracts on Hand" report (page 2) $ .*`-I 7 3) -3k ( . I further certify that the "Status of Contracts on Nand' report (page 2) was prepared as follows; 1. If the letting is before the 25'-' day of the month: the certificate and report reflect the uncompleted work as of the 15' day of the month. last preceding the month of the letting. 2. If the letting is after the 25'7day of the month, the certificate and report reflects the uncompleted work in progress as of the 157' day of the month of the letting. 3. All new contracts (and subcontracts) awarded earlier than five days before the letting date are included in the report and charged against our total rating. I certify that the information above is correct. NAME Sworn to and subscribed tt-i. ay +n���, _,. r_ ._= ofr ✓t.'- ��.r, - .Ex;: Overtown Greenway at NW 11th Terrace Phase 2 - Project No.: B-30624 IRM rec2,TAL1-r Title ITB No.: 17-18-029 STATUS OF CONTRACTS ON HAND (Furnish complete information about all your contracts, wl tether prime or subcontracts; whether in progress or awarded. but not yet begun; and regardless of whom contracted with.) 52.9.4111,,t1; kAnta,(1: munl:T I !of 1 PROJECTS OWNER, LOCATION AND DESCRIPTION 62- M111; "^ 91/ti clovv\0& el,. 4-0 .44I'L54-- 1<trAlLo IA al. Kor a i102- yore__ 1,4L,ekti )3p,Le.14 - irf)rucit-- ?vny 4 `042Vaubi 2 CONTRACT {OR St I BCONTRACT) AMOUNT AMOUNT SUBLET TO OTHERS gO, 000 (F) 0 - 00 4 5 BALANCE OF CONTRACT AMOUNT 15()7?)Ci ,03 4 4o0, boo 6 UNCOMPLETED AMOUNT TO BE DONE BY YOU AS PRIME AS CONTRACTOR SUBCONTRACTOR .. _ 151 7 3le 0 3 4.1069,, (coo _ trt) cf, 170, OOD. CD ,14,4(16 4ro NOTE: Columns 2 and 3 to show total contract (or subcontract) amounts. Column between columns 2 and 3. Amount in columns 5 or 6 to be uncompleted portion of amounts to be shown to nearest MO. The Contractor may consolidate and list as contracts which, individually. do not exceed 3% of total, and which. in the aggregate 20% of the iotal. Overtown Greenway at NW tlth Terrace Phase 2 - Project. No.: B-30624 4 to be difference amount in column 4. All a single item all . amount to less than TOTALS _. „ c...3rde,70. TOTAL UNCOMPLETED WORK ON HAND TO BE DONE BY YOU (TOTAL COLUMNS 5 AND 6) 0.00 $0.04dr13;311l3 - ITB No: 17-18-029 Section 5 - Attachments BID BOND FORM (Page 1 of 3) State of Florida County of Miami -Dade City of Miami KNOWN ALL PERSONS BY THESE PRESENTS, that R&G ENCi1NEERING_ INC. as principal, QBE INSURANCE CORPORATION as Surety, are held and firmly bound unto the City of Miami, in the pen& sum of 1,1{( , ., crr rxr ;t,rls=r. Dollars ($5"0 ) 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 LI' F 6 , 2018 , for: Overtown Greenway at NW 119' Terrace — Phase 2 — t3-30624 NOW THEREFORE: (a) If the Principal shall not withdraw said Bid within one hundred twenty (180) days after date of opening the same, and shall within ten (10) days after the prescribed forms are presented to him for signature, enter into a written contract with the City, in accordance with the Bid as accepted, and give bond with good and sufficient Surety or Sureties, as may be required, for the faithful performance and proper fulfillment of such contract; or, (b) In the event if the withdrawal of said Bid within the period specified, or the failure to enter into such contract and give such bond within the time specified, if the principal shall pay the City the difference between the amount specified In said Bid and the amount for which the City may procure the required Work and supplies, if the latter amount be in excess of the former, then the above obligation shall be vold and of no effect, otherwise to remain in full force and virtue. Overlown Greenway at NW llth Terrace 91 Phase 2 - Project No.: B-30624 ITB No,: 17-18-029 SID BOND FORM (Page 2 of 3) IN WITNESS WHEREOF, the above bound parties have executed this instrument under their several seats, this "TIT day of .TUNE , 20 ]. S , the name and corporate seal of each party being hereto affixed and these presents duly signed by its undersigned representative, pursuant to authority of its governing body. WITNESS: (if Sole Ownership, Partnership, or Joint Venture, two (2) Witnesses are required. If Corporation, Secretary only will attest and/affix seal.) 7/ / / PRINCIPAL: R&CI E^ C,INEERIN..r, INC'. d(Natiie of Firm) (Signature of A`ithorized Officer) r_tG4rk1 (Title) 1!)i;3O N.W, 23 STREET Affix Seal (Business Address) M.IAMI. FL 33172 City State Zip Surety; OBE INSURANCE CORPORATION (Corporate Surety) Affix Seal Surety Secretary (Signature of Authorized Officer) JOH\ W. CHA.RLTO\. ATTORNEY -I• -FACT (Title) 7n0 SOl.711 DIME IIiG1i\3 \Y. StrlTE (Business Address) CORAL GABLES, FL 33 146 City State Zip Overtown Greenway at NW filth Terrace 92 Phase 2 - Project No.: B-30624 ITB No.: 17-I8-029 BID BOND FORM (Page 3 of 3) CERTIFICATE AS TO CORPORATE PRINCIPAL , certify that I am the Secretary of the Corporation named as Principal in the within bond; that of said corporation; that I know their signature, and the signature hereto is genuine; and that said bond was duly signed, sealed and attested for and In behalf of said corporation by authority of its governing body, STATE OF FLORIDA ) COUNTY OF MIAMI-DADE ) SS City OF MIAMI (Corporate Seal) Before me, a Notary Public duly commissioned, and qualified, personally appeared Jot' W. CHARLTON to eye well known, who being by me first duly sworn upon oath, says that hshe is the attorney -in -fact, for the QBE I Si_ R.\NCE C ORPOR.-AT!o\ and that CO/she has been authorized by ITS PRES?DEN-I to execute the foregoing bond on behalf of the Contractor named therein in favor of the City of Miami, Florida. Subscribed and sworn to before me this 6TH day of SU E , 20 18 INSTRUCTIONS; Bid Bonds must be accompanied by a Power of Attorney, In compliance with Instructions to Bidders � � r Notary Put&lio, State of Florida at Large My Commission Expires: DECEMBER 7. 2021 Rafford Commission GGte54O Expires: December 7, 2021 Bowled thi Linn Notar) Overtown Greenway at NW llth Terrace 93 Phase 2 - Project No.; B-30624 ITE No.: 17-18-029 QBE WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE BLUE BORDER POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS, that OBE Insurance Corporation (the -Company"). a corporation duty organized and existing under the taws of the State of Pennsylvania, having its principal office at 55 Water Street 20'i' Floor, New York, NY 10041, has made, constituted and appointed, and does by these presents make, constitute and appoint D.W. Matson III and John IN. Charlton of Matson -Charlton Surety Croup of Coral Gables, FL its true and lawful Attorney -in -Fact, to sign its name as surety only as delineated below and to execute, seal, acknowledge and deliver any and all bonds and undertakings, with the exception of financial guaranty insurance, to the same extent as if such bonds had been duty executed and acknowledged by the regularly elected officers of the Company at its principal Office in their own proper persons This Povier of Attorney shall be construed and enforced in accordance with, and governed by. the laws of the State of New York, without giving effect to the principles of conflict of laws. This Pourer of Attorney is granted pursuant to the following resolutions, which were duly and Validly adopted at a meeting of the Board of Directors of the Company with effect from June 30, 2014: RESOLVED, that the Chief Execu:ive Officer, any President, any Executive Vice Pres:dent, any Senior Vice President, any Vice President. the Corporate Secretary or any Assistant Corporate Secretary is authorized to appoint one or more Attorneys -in -Fact and agents 10 execute on behalf of the Company. as surety, any and all bonds, undertakings and contracts of suretyship, or other written obligations in the nature thereof: to prescribe their respective duties and the respective limits of their authority: and to revoke any such appointment at any time: FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a pond, recognizance, or conditional undertaking will be valid and binding upon the Company when (a) signed by any of the aforesaid authorized officers; or (b) duly executed (under seal, if required) by one or more Attorneys -in -Fact and agents pursuant to the power prescribed in his/her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority. and FURTHER RESOLVED, that the signature of any authorized officer and the seal of the Company may be drawn on or affixed by facsimile or electronically transmitted by email to any power of attorney ar certification thereof authorizing the execution and delivery of any bond, undertak lg, recognizance, or other suretyship obligation of the Company. and such signature and seal when so used shall have the same force and effect as though manually affixed. The Company may continue to use for the purposes herein staled the facsimile or electronically reproduced signature of any person or persons who shall have been such officer or officers of the Company, notwithstanding the fact that they may have ceased to be such at the time when such instruments shall be issued IN WITNESS WHEREOF, the Company has caused these presents In be signed and attested by its appropriate officers and its Corporate seal hereunto affixed this December 15, 2017: QBE INSURANCE CORPORATION (Seal) By_ 6M / 1 By: Brett Halsey Matt Curran Senior Vice President Senior Vice President Attest: STATE OF NEW YORK )SS COUNTY OF NEW YORK ) On this December 15, 2017, before me personally appeared Brett I latsey and Matt Curran, Dotti to hear known to be s enior Vice Presidents of QBE Insurance Corporation, end that each, as such, being authorized to do, execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporaticn by each as a duly authorized officer. HarpFeet Kaur Malin Notary Putik, State of Now York No. 02MA6335099 Qualified is New York County COIIIXIAZACII Expires December 28, 2019 By: c. t (Alki ' f_it (if .11, j, t. Harpreet I{aur Mann. Notary Public CERTIFICATE I Jose Ramon Gonzalez, Jr., the undersigned. Corporate Secretary of OBE Insurance Corporation do hereby certify that the foregoing is a true, correct and complete copy of the original Pourer of Attorney; that said Power of Attorney has not been revoked ar rescinded and that the authority of the Attorney -in -Fact set forth herein. who executed the bend or undertaking to which this Power of Attorney is attached. is in full force and effect as of this date. Given under my hand and seal of the Company. this 61h (Seal) day cf JUNE By: .J 1 A Jose Ramon Gonzalez, Jr.. Corporate Secretary 2018. CTOB CERTI?.CATECF C.; P E-. -201801 1, .--r,it3INEERING INC D . b A : GARC//, P,AMON ce-tibe-^- a! ;,:-ONT11.3,' -G IL QUALIFYING TRADE(S) GC33 PIPE LINE ENG CODY PAVING ENGINPERING '1-6 P STATE OF FLORIDA `i DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION r `a1^r CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 FUNDORA, CARLOS R&G ENGINEERING INC 18735 SW 124TH AVE MIAMI FL 33177 -0321 Congratulations! With this license you become one of the nearly cne million Floridians licensed try the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please lore onto www.myfloridatteense.com. There you can find more inrorrnation about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your custorr.ers. Thank you for doing business in Florida, end congratulations on your new license! RICK SCOTT, GOVERNOR STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CGC1518082 ISSUED: 10/23/2018 CERTIFIED GENERAL CONTRACTOR FUNDCRA, CARLOS R&G ENGINEERING INC IS CErTIFiED under the provisions o; Ch_4B9 FS. E.vp:rauon ; AUG 1.1, 201a 1_16102aCC0142:) DETACH HERE KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD PIr•iVE 411.1 (=)-1; CGC1518082 The GENERAL CONTRACTOR Warned below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,.2018 FUNDORA, CARLOS R&G ENGINEERING INC 18735 SW 124TH AVE MIAMI FL 33177-0321 ISSUED: 10f.2al2016 DISPLAY AS REQUIRED BY LAW SE() L1610223-0001423 F MEAMIQADE`=.: miarnidade.gev February 6 2018 Ramon Garcia R & G ENGINEERING, INC. 10830 NW 23rd St Miami. FL 33172 Approval Date: January 23, 2018 - Disadvantaged Business Enterprise (DBE) Anniversary Date: January 23. 2019 Dear Ramon Garcia, Internal Services Department Small Business Development 111 NW 1 Street. loth F':oer Miami, Florida 33128 miamidade.gov3305 375-3111 F 335-375-3160 Miami -Dade County Small Business Development (SBD), a division of the Internal Services Department (ISD), is pleased to notify you that your firm is certified under the Florida Unified Certification Program (UCP). Your firm meets the eligibility requirements for certification as a Disadvantaged Business Enterprise (DBE) in accordance with 49 CFR Part 26. DBE certification is continuous with no expiration date; however, firrns are required to attest that there are no changes via the No Change Declaration form on or before the firm's anniversary date to remain certified. You will be notified of your annual responsibilities in advance of the Anniversary Date listed above. You must submit the annual No Change Declaration form no later than the Anniversary Date to maintain your eligibility. Your firm will be listed in the UCP DBE Directory which can be accessed through the Florida Department of Transportation's website: http.i/www3b.dot state.fl.us /EqualOoDor tunitvOfficeBusinessDirectorv/. DBE certification is NOT a guarantee of work. but it enables the firm to compete for and perform contract work on all USDOT Federal Aid (FAA, FTA and FHWA) projects in Florida as a DBE contractor, sub -contractor, consultant, sub -consultant or material supplier. If at any time there is a material change in your firm, you must advise this office by sworn affidavit and supporting documentation within thirty (30) days. Changes include. but are not limited to ownership, officers, directors, management, key personnel. scope of work performed, daily operations, on -going business relationships with other firms, individuals or the physical location of your firm. After our review. you will receive instructions as to how you should proceed, if necessary. Failure to comply will result in action to remove your firm's DBE certification. 11 is strongly recommended that you register your firm as a vendor with Miami -Dade County. To register, you may visit: http//w w m arnidade.qov/procurementivendor-registration asp. Thank you for your interest in doing business with Miami -Dade County If you have any questions or concerns, you may contact our office at 305-375-3111 or sbdcertQmia midade._oov. Sincerely, ClaLldious Thompson, Section Chief Small Business Development NAICS & industry. Tille: {Your form ,s e!igtoie to compete for and perform work on all USCOT Federal Aid protects Ihrouggheut Florida and may earn DBE. or .ACDBE. credit for work performed in the fo'lowttng areas.) NAICS 23,3115: NEW SINGLE-FAMILY HOUSING CONSTRUCTION (EXCE;= T FOR•$ALE 1?UiLDERS) NAICS236116 NEW MULTIFAMILY HOUSING CONSTRUCTION sEXCEPT FOR -SALE BUILDERS} NAICS 23,5117. NEW HOUSING FOR -SALE BUILDERS NAICS 236118' RESIDENTIAL REIvIODELERS NAICS 236210: INDUSTRIAL BUILDING CONSTRUCTION NAICS 236220. COMMERCIAL AND INSTITUTIONAL BUILDING CONSTRUCTION NAICS 237110: WATER AND SEWER LINE AND RELATED STRUCTURES CONSTRUCTION NAICS 237310: HIGHWAY, STREET, AND BRIDGE CONSTRUCTION NAICS 238110. POURED CONCRETE FOUNDATION AND STRUCTURE CONTRACTORS NAICS 238123. STRUCTURAL STEEL AND PRECAST CONCRETE CONTRACTORS NAICS 2338919: SITE PREPARATION CONTRACTORS Local Business Tax Recall) of F' o:rluL7, SUSINE55 NAME LOCATION SECEIPT NO. R & C_ ` RENEWAL I C83":'';J 23 5 5408109 SliEET,VA7ER Y:.3.3 i 72 EXPIRES SEPTEMBER 30, 2013 C,"^. - S S. t SEC. TYPE OF 'BUSINESS - —fit_ 5 -- :=�4 ti. s� • . -.✓ PAYMENT RECEEVED BY T. X COLL. G'."f `ia :a7 s,-tatthiLe3aiSusie=.35?ax The .3ereig€ saea3licease. permit. er a r.srldicat€en cl the. : cr'S 9 a. r�;,ai'saas:a de a;:siness ""i_ mcsE ceirp,r with ail). Sa Val ,-ndma er ncngGvr. r,-517,a= r u+a::r,• e€a.., .eraatil_' apply tc ahQ ;;s€cress. Tae S CEIP7 NO.31)'41,ue court S :ia,a€3 s_ as a € -.a.E Zmre€2: r,tic°ss « ta:r —trade Cade S.3s.2a-27$. tha-?%ilif?cnai cn,•.€s,.......,-is i i:jr;atr:•i€i<xr, ll8c.•;,f Zar Local Business Tax Receipt Miami —Dade County, State of orida .s:s NOT A -DC, N -P.AY 3732063 6VSI.NESS NAM75/LOCATION .RECEIPT NO. G 3NCi^i__i;NC RENEWAL 3 cr3 '.;'! ST 3897023 OWNER SEC'. TYPE OF BUSINESS EXPIRES SEPTEMBER 30, 2018 7.7 PAYMENT RECEIVE.? EY T':.X COL ECTOA -5.00 O j031231'7 CR=D._.CAR }—'17 0: .i ;:if::! Y. ' _ nr . of :ht Tax. it:s . ?tC?j 31 :3 tsCl k i€:_^S? pe.T,3=€. C• .... ,..,.pititth u:Ua':i£3:-. ^'N Erma"'. GdrfT€i: i..b.3,re.L _.,::,7-,unf41 i.., S.. _ .9 >�33ty iithe E'u5:0e55- -I 'ECE'Pir NO, it'c7EFGla,,-• a i:. ._,.._[..h°c?es M1':s=:..—J >.Cade Se: _, .�'. •1:_ il!i�F^t:se..'lf�3�':t.r.......'.;I;;�3:s—._Jti; tSY::li���!�C City of Sweetwater 500 SW 109'" Ave Sweetwater FL 33174 Business Tax Department (305)221-0411 Business Tax Receipt Effective Date: '10/1/2017 Expira;[ ri Date: 9/30/2018 RAMON GARCIA/ R & G ENGINEERiNG INC: 10 530 NW 23 ST SWEETWATER, FL 33172 RAMON GARCIA Phone Number: (305) 470-1905 Contractor -Engineer -General City of Sweetwater 500 SW 109"' Ave Sweetwater FL 33174 Business Tax Department (305)221 0411 Business Tax Receipt Effective Date: 10/1/2017 Expiration Date: 9/30/2018 R & G ENGINEERING INC 10830 NW 23 ST SWEETWATER, FL 33172 RAMON GARCIA Phone Number: (305) 470-1905 Administrative Office Penalty is imposed for failure to keep this receipt displayed conspicuously License Description: Contractor -Engineer -General License No: 171000001 Restrictions: RAMON GARCIA / R & G ENGINEERING INC 10830 NW 23 ST, SWEETWATER, FL 33172 Penalty is imposed for failure to keep this receipt displayed conspicuously License Description: Administrative Office License No: 104000121 Restrictions: R & G ENGINEERING INC 10830 NW 23 ST SWEETWATER, FL 33172 1S6RIN FOGHT TO WORK = , R & G ENGINEERING INC RIGHT TO WORK 108.30 NW 23 ST F.- :33172 2018001522 S30,00 ACOW Li CERTIFICATE OF LIABILITY INSURANCE DATE IMhtiDINYYYYI 05'.i012018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the palicy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditionS of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER A&A Underwri ers Inc. 8778 SW 8st iYliami FL 33174 •CONTACT INAmEdnana L Cav ja Maor EA C ONE. FA(305)220-7447 1, FAX Nrrj: (305) 22.0-4821 &MAIL ADD Ess; certiflcatesgaatindervrlters.com INSURERtS! AFFORDING COVERAGE NA€C X INSURER A:. cvanstonInsurance Ccrnpa;ly 35378 INSURED R&G Engineering, Inc. 10830 NW 23rd ST Ivlia:m' FL 33167 INSURER a : Progressive Express Insurance Company 10193 INSURER C : Hudson; Specialty Insurance Company 37079 INSURCR 0: BridgefeId Eniployers Insurance Company 12158 INSURER E , Scottsdale Insurance Company 41 297 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES CF INSURANCE -'FST D BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERPOD INDICATED. 4OT'aATHSTANDING ANY REOLP EMENT TE:��OR CONDITION CF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO `vi;1-;!Cri THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN: 4 THE €N0tJNANCI= AFFORDED BY THE POLICIES DESCR'EED HEREIN 15 SUBJECT TO ALL THE TERMS. EXCLUSIONS AND COND€TIONSOr- SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IriSR - A =0i.-SL ER POLICY EFF r -a TYPE OF INSURANCE ;.;51-; y:,:^. POLICY NUMBER fRIMIDO.NYYYI POLICY EXP I.•,'€M,OONYYY3 LI€A€T$' X COMMERCIAL GENERAL LIABILITY HC0 1000013-0'. 01117;2018 _ a 1,000-00 ,x.r,r5 u'wE X CC._wr. - =s ; - 100,000 X Blanket R.ddilional Insured V.I.:.-0 EXR € - :re r.erzonl S 5,000 A X : BIanKet Waiver of Subroga0on 01/1712019 12019 PEesr r .?, Anv iN ,,NCR,,. s 1,000.000 =EN_ AG2-RESATE LACT AP: LE5 ER: GENERAL A3C:%<_, Arr s 2.000,000 ' L n : X : FoC'' : W c ,.; ; (-:.'s - comP u'r AGC , 2.000,00€0 X =v _.=. Primary and Non Contribu DedGrtwle Pe-Clairn ', s 2500 AUTOMOe ILE LIAeLLIry ANY :_rY_^,. B T~ AL " E_ i< c 0645310$-0 01/08i2018 - - _- : : b 1,000,000 =_-=I_ ,.JRY(Per 5a.!4Gr".j S 01i08/2019 EcCI! ,.'.. :Y /Pe 5 ve .ii $ G 1vY . D ALITCS .=CS OAM;A.Gfi $ ..r =- X PIP 10,000 X UM20,000 l 5 UMBRELLA LIA6 : X , ,,,F, C X EXCESS _JAB o - rs 41 NIKO/2EJL102173 01,117/2018 EACH OCCURRENCE s 3.000.000 01 17,12O19 I AatREa E ; S 3,000,000 D77. RETENTQN» S I WORKERS COMPENSATION AND EMPLOYERS' LIABILITY - Y:ry. I 834-41737 04114)2Lt18 I 1 '' I �` , 5 }. w ,.. ? :N7 E.L.EACH S 1.000,000 r'=? a P , IVc D „vex , ::-_.-_ *':.---_. 1Y ,'' N: A (Mandatory ,n NH! c 04/14;20 9 ! _-L, G=a_rse EA E.. '_:. _ _• 3 1 ,000,D00 L. E °EAS Po ICY IM! 1.000,000 Commercial inlan6 Marine C S2707;:09 08105/2017 EQUIPMENT LIMIT 5 965.708 08/05/2018 COINS 90 g DED 5 1,000 ACV DESCRIPTION CF OPERATIONS: LOCATIONS `VEHICLES 5ACORD 101, Additional Ramat Seeeduie. may be akachnt4 If more space .s required' CERTIFICATE HOLDER CANCELLATION .City of Miami 3500 Pan A{rerican Drive Miami, FL 33133 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CANCELLED BEFORE THEEXPIRATroN DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PRODUCER ACG7h'/..? CERTIFICATE OF LIABILITY INSURANCE Date THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE_QERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT POMP F4taiueth GAM:4 PHO'JF I FAX jA.C. Ji0 ExtJ: 3USa44361.% J:,:C. Nol: 3135A,t1S5J, E MAIL AD RESS ELIZA9ETH,CFGOL3ENA.LLIA'C OM INSUFtFRISt AFr-oa Imm COVERAGE NALC M iEJl A •":i"�Jy kr9•ur c: 1-s . _ j.i r,'•;Y 3Sa5: INSLJRED 4 3,3 Erreerr- ICE =... S3R7..33172 NSURE. B : INSURED C : INSURE D - lr 1 1RE0 E : Ir1SJFED F • COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: T,,15 15 TC) CE%,TIF" THAT TH PCL :ES OF INSURANCE LIS =3 BEL3W HAVE BEEN ISSUED ' U THE 'NSU".ED NA ,1=.= ABOVE FOR THE r'UL:cY PERIOD iNCICATED MO i WiTHST MJC1NG ANY R Q'UREMENT. TERM OR CCND!-ION OF ANY CONi TACT OR OT%ER Dot; jMENT t'JiT! l HESPrI T TO WI-ECH THIS GER- FICATE s1AY 3E ISSUED UR MAY PERTAIN. T-E INSURANCE AF;ORDEG SY THE F :!t.IC.ES DE3r r'?IEIE.: H_Lt.E:, IS SUBJE,f -0 ALL THE TERMS EXv JSiCINS AND COND.TICNS r ,- 'SUCH PL-LIC'ES Lim 7 S S',..0 • N MAY HAVE BEEN RELIJ 9D 9Y ?:.IL „:,.A1,15 NSS Ai'DL - SUER TYPE OF INSURANCE LIR INSo i vAto P;.'L'CY NUMBER POLICY EF= I PCLICY EXP LIMPS COMMERCIAL GENERALLIABILt`Y I _ 'AFL.'RAP ,,Any o'e pars;ri 15 RSC?tsAL L AD4' T i.,Ua' s .:=.`J' _ -.. �r Ev _ _:5,`.I- APeL:ES r--ER: GENE9::L_AOir E..N T5 ss'f _ IOC :.RC:IS L-S-.C.C? C ;1'4EP 5 AUTOMOBILE'LiAHIL1iY CCLA5ESrw='NCLE:_:M1T 1„2 Attica(,' 3•,{lck.13 J P PN J-` BCD:LY:,,_'RY;Per ,erscn) 3 A :l: _JF_' . � .._ -1,=" cr---': „EL' ? t� „ _.. 5+'u9BOCot15.J14GE1 Ot,+a'z.r 7a aiJ18J2C19 9 l!, 6JRYsPec acz:tfon'; 5 A A ::-,aa ONLI,` NCv....5`a_? i _-:5 C.: P C EP.".OrS15GE /Pada�N:c- „ $ - uMBReLLALlAJs -,•..:R _ i:N Wi.WiRENCE - _ EXCESS LAB ;:L.CMS•:':P_E _ F :r-_ $ WORKERS COVPENSATI:7, ANZ`EEMPLOYERS L'ABIL'.`l Y' M Nam1Atsr/In NHj a N N1n i cf.! _. �. _--' .5 DESCRIPTION Or OPESA71O1JS / LOCATONS t VEHICLES I ACORD 16t, Ad5ltionat Remarks Sches9Lfe, may be attache* tI re.,, spaea 11 regl,tad) CERTIFICATE HOLDER CANCELLATION City of Miami 35C0 Pan American D rive Miami Ft. 33133 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BECANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I ACCORDANCE WITH THE POLICY PROVISIONS. ALJTY5 R?2ED REPRESENTATIVE �L{ 1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Inginfering, LIM OF COMPUF.SC. Fk-2:;1C-71. IN IKE 1.337 FIVE 'fan Cor7+,:cf No Nome Owner Inferrneten , • -• ="7." :;.• s• • ' ' FE,. Scone Valee Co-drnesnn Stolui ••. ,-.•=•=• Se,.,• ._-^" 7 ' e ' • _1•-••., 31'• I 'L." r7V:: arz cve 7"= n'e.:;•• • =s Fs =:•= -; z-= es' 7. • "...=,:==••'-rstcs,ra!:::- =sr.; 7.-C:ses. • '=:•,- , - == 7.• '' ' = =:•• erc.• F•sc • = . !E•,... OcCrc.,-r], rc!.77reVe,:.1•Cre: : • .7-.75•4-1E-7,7.-F... C.cr,,c7eTe= verA --ssn-st-4 „ !S., • j 7 7 ?-7 T.• t*". i?: ; : • !--B5,7-7111c.7, z. .7,-5, • • - e_ :57 rr • • ;5 c .7 C 7 -7,5 • _7- • 7.7; 5 • n7-7-7 55v' 1'117- 7 t"...7 7 1 •-= LT CF CONS -rim,: u"....54 PRO:EC..5 rROC.5 Cararoci No, i" i"nr...r,:` • S • r. 4.- .7- Ow7Le:Irlo5rration Scope Value Coneaci aHon Stalus $.11,35 • 5 LI :E.:a • 2 I r :!--: ;55:5 .•- • :;55.' .55 '4.... • c ! - '771 "L:- 1":": .1.: • .17 '7,- : f7 54' '7..77-;7077 Engineering, Inc. i6i:J-DLJE DATE: DURATION; Bid No. 17-18-029 / Overtowri Gree[iway at NW i_th Terrace - Phase 2 from NW 3rd Avenue to 6t-1 Avenue. City of Miami 6/6/2018 300 Days Equipment Item Nunter mahi:facterer Type M:ode1 Description Year Serra!;f0 Ntrmuer Amount of!n5tsra`1ce 1 Caterpillar Compactor C3214E Mum Compactor 2006 21400742 $20,000.00 2 Caterpillar Compactor 43B Roll Roll Compactor 199.9 3TM00932 S25,000.00 Komatsu Excavator PC228 Excavator 2004 30987 $50,000.00 4 Komatsu Loader Wa250 Loader 19 3 53364 'S30,060.00 E Caterpillar Bacltmce 420.0 Backhce 2305 7dp021956 S330.000.00 6 John Deere Backhhe 410-G Backhoe 2002 TO410gx91075 620,000.00 7 La -Mor Broom 8HC Lay Vlor 2005 27325005 S10,300,00 3 Ja:ir Deere Beckhoe 3105 Backhoe 2XS T0310sJ ic8522 552,000,00 9 John Deere Skid Steer 326.0 Skid Steyr Loader 2010 T0326DbM179841 541,500.00 Lee Boy As�has: Paver 700C Asphalt Paver 2006 46115 $47,000.00 _ Caterpiliar Tractor 0.3axl Track Type Tractor 2005 JMH01670 5.2,500,00 12 Caterpillar Skid Steer 2E3B Skid Steer Loader 2007 SN-Lba01867 $10,000.00 13 Tere t Asphalt lipaera -340TV120C I Asnpalt Roller 2007 5L13TVPRBE104c4082 516:C00.00 Case Skid Steer 1840 Skid Steer Loader 1997 Jaf028956Z $11,000.00 IS John. Deere 9ackhi?e 3105J Wl ter Loader Backhoe 2009 T0.3,1052170732 S48,500.00 I5 Hitachi Excavator 2x300 LC 6 xcavator with 30' Rock Bucket 2015 1FF0Df'7 CFF840024 $272,90.8.00 17 John 0e^re Excavates 120C Excavator 2038 PF120CX336470 $70,000.O0 18 Johr Deere Skid Steer 3260 Skid Steer Loader 2011 T 326DL186210 $30,000.00 19 international Truck 257 Vactor Truck 2003 IHT0GAT0YH2S6485 $78,000.00 Engineering, Inc, 23 ,..":rni, FL 33172 • T.. iC'`; e.'1 -. Far •, C d7, 1975 Liquidated Damage History PROJECT: OWNER: BID -DUE DATE: DURATION: Bid No. 17-18-029 Overtown Greenway at NW nth Terrace - Phase 2 from NW 3rd Avenue to 6th Avenue. Cty of Miami 6/6/2018 300 C&endar Drys Project Type of Penalty Description Amount Pump Station City Two Liquidated Damage NTP was given around 3 months before having paperworks approved $174,000,00 To Whom It May Concern Subject: Reference Letter - -- Name of Bidder L.? • The above referenced Bidder is responding to a Bid that has been issued by the City of Miami. The City requires that the Bidder provide written references with their Eld submission, By providing you with this document, the Bidder is requesting that ycu provide the fnItowing reference informatiom The City would appreciate you providing the information requested below, as well as any other information you feel is pertinent t • Name of Re,terenced Pro-ject: • Scope of Referenced Work: jo.u2r.),,n-.0.„+--, ti/L 3{ L1-: 12; L0.61. ,4,1r Atd f‘-`.4) 141'4.11'1' 1'4 Did the Scope invoive the Construction, installation, repair and/or replacement of drainage system components, sidewalks, pedestrian lighting or ADA ramps? YesJ No ( Value of Project: $jI Date Completed: Percentage of physical construction labor self -performed y Bidder: 0 Q/0 Was project completed on time and within budget L Yes LI No If no, was the Bidder 8t fauh or contribute to the cielay(s) cr increased cost? Li Yes [4/No if yes, please provide details: Comments: Name of Project Owner: ivii.4Vi J Date: Signature Title: Lp3 Project Owner's 79(3 M D-WAS Telephone. 78 2..S8 - 2, S' -7 3 E-mail: W Sincerely, Annie Perez, CPPO, Director Department of Procurement Overtown Greenway at NINilth Torrace Phase 2 - Proiect No.: B-30624 Representative: ITB No,: 17-10-02D To Whom It May Concern Subject: Reference Letter • Name of Bidder: The above referenced Bidder is responding to a Bid that has bean issued by the City of Miami. The City requires that -the Bidder provide written references i,,p/th their Bid submission, By providing you with this document:the Bidder is requesting that you provide the. toliciw:ng reference Information. The City Would appreciate you provicfing the information requested below, as well as any other information you feel is pertinent: Name of Refer-enced Project.; r- Scope of Referenced Did the Scope involve the consruction,'installation, repair and/or replacement of drainage system components, sidewalks, pedestrian lighting or ADA ramps? Et -Yes ri No Value of Project: cif 5.,f)(0 Date Completed. Percentage of physical construction labor self -performed by Bidder: Was project completed an time and within budget: R7 Yes 1-71 No If no, was the E3idder at fault or contribute to the delay(s) or increased cost'? 0 Yes No If yes. please provide- details: Comments Name of Project Owner: Signature Titiel Telehone- Sincerely, Annie Perez, CPPO, Director Department of Procurement IT -4.fe Date: oject 8 20 Overtown Greenway at NW lith Terrace 91) Phase 2 - Project No.: E3,.30624 Owner's M Wleprosentative• O-14 1TB No.: 17-18- 9 To Whorn It May Concern Subject: Reference Letter Name of Bidder' " «I: :ri i L1i; The above referenced Bidder is responding to a Bid that has been issued by the City of Miami. The City requires that the Bidder provide written references with their Bid submission. By providing you with this document, the Bidder is requesting that you provide the following reference information. The City would appreciate you proviring the information requested below, as well as any other information you feel is pertinent: Name of Referenced Project: S. L Scope of Referenced 'Work: -f. .-,, ', r , `r =i � � n � r-��u• ( P.-r Did the Scope involve the construction, installation, repair and/or replacement of drainage system components, sidewalks, pedestrian lighting or ADA ramps? "'Yes Li No Value of Project: $ ,11,51, a-k , Date Completed _ "Aliki%off Percentage of physical construction Tabor self -performed by Bidder: O Was project completed on time and wi:hin budget: Yes C, No if no, was the Bidder at fault or contribute to the delay(s) or increased cost? El Yes E No If yes, please provide details: Comments: Name of Project Owner: ,` Signature l+.tde-e'-',fZ C-4; i re r' Date: of Project Owner's R?p-esentative• Title: Telephone: Sincerely. Annie Perez, CPPO, Director Department of Procurement Overtown Groenway at NW 11th Terrace Phase 2 • Project No.: B-30624 ITS No.: 17-.1 t3-029 E-mail: Project No. B- 30624 CITY OF MIAMI CAPITAL IMPROVEMENTS PROGRAM SUBCONTRACTOR UTILIZATION FORM Project Title: Overtown Greenway at NW 1 lth Terrace - Phase 2 Sheet No. 1 of 1 This Form should be submitted with a bidder's bid form submittal. Failure to submit this Form with the bid may result in the bid being rejected as non -responsive. The City in its reasonable discretion may allow, in the interest of the competition, the Bidder to submit the Form after bids are due (as supplemental information). Provide the following information for each subcontractor regardless of tier.* Attach additional sheets if necessary. Name of Business Portion of Work Dollar Amount Percent Address/City/State/Zip License Information** Miami-DadeCertification* CBE CSBE N/A Type Number Road Runners Striping $ 30,000.00 1.7%d yn04 NW e0m Ave. Hialeal5 Gardens. FL. 3301E MDC-CTQB 07BS00834 Q QEl Florida So! Electrical $ 150,000.00 8.5% 7055 SW 10th ST, Miami, FL. 33144 Electrical license ER0000305 In I• ✓ H&J Asphalt Asphalt $ 50,000.00 2.8% 4310 NW 35th Ave. Miami. FL. 33142 General Contractor GC1513867 0 0 ✓ Acton Sod Landscape $ 220,000.00 1 2.5% 5700 SW 123rd Ave. Miami, FL. 33183 N/A N/A 0 ✓ n IN © 0 0 E a a a a o o . MI a a * Must be certified by Miami -Dade County. AU tiers must be shown, including multiple sub -tiers, if permitted by the Contract Documents. **List only those relevant to this Project. ***Check N/A if the listed SU does not have a CBE/CSBE certification (e.g., independent third party verifier) Form SU STATE Or FLORICA DEPARTMENT or TRANSPORTATION CERTIFICATION FOR DISCLOSURE OF LOBBYING ACTIVITIES ON FEDERAL -AID CONTRACTS (Compliance with 49CFR, Section 20.100 (b)) 375-030-33 PROCUREMENT 10/01 The prospective participant certifies, by signing this certification, that to the best of his or her knowledge and belief:: 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 federal 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 or will be paid to any person for influencing or attempting to influence an officer or employee of any federal 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 of Lobbying Activities", in accordance with its instructions. (Standard Form-LLL can be obtained from the Florida Department of Transportation's Professional Services Administrator or Procurement Office.) 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 prerequisite 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. The prospective participant also agrees by submitting his or her proposal that he or she shall require that the language of this certification be included in all lower tier subcontracts, which exceed $100,000 and that all such subrecipients shall certify and disclose accordingly. Name of Consultant: h r e"i r By: Authorized Signature: Title: 216 Overtown Greenway at NW 11th Terrace - ITB No.: 17-18-029 Phase 2 — Project No.: B-30624 STATE or FLoRk)A OEP.ARTM. ENT OF TRANSPORTATION DISCLOSURE OF LOBBYING ACTIVITIES Is this form apppcabi to your firm? YES ❑ NO If no, then please complete section 4 below for -Prime" 375030-34 F OCUf EMEnT Multi 1. Type of Federal Action: a. contract b. grant c. cooperative agreement d.loan e. loan guarantee f. loan insurance 2. Status of Federal Action: a. bid/offer/application b. initial award c. post -award 1 Report Type: a initial filing b. material change For Material Change Only: Year: Quarter: Date of last report. (mm/dd/yyyy) 4 Na and Address of Reporting f ►Prime ❑ Subawardee Tier Entity: if known: 5 If Reporting En Address of Prime: ity in No. 4 is a Subawardee, Enter Name and Congressional District. if known: 40030 APO (-4` SI-,dd /11 0-('ti r .K _ 3 3f7 . ,2- Congressional District, if known: 4c 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, if applicable: 8. Federal Action Number, if known: 9. Award Amount, $ if known: 10. a. Name and Address of Lobbying Registrant if individual, last name, first name, MI): b. Individuals Performing Services (inclkding address if different from No. !Oa) (last name, first name, MI): 11. information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this Transaction was made cr entered into. This disclosure is required pursuant to 31 U S.C. 1352, This information will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10.000 and not more than $100,000 for each such failure. / t..- '_r Signature: l L f 0� �� rl reAA Print Name: Rl i c Title: { res;Atilt Telephone No.:'.-' 4170-I'Date (mm/dd/yyyy): 13 Federal Use Only: Atorize stands dFormLl LI ItRevv g7 7 an 375.034-3< PROCUREMENT 04.0.4 Page 2 of 2 INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES This disclosure farm shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity 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 a covered Federal action. Complete all items that apply for both the initial filing and material change report Refer to the implementing guidance published by the Office of Management and Budget for additional information. 1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. 2. Identify the status of the covered Federal action. 3. Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred Enter the date of the last previously submitted report by this reporting entity for this covered Federal action. 4 Enter the fullname, address, city, State and zip code of the reporting entity. include Congressional District, if known, Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g , the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in item 4 checks "Subawardee," then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (itern 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitation for Bid (IFB) number: grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Include prefixes, e,g., "RFP-DE-90-001." 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5. 10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a). Enter Last Name, First Name, and Middle Initial (MI). 11. The certifying official shall sign and date the form, print his/her name, title, and telephone number. According to the 'Paperwork Reduction Act, as amended, no persons are required to resperid to a collection of information unless it displays a valid OMB Control Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed. and completing and reviewing the collection of information. Send comments regarding the burden eslimale or any other aspect of this collection of information. including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Projecl (0348-0046), Washington, DEC 20505 S 7 E OF F_ORSD.A DEPARTMENT OF TRANSPCR ATION CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION -LOWER TIER COVERED TRANSACTIONS FOR FEDERAL AID CONTRACTS (Compliance with 2 CFR Parts 180 and 1200) 375-030-32 PROCUREMENT 11/15 tt is certified that neither the below identified firm nor its principals are presently suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency. Name of Consultant/Contractor: R S; 2.4 By: I118r✓l. G ✓ r Date: (Q I3f 2 71'g Title: !ft' °Llilt Instructions for Certification Instructions for Certification - Lower Tier Participants (Applicable to all subcontracts, purchase orders and other lower tier transactions requiring prior FHWA approval or estimated to cost $25,000 or more - 2 CFR Parts 180 and 1200) a, By signing and submitting this proposal, the prospective lower tier is providing the certification set out below. b. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government. the department, or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. c. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous by reason of changed circumstances. d. The terms "covered transaction," "debarred," "suspended," "ineligible," "participant." "person," "principal," and "voluntarily excluded," as used in this clause. are defined in 2 CFR Parts 180 and 1200. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. First Tier Covered Transactions" refers to any covered transaction between a grantee or subgrantee of Federal funds and a participant (such as the prime or general contract). "Lower Tier Covered Transactions" refers to any covered transaction under a First Tier Covered Transaction (such as subcontracts). "First Tier Participant" refers to the participant who has entered into a covered transaction with a grantee or subgrantee of Federal funds (such as the prime or general contractor). "Lower Tier Participant" refers any participant who has entered into a covered transaction with a First Tier Participant or other Lower Tier Participants (such as subcontractors and suppliers). e. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated. f. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions exceeding the $25,000 threshold. g. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant is responsible for ensuring that its principals are not suspended, debarred, or otherwise ineligible to participate in covered transactions. To verify the eligibility of its principals, as well as the eligibility of any lower tier prospective participants, each participant may. but is not required to, check the Excluded Parties List System website (https:/www.epts.govl), which is compiled by the General Services Administration. h. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings, 21S Overtown Greenway at NW 11th Terrace - ITB No.: 17-15-029 Phase 2 — Project No.: B-30624 i. Except for transactions authorized under paragraph e of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible. or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment Overtown Greenway at NW 11th Terrace - ITB No.: 17-18-029 Phase 2 — Project No.: B-30624 STATE O1 FLORIDA DEPARTMENT C: IRANSR)FRFAr ION NON -COLLUSION DECLARATION AND COMPLIANCE WITH 49 CFR § 29 1, ctirlog a. (NAME) 5l5-Co13 RIGHT CIF WAY OS01 Page 1 ::r 3 ITEM/SEGMENT NO.: F,A,P. NO.: MANAGING DISTRICT: PARCEL NO.: COUNTY OF: BID LETTING OF: , hereby declare that I am of X Y►�'j i ± �f' riYL r v1c . (TITLE) (FIRIN2) of Mroc ii (CITY AND STATE) and that 1 am the person responsible within my firm for the final decision as to the price(s) and amount of this Bid on this State Project. I further declare that: 1. The prices(s) and amount of this bid have been arrived at independently, without consultation, communication or agreement, for the purpose of restricting competition with any other contractor, bidder or potential bidder. 2. Neither the price(s) nor the amount of this bid have been disclosed to any other firm or person who is a bidder or potential bidder on this project, and will not be so disclosed prior to the bid opening, 3. No attempt has been made or will be made to solicit, cause or induce any other firm or person to refrain from bidding on this project, or to submit a bid higher than the bid of this firm, or any intentionally high or non-competitive bid or other form of complementary bid. 4. The bid of my firm is made in good faith and not pursuant to any agreement or discussion with, or inducement from, any firm or person to submit a complementary bid. 5. My firm has not offered or entered into a subcontract or agreement regarding the purchase of materials or services from any firm or person, or offered, promised or paid cash or anything of value to any firm or person, whether in connection with this or any other project, in consideration for an agreement or promise by any firm or person to refrain from bidding or to submit a complementary bid on this project. 6. My firm has not accepted or been promised any subcontract or agreement regarding the sale of materials or services to any firm or person, and has not been promised or paid cash or anything of value by any firm or person, whether in connection with this or any other project, in consideration for my firm's submitting a complementary bid, or agreeing to do so, on this project. 7. 1 have made a diligent inquiry of all members, officers, employees, and agents of my firm with responsibilities relating to the preparation, approval or submission of my firm's bid on this project and have been advised by each of them that he or she has not participated in any communication, consultation, discussion, agreement, collusion, act or other conduct inconsistent with any of the statements and representations made in this Declaration. 8. As required by Sectidn 337.165, Florida Statutes, the firm has fully informed the Department of Transportation in writing of all convictions of the firm, its affiliates (as defined in Section 337,165(1)(a), Florida Statutes), and all directors, officers, and employees of the firm and its affiliates for violation of state or federal antitrust laws with respect to a public contract or for violation of any state or federal law involving fraud, bribery, collusion, conspiracy or material misrepresentation with respect to a public contract. This includes disclosure of the names of current employees of the firm or affiliates who were convicted of contract crimes while in the employ of another company. 575-C,6 .13 RIGS-T O NiA1' 05gr Page 2oP7 9. I certify that, except as noted below, neither my firm nor any person associated therewith in the capacity of owner, partner, director, officer. principal, investigator, project director, manager, auditor, and/or position involving the administration of Federal funds: (a) is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions, as defined in 49 CFR §29.110(a), by any Federal department or agency; (b) has within a three-year period preceding this certification been convicted of or had a civil judgment rendered against him or her for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a Federal, State or local government transaction or public contract; violation of Federal or State antitrust statutes: or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements or receiving stolen property: (c) is presently indicted for or otherwise criminally or civilly charged by a Federal, State or local governmental entity with commission of any of the offenses enumerated in paragraph 9(b) of this certification: and (d) has within a three-year period preceding this certification had one or more Federal, State or local government public transactions terminated for cause or default. 10. I(We), certify that I(We), shall not knowingly enter into any transaction with any subcontractor, material supplier, or vendor who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this contract by any Federal Agency unless authorized by the Department. Where I am unable to declare or certify as to any of the statements contained in the above stated paragraphs numbered (1) through (10), I have provided an explanation in the "Exceptions" portion below or by attached separate sheet. EXCEPTIONS: (Any exception listed above will not necessarily result in denial of award, but will be considered in determining bidder responsibility. For any exception noted, indicate to whom it applies, initiating agency and dates of agency action. Providing false information may result in criminal prosecution and/or administrative sanctions.) I declare under penalty of perjury that the foregoing is true and correct. CONTRACTOR: / (Seal) BY: Gu tGi] f- (CIA .e5 i G1e•Y M A D TITLE PRINTED BY: GNATURE Executed on this 43 r4 day of Tub WITNESS: WITNESS: FAILURE TO FULLY COMPLETE AND EXECUTE THIS DOCUMENT MAY RESULT IN THE BID BEING DECLARED NONRESPONSIVE