HomeMy WebLinkAboutBid Information and Packets •
Prescribed by State Boatel of Accounts 990549-5536759 General Form No.99?(Rev 2009A)
CITY OF CARMEL-TOPICS LEGALS To: INDIANAPOLIS NEWSPAPERS
307 N PENNSYLVANIA ST - PO BOX 145
COUNTY, INDIANA INDIANAPOLIS, IN 46206-0145
PUBLISHER'S CLAIM
LINE COUNT
Display Matter-(Must not exceed two actual lines, neither of which shall
total more than four solid lines of the type in which the body of the
advertisement is set). -number of equivalent lines
Head - Number of lines
Body- Number of lines
Tail - Number of lines
Total number of lines in notice
NONaPealli � 5F CHARGES
Nq�ice's reb gi mat th¢Bpyrd MI Wgrhs ap
Sa aty 1¢rd e iry o fa,m¢l Hama ton unry.Sr��ags,w,Itll .0 columns wide equals 56.0 equivalent lines at .649
r erne sea etl ipsvltQOr one I�I N F ¢k-up tru[F un111 —
rk moor pmepnteer711..2(I ate,eamaI 'ine $ 36.34
Prk-�B surer[i'e q u ¢I, ne lC' R u ere, arms - 1
e win be np¢nal the same prey on dret her I e for notices containing rule and figure work 50 per cent
10 g�m.lar2l hueesaro Pp hts,io r.�eebggg� �g ° ( p
ti e A cif LPambers al the same ad�ress,No 121¢Bit mount) .
b(ds as be rsmmianiet by a cerb�g�neck cashiers ra proofs of publication ($I-00 for each proof in excess of two) .00
eq a 10 d4lpgnt to1 o the bid.8i s _
'mpttyg�rgrifi 911�ay5Allll ov 51nYS[p 5yblnitttt�eporge
Slato.V$1 9fea? ats aoprrn o!!a t' bp,neer Oic .MOUNT OF CLAIM $ 36.34
lW9 puan a sea? ��77d^av leh¢words FE�n99ineennq i[k-
p�tlidd m the I�µ�r 1nn ha�at ocoo.ph kidders must hie a
h fist I sin Atli ant p all Ixcetlhans [haA9 must WINO cos I
h I'steanan a separate pag Ifie ht t�o'elect a or nd all
p r ant 5�{eq r elves e h id,et any and all
61814 Cgpr pl spen ad9ns mayf$9thuine a: 'column 5c88 ems Size of type?
mtr Let lYdnFn6 Department 7
{{n�a� rtions _ 0
l' Y1 44I
(1L-9/17/19,9/24/39-5536759) r
Pursuant to the provisions and penalties of IC 5-11-10-I, I hereby certify that the foregoing account is
just and correct, that the amount claimed is legally due, after allowing all just credits, and that no pal of the same
has been paid.
I also certify that the printed matter attached hereto is a true copy, of the same column width and type size,
. which was duly published in said paper 2 times. The dates of publication being between the dates of
09/17/2009 and 09/24/2009
Additionally,the statement checked below is true and correct:
Newspaper does not have a Web site.
Newspaper has a Web site and this public notice was posted on the same day as it was published in
the newspaper
Newspaper has a Web site, but due to a technical problem or error, public notice was posted on
Newspaper has a Web site but refuses to post the public notice.
R � 5\,31 =Tt3 UV\
DATE: 09/24/2009 Title: Clerk
Prescribed by State Board of Accounts 900549-5536751 antral Form No.99P(Rev_2009A)
CITY OP CARMEL—TOPICS LEGAI.S To: INDIANAPOLIS NEWSPAPERS
307 N PENNSYLVANIA ST — PO BOX 145
COUNTY, INDIANA INDIANAPOLIS, IN 46206-0145
PUBLISHER'S CLAIM
LINE COUNT
Display Matter-(Must not exceed two actual lines,neither of which shall
total more than four solid lines a F the type in which the body of the
advertisement is set).-number of equivalent lines
Head -Number of lines
Body- Number of lines
"Pail-Number of lines
Total number of lines in notice
cEmemo�gs OF CHARGES
yuta""e a 0 columns wide equals 58.0 equivalent lines at .649
wore, h re5 g n irat'tbP B rd al Pubi Works an q y
'$H1Ery Ir e It �InR� i°�g� u n is '
rrreeivc se e�6p.m.local rvm t21 o (dot g hat e,line $ 37.64
Aunt am.uzulme�n(doter hg gat eie
ac 2rk.$j surer o t an a eCin kyae,srgc Rx notices containing rule and figure work(�0 per cent
":204,,el nay wlllbg990a time toirldPubc,pn Or
er 1, e�`On I�L a�al toe the sa ml edor ss.No'amount)
fp`!IIIgiIn eWalKt i31 e15 d[1252me 2d @ss. o
to Bi 5Wi ee Aaepte. ttra proofs of publication($1.00 for each proof in excess of two) .00
AIt
hIplini be accom tied by acera7 BA ch k,cashiers
cnet oer ldhnr r�a!in roar aoF�he bj en AMOUNT OF CLAIM $ 37.64
st e r d Pr t are Farm ThtI rn ante-
11" r a unt aafr a fur 9tneer, id are
�°id ri tp lowut en-and-corner.Al bidders finer Hti e a
Id maarow at.andirenr.Rins ere puisma
oted cia a wear and aR The lrmeokoora tls istit PUTING COST
Ilsted r a secifir ensi me timed y r ('ebli
V prl an 5 ery r roes the nght lo,ret c1 any and ad51,e column 5_8 ems Size of type 7
•Cathie copy r�spec trrnamay he rbialfR�al'
rm DEn tare goapartment tendons 2.0
nrc��ivi`ps�d�guare
MIS?
Diana L Coorrdrag CletHreasurei
ML-9/V/09,9124/09.5536751)
-- -- t uenumu"rV we provisions and penalties of IC 5-1 1-10-1, I hereby certify that the foregoing account is
just and correct, that the amount claimed is legally due,after allowing all just credits,and that no part of the same
has been paid.
I also certify that the printed matter attached hereto is a true copy,of the same column width and type size,
which was duly published in said paper 2 times. The dates of publication being between the dates of:
09117/2009 and 09/24/2009
Additionally,the statement checked below is true and correct:
Newspaper does not have a Web site.
V Newspaper has a Web site and this public notice was posted on the same day as it was published in
the newspaper
Newspaper has a Web site,but due to a technical problem or error,public notice was posted on
Newspaper has a Web site but refuses to post the public notice.
`_ice _ tmow r,
DATE: 09/24/2009 Title: Clerk
ti ( nfF(_/2,nIC H.
COMPANY BID AMOUNT ALTERNATIVE ALTERNATIVE
SJn/o
sent_
VII
p00000•00000
4.
rreseucen oy Slain hoard dl accounts 6nyce Fo,ms.Sysiema.Munde.iN,2an Ferm No.96■F¢rlfod 2000
CONTRACTORS BID FOR PUBLIC WORKS
PART I
(To be completed for all bids)
(Please type or print)
Date: /a/6/041
1. Governmental Unit (Owner): ii II r O F A km �`L- ar AN I
2. County: z +�1;&�1n L. re/.-
3. Bidder (Firm): i3ILL ESTCS l knvP.acF_-r 117,,vc .
Address: l 0 5 Gj, 46.1 S+
City/State (}rthroc. , W 2_6 Y
4. Telephone Number: 3+ 1 - c7.1- 331 '6-
5. Agent of Bidder (if applicable):
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the
public works project of (cr— ex.F(-- Ail ,(Governmental Unit) in accordance with plans and specifications prepared by Gs c s Cµ U'P41.5 r ic.
and dated /0 /e, /09 for the sum of
$ lig eS
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the
notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the
notice. Any addendums attached will be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as that
shown in the original contract if accepted by the Governmental Unit. If the bid is to be awarded on a unit basis,
the itemization of the units shall be shown on a separate attachment.
The Contractor and his subcontractors, it any, shall not discriminate against or intimidate any employee, or
applicant for employment, to be employed in the performance of this contract, with respect to any matter directly
or indirectly related to employment because of race, religion, color, sex, national origin or ancestry. Breach of this
covenant may be regarded as a material breach of the contract.
CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS
(If applicable)
I. the undersigned bidder or agent as a contractor on a public works project, understand my statutory obligation
to use steel products made in the United States. I.C. 5-16-3-2. I hereby certify that I and all subcontractors employed
by me for this project will use U.S. steel products on this project if awarded. I understand that violations hereunder
may result in forfeiture of contractual payments.
Fonn No 95(Rene.0 20990)
BID OF
(Contractor)
(Address)
FOR
PUBLIC WORKS PROJECTS
OF
Filed
Action taken
NON - COLLUSION AFFIDAVIT
The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other member,
representative, or agent of the firm, company, corporation or partnership represented by him, entered into any
combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor
to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without
reference to any other bid and without any agreement, understanding or combination with any other person in
reference to such bidding.
He further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly,
any rebate, fee, gift, commission or thing of value on account of such sale.
OATH AND AFFIRMATION
I affirm under the penalties of perjury that the foregoing facts and information are true and correct to the best
of my knowledge and rrbelief. /
Dated at KU- 1=Lc s (W-1,111-1“-FL C-!;:. this f7T� day of Qrfnh.e.i` , #2.001 .
C BftL STTS (06.4,21t,Er f vc
( me of Organization)
By
(Title of Person Signing)
ACKNOWLEDGEMENT
svtw
STATE OF I NJ ) .k^"3' CHRISTINE KEOWN
.w.ury Hamilton County
SS: ;�. :ik,• M Commission Expires
COUNTY OF AO 21,2016
ems.
J O 1;4.1 SP4R-0 ICS c being duly sworn, deposes and says that he is
4-(..an of the above PILL S 1g..5 CHG✓2octr .. ( _ and that the
(Title) (Name of Organization)
statements contained in the foregoing bid, certification and affidavit are true and
`�correct
. y�9
Subscribed and sworn to before me this 62 day of OC7Ube✓ , p�a.� .
Notary Public
My Comission Expires: 7-a1-rga CHRISTINE KEOWN
II � ' Hamilton County
County of Residence: ah^f Jn '.. My Commission Expires
"�" April 21,2016
Form No.96(Revised 2005)
BID OF
CAILSO J F6 a)
(Contractor)
/oA5a 90. M•0-1) 16 �D
(Address)
a&Su1t� 2-3 Ybo77
FOR
PUBLIC WORKS PROJECTS
OF
'Loin Re-% curl Extet7p
(5 9-/3 u 1— W1,e4.{ Virtue. Pi ciC uD
Filed
Action taken
State Form 52414
Prescribed by Slate Board of Accounts Form No.96(Revised 2005)
CONTRACTOR'S BID FOR PUBLIC WORK - FORM 96
PART I
(To be completed for all bids. Please type or print)
Date: / 0 /L.l zoO
1. Governmental Unit(Owner): ,tcy, or O4.,2,m L/ 2'J
2. County : 61s9,en>
3. Bidder(Firm): t i± *t5a3
Address: / r?6 .cc /)• /1'thr J £Q
City/State: -2-/ d l 0 t Sv e. f S,J tJ`1477
4. Telephone Number 3[ 7- 27 3- 3333
5. Agent of Bidder(if applicable): rer J/ Siell .ie45
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete
the public works project of Z o,o L/ar,t Fug Ex-Tic/40a (0,413 wit P crc ap
(Governmental Unit) in accordance with plans and specifications prepared by [�h+f y. p f `' ,�.t pa
and day C1 for the sum of
�JlN�rt�� -01/S- do trat)glf14416IONA/t:/341$ /1139d'
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the
notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the
notice. Any addendums attached will be specifically referenced at the applicable page,
If additional units of material included in the contract are needed, the cost of units must be the same as
that shown in the original contract if accepted by the governmental unit. If the bid is to be awarded on a unit
basis, the itemization of the units shall be shown on a separate attachment.
The contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee,
or applicant for employment, to be employed in the performance of this contract, with respect to any matter
directly or indirectly related to employment because of race, religion, color, sex, national origin or ancestry.
Breach of this covenant may be regarded as a material breach of the contract.
CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS
(If applicable)
I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory
obligation to use steel products made in the United States (I C. 5-16-8-2). I hereby certify that I and all
subcontractors employed by me for this project will use U.S. steel products on this project if awarded. I
understand that violations hereunder may result in forfeiture of contractual payments.
fi
SECTION IV CONTRACTOR'S NON— COLLUSION AFFIDAVIT
The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other
member, representative, or agent of the firm, company, corporation or partnership represented by him, entered
into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such
letting nor to prevent any person from bidding nor to include anyone to refrain from bidding, and that this bid is
made without reference to any other bid and without any agreement, understanding or combination with any other
person in reference to such bidding.
He further says that no person or persons, firms, or corporation has, have or will receive directly or
indirectly, any rebate, fee, gift, commission or thing of value on account of such sale.
SECTION V OATH AND AFFIRMATION
I HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS AND INFORMATION
CONTAINED IN THE FOREGOING 'In 1=OR PUBLIC WORKS ARE TRUE AND CORRECT.
Dated at 2/OA)Sv/lIC- REf
this �� ^- day of oc r zp Qp
C f172 ,/l0 ' �uu
(Name off 0 ganization)
By :v __.• -GE�1T
057/i "01 S -Fiend MG,e
(Title of Person Signing)
ACKNOWLEDGEMENT
STATE OF 0crte # )
) ss
COUNTY OF /Yid i �ll )
Before me, a Notary Public, personally appeared the above-named pot( `� R� r L°�� S�k and
swore that the statements contained in the foregoing document are true and correct. }f�L y7 ��
Subscribed and sworn to before me this cit. day of • v U 0 Q
Notary Public
My Commission Expires: a 6(24-/ IS
//�/
County of Residence: 1 1114 ��O
ACCEPTANCE
The above bid is accepted this day of , subject to the
following conditions:
Contracting Authority Members:
PART II
(For projects of$100,000 or more — IC 36-1-12-4)
Governmental Unit:
Bidder(Firm)
Date
These statements to be submitted under oath by each bidder with and as a part of his bid.
Attach additional pages for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
1. What public works projects has your organization completed for the period of one (1)year prior to the
date of the current bid?
Completion
Contract Amount Class of Work Date Name and Address of Owner
2. What public works projects are now in process of construction by your organization?
Expected
Contract Amount Class of Work Completion Name and Address of Owner
Date
3. Have you ever failed to complete any work awarded to you? Li O If so, where and why?
4. List references from private firms for which you have performed work.
1,-)91e.Oo cJ ca
oC &( sri2 5z Tpr
fnh-'UoIJ ee . Adlit 1s5
Z7oIJsvilfr Cou.-Mudu 4Vi j ad5
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Explain your plan or layout for performing proposed work. (Examples could include a narrative of when
you could begin work, complete the project, number of workers, etc. and any other information which you
believe would enable the governmental unit to consider your bid.)
2. Please list the names and addresses of all subcontractors(i.e. persons or firms outside your own firm
who have performed part of the work)that you have used on public works projects during the past five (5)
years along with a brief description of the work done by each subcontractor.
3. If you intend to sublet any portion of the work, state the name and address of each subcontractor,
equipment to be used by the subcontractor, and whether you will require a bond. However, if you are
unable to currently provide a listing, please understand a listing must be provided prior to contract
approval. Until the completion of the proposed project, you are under a continuing obligation to
immediately notify the governmental unit in the event that you subsequently determine that you will use a
subcontractor on the proposed project.
4. What equipment do you have available to use for the proposed project? Any equipment to be used by
subcontractors may also be required to be listed by the governmental unit.
5. Have you entered into contracts or received offers for all materials which substantiate the prices used in
preparing your proposal? If not, please explain the rationale used which would corroborate the prices
listed.
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial
statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to
the governing body awarding the contract must be specific enough in detail so that said governing body can make
a proper determination of the bidder's capability for completing the project if awarded.
P„5l,,eJ LY sa,e,,1,T,O,ncMOms Eyla r w y.`A93mY.dimoe.IN 12A0 Fo,n,No.v5 IRev'S d 2002..
CONTRACTORS BID FOR PUBLIC WORKS
PART I
(To be completed for all bids)
(Please type or print)
Date: 76/0�f
1. Governmental Unit (Owner): l {T1' of CA-Rrn LL- sti
2. County: i M ro
3. Bidder (Firm): S T E3 ` HFV2QL
Address: '-(o.$ &r gb7N
City/State: �T bi (}r1Af0 tS _-LNDtnr'l y626 5�
4. Telephone Number: 3/ 1 - 27 d • 331S-
5 Agent of Bidder (if applicable):
f ursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete the
public works project of (JrrY be Cf4ttin.rr�
(Governmental Unit) in accordance with plans and specifications prepared by 2JN.L Lsr`6S L J �Uaou..r mac.
and dated /0 ,b /4 9 for the sum of
$ —`17tDg11o”
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the
notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the
notice. Any addendums attached will be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as that
shown in the original contract ii accepted by the Governmental Unit. If the bid is to be awarded on a unit basis,
the itemization of the units shall be shown on a separate attachment.
The Contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee, or
applicant for employment, to be employed in the performance of this contract, with respect to any matter directly
or indirectly related to employment because of race, religion, color, sex, national origin or ancestry. Breach of this
covenant may be regarded as a material breach of the contract.
CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS
Of applicable)
I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory obligation
to use steel products made in the United States. I.C. 5-16-8-2. I hereby certify that I and all subcontractors employed
by me for this project will use U.S. steel products on this project if awarded. I understand that violations hereunder
may result in forfeiture of contractual payments.
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial statement as
required by statute shall thereby be rendered invalid. The financial statement provieded hereunder to the governing
body awarding the contract must be specific enough in detail so that said governing body can make a proper
determination of the bidder's capability for completing the project if awarded.
SECTION IV OATH AND AFFIRMATION
I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for
public works are true and correct to the best of my knowledge and belief.
Dated at this • day of
(Name of Organization)
By
(Title of Person Signing)
ACKNOWLEDGEMENT
STATE OF
COUNTY OF
being duly sworn, deposes and says that he is
of the above
(Title) (Name of Organization)
and that the answers to the questions in the foregoing questionnaires and all statements therein contained are
true and correct.
Subscribed and sworn to before me this day of
Notary Public
My Commission Expires:
County of Residence:
al`agp��� � A, ,R T .t of T.-,i y _ a
ACCEPTANCE
The above bid is accepted this day of subject to the
following conditions:
Contracting Authority Members:
PART II
(Complete sections 111III, and IV for all state and local public works projects as required
by statutes if project is one hundred thousand dollars ($100.000) or more. (IC 36-1-12-4)
Governmental Unit:
Bidder (Firm)
Date:
These statements to be submitted under oath by each bidder with and as a part of his bid.
Attach additional pages for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
1. What public works projects has your organization completed for the period of one (1) year prior to the date
of the current bid?
Contract Amount Class of Work When Name and Address of Owner
Completed
2. What public works projects are now in process of construction by your organization?
Contract Amount Class of Work When to be Name and Address of Owner
Completed
BID, OFFER OR PROPOSAL FOR SALE OR LEASE OF MATERIALS
Date: /O- 7- 09
1. Governmental Unit: `• /airnne I �n nee1l nq .ltrp _
2. County: Mom,/{on ,,77 •1
3. Bidder(Firm): D01 nc,,JQs !'ovQ
Address: /,...��2d/O f orQL Dtvg e.
City/State: , ds1tecs -YN Aid 0,
4. Telephone Number: 317 f 43 /Soon n
5. Agent of Bidder(if applicable): Dcev / 'Leae( _
Pursuant to notices given, the undersigned offers(bid)s to `acne 1 einqq,nce c nigq J.eP l (Governmental
Unit)in accordance with the following attachment(s)which specify the clasSbr item nur»l5er or description, quantity, unit, unit
price and total amount.
The contract will be awarded by classes or items, in accordance with specifications. Any changes or alterations in the items
specified will render such bid void as to that class or itern. Bidder promises that he has not offered nor received a less price
that the price stated in his bid for the materials included In said bid. Bidder further agrees that he will not withdraw his bid from
the office in which it is filed. A certified check or bond shalt be filed with each bid if required, and liability for breach shall be
enforceable upon the contract, the bond or certified check or both a case may be
Signature of Bidder or en/tt
Decry 'lea /�
_-
Printed Name of Bidder or Agent
BID OFFER OR PROPOSAL
Attach separate sheet listing each item bid based on specifications published by governing body. Following is an example of
the bid format: /
LQnnoI @ualcorn/ee cOel,'J 'e� cQade beccc. /2-31-09
Class or Item Quantity Unit -Description Unit Price Amount
/ Haw FotA escapt IAA, .Z a 9G/O° no 96/•
/ Lestd2 Chty.Ts�a lKat - 6taoo-'s
NON-COLLUSION AFFIDAVIT2o9"�
STATE OFINDIANA) / Ncw rota. es A5, 24,9dI•°-° 4'2/� 2d/4-1O
1 ss, / ate Che-7(ca,tblactc - 7, 7'00.
�to COUNTY) "t 222 ' 1;-10.
The undersigned bidder or agent, being duly sworn on oath, says that he has no nor has any other member, representative, or
agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or
agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor
to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any
agreement, understanding or combination with any other person in reference to such bidding.
He further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee,
gift, commission or thing of value on account of such sale. ^^ � //// n
✓en t'l�nbc5 `OC�
Signature of Bidder or`t -
Da;Y c P2ect tc
Printed Name of Bidder or Agent
Subscribed and sworn to before me this .%vN day o •elohcv 20 0
My commission Expires: 3 i1"/4° Ti�/1�!�l'
SIBBALD
Hamilton County
-N. ;# My Commission Expires
ACCEPTANCE ": „s' March IS,2015
There now being sufficient unobligated appropriated funds available, the contracting authority of
(Governmental Unit)hereby accepts the terms of the attached bid for classes or item numbered and
promises to pay the undersigned bidder upon delivery the price quoted for the materials stipulated in said bid.
Contracting Authority Members: Date:
- Forth No.96(Revised 2005)
c>7 BID OF
ei42Son1
( i • (Contractor)
x� /also 4J. �Yl�ctii�,q•J ,P0
(Address)
sOrN Si)fit. 440 77
FOR
PUBLIC WORKS PROJECTS
OF
rn
ore,- :vie)/a EScA,ae- Ale na
Filed •,
Action taken
Prescribed by State Board of Accounts State Form 52414
Form No.96(Revised 2005)
CONTRACTOR'S BID FOR PUBLIC WORK — FORM 96
PART I
(To be completed for all bids. Please type or print)
Date: gyp` / /2A0//^
1. Governmental Unit (Owner): 64-7(a. p` O/4�.4t&f
2. County : t!�/4rnt.�!
3. Bidder(Firm): ?emits/1J A 44 � r.
Address: / O(-SDA.) /l'1eGf/r,J
CitylState: ZoN,Su„�� � UVA077
4. Telephone Number: 3i-7-677?- 33 33
5. Agent of Bidder(if applicable): i3 1i JA t.,Ye z-s
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete
the public works project of —ettli !+J ec J2 /'u 6v,() , 7)
(Governmental Unit)in accordance with plans and specifications prepared by [ /`f�y OF n Mt 1-
EN J iC - e r+n T. 'papa P":* 6# and data, o y, for the sum of
&e�y 7t�—ntovssop Fi5 r fl S0 7 �&76a • do
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the
notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the
notice. Any addendums attached will be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as
that shown in the original contract if accepted by the governmental unit. If the bid is to be awarded on a unit
basis, the itemization of the units shall be shown on a separate attachment.
The contractor and his subcontractors, if any, shalt not discriminate against or intimidate any employee,
or applicant for employment, to be employed in the performance of this contract, with respect to any matter
directly or indirectly related to employment because of race, religion, color, sex, national origin or ancestry.
Breach of this covenant may be regarded as a material breach of the contract.
CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS
(If applicable)
I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory
obligation to use steel products made in the United States (I.C. 5-16-8-2). I hereby certify that t and all
subcontractors employed by me for this project will use U.S. steel products on this project if awarded. I
understand that violations hereunder may result in forfeiture of contractual payments.
3. Have you ever failed to complete any work awarded to you? Li D If so, where and why?
4. List references from private firms for which you have performed work.
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SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1. Explain your plan or layout for performing proposed work. (Examples could include a narrative of when
you could begin work, complete the project, number of workers, etc and any other information which you
believe would enable the governmental unit to consider your bid.)
2. Please list the names and addresses of all subcontractors (i.e. persons or firms outside your own firm
who have performed part of the work)that you have used on public works projects during the past five(5)
years along with a brief description of the work done by each subcontractor.
3. If you intend to sublet any portion of the work, state the name and address of each subcontractor,
equipment to be used by the subcontractor, and whether you will require a bond. However, if you are
unable to currently provide a listing, please understand a listing must be provided prior to contract
approval. Until the completion of the proposed project, you are under a continuing obligation to
immediately notify the governmental unit in the event that you subsequently determine that you will use a
subcontractor on the proposed project.
4. What equipment do you have available to use for the proposed project? Any equipment to be used by
subcontractors may also be required to be listed by the governmental unit.
5. Have you entered into contracts or received offers for all materials which substantiate the prices used in
preparing your proposal? If not, please explain the rationale used which would corroborate the prices
listed.
SECTION III CONTRACTOR'S FINANCIAL STATEMENT
Attachment of bidder's financial statement is mandatory, Any bid submitted without said financial
statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to
the governing body awarding the contract must be specific enough in detail so that said governing body can make
a proper determination of the bidder's capability for completing the project if awarded.