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HomeMy WebLinkAboutRESPONSE - BID - 5816 US 287 CROSSWALKSSECTION 00300 BID FORM PROJECT: US 287 CROSSWALKS; BID NO. 5816 Place P"re ka-51eJ6, eq5 tj' A4A Sm--S+. Date -( L f �7_-3 n. 2,2o 3 1. In compliance with your Invitation to Bid dated -fi / 2 0e and nsubject to all conditions thereof, e--undersigned tqo r-fi=,S�U^ Cii�Y7C�i�� f /ncy. a ** 1gorporatio) Limited Liability Company, Partnership, Joint Venture, or Sole Proprietor)** authorized to do business in the State of Colorado hereby proposes to furnish and do everything required by the Contract Documents to which this refers for the construction of all items listed on the following Bid Schedule or Bid Schedules. 2. The undersigned Bidder does hereby declare and stipulate that this proposal is made in good faith, without collusion or connection with any other person or persons Bidding for the same Work, and that it is made in pursuance of and subject to all the terms and conditions of the Invitation to Bid and Instructions to Bidders, the Agreement, the detailed Specifications, and the Drawings pertaining to the Work to be done, all of which have been examined by the undersigned. 3. Accompanying this Bid is a certif'ed,or cashier's check or standard Bid bond in the sum of — .d�Zm _.accL;f� ($ in ordance with the Invitation To Bid and Instructions to Bidders. 4. The undersigned Bidder agrees to execute the Agreement and a Performance Bond and a Payment Bond for the amount of the total of this Bid within fifteen (15) calendar days from the date when the written notice of the award of the contract is delivered to him at the address given on this Bid. The name and address of the corporate surety with which the Bidder proposes to furnish the specified performance and payment bonds is as follows: 5. All the various phases of Work enumerated in the Contract Documents with their individual jobs and overhead, whether specifically mentioned, included by implication or appurtenant thereto, are to be performed by the CONTRACTOR under one of the items listed in the Bid Schedule, irrespective of whether it is named in said list. 6. Payment for Work performed will be in accordance with the Bid Schedule or Bid Schedules subject to changes as provided in the Contract Documents. 7. The undersigned Bidder hereby acknowledges receipt of Addenda No. L— through 7/96 Section 00300 Page 1 COLORADO DEPARTMENT OF TRANSPORTATION CERTIFICATION OF EEO COMPLIANCE Instructions: Bidders and subcontractors must complete and submit this form with bid proposals for federally funded contracts greater than $10,000. This is required by the Equal Employment Opportunity Regulations [41 CFR 60-1.7(b) (1)]. The regulation also requires that if you have participated in a previous contract or subcontract and have not filed a Standard Form 100 (EEO- 1), you cannot be awarded this contract. You may file a report covering the delinquent period for consideration by the Federal Highway Administration or the Director of the Office of Federal Contract Compliance, U.S. Department of Labor. The Standard Form 100 (EEO-1) may be requested from the: Joint Reporting Committee P.O. Box 779 Norfolk, VA 23501 (757)461-1213 1. $ Yes ❑ No I have developed and have on file at each establishment an affirmative action program as ` required by 41CFR Chapter 60, Part 60-2. 2. Yes ❑ No I have participated in a previous contract/subcontract subject to the equal opportunity clause. 3.( Yes ❑ No I have filed with the Joint Reporting Committee, the Director, or the Equal Employment Opportunity Commission all reports due under the applicable filing requirements. I declare under penalty of pedury in the second degree and any other applicable state or federal laws, that the state- ments made in this document are true and complete to the best of my knowledge. Company dD & -a c n«" I c [ n L bidder ❑ proposed subcontractor a : Tine: �►'G��t" Date: l�li3��3 COLORADO DEPARTMENT OF TRANSPORTATION pmj� # M �15 5 - 068 I �v7 UNDERUTILIZED DBE BID _ n CONDITIONS ASSURANCE U5a?07 Cyr ssWakl s, P�—011ipts mowuutions: writractor - wmpieis ana suDmit mis form Mtn your bid. Report only Underutilized DBE (UDBE) participa- tion which qualifies under the contract goal specification for this Droiect. POLICY It is the policy of the Colorado Department of Transportation that underutilized disadvantaged business enterprises have maximum opportunity to participate in the performance of contracts financed with federal, state or local entity funds. INTENDED UNDERUTILIZED DBE PARTICIPATION 1) Will your company's intended Underutilized DBE (UDBE) participation meet contract goals? ❑ yes A no Meets contract goals 2) Total intended Underutilized DBE (UDBE) participation: {J % ❑ yes ❑ no 3) List the UDBE firms you intend to use for your UDBE participation Name of UDBE firm(s) Certification Intended item(s) expiration date of work l�i ke, Colo. f {- c. C"4ro lD ,3! o� 1 rape Caxi7'b� I understand that, if my company is determined to be the low bidder for the contract on this product, I must submit a completed CDOT Form #715 CERTIFICATION OF UNDERUTILIZED DBE PARTICIPATION to the Transportation Department by 4:00 pm the day after the bids are opened. In addition, if my company does not meet the intended contract goals, I must submit a completed CDOT Form #718 DBE GOOD FAITH EFFORT DOCUMENTATION before the above stated deadline. I understand my obligation to abide by the policy stated above. I shall not discriminate on the basis of race, color, age, sex, national origin, or handicap in the bidding process or the performance of contracts. I DECLARE UNDER PENALITY OF PERJURY IN THE SECOND DEGREE, AND ANY OTHER APPLICABLE STATE OR FEDERAL LAWS, THAT THE STATEMENTS MADE IN THIS DOCUMENT ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. Company name �lo► u:5tar CoKcr6k Lot, . Date ►b j23103 Company officer slW ature TO preydeK r Wua somowr are ooaoarca ana may not ns uaaa War Form 0714 dit COLORADO DEPARTMENT OF TRANSPORTATION CONTRACTORS PERFORMANCE CAPABILITY STATEMENT Project# M41;s-058 C 131-7`t) 1. List names of partnerships or joint ventures none 2. List decreases in the contractors fiscal or workmanship qualifications compared to the last prequalification statement submitted to CDOT. (Attach additional sheets if necessary.) a. Key personnel changes none b. Key equipment changes none c. Fiscal capability changes (legal actions, etc.) $ none d. Other changes that may effect the contractors ability to perform work. none I DECLARE UNDER PENALTY OF PERJURY IN THE SECOND DEGREE, AND ANY OTHER APPLICABLE STATE OR FEDERAL LAWS, THAT THE STATEMENTS MADE ON THIS DOCUMENT ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE Contractor's firm or company name KA/ �o 6 �C� D Y-1'fnS-�-G r' �j't!it' , BY Date O Z� Off✓ Tide 2nd Contractor's firm or company name (if joint venture) By Date Title awr rannmw Im COLORADO DEPARTMENT OF TRANSPORTATION PROJECT No. ASSIGNMENT OF ANTITRUST CLAIMS iaE 058(l3't7'7) Contractor and Colorado Department of Transportation (CDOT) recognize that in actual economic practice antitrust violations ultimately impact on CDOT. Therefore, for good cause and as consideration for executing this contract and for receiving payments hereunder: Contractor hereby irrevocably assigns to CDOT any and all claims it may now have or which may hereafter accrue to it under federal or state antitrust laws in connection with the particular project, goods or services purchased or acquired by CDOT pursuant to this contract. 2. Contractor hereby expressly agrees: a. That, upon becoming aware that a third party has commenced a civil action asserting on Contractor's behalf an antitrust claim which has been assigned to CDOT hereunder, Contractor shall immediately advise in writing: (1) Such third party that the antitrust claim has been assigned to CDOT, and (2) CDOT that such civil action is pending and of the date on which, in accordance with subparagraph a. (1) above, Contractor notified such third party that the antitrust claim had been assigned to CDOT; b. To take no action which will in any way diminish the value of the claims or rights assigned or dedicated to CDOT hereunder; and c. Promptly to pay over to CDOT its proper share of any payment under an antitrust claim brought on Contractor's behalf by any third party and which claim has been assigned to CDOT hereunder. 3. Further, Contractor agrees that in the event it hires one or more subcontractors to perform any of its duties under the contract, Contractor shall require that each such subcontractor: a. Irrevocably assign to CDOT (as a third party beneficiary) any and all claims that such subcontractor may have or which may thereafter accrue to the subcontractor under federal or state antitrust laws in connec- tion with any goods or services provided by the subcontractor in carrying out the subcontractor's obliga- tions to Contractor; b. Upon becoming aware that a third party has commenced a civil action on the subcontractor's behalf asserting an antitrust claim which has been assigned to CDOT hereunder, shall immediately advise in writing: (1) Such third party that the antitrust claim has been assigned to CDOT, and (2) Contractor and CDOT that such civil action is pending and of the date on which, in accordance with subparagraph b. (1) above, the subcontractor notified such third party that the antitrust claim had been assigned to CDOT; c. Take no action which will in any way diminish the value of the claims or rights assigned or dedicated to CDOT hereunder; and d. Promptly pay over to CDOT its proper share of any payment under an antitrust claim brought on the subcontractor's behalf by any third party and which claim has been assigned or dedicated to CDOT pursuant hereto. I, acting in my capacity as officer of a bidder (bidders if a joint venture) do agree to the above assignment of antitrust claims. o.cur. vm «company name B tal Z-3 16r3 9 name. (wpm vemme.) 113Y/ 1 1Dele Coax Fb m*M 12A1 COLORADO DEPARTMENT OF TRANSPORTATION Project No.: )`�`��'� CERTIFICATE OF PROPOSED UNDERUTILIZED DBE (UDBE) Project Code (SA#): PARTICIPATION Location: Ft Co i k ylS . CO Form #: of Prime Contractor — Send completed/signed form to the Business Programs Office (instructions on second page). Irry r r: Dee 4a crrc part zu.00, ana the -vut - uetmiuons and Requirements- in the Standard Special Provisions, for further information concerning counting DBE participation of subcontractors, suppliers and service providers toward the project's UDBE goal.) PART I — SURCnNTRACT NAME OF UDBE FIRM TIER CERTIFICATION # EXPIRATION ELIGIBLE UDBE SUBCONTRACT AMOUNT DATE ACTUAL CONTRACT AMOUNT f - /� (�' n �Y�1t�.^nC0(0r2i DTV-e�'(C`px f �� 1g'Wi3E/ C IO I3i /C7Cj ��Cjb Taft CCtm I ITEMS OF WORK SUBCONTRACTED: PART I —SUPPLY CONTRACT z If the supplier is a UDBE °Manufacturer" of the item(s): • ACTUAL UDBE AMOUNT = Entire expenditure for materials and supplies including co;t pf WWdelli pro ided by the firm • ELKNBLE UDBE SUPPLY AMOUNT = [ (ACTUAL UDBE AMOUNT) X 100% If the supplier is a UDBE "Regular Dealer of the dem(s): r3. • ACTUAL UDBE AMOUNT = Entire expenditure for materials and su ep III-0, cod anIvery services provided by the firm • ELIGIBLE UDBE SUPPLY AMOUNT = (ACTUAL UDBE AMOU[? If the supplier is neither a "Manufacturer" nor a "Regular Deal ef" ofh( sAtT 1c - SERVICE I BROKER CONTRACT. NAME OF UDBE FIRM N 1A MATERIALS SUPPLIED: PART 1c— / RRnKFR CANTRACT Transportation service'(tiiuling) fees/commissions are to be counted toward contract goals in this section (provided the trucker is NOT classified as am Manufacture or a "Regular Dealer" for the materials supplied). Examples of other services to include in this section would be brokering, bonding, consulting, security guards, and insurance. For a UDBE •SerAce/Broker Contract": • ACTUAL UDBE AMOUNT = Entire expenditure for services rendered including cost of any materialsisupplies provided by the firm ELIGIBLE UDBE SERVICE FEE AMOUNT = I (ACTUAL UDBE AMOUNT) — (Cost of any materials and supplies) J (NOTE: The amounts that count toward UDBE goals are limited to the compensation retained by the UDBE broker/agent for services rendered, provided the fee/commission is determined by CDOT to be reasonable and not excessive as compared with fees customarily charged for similar services.) NAME OF UDBE FIRM CERTIFICATION # EXPIRATION ACTUAL UDBE ELIGIBLE UDBE SERVICE FEE DATE AMOUNT AMOUNT Af IA / ! SERVICES RENDERED: __a..._. ___--..-,.-..... .....,,,, rro•"vua eun"vna may gum ue tgv wvi rorm rig V"J i PART 2 — UDBE PARTICIPATION SUMMARY A) What is the total dollar value of this proposed subcontract, supply contract, OR service/broker contract that is eligible for counting toward contract goals? o0 (NOTE: Provide in actual subcontractor dollars and not prime contract prices) A> 46 oo e A = [ TOTAL FROM "ELIGIBLE" COLUMNS IN PART 1 ] B) What is the total dollar value of proposed subcontracts that are eligible for courting towards B> =o O contract goals from prior sheetstforms? C) What is the accumulative value of proposed subcontracts that are eligible for counting towards contract goals? C> l�G C=[A+ B] D) What is the original contract bid total? D> el 1 z5 5 3 Lj- E) What is the accumulative percent of contract bid total subcontracted to all underutilized DBEs? F . T , E=[(C_D)X100] PART 3 — PRIME CONTRACTOR CERTIFICATION I certify that: • my company has met the contracted UDBE goals or hDOT Form #718, DBE Good Faith Effort Documentation. �`� • m company has accepted a proposal from h D u Y P Y P P P ] ��, � ��io[�adtbr,nanied above. • my company has notified the proposed, ?pF�ctot of#ebontracted UDBE commitment. • my company's use of the proposed ,4J r app�{ abtof" jthe items of work listed above is a condition of the contract award. • my company will invRe the prgpos sfibc'tto attend the preconstruction conference. • my company will not us a subhtractor for the proposed UDBE subcontractor's failure to perform under a fully executed subny complies with the definitions and requirements section of the DBE Special Provisions. • I understaQ(itt t t j e t�b witfiFtha information shown on this form will be considered grounds for contract termination. 1 declare under made on this d Sin the second degree, and any other applicable state or federal laws, that the statements and complete to the best of my knowledge. IPrime Contractor Name: �()y g Y CO�CX �+ I ��. Date: t o / Z3 / 02 I IOfficer Signature and Title: i YGSIde,4,+ I FORM Prime Contractor: v 1. An officer of the contractor(s) must complete this form. 2. Include only DBE fines which meet the underutilized criteria in the contract goal specification for this project (i.e., UDBE fines). 3. Complete ONLY ONE section for Part 1 (1a, 1b, OR 1c) 4. Complete ALL sections of Part 2 and Part 3 5. Submit a separate CDOT Form #715 for EACH proposed UDBE. 6. Retain a photocopy for your records. 7. Send original to: Colorado Department of Transportation Business Programs Office 4201 E. Arkansas Ave. Denver, Colorado 80222 FAX: (303) 757-9019 Previous editions may not be used CDOT Form 716 PAGE 2 COLORADO DEPARTMENTOFMWISPORTATION UNDERUTILIZED DBE GOOD FAITH EFFORT DOCUMENTATION Project VS 20-7 Gtass��al Location V:;c7 CD1k I t2 5 co Date i ne Contractor who is the apparent low bidder on a CDOT construction project and has failed to meet the Underutilized DBE (L contract goals shall use this form to document good faith efforts made to date by said Contractor to attempt to meet these goals. FAILURE TO FULLY COMPLETE THIS FORM MAY RESULT IN REJECTION OF THE BID. Each portion of this form is to be addressed in the space provided, or on supplemental sheets. Attach supporting documentation as required. This completed form and required attachments are to be submitted to the Business Programs Office in the Center for Equal Opportunity prior to 4:00 p.m. on the day after the day bids are opened. This form may be submitted by FAX (303-757-9019) with an original copy to follow. An extension may be granted by the DBE Liaison. Solely at its discretion, CDOT may request additional information and accept additional UDBE participation at any time and prior to the final decision concerning Good Faith Efforts. I. List sufficient bid items (including portions of bid items) identified as subcontract work to be performed by UDBEs to achieve the established UDBE participation goal. Indicate the total percentage of work identified for UDBE participation. The total percentage of subcontract items identified for UDBE participation must equal or exceed the percentage goal established by CDOT. If. For each subcontract item identified, contact by mail, FAX and/or telephone a minimum of two currently COOT -certified UDBEs whose work and function codes match the type of work being solicited. For projects in areas of the state where there are more than two UDBEs capable of performing identified subcontract items, contact at least two thirds of those UDBEs. If soliciting by telephone, provide a telephone log of calls, including topic of discussion, date, time, name of person contacted, and the response received. If soliciting by mail, provide copies of letters to UDBEs and their responses. Letters and FAXes must specifically identify the project, the items to be subcontracted, and the bid date. Letters and FAXes must provide an address and phone number where specific quantifies or details will be available to bidders. The Contractor shall provide sufficient time to allow the UDBEs to participate effectively in the bidding process. Submit a detailed explanation addressing failure to provide any of the above. OK Vowe 2 �d i�wtS � 4-�t(s ro, C -io (oe_ C WJK p l�P % �yi� LoJC- t- ' I + s a v�v5E, a,� 4Q ty+�vr Lt?-M (By-i4—FAVer) %� e, ►�-c��t vr•�e( 2 �u.o �-es -�r a-otd - at f �xk� lc�c�s Prntoerr 0010M w ohsoNts mW may not a wed CDOT Form #71e ales III. List all UDBE and non-UDBE bidders, bid dollar amounts for each bid item, and the name of the successful bidder. Describe how bid items were broken down to increase opportunities for specific UDBE bidders. If the UDBE bids were rejected, give reasons for each case. Cost alone may not be adequate justification for failure to use a UDBE bid. If the work is to be counted as a potential UDBE subcontract item, the Contractor cannot elect to perform that work itself when a UDBE bid is competitive or only UDBE bids are received. When a non-UDBE bid is significantly lower than a UDBE bid, the Contractor may choose to perform the item itself. Whether a bid is "competitive" or "significantly lower" will be determined by CDOT. Provide a detailed explanation for failure to provide any of the above. g to�oi,2-v3 '. G• iktl abav<� �� � 00 Horn — vt I:>P-5 A. P v-i Gk- Pave*rs Iho+- Vevy rVIOLOV tn'tAY&JCYS Bbdc�,ers : 11 � 1I 0. . CX G-�.—Ti J•G.... � r6t r'o C G.-p{SS 4 sic cessQ bi,-4,4e r 4 4 50a -*Zip-134u a -�V 14-k,s "4, QD3E was I�e�ec�i-ecQ I�Ucc�tti�-�e b,af j,�laS n1A IV. The efforts required herein are not exhaustive or exclusive. Other factors or types of efforts may be relevant in appropriate cases. In determining whether Good Faith Efforts have been made, the quantity and intensity of the efforts made as well as kinds of efforts made may be considered. List any additional efforts to increase UDBE contract participation, such as requesting subcontractors to assist with providing UDBE participation. Note the results of such efforts. o v t-a j-, of 51 t(7(7 e t'S ap—�e r I a-1 s -Tv o-a wkty-t ao6e� av+ifi�d , THE CONTRACTOR UNDERSTANDS THAT DEMONSTRATION OF GOOD FAITH EFFORTS IN ACHIEVING THE UDBE GOALS ESTABLISHED BY CDOT IS REQUIRED THROUGHOUT THE PERFORMANCE OF THE CONTRACT. Comlmm Igo► N I�iztr Coveire {>� Inc, p.2 SECTION 00410 BID BOND KNOW ALL MEN .BY THESE PRESENTS: that we, the undersigned Ng-Ubzlar _ COnCr-a- r as Principal, and Surety, are hereby held and firmly bound unto the City of or Collins, Colorados as OWNER, in the sum of $ 7 truly to be made, we hereby a PerrPnr for the payment of which, well and assigns. y jointly and for bind ourselves, successors, and THE CONDITION of this obligation is such that whereas the Principal has submitted to the City of Fort Collins Colorado the accompanying Bid and hereby made a part hereof to.enter into a Construction Agreement for the construction of Fort Collins Project, US 287 CROSSWALKS; BID NO. 5816. NOW THEREFORE, (a) "If .said Bid shall be rejected, or (b) If said Bid shall be accepted and the Principal shall execute and deliver a Contract in the form'of Contract attached hereto (properly completed in accordance with said Bid) and shall furnish a BOND for his faithful performance of said Contract, and for payment of all persons performing labor or furnishing materials in connection therewith, and shall in all other respects perform the.Agreement created by the acceptance of said Bid, then this obligation shall be void; otherwise the same shall remain in force and effect, it .being expressly understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed the penal amount of this obligation as herein stated. The Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and its BOND shall be in no way impaired or affected by any extension of the time within which the OWNER may accept such Bid; and said Surety does hereby waive notice of any such extension. Surety Companies executing bonds must be authorized to transact business in the State Of Colorado and be accepted by the OWNER. 7/96 Section 00410 Page 2 p.3 IN WITNESS WHEREOF, the Principal and the Surety have hereunto set their hands and seals this 20th day of October 200, and such of s are corporations have caused their corporate seals to be hereto affixedhandem athese presents to be signed by their proper officers, the day and year first set forth above. PRINCIPAL, Name: _NORTHSTAR ON BETE INC Address: P_O_ Box Y BY : i tcu-41- Title: ATTEST: By: (SEAL) 7/96 SURETY INLAND INSURANCE CO. BY: S n E. Ara o Title:Attornev In Fact (SEAL) Section 00410 Page 3 IV O y-{ k '-�iV l [TYIG ✓P T� - I YI L CONTRACTOR BY: ADDRESS: i �Q sox i & r-t-ho il(d CO 8C513 8. BID SCHEDULE (Base Bid) Please use the attached Bid Schedule when submitting your bid. 9. PRICES The foregoing prices shall include all labor, materials, transportation, shoring, removal, dewatering, overhead, profit, insurance, etc., to cover the complete Work in place of the several kinds called for. Bidder acknowledges that the OWNER has the right to delete items i"n the Bid or change quantities at his sole discretion without affecting the Agreement or prices of any item so long as the deletion or change does not exceed twenty-five percent (25%) of the total Agreement Price. O az 05 Da e Title License Number (If Applicable) (Seal - if Bid is by corporation) l Attest: Address Telephone 0)70 63c� 7/96 Section 00300 Page 2 INLAND INSURANCE COMPANY Lincoln, Nebraska POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the INLAND INSURANCE COMPANY, a corporation of the State of Nebraska having its principal office in the City of Lincoln, Nebraska, pursuant to the following Bylaw, which was adopted by the Board of Directors of the said Company on July 23, 1981, to wit "Article V-Section 6. RESIDENT OFFICERS AND ATTORNEYS -IN -FACT. The President or any Vice President, acting with any Secretary or Assistant Secretary, shall have the authority to appoint Resident Vice Presidents and Anomeys-in-Fact, with the power and authority to sign, execute, acknowledge and deliver on its behalf, as Surety: Any and all undertakings of suretyship and to affix thereto the corporate seal of the corporation. The President or any Vice President, acting with any Secretary or Assistant Secretary, shall also have the authority to remove and revoke the authority of any such appointee at any time." does hereby make, constitute and appoint Wayne Six or Randall P. Geving or Thomas F. Whalen or Deborah Epler, Colorado Springs, Colorado, or Sandra E. Aragon, Denver, Colorado or Lynn M. Worland, Lakewood, Colorado its true and lawful Attomey(s)-in-Fact, to make, execute, seal and deliver for and on its behalf, as Surety: Any and all undertakings of suretyship And the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Company, as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the Company at its offices in Lincoln, Nebraska, in their own persons_ The following Resolution was adopted at the Regular Meeting of the Board of Directors of the INLAND INSURANCE COMPANY, held on July 23,1981: "RESOLVED, That the signatures of officers of the Company and the seal of the Company may be affixed by facsirrdle to any Power of Attorney executed in accordance with Article VSection 6 of the Company Bylaws: and that any such Power of Attorney bearing such facsimile signatures, including the facsimile signature of a certifying Assistant Secretary and facsimile seal shall be valid and binding upon the Company with aspect to any bond, undertaking or contract of suretyship to which it is attached." All authority hereby conferred shall remain in full force and effect until terminated by the Company. IN WrMESS WHEREOF, INLAND INSURANCE COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be hereunto affixed this 12th day of April 20 03 . INLAND INS URAN COMPANY CZ44e viv State of Nebraska Vice President troaroattt tfK ss. �. County of Lancaster) On this �h day of AD r i 1 , 2003 before me personally came Robert L. Privett, to me known, who being by me duly swum, did depose and say that (sd resides c the County of Seward State of Nebras that s e is the Vice President of the INLAND INSURANCE COMPANY, the c �' (� arpoxation described in and which executed the above instrutrrent that (s)he knows the seal of the said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so affixed by Order of the Board of Directors of said corporation; that (s)hc signed (his) (her) name by like order, and that Bylaw, Article V-Section 6, adopted by die Board of Directors of said Company, referred to in the preceding instrument, is now in force. anEw MY Com mission Expires April 12, 2007. Notary Public 1, Jeanne Bower, Assistant Secretary of INLAND INSURANCE COMPANY, do hereby certify that the above and foregoing is a true and correct c Attorney executed by said INLAND INSURANCE COMPANY, which is still in full force and effect copy of a Power of Signed and sealed at die City of Lincoln, Nebraska this 2 0 t h d,y of O C t O b (r 20 0 3 Z. �� Assistant Secretary SECTION 00330 BID SCHEDULE US 287 Crosswalks - College and Laporte Intersection City of Fort Collins Bid No. 5816 CDOT Project No. SHE M455-058 (13777) Item No. Description Unit - Contract Quantity Estimated Cost Unit Cost Total Project Cost 202.01 Removal of Concrete Pavement SY _ 652 $ `(� /O 3, oc 202.02 Removal of Concrete Mat (Medians) SY 13 $ sal0 $ 202.03 Removal of Curb & Gutter LF III S a= $ / 0 00 202.04 Removal of Sidewalk & Ramps SY 252 S $ Q3oZ CO 202.05 Removal of Pavers SF 260 $ 202.06 Removal of Traffic Signal Pole Concrete Base EA 1 $ 0 0 S 5 DD " 208.01 Erosion Control LS 1 S 0° $ 210.01 Modify Inlet EA - 1 $ °O $ .,?'750 210.02 Adjust Manhole EA I S 3,00 0_0 $ Soo 210.03 Adjust Valve Box EA I S a00 Or $ o? 00 °o 403.02 Hot Bituminous Pavement Patching -Grading S TON 14 S 0o S c, w 412.01 Concrete Pavement (6') (Patching) - SY 171 S a� 75 25 S / 14 412.02 Concrete Pavement (10")(Colored Concrete Crosswalk) SY 405 S �.3 pO S 608.01 Concrete Sidewalk (6") SY 350 S JJ -!�s $ °r 608.02 Concrete Curb Ramp (6") SY 22 S Oo $ / r 608.03 Concrete Curb Ramp (Special) SY 40 S 00 6s - t ca $ a�aa 608.04 Detectable Warnings (Truncated Domes) SF 251 S °O $ oc 609.01 Curb & Gutter Type 2 (Section IIB) LF 89 _ $ f °o $ 00 609.02 Curb Type 2 (6" Barrier) (Section B) (6" wide) LF l l S cc $ o_o 609.04 Curb Type 2 (6" Barrier) (Section B) (18" Wide) LF I I $ J g oe• S 00 610.01 Brick Pavers (Type 1) SF 160 S eo $ 00 610.02 Brick Pavers (Type 2) - SF 884 S oZ $ 625.01 Construction Surveying LS 1 S 1000 or, $ O 0 PD 626.01 Mobilization - LS I S `°r' 33�00- $ °^ 630.01 Construction Tragic Control LS 1 $ on TOTAL COST S 5 13 a r V -T Y1012 et ivA L(p (I l(1 7 E j I' / L( Imo' Dollars and " (K , - &Cents. 2 Signed .-Address .P-o Box 1 Company CSY) C Y C le ✓ 4 0 -1CP 0 0 13 Phone/Fax 617053z- 0F06 / 'i7053Z-460-7 Check One: Individual Doing Business in Company Name TCorporation Partnership Section 00300 Page 3 SECTION 00400 SUPPLEMENTS TO BID FORMS 00410Bid Bond 00420Statement of Bidder's Qualifications 00430Schedule of Subcontractors 7/96 Section 00410 Page 1 u SECTION 00420 STATEMENT OF BIDDER'S QUALIFICATIONS All questions must be answered and the data given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate attached sheets. The Bidder may submit any additional information he desires. 1 . Name of Bidder: NOr�k,or4 (`� �cce to K)r�&� 2. Permanent main office address: \yy 3. When organized: jwlnrc�. )gnIQ 4. If a corporation, where incorporated: 5. How many years have you been engaged in the contracting business under your present firm or trade name? I 6. Contracts on hand: (Schedule these, showing the amount of each contract and the appropriate anticipated dates of completion.) 7. General character of Work performed by your company: C,¢xr�rj'P'k1r 8. Have you ever failed to complete any Work awarded to you? \-yp If so, where and why? 9. Have your ever defaulted on a contract? rU If so, where and why? 10. Are you debarred by any government agency?, If yes list agency name. 7/96 Section 00420 Page 1 11. List the more important projects recently completed by your company, stating the approximate cost of each, and the month and year completed, location and type of construction. 12. List your major equipment available for this contract. LQ Le he C-:§s Z (c) cam. C v- s z 13. Experience in construction Work similar in importance to this project: 14. Background and experience of the principal members of your organization, including officers: 15 Credit available: 16. Bank reference: 17. Will you, upon request, fill out a detailed financial statement and furnish any other information that may be required by the OWNER? 18. Are you licensed as a General CONTRACTOR? ,np If yes, in what city, county and state? What class, license and numbers? 19. Do you anticipate subcontracting Work under this Contract? .a - If yes, what percent of total contract? and to whom? 20. Are any lawsuits pending against you or your firm at this time? nC-� If DETAIL yes, 7/96 Section 00420 Page 2 C 21. What are the limits of your public liability? DETAIL What company?_CMC. 22. What are your company's bonding limitations? 23. The undersigned hereby authorizes and requests any person, firm or corporation to furnish any information requested by the OWNER in verification of the recital comprising this Statement of Bidder's Qualifications. Dated at this Z'Z day of ©C20C):j Nameidder By: i nn i Title Statd of County of Lc'.1 rv.o being duly sworn deposes and says that he is of�gC-t-e and that (name of organization) the answers to the foregoing questions -and all statements therein contained are true and correct. Subscribed and sworn to before me this ZZ day of OCAv , 2 0-0-1-. .-�na i✓t�ry Qp` Nlly Notary Public •�TAg2 My commission expires 7/96 '..p G t •.. l� o 9�0 � OLoe'PO Section 00420 Page 3 SECTION 00430 SCHEDULE OF SUBCONTRACTORS List all subcontractors for the work items listed below and all subcontractors performing over 150 of the contract. ITEM 7/96 SUBCONTRACTOR Section 00430 Pagel COLORADO DEPARTMENT OF TRANSPORTATION PROJECT NO. NA 4_>5-oeg(l3-1- -1 ANTI -COLLUSION AFFIDAVIT LOCATION us 28� C�a�vva��5,Cdllns I hereby attest that I am the person responsible within my firth for the final decision as to the price(s) and amount of this bid or, it not, that I have written authorization, enclosed herewith, from that person to make the statements set out below on his or her behalf and on behalf of my firm. I further attest that: 1. The pdoe(s) and amount of this bid have been arrived at independently, without consultation, communication or agreement for the purpose or with the effect of restricting competition with any other firm or person who is a bidder or potential prime bidder. 2A. 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 prime bidder on this project, and will not be so disclosed prior to bid opening. 2B. Neither the prices nor the amount of the bid of any other firm or person who is a bidder or potential prime bidder on this project have been disclosed to me or my firm. 3A. No attempt has been made to solicit, cause or induce any fine or person who is a bidder or potential prime bidder to refrain from bidding on this project, or to submit a bid higher than the bid of this fine, or any intentionally high or non- competitive bid or other form of complementary bid. 3B. No agreement has been promised or solicited for any other firm or person who is a bidder or potential prime bidder on this project to submit an intentionally high, noncompetitive or other form of complementary bid on this project. 4. The bid of my firm is made in good faith and not pursuant to any Consultation, communication, agreement or discussion with, or inducement or solicitation by or from any fine or person to submit any intentionally high, noncom- petitive or other form of complementary bid. 5. My firm has not offered or entered into a subcontract or agreement regarding the purchase or sale 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 fine or person to refrain from bidding or to submit any intentionally high, noncompetitive or other form of complementary bid or agreeing or promising to do so on this project. 6. My fine 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 any intentionally high, noncompetitive or other form of complementary bid, or agreeing or promising 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, or other conduct inconsistent with any of the statements and representations made in this affidavit. 6. 1 understand and my firm understands that any misstatement in this affidavit is and shall be treated as a fraudulent concealment from the Colorado Department of Transportation, of the true facts relating to submission of bids for this contract. 1 DECLARE UNDER PENALTY OF PERJURY IN THE SECOND DEGREE, AND ANY OTHER APPLICABLE STATE OR FEDERAL LAWS, THAT THE STATEMENTS MADE ON THIS DOCUMENT ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. Corltractoft firm or coapary name By Date ItO Tme 'Gjac r " .J 2W cm wim 9 firm a conpeny name. (Ijolm v"=.) By Date Tale •.....� Sworn to before me this 23 day of, � ; •�O?Aq ••� 0O . N ' A •• O OF C01.O uy aommbapn axprea NOTE: This document must be signed In Ink. My C,atrt�ebn [008 Coax r«m nwa um