Bid Packet (PDF) - Eastern Engineering Plan Room

BID FORMOwen CountySR43 Sanitary Sewer ExtensionTABLE OF ARTICLESPageArticle 1 – Bid Recipient ......................................................................................................................................................................1Article 2 – Bidder’s Acknowledgements..............................................................................................................................................1Article 3 – Bidder’s Representations....................................................................................................................................................1Article 4 – Further Representations ......................................................................................................................................................2Article 5 – Basis of Bid.........................................................................................................................................................................2Article 6 – Time of Completion............................................................................................................................................................7Article 7 – Attachments To This Bid....................................................................................................................................................7Article 8 – Defined Terms ....................................................................................................................................................................8Article 9 – Bid Submittal ......................................................................................................................................................................8EJCDC C-410 Bid Form for Construction ContractsCopyright © 2002 National Society of Professional Engineers for EJCDC. All rights reserved.Page iii

G. Bidder is aware of the general nature of work to be performed by Owner and others at the Site that relates to theWork as indicated in the Bidding Documents.H. Bidder has correlated the information known to Bidder, information and observations obtained from visits to theSite, reports and drawings identified in the Bidding Documents, and all additional examinations, investigations,explorations, tests, studies, and data with the Bidding Documents.I. Bidder has given Engineer written notice of all conflicts, errors, ambiguities, or discrepancies that Bidder hasdiscovered in the Bidding Documents, and the written resolution thereof by Engineer is acceptable to Bidder.J. The Bidding Documents are generally sufficient to indicate and convey understanding of all terms and conditionsfor the performance of the Work for which this Bid is submitted.K. Bidder will submit written evidence of its authority to do business in the state where the Project is located not laterthan the date of its execution of the Agreement.ARTICLE 4 – FURTHER REPRESENTATIONS4.01 Bidder further represents that:A. this Bid is genuine and not made in the interest of or on behalf of any undisclosed individual or entity and is notsubmitted in conformity with any agreement or rules of any group, association, organization or corporation;B. Bidder has not directly or indirectly induced or solicited any other Bidder to submit a false or sham Bid;C. Bidder has not solicited or induced any individual or entity to refrain from bidding; andD. Bidder has not sought by collusion to obtain for itself any advantage over any other Bidder or over Owner.ARTICLE 5 – BASIS OF BID5.01 Bidder will complete the Work in accordance with the Contract Documents for the following price(s) listed in the BidSchedule. The Bid Schedule contains alternates which are explained as follows:A. The Bid Schedule includes Mandatory Alternates. Bidders are required to provide add/deduct prices for theseitems. The Owner is not obligated to accept any of the Mandatory Alternates listed. If the Owner elects to accept aMandatory Alternate, the add/deduct will be combined with the Base Bid in order to determine the low Bidder onthe project.EJCDC C-410 Bid Form for Construction ContractsCopyright © 2002 National Society of Professional Engineers for EJCDC. All rights reserved.00410 - 2

BID SCHEDULEOWEN COUNTYSR43 SANITARY SEWER EXTENSIONThe BIDDER agrees to perform all work described in the CONTRACT DOCUMENTS for the following UNIT PRICEBID. All prices listed below include materials, installation, and other costs. Unit price extensions must equate to thetotal bid price. Unit cost prices will be used to negotiate changes in more or less scope of work.BASE BIDItem Description Unit1 Clearing2A2B3A3B3C3D3E4A4B4C4D56788" PVC Sanitary Sewer w/NativeBackfill, Less than 8' dp8" PVC Sanitary Sewer w/B-Borrow, Less than 8' dp12" PVC Sanitary Sewer w/B-Borrow, Less than 8' dp12" PVC Sanitary Sewer w/NativeBackfill, 8-10' dp12" PVC Sanitary Sewer w/B-Borrow, 8-10' dp12" PVC Sanitary Sewer w/B-Borrow, 10-12' dp12" PVC Sanitary Sewer w/B-Borrow, 12-14' dp15" PVC Sanitary Sewer w/NativeBackfill, 8-10' dp15" PVC Sanitary Sewer w/B-Borrow, 10-12' dp15" PVC Sanitary Sewer w/NativeBackfill, 12-14' dp15" PVC Sanitary Sewer w/B-Borrow, 12-14' dp15" PVC Sanitary Sewer -Directional Drill (Restrained JointSDR-21)6" x 15" Wye for Sanitary LateralConnection (SDR 35)6" x 15" Wye for Sanitary LateralConnection (SDR 21)6" Sanitary Sewer Laterals (SDR-35)LS 1LF 51LF 0LF 532LF 27LF 1992LF 636LF 809LF 385LF 30LF 377LF 20LF 399EA 1EA 1LF 25EstimatedQuantity Unit Cost AmountEJCDC C-410 Bid Form for Construction ContractsCopyright © 2002 National Society of Professional Engineers for EJCDC. All rights reserved.00410 - 3

BASE BIDItem Description Unit9101112A12B131415A15B15C15D15E6" Sanitary Sewer Laterals (SDR-21)Jack & Bore Under State Highway(28" Steel Casing with 15" PVCCarrier Pipe)Jack & Bore Under State Highway(16" Steel Casing with 8" PVCCarrier Pipe)4" PVC Force Main - Open Cut withNative Backfill4" PVC Force Main - Open Cut withB-Borrow4" HDPE Force Main - DirectionalDrill (Wetland)4" HDPE Force Main - DirectionalDrill (Stream Crossing)48" Standard Precast Manhole,0-8' dp48" Standard Precast Manhole,8-10' dp48" Standard Precast Manhole,10-12' dp48" Standard Precast Manhole,12-14' dp48" Standard Precast Manhole,> 14' dp16 60" Drop Manhole, 10-12' dp17AAir Release Valve Vault (72" Vaultwith 2" Valve)18 Connection to Existing Manhole19 Stone Drive Repair20 Rock Excavation21 Asphalt Base22A23AAsphalt SurfaceTack for Asphalt24 Seeding & Restoration25 Lift StationLF 25LF 70LF 80LF 7735LF 975LF 600LF 570EA 7EA 7EA 5EA 1EA 1EA 1EA 2EA 1LF 450CY 2500TON 465TON 925TON 2LS 1LS 2EstimatedQuantity Unit Cost AmountEJCDC C-410 Bid Form for Construction ContractsCopyright © 2002 National Society of Professional Engineers for EJCDC. All rights reserved.00410 - 4

BASE BIDItem Description UnitEstimatedQuantity Unit Cost Amount26 Field Office27 Erosion Control28 Construction Engineering29 Maintenance of Traffic30Mobilization/Demobilization,Bonds & Insurance (NTE 5%)TOTAL BASE BID AMOUNTLS 1LS 1LS 1LS 1LS 1Total Base Bid:Written As:__________________________________________________ DollarsFigures: $___________________________________________________EJCDC C-410 Bid Form for Construction ContractsCopyright © 2002 National Society of Professional Engineers for EJCDC. All rights reserved.00410 - 5

MANDATORY ALTERNATE BID #1Mandatory Alternate Bid #1 shall include the additional cost for installing a 10-inch force main parallel to the 4-inch forcemain.MANDATORY ALTERNATE BID #1Item Description UnitEstimatedQuantity Unit Cost Amount2" Air Release Valve on 10" PVC17B Force MainEA 210" PVC Parallel Force Main - OpenCut with Native Backfill (Same LF 773531A Trench as 4" Force Main)10" PVC Parallel Force Main - OpenCut with B-Borrow (Same Trench as LF 97531B 4" Force Main)323310" HDPE Force Main - DirectionalDrill (Wetland)10" HDPE Force Main - DirectionalDrill (Stream Crossing)TOTAL MANDATORY ALTERNATE BID #1 AMOUNTLF 600LF 570Total Mandatory Alternate Bid #1:Written As:__________________________________________________ DollarsFigures: $___________________________________________________EJCDC C-410 Bid Form for Construction ContractsCopyright © 2002 National Society of Professional Engineers for EJCDC. All rights reserved.00410 - 6

MANDATORY ALTERNATE BID #2Mandatory Alternate Bid #2 shall include the additional cost for furnishing asphalt to extend the asphalt resurfacing alongOld River Road from the DNR Boat Ramp Access Drive to Pottersville Road.MANDATORY ALTERNATE BID #2Item Description UnitEstimatedQuantity Unit Cost AmountAsphalt Surface - Extend to22B Pottersville RoadTON 1228Tack for Asphalt - Extend to23B Pottersville RoadTON 3TOTAL MANDATORY ALTERNATE BID #2 AMOUNTTotal Mandatory Alternate Bid #2:Written As:__________________________________________________ DollarsFigures: $___________________________________________________ARTICLE 6 – TIME OF COMPLETION6.01 Bidder agrees that the Work will be substantially complete and will be completed and ready for final payment inaccordance with Paragraph 14.07.B of the General Conditions on or before the dates or within the number of calendardays indicated in the Agreement.6.02 Bidder accepts the provisions of the Agreement as to liquidated damages in the event of failure to complete the Workwithin the Contract Times.ARTICLE 7 – ATTACHMENTS TO THIS BID7.01 The following documents are attached to and made a condition of this Bid:A. Bid Form - Signed and ExecutedB. Required Bid Security in the form of certified check or bond in the amount of 5% of the bid amountC. Form 96 - Signed and ExecutedD. List of Proposed SubcontractorsEJCDC C-410 Bid Form for Construction ContractsCopyright © 2002 National Society of Professional Engineers for EJCDC. All rights reserved.00410 - 7

ARTICLE 8 – DEFINED TERMS8.01 The terms used in this Bid with initial capital letters have the meanings stated in the Instructions to Bidders, the GeneralConditions, and the Supplementary Conditions.ARTICLE 9 – BID SUBMITTAL9.01 This Bid submitted by:___________________________Firm/Company_____________________Date________________________________________________Signature Title (Seal)EJCDC C-410 Bid Form for Construction ContractsCopyright © 2002 National Society of Professional Engineers for EJCDC. All rights reserved.00410 - 8

Form No. 96 (Revised 2005)BID OF________________________________________________________(Contractor)________________________________________________________(Address)_____________________________________________FORPUBLIC WORKS PROJECTSOF_______________________________________________________________________________________________________________Filed ________________________________, _______Action taken _______________________________________________________________________00415-1 1

State Form 52414 (10-05)Prescribed by State Board of Accounts Form No. 96 (Revised 2005)CONTRACTOR'S BID FOR PUBLIC WORK – FORM 96PART I(To be completed for all bids. Please type or print)Date:__________________________1. Governmental Unit (Owner):____________________________________________2. County :____________________________________________________________3. Bidder (Firm):________________________________________________________Address:________________________________________________________City/State:________________________________________________________4. Telephone Number:___________________________________________________5. Agent of Bidder (if applicable):___________________________________________Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to completethe public works project of ____________________________________________________________________(Governmental Unit) in accordance with plans and specifications prepared by _____________________________________________________________________________ and dated _____________________ for the sum of____________________________________________________ $_____________________________________The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in thenotice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with thenotice. 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 asthat shown in the original contract if accepted by the governmental unit. If the bid is to be awarded on a unitbasis, 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 matterdirectly 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 statutoryobligation to use steel products made in the United States (I.C. 5-16-8-2). I hereby certify that I and allsubcontractors employed by me for this project will use U.S. steel products on this project if awarded. Iunderstand that violations hereunder may result in forfeiture of contractual payments.00415-2

ACCEPTANCEThe above bid is accepted this _____________ day of _________________, ________, subject to thefollowing 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 QUESTIONNAIRE1. What public works projects has your organization completed for the period of one (1) year prior to thedate of the current bid?Contract AmountClass of WorkCompletionDateName and Address of Owner2. What public works projects are now in process of construction by your organization?Contract AmountClass of WorkExpectedCompletionDateName and Address of Owner00415-3

3. Have you ever failed to complete any work awarded to you? _______________ If so, where and why?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________4. List references from private firms for which you have performed work.__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE1. Explain your plan or layout for performing proposed work. (Examples could include a narrative of whenyou could begin work, complete the project, number of workers, etc. and any other information which youbelieve 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 firmwho 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 areunable to currently provide a listing, please understand a listing must be provided prior to contractapproval. Until the completion of the proposed project, you are under a continuing obligation toimmediately notify the governmental unit in the event that you subsequently determine that you will use asubcontractor on the proposed project.4. What equipment do you have available to use for the proposed project? Any equipment to be used bysubcontractors 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 inpreparing your proposal? If not, please explain the rationale used which would corroborate the priceslisted.SECTION III CONTRACTOR’S FINANCIAL STATEMENTAttachment of bidder’s financial statement is mandatory. Any bid submitted without said financialstatement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder tothe governing body awarding the contract must be specific enough in detail so that said governing body can makea proper determination of the bidder’s capability for completing the project if awarded.00415-4

SECTION IV CONTRACTOR'S NON – COLLUSION AFFIDAVITThe undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any othermember, representative, or agent of the firm, company, corporation or partnership represented by him, enteredinto any combination, collusion or agreement with any person relative to the price to be bid by anyone at suchletting nor to prevent any person from bidding nor to include anyone to refrain from bidding, and that this bid ismade without reference to any other bid and without any agreement, understanding or combination with any otherperson in reference to such bidding.He further says that no person or persons, firms, or corporation has, have or will receive directly orindirectly, any rebate, fee, gift, commission or thing of value on account of such sale.SECTION V OATH AND AFFIRMATIONI HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS AND INFORMATIONCONTAINED IN THE FOREGOING BID FOR PUBLIC WORKS ARE TRUE AND CORRECT.Dated at ____________________ this ______________ day of __________________, _________________________________________________________________(Name of Organization)By__________________________________________________________________________________________________________________(Title of Person Signing)STATE OF ______________________)) ssCOUNTY OF_____________________)ACKNOWLEDGEMENTBefore me, a Notary Public, personally appeared the above-named _________________________________ andswore that the statements contained in the foregoing document are true and correct.Subscribed and sworn to before me this ____________ day of ___________________, ________.____________________________________________Notary PublicMy Commission Expires:_____________________County of Residence:________________________00415-5

Contractor’s Financial StatementSubmitted by______________________________________________________________A CorporationA Co-partnershipAn Individualwith principal office at _________________________________________________________________________________To_______________________________________________________________________________________________ASSETS Dollars Cts.1. Cash: (a) On Hand $ ________ (b) In bank $ _________ (c) Eslewhere $2. Notes receivable (a) Due within 90 days(b) Due after 90 days(c) Past Due3. Accounts payable from completed contracts, exclusive of calims not approved forpayment4. Sums earned on uncompleted contracts as shown by engineer’ or architects estimate(a) Amount receivable from deducting retainage(b) Retainage to dade, due upon completion of contracts5. Accounts receibable from sources other than construction contracts6. Deposits for bids or other guarantees: (a) Recoverable within 90 days(b) Recoverable after 90 days7. Interest accured on loans, securities, etc.8. Real estate: (a) Used for business purposes(b) Not used for business purposes9. Stocks and bonds: (a) Listed – present market value(b) Unlisted – present value10. Materials in stock not included in Item 4 (a) For uncompleted contracts (present value)(b) Other materials (present value)11. Equipment, book value12. Furniture and fixtures, book value13. Other assetsLIABILITIES1. Note payable: (a) To banks regular(b) To banks for certified checks(c) To others for equipment obligations(d) To other exclusive of equipment obligations2. Accounts Payable: (a) Not past due(b) Past due3. Real estate encumbrances4. Other liabilities5. Reserves6. Capital stock paid up: (a) Common(b) Common(c) Perferred(d) Perferred7. Surplus (net worth)CONTINGENT LIABILITIES1. Liability on notes receivable, discounted or sold2. Liability on accounts receivable, pledged, assigned or sold3. Liability as bondsman4. Liability as guarantor on contracts or on accounts of others5. Other contingent liabilitiesTotal assetsTotal liabilitiesTotal contingent liabilities00135-1

1 CashDETAILS RELATIVE TO ASSETS(a) on hand__________________________________________________ $___________________(b) deposited in banks named below________________________________ $___________________(c) elsewhere – (state where)_____________________________________ $___________________NAME OF BANK LOCATION DEPOSIT IN NAME OF AMOUNT2 Notes receivable(a) due within 90 days__________________________________ $__________________(b) due after 90 days___________________________________ $__________________(c) past due_________________________________________ $__________________RECEIVABLE FROM: NAME AND ADDRESS FOR WHAT DATE OFMATURITYHOW SECUREDAMOUNTHave any of the above been discounted or sold? ____________ If so, state amount, to whom, and reason ________________________________________________________________________________________________________________________________________________________________________________________________________________________3 * Accounts receivable from completed contracts exclusive of claims not approved for payment $__________________NAME AND ADDRESS OF OWNERNATURE OF CONTRACTAMOUNT OFCONTRACTAMOUNTRECEIVABLEHave any of the above been assigned, sold or pledged? ___________ If so, state amount, to whom, and reason ___________________________________________________________________________________________________________________________________________________________________________________________________________________4 *Sums earned on uncompleted contracts, as shown by engineer’s or architect’s estimate:(a) Amount receivable after deducting retainage ____________________________ $__________________(b) Retainage to date due upon completion of contract________________________ $__________________DESIGNATION OF CONTRACTAND NAME AND ADDRESSOF OWNERAMOUNT OFCONTRACTAMOUNTEARNEDAMOUNTRECEIVEDRETAINAGEWHEN DUEAMOUNTAMOUNT EX-CLUSIVE OFRETAINAGEHave any of the above been sold, assigned, or pledged? ____________ If so, state amount, to whom, and reason_______________________________________________________________________________________________________________________________________________________________________________________________________________*List separately each item amounting to 10 percent or more of the total and combine the remainder00135-2

DETAILS RELATIVE TO ASSETS (Continued)5 * Accounts receivable not from construction contracts______________________________ $___________________RECEIVABLE FROM: NAME AND ADDRESS FOR WHAT WHEN DUE AMOUNTWhat amount, if any, is past due___________________________________________________$___________________6 Deposits with bids or otherwise guarantees____________________________________ $___________________DEPOSITED WITH: NAME AND ADDRESSFOR WHATWHENRECEIVABLEAMOUNT7 Interest accrued on loans, securities, etc._____________________________________ $___________________ON WHAT ACCRUED TO BE PAID WHEN AMOUNT12345678Real estatebook valueDESCRIPTION OF PROPERTY(a) Used for business purposes____________________________ $ __________________(b) Not used for business purposes_________________________ $ __________________NATURE OF IMPROVEMENTSIMPROVEMENTSBOOK VALUETOTAL BOOKVALUELOCATIONHELD IN WHOSE NAMEASSESSEDVALUEAMOUNT OFEMCUMBRANCES1234567_________________________________________________________________________________________________List separately each item amounting to 10 percent or more of the total and combine the remainder.DETAILS RELATIVE TO ASSETS (Continued)00135-3

9 Stocks and Bonds(a) Listed – present market value______________________ $_______________________(b) Unlisted – present market value___________________ $_______________________1234567DESCRIPTIONWHO HAS POSSESSION123456710ISSUING COMPANYLAST INT.OR DIV.PAIDDATE %PARVALUEPRESENTMARKETVALUEIF ANY ARE PLEDGED OR IN ESCROW, STATE FOR WHOM AND REASONQUAN-TITYAMOUNTAMOUNTPLEDGED OR INESCROWMaterials in stock and not included in Item 4, Assets:(a) For use on uncompleted contracts (present value)____________________ $_______________________(b) Other materials (present value)___________________________________ $_______________________PRESENT VALUEDESCRIPTION OF MATERIALQUANTITYFOR UNCOM-PLETEDCONTRACTSOTHERMATERIALS11* Equipment at book value______________________________________________ $________________________QUAN-TITYDESCRIPTION AND CAPACITY OF ITEMSAGE OFITEMSPRUCHASEPRICEDEPRECIATIONCHARGED OFFBOOKVALUEAre there any liens against the above? ____________________ If so, state total amount________________ $____________* If two or more items are lumped above, give the sum of their ages.DETAILS RELATIVE TO ASSETS (Continued)00135-4

12 Furniture and fixtures at book value_______________________________________ $________________________13 Other assets_______________________________________________________ $________________________DESCRIPTIONAMOUNTTOTAL ASSETS $1 Notes PayableDETAILS RELATIVE TO LIABILITIES(a) To banks, regular______________________________ $_____________________(b) To banks for certified checks______________________ $_____________________(c) To others for equipment obligations_________________ $_____________________(d) To others exclusive of equipment obligations __________ $_____________________TO WHOM: NAME AND ADDRESS WHAT SECURITY WHEN DUE AMOUNT2 Accounts PayableTO WHOM: NAME AND ADDRESS(a) Not past due______________________________ $_____________________(b) Past due_________________________________ $_____________________FOR WHATDATEPAYABLEAMOUNT3 Real estate encumbrances (See Item 8, Assets)______________________________ $_____________________4 Other Liabilities_____________________________________________________ $_____________________DESCRIPTIONAMOUNT5 Reserves_________________________________________________________ $_____________________INTEREST INSURANCE BLDGS. & FIXT. PLANT DEPR. TAXES BAD DEBTS$_______ $_________ $____________ $__________ $________ $__________ $________ $________6 Capital stock paid(a) Common_________________________________ $_____________________(b) Preferred_________________________________ $_____________________7 Surplus __________________________________________________________ $_____________________TOTAL LIABILITIES $00135-5

If corporation answer this:Amount for which incorporated_________________________________________________________________Capital paid in cash_____________________________________________$ ______________________When incorporated _________________________________________________________________________In what state ______________________________________________________________________________Names and titles of all persons having authority to execute and receipt estimate vouchers and to conduct other businessfor the corporation, including its officers, the signatures of whom are legally binding.Do you have necessary “certificate of authority” to transact corporate business in this state, under the terms ofChapter 215, Acts of 1929, and acts amendatory thereto? ____________________________________________________If a co-partnership answer this:Date of organization_________________________________________________________________________State whether co-partnership is general, limited or association___________________________________________Give the manes, addresses and proportional interests of all parties:Name Address Share_________________________________________________________________________$_____________________________________________________________________________________________$_____________________________________________________________________________________________$_____________________________________________________________________________________________$_____________________________________________________________________________________________$_____________________________________________________________________________________________$_____________________________________________________________________________________________$_____________________________________________________________________________________________$_____________________________________________________________________________________________$____________________00135-6

The name of the partnership firm under which the above partners are operating is_______________________________________________________________________________________________________________________________________________________________________________Give names and titles of all persons having authority to execute and receipt estimate vouchers and to conduct other business for the partnership, thesignatures of whom are legally binding.________________________________________________________________________________________________________________________The undersigned hereby declares that the foregoing is a true statement of the financial condition of the individual co-partnership orcorporation herein first named, as of the date herein first given; that this statement is for the express purpose of inducing the party to whom it issubmitted to award the submitter a contract; and that any depository, vendor or other agency herein named is hereby authorized to supply such partywith any information necessary to verify this statement.____________________________________________Note: A co-partnership must firm name and address andsignatures of all partners. A corporation must give full corporatename, signature of official and affix corporate seal.__________________________________________________________________________________________________________________STATE OF ______________COUNTY OF_____________SS:Affidavit for individual_____________________________________________________________________ being duly sworn, disposes and says that the forgoing financialstatement, taken from his books, is a true and accurate statement of the financial condition as of the date thereof and that the answers to theforegoing interrogatories are true.Subscribed and sworn to before me this____________day of_________________________20___________________________________________________(Member of firm must sign)________________________________________________Notary PublicSTATE OF ______________COUNTY OF_____________SS:Affidavit for Co-partnership_________________________________________________________ being duly sworn, disposes and says that he is a member of the firm of________________________________________________; that he is familiar with the books of the said firm showing its financial condition; that theforgoing financial statement, taken from his books of said firm, is a true and accurate statement of the financial condition of the said firm as of the datethereof and that the answers to the foregoing interrogatories are true.Subscribed and sworn to before me this____________day of_________________________20___________________________________________________(Member of firm must sign here)_______________________________________________Notary PublicSTATE OF ______________COUNTY OF_____________SS:Affidavit for Corporation___________________________________________________________________being duly sworn, disposes and says that he is_______________________ of the ________________________________________; the corporation described in and which executed the foregoingstatement, that he is familiar with the books of the said corporation showing its financial condition; that the forgoing financial statement, taken from hisbooks of said corporation, is a true and accurate statement of the financial condition of the said corporation as of the date thereof and that the answersto the foregoing interrogatories are true.Subscribed and sworn to before me this____________day of_________________________20___________________________________________________________(Member of firm must sign here)________________________________________________Notary Public00135-7

PENAL SUM FORMBID BONDAny singular reference to Bidder, Surety, Owner or other party shall be considered plural where applicable.BIDDER (Name and Address):SURETY (Name and Address of Principal Place of Business):OWNER (Name and Address):BIDBid Due Date:Description (Project Name and Include Location):BONDBond Number:Date (Not earlier than Bid due date):Penal sum $(Words)(Figures)Surety and Bidder, intending to be legally bound hereby, subject to the terms set forth below, do each causethis Bid Bond to be duly executed by an authorized officer, agent, or representative.BIDDERBidder’s Name and Corporate Seal(Seal)SURETYSurety’s Name and Corporate Seal(Seal)By:SignatureBy:Signature (Attach Power of Attorney)Print NamePrint NameTitleTitleAttest:SignatureAttest:SignatureTitleTitleNote: Above addresses are to be used for giving any required notice. Provide execution by any additionalparties, such as joint venturers, if necessary.EJCDC C-430 Bid Bond (Penal Sum Form)Prepared by the Engineers Joint Contract Documents Committee.Page 1 of 2

PENAL SUM FORM1. Bidder and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors,and assigns to pay to Owner upon default of Bidder the penal sum set forth on the face of this Bond. Payment ofthe penal sum is the extent of Bidder’s and Surety’s liability. Recovery of such penal sum under the terms of thisBond shall be Owner’s sole and exclusive remedy upon default of Bidder.2. Default of Bidder shall occur upon the failure of Bidder to deliver within the time required by the BiddingDocuments (or any extension thereof agreed to in writing by Owner) the executed Agreement required by theBidding Documents and any performance and payment bonds required by the Bidding Documents.3. This obligation shall be null and void if:3.1 Owner accepts Bidder’s Bid and Bidder delivers within the time required by the Bidding Documents (orany extension thereof agreed to in writing by Owner) the executed Agreement required by the BiddingDocuments and any performance and payment bonds required by the Bidding Documents, or3.2 All Bids are rejected by Owner, or3.3 Owner fails to issue a Notice of Award to Bidder within the time specified in the Bidding Documents(or any extension thereof agreed to in writing by Bidder and, if applicable, consented to by Surety whenrequired by Paragraph 5 hereof).4. Payment under this Bond will be due and payable upon default of Bidder and within 30 calendar days afterreceipt by Bidder and Surety of written notice of default from Owner, which notice will be given with reasonablepromptness, identifying this Bond and the Project and including a statement of the amount due.5. Surety waives notice of any and all defenses based on or arising out of any time extension to issue Notice ofAward agreed to in writing by Owner and Bidder, provided that the total time for issuing Notice of Awardincluding extensions shall not in the aggregate exceed 120 days from Bid due date without Surety’s writtenconsent.6. No suit or action shall be commenced under this Bond prior to 30 calendar days after the notice of defaultrequired in Paragraph 4 above is received by Bidder and Surety and in no case later than one year after Bid duedate.7. Any suit or action under this Bond shall be commenced only in a court of competent jurisdiction located inthe state in which the Project is located.8. Notices required hereunder shall be in writing and sent to Bidder and Surety at their respective addressesshown on the face of this Bond. Such notices may be sent by personal delivery, commercial courier, or by UnitedStates Registered or Certified Mail, return receipt requested, postage pre-paid, and shall be deemed to be effectiveupon receipt by the party concerned.9. Surety shall cause to be attached to this Bond a current and effective Power of Attorney evidencing theauthority of the officer, agent, or representative who executed this Bond on behalf of Surety to execute, seal, anddeliver such Bond and bind the Surety thereby.10. This Bond is intended to conform to all applicable statutory requirements. Any applicable requirement of anyapplicable statute that has been omitted from this Bond shall be deemed to be included herein as if set forth atlength. If any provision of this Bond conflicts with any applicable statute, then the provision of said statute shallgovern and the remainder of this Bond that is not in conflict therewith shall continue in full force and effect.11. The term “Bid” as used herein includes a Bid, offer, or proposal as applicable.EJCDC C-430 Bid Bond (Penal Sum Form)Prepared by the Engineers Joint Contract Documents Committee.Page 2 of 2

SECTION 00450SUBCONTRACTOR LISTPursuant to bidding requirements for the Work titled:Owen CountySR43 Sanitary Sewer Extensionfor portions of the work equaling or exceeding $10,000.00, Bidder proposes to use the followingSubcontractors. Except as otherwise approved by Owner, Bidder proposes to perform all other portionsof the Work with his own forces:Portion of the Work:Subcontractor Name & Address:00450-1