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American Evergreen~r~er~can.f,~~~~n PROPOSAL FOR TOWN OF WAPPINGER UNITED WAPPINGER WATER DISTRICT WATER MAIN EXTENSION TO CHELSEA HAMLET CONTRACT NO. 13-006 DIVISION 200 BID FORM PREPARED BY: MORRIS ASSOCIATES ENGINEERING CONSULTANTS, PLLC 9 ELKS LANE POUGHKEEPSIE, NEW YORK 12601 SEPTEMBER 2013 REVISED FEBRUARY 2014 MA#: W21215.11 2Q0 01 TOWN OF WAPPINGER UNITED WAPPINGER WATER DISTRICT WATER MAIN EXTENSION TO CHELSEA HAMLET CONTRACT NO. 13-006 BID FORM ~ THE TOWN RESERVES THE RIGHT TO REJECT ANY OR ALL BIDS. EACH BID FORM SHALL BE ACCOMPANIED BY BID SECURITY (AS DESCRIBED IN THE INSTRUCTION ~"' TO BIDDERS). TO THE TOWN BOARD, TOWN OF WAPPINGER, NEW YORK Pursuant to and in compliance with your invitation to bid contained in the Notice to Contractors dated iwla ~< < `~, ZU---! ' (month) (day) (year) the undersigned hereby proposes to furnish all labor, machinery, equipment, facilities, ~" tools, transportation, supplies, materials, insurances, permits, certificates, tests, guarantees, protection of equipment and property and life during construction; as well as competent and qualified supervision for all phases of the work, and other facilities and things necessary or proper for or incidental to, Town of Wappinger Water Main Extension to Chelsea Hamlet Project, Town of Wappinger, as required by and in strict accordance with the plans, specifications and all other documents relating to Contract No. 13-006, or the prices stipulated and as shown on this bid form. C., j~,, Name of Bidder: - M 1'r C ~/~ c r'cG (Individual, Partnership,~Corporation r LLC)* * Circle applicab a word The undersigned declares that the bidding and contract documents have been carefully examined and that all things necessary for the completion of the work shall be provided. Receipt of the following addenda is hereby acknowledged: DATE SIGNATURE ADDENDUM NO. 1 ~~aa ~~~ ~` NO. 2 3' d S '~f ADDENDUM ADDENDUM NO. 3 ADDENDUM NO. 4 200 02 i_ i»- In consideration of, and to induce the award of this contract to him/her, the bidder represents and warrants that: '~ (a) If this bid is accepted by the Town Board, Town of Wappinger, as evidence by issuance of a Notice of Award by the Owner, and mailed by registered mail with return receipt requested to the address of the bidder as fr~dicated ~ on his/her bid, the bidder will execute a contract on the form of agreement herein provided and will comply with all provisions of said Notice of Award. (b) This bid is made without any understanding, agreement or connection with any other person, firm or corporation making a bid for the same work, and that it is in all respect fair and without collusion or fraud. (c) The bidder has carefully examined and fully understands all of the parfis of the contract documents, and that the bidder will execute the contract and will completely perform it in strict accordance with the provisions thereof for the sum set forth on the bid. Unit Prices have been computed in accordance with the Contract Documents. Bidder acknowledges that estimated quantities are not guaranteed, and are solely for the purpose of comparison of Bids, and final payment for alt Unit Price Bid items will be based on actual quantities, determined as provided in the Contract Documents. (d) No officer or employee of the Town Board, Town of Wappinger, or any person whose salary is payable in whole or in part by the Town Board is, shall be, or shall become interested directly or indirectly as a contracting party, partner, stockholder, surety or otherwise in this bid or in the pe~ormance of the contract or in the supplies, materials or equipment, or to work or labor to which it relates, or in any portion of the profits thereof. (e) The bidder is not in arrears to the Town Board upon debt or contract and is not a defaulter as surety, contractor, or otherwise upon any obligation to the Town Board, Town of Wappinger. (f) All work shall be completed within the time allotted, from the date specified in the Notice to Proceed or set by the contract documents, mailed to the undersigned by registered mail with return receipt requested to the legal address of the bidder as indicated on his/her bid. (g) If the bid documents contain any unlawful provision not an essential part of the bid and which shall not appear to have been a controlling or material inducement to the making thereof, the same shall be deemed of no effect and will upon notice by either the Owner or the bidder be deemed stricken from the bid documents without affecting the binding force of the remainder. v 200 03 1 ri Ir- (h) Each and every provision of any law and clause required by law to be inserted in the bid documents shall be deemed to be inserted herein and the bid documents shall be read and enforced as though it were included herein; and if through mistake or otherwise any such provision is not inserted or is not correctly inserted, then upon the application of either party, the bid documents shall forthwith be physically amended to make such insertion. (i) The bidder is financially solvent and sufficiently experienced and competent to perform the work. (j) The work can be performed as called for by the proposal and that the plans and specifications are in all respects suitable and adequate for the work. (k) The facts stated in his/her bid and the information given by him/her are true and correct in all respects. (I) The bidder is fully informed regarding all the conditions affecting the work to be done and labor and materials to be furnished for the completion of this contract, and that his/her information was secured by personal investigation and research. (m) In the event of a lawsuit, the bidder agrees that said suit shall be filed in the same county as the location of the project. BID FOR CONTRACT WORK: Base Bid Install water distribution improvements and related items in accordance with the Contract Documents, not including Bid Alternate 1. Thall lgrov'sionstof eac~hoand every Contradt ~ items furnished and strict compliance with p t ~ Document relating to Contract 13-006, agrees to accept (unless modified pursuant tot e terms of the General Conditions) a total, final and fixed contract price not to exceed: g D -. ~ ° ° (Figures) ~~ V 4 MAR ~ 1 2014 T~ wN ~F VV - Zoo 04 `~WN ~~ FINGER , e_~K-^ -~~ro G~~ts '~ -~ } Add Alternate 1 Bid For Add Alternate 1: Overlay paving of Entire Stenger Court, the signatory to this bid, for all work proposed, items furnished and strict compliance with all provisions of each and every Contract Document relating to Contract 13-006, agrees to accept (unless modified ~,,, pursuant to the terms of the General Conditions) a total, final and fixed contract price not to exceed: ~ '-~~ G<.~o ~ryvS~ h~ G/lG~'S 2erv Cert~S (Words) Sa, o~~, Ga (Figures) Also made a part of this bid is the attached documentation per Division 100, Article C.3. ~~ Sign Bid Here AU HORIZED SIGNATURE ~ ~ ~~~ Print Name ~~ o s ~~h / , ~ S Title i~res'~~~~ t Official Company Name ~ ~ Lci- ~~ rt c (Individual, Partnership, Cor oration LLCj* * Circle applicable word Company p Mailing Address I r~- ~o X ~o~ 6 STREET Gy~~u~~sl~~~~~ ~vY ray ~~' CITY STATE ZIP CODE Fede{al Employer /Ll ~~`d`O/ Identification No. Telephone No. S l 8 ~ 3 olb ~ ~ a r~ a~ A~~ ~(fcu< ~~ a h;'vP ~ n ~ ~'leven /i'IOySG~IGQ NO`l4rS ~~a ~~~S ti~ 200 05 ~r- ~r (If bidder is a corporation, fill in the following blanks.) Organized under the laws of the State of: /~e~,~, ~a ~ K Name and Address of President: ~'o ~~ ~t % ~~5~~~ +' Name and Address of Secretary: f'1,ctic,~( t1 CA S R ~ ~ Name and Address of Treasurer: ('1;chuc( (~ ~'~s~ l~- (If bidder is a Limited Liability Company, fill in the following blanks.) Organized under the laws of the State of: Name of Manager or Managing Member: Agent for Service of Process: Address for Service of Process: 200 06 J J RK STATE OF NEW YO ) ss: ,,, COUNTY OF ~~ Z ~ ~~ day of ~Grc ~ ,before me, the On the _________ / undersigned, a Notary Public in and for said State, personally appeared ~ (`~ personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity, and that by his signature on the instrument, the individual, or the person upon behalf of which the individual acted, executed the instrument. Jeffery Jordan Notary Puk~lic State of New York Residing in Sarataga Co my My commissian expires ~~ 200 07 ~. J s s ~ 6 a O Q ~ 'r .~ ~. J •. O ~J Q ~ L ~ a .~ q ~+ p ~ `7 ^ O 0 Qm ~ O d 4 0 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ O ~w ~ ~ fl ~ O O ~ p o .~ ~ ~ © O ~ a ~ ~ ~ ~ ~ ~ ~ ~ O o ~' ~ ~ ~ ~ ~ ~' Q ?~ M ~- `fit ~ ~` ~ ~ o a ~ o 0 0 ~, ° o 0 0 ~ o Q o ~ o o ~ ~ cn ~ a c ~ " '~ ~ ~ c ~ ° `~ O ° O ~ © ~j O ~ 0 O ~ ~ ~ ,0 Imo; ~ ~ (`~ ~ o ~ p 0 O ~ ~ ~ a' ~ ~'' r J ~ ~ bo CT' o z ~ O ~ ~ ~ ~ -.. m ~ ~ O U ~ ~ ~ ~ ~ ~ ~~`~ ,•~ ~ ~ ~ ~ Z O ~ ~ ~ ~ ? 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'O ~ ~ +'r _ ~ ~ O U N Q~ _ •~ Q N LL U ~ ~ ~ O (~ L ~ (n W .. r' ~ (~ ~k ~ ~ N U ~k • ~ N ' ~ ~ ~ ~ O r--~ ~ '_ O+ ± •«-~ V U ~ ~ Z (a ~ ~ L W ~ (L5 N ~ co L ~ ~ ~ ~ ~ ~~ ~ ~ N ~ - ~ N "a O Q ao L „ ~ Q°-~°' U O U G7 N t a a m v 3 m a~ a t? a~i Q 0 N ~ w o o~ o= N m m N N U u~ N' O N C w a w 0 U } Z N_ N N O N (6 a~ rn c .Q a m w a E U 0 w +~ f BID BOND KNOW ALL MEN BY THESE PRESENTS: that * American Evergreen, Inc. 3 Agway Drive, Rensselaer, NY 12144 ** Liberty Mutual Insurance Company 175 Berkeley St. Boston, MA 02116 as Principal; and as Surety, are hereby held and firmly bound unto the Town Board, Town of Wappinger, New York in the amount of: Five Percent of Arrount Bid Dollars $ ----5~--- for the payment whereof .Principal ,and .Surety bind ourselves, our heirs, executors, administrators, successors and assigns, jointiy,and severally, firmly by these presents. Signed this 31st day of March 2014 WHEREAS, the condition of the above obligation is such that, whereas the Principal has submitted to the Town Board a certain bid, attached hereto and hereby made a part hereof, to enter into a contract in writing for the Water Main Extension to Chelsea. Hamlet for. the Town of Wappinger, New York, as shown and specified in Contract No. 13-006. NOW THEREFORE, (a) If said Bid shall be rejected, or in the alternate (b) If said Bid shall be accepted and the Principal shall execute and deliver a contract in the Form of an Agreement attached hereto (properly completed in accordance with said Bid) and shall in all 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 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 in no way be impaired or affected by any extension of the time within which the Principal may accept such bid; and said Surety does hereby waive notice of any such extension. FAN WITNESS WHEREOF, the Principal and the Surety have hereunto set their hands and peals, and such of them as are Corporations have caused their Corporate seals to be ~_b~etaaffixed and these presents to be signed by their proper officers, the day and year -t^+rst se_t forth above. (`E.~L) American Evergreen, Inc. PR CIPAL *lnsart Bidder's Name By~ ~ **Insert Surety's Name Joseph T. Casale. President 200 09 vy Signed, sealed and delivered in the presence of S, (Corporate seal of Contractor if a corporation) American Evergreen, Inc. Contractor Josep T. Casale, President Liberty Mutual Insrirancp Crn~,n, By Dawn J. Riley, Attorney-in-F t(Title of Officer) (Corporate seal of Surety) Attest ~ Power' of Attorney (Title of Officer) Notary Public, State of New York aualified in Schenectady Cou~ J` No. 4850071 Commission Expires January 13, _,,,~„~ 200 U10 rti t STATE OF NEW YORK ) ss: COUNTY OF RPnssPlaPr ) On the 31st day of March, 2014 _, before me, the undersigned, a Notary. Public in and for said_State, personally appeared Joseph T. Casale personally known to me or proved to me .on the basis of satisfactory evidence to be .the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity, and that by his signature ~n the instrument, the individual, or the person upon behalf of which the individual acted, executed the instrument. lL NOTARY PUBLIC DONNA L. SHARPE Notary Public, State of New York Qualified in Schenectady County No. 4850071 Commission Expires January 13 ~n~ 2UQ 11 Surety Acknowledgment State of New York County of Albany On this 31st day of March , 20 14 ,before personally came Dawn J Riley to me known, who being by me duly sworn, did depose and say that he resides in Albanv New York that she is the Attorney-in-Fact of the Liberty Mutual Insurance Company ,the corporation described in and which executed the foregoing instrument; that she knows the Seal of said corporation; that one of the Seals affixed to the foregoing instrument is such Seal; that it was so affixed by order of the Board of Directors of said corporation; and that she signed her name thereto by like order. Notary Public DONNA L. SHARPE My commission expires Notary Public State of New York ua ~ ie m c~enectady County No. 4850071 Commission Expires January 13,1 Liberty Mutualr, SURETY LIBERTY MUTUAL INSURANCE COMPANY FINANCIAL STATEMENT -DECEMBER 31, 2012 Assets Cash and Bank Deposits .................................. ....... $ 903,711,694 *Bonds - U. S Government .............................. ....... 1,166,929,471 *Other Bonds ................................:.................... ....... 11,415,194,219 *Stocks .............................................................. ....... 8,104,853,899 Real Estate ....................................................... ....... 255,967,320 Agents' Balances or Uncollected Premiums.... ....... 3,482,069,753 Aecrued~lnterest and Rents .............................. ....... 144,016,763 Other Admitted Assets ...................................... ........ 14 732.623.458 Total Admitted Assets ...........:......................... $4QZQ5_i66.577 Liabilities Unearned Premiums ............................................... . $4,205,141,671 Reserve for Claims and Claims Expense .............. .. 17,056,420,207 Funds Held Under Reinsurance Treaties ............... .. 1,315,062,091 Reserve for Dividends to Policyholders ................ .. 2,455,411 Additional Statutory Reserve ................................ .. 49,768,998 Reserve for Commissions, Taxes and .Other Liabilities ........................................:....: .: 3.066.051.537 Total ........................................................... .. $25,694,899,915 Special Surplus Funds ................. $604,621,497 Capital Stock .:......................:.:.... 10,000,000 Paid in Surplus ............................ 7,899,471,886 Unassigned Surplus ..................... 5,996,373,279 Surplus to Policyholders ............................... 14,510.466,662 Total Liabilities and Surplus ................................ ,~JP' OR pggqNr ~ ;~ ~ ~, *Bonds are stated at amortized or investment value; Stocks at Association Market Values. tstz 3 The foregoing financial information is taken from Liberty Mutual Insurance Company's financial yq'rSAC}I~'~!2 statement filed with the state of Massachusetts Department of Insurance. I, TIM MIKOLAJEWSKI, Assistant Secretary of Liberty Mutual Insurance Company, do hereby certify that the foregoing is a true, and correct statement of the Assets and Liabilities of said Corporation, as of December 31, 2012, to the best of my knowledge and belief. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of said Corporation at Seattle, Washington, this 25th day of March, 2013. Assistant Secretary S-1262LMIC/a 4/12 THIS POWER OF ATTORNEY 1S NOT VALID UNLESS IT IS PRINTED ON.RED BACKGROUND. This Po~1~er of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Certificate No. 6133Q05 American Fire and Casualty Company. Liberty Mutual Insurance Company ..The Ohio Casualty Insurance Company West American Insurance Company :POWER OF ATTORNEY KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire 8 Casualty Company and. The Ohia Casualty Insurance Company are corporations duly organized under the laws of the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the1aws of the State of Massachusetts, and West American Insurance Company is a corporation duly organized under the laws of the State of Indiana (herein collectively called the "Companies', pursuant to and by authority herein set forth, does hereby name, constitute and appoint, .hristopher 1. Knauf: Dawn J. Riley Donna L Sharpe. Guy Alonge_ Ilk Richard W. Mahtstedt all of the city of Aibanv . state of NY each individually if there be more than one named, its true and lawful attorr>ey-in-fact to make, execute; seal, acknowledge and deliver, for and on -its behalf as surety and as its act acrd deed. any antl aB undertakings, bonds, recognfzances and other surety obligations, in pursuance of these presents and shall be as binding upon the. Companies as if they have been.duly signed bythe president and attested by the secretary of the Companies in their ownproper persons. IN WITNESS WHEREOF; this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed thereto this 21st day of Mav 2013 ~ American Fire and Casualty Company a The Ohio Casually Insurance Company H Liberty Mutual Insurance Cornpany WestAmerican Insurance Company •y ~ ~ d ~ ~ gy; ~"'` ~~+G~~ .G ~ +~ C Gregory VV. Davenport, Assistant Secretary STATE OF WASHINGTON ss = ~ ~ COUNTY OF KING _ d ~ On this 2tst day of MaV 2013 ,.before me personally appeared Gregory W. Davenport, .who acknowledged himself to be the Assistant Secretary of American v ~ F- V ~ Fin: and Casualty Company, liberty Mutual Insurance Company, The Ohio Casualty Company, and West American Insurance Company, and that he, as such, being authorized so to do, N G ~ execute the foregoing rnstrument for the purposes therein contained by signing on behalf of the corporations by himself a5a duly authorized officer. ` G d > IN WITNESS WHEREOf, I have hereunto subscribed my name and affrxed my notarial seal at Seattle, Washington, on the day and year first above written. . O d ~ M Q O i KD Riley ,Not Public 3 d`o iE _ ~ This Power of Attorney is made and executetl pursuant to and by authority of the following By-laws andAuthorizations ofAmerican Fire and Casualty Company, The Ohio Casually Insurance i rrr c ~ m .r Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are nowin full force and effect reading as folbws: ~ o f, . . ~ ` ARTICLE N-OFFICERS -Section 12: PowerofAttorney.Ariy officer or other offiGatof the Corporation authorized for that purpose in writing by the Chairman or the President, and subject 0 p ~ ~ a; to such limitation as the Chaimtan or the Presideni may preserfbe, shat- appoint such attorneys-in-fact, as may be necessary to act in trettaff of the Corporation to make, execute; seal, p ~ acknowledge and deliver as surety any and alt undertakings, bonds, recognizances and othersurety obltgatrons. Such attorneys-in-fact, subject to the limitations set forth in their respective ~ ~ powers of attorney, shall have fuH power to bind the Corporaton by their signature and execution of any such instnrmerss and to attach thereto the seal of the Corporation. Wheq so '~ d C ~ executed, such instnrments shall be as binding as if signed by the Presiders and attested to by the Secretary. Any power or authority granted to anyrepresentative or attorney-in-fact under. > ~ ~ ~ the provisions of this article may be revoked at any time by the $oard, the Cha+rman; the President or by the officer or officers granting such power or authority: m ~ '~ = ARTICLE XIII -Execution of Contracts -SECTION 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president, ~ > d and subject to such limitations as the chairman or the president may prescribe, shall appoinfsuch attorneys-m-fact, as may be necessary to actin behalf of the Company to make, execute, ti,. M p ~ seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys-in-fact subject to the limitations set forth in their ~ a~ Z V respective powers of attorney, shah have full power to bind fhe Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so v o executed such instruments shall be as binding as if signed by the president and attested by the: Secretary. C cQ Certificate of Designation.-The President of the Company acting pursuant to the Bylaws of the Company, authorizes Gregory. W Davenport, Assistant Secretary to appoint such ~'~ attorneys-in-fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and alF undertakings; bonds, recognizances and other surety obligations. Authorization - By unanimous consent of the Companys Board of Directors, the Company consents that facsimile. or mechanically reproduced signature of any assistant secretary of the Company, wherever appearing upon a certified copy of any power of attorney issued. by the Company in connection with surety bonds, shall be valid and binding upon the Company with the same force and effect as though manually affixed. I, David M. Carey, the undersigned, Assistant Secretary, Of America Flre and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Comp~y, and West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full; true and correct copy of the Power of Attorney executed by said Companies, is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies th's 31~t day of _March , ~ 14 ~ lay: ~~~~1 _' bawd M. Carey, Assistant Secretary Ills 12873 092012 ~ ~ 111 Of 150 BID BOND If a bond is used, the form bound in this manual should be used. No other form may be used except with prior approval by the Owner after review by the Town Attorney which approval may be granted or withheld, in the Owner's discretion. 200 08 s J L BID BOND KNOW ALL MEN BY THESE PRESENTS: that as Principal; and ** as Surety, are hereby held and firmly bound unto the Town Board, Town of Wappinger, New York in the amount of: Dollars $ for the payment whereof Principal and Surety bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. Signed this day of 20 WHEREAS, the condition of the above obligation is such that, whereas the Principal has submitted to the Town Board a certain bid, attached hereto and hereby made a part hereof, to enter into a contract in writing for the Water Main Extension to Chelsea Hamlet for the Town of Wappinger, New York, as shown and specified in Contract No. 13-006. ~" NOW THEREFORE, (a) If said Bid shall be rejected, or in the alternate (b) If said Bid shall be accepted and the Principal shall execute and deliver a "' contract in the Form of an Agreement attached hereto (properly completed in accordance with said Bid) and shall in all 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 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 in no way be impaired or affected by any extension of the time within which the Principal may accept such bid; and said Surety does hereby waive notice W of any such extension. IN WITNESS WHEREOF, the Principal and the Surety have hereunto set their hands and seals, and such of them as are Corporations have caused their Corporate seals to be hereto affixed and these presents to be signed by their proper officers, the day and year first set forth above. (SEAL) PRINCIPAL *Insert Bidder's Name **lnsert Surety's Name By 200 09 ~. J J 1 J 1 ~ Signed, sealed and delivered in the presence of (Corporate seal of Contractor if a corporation) Contractor gy sy (Title of Officer) (Corporate seal of Surety) Attest (Title of Officer) 200 Q10 J J J STATE OF NEW YORK COUNTY OF ss: On the day of ,before me, the undersigned, a Notary Public in and for said State, personally appeared personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within_instrument and acknowledged to me that he executed the same in his capacity, and that by his signature on the instrument, the individual, or the person upon behalf of which the individual acted, executed the instrument. NOTARY PUBLIC 2UQ 11 3 i J J s `g, CERTIFICATION OF NON-COLLUSION BY BIDDER No bid will be considered unless this Certification remains attached to and is submitted with the Bid By submission of this bid, each bidder and each person signing on behalf of any bidder certifies, and in the case of a joint bid each party thereto certifies as to its own organization, under penalty of perjury, that to the best of his knowledge and belief: (1) The prices in this bid have been arrived at independently, without collusion, consultation, communication, or agreement for the purpose of restricting competition as to any matter relating to such prices, with any other bidder or with any competitor. (2) Unless otherwise required bylaw the prices which have been quoted in this bid have not knowingly been disclosed by the bidder and will not knowingly be disclosed by the ,,, bidder, directly or indirectly, to any other bidder or to any competitor, before the time of the bid opening. (3) No attempt has been made or will be made by the bidder to induce any other person, partnership or corporation to submit or not to submit a bid for the purpose of restricting ~, competition. A bid shall not be considered for award nor shall any award be made where (1) (2) and (3) above have not been complied with; provided however, that if in any case the bidder cannot make the foregoing certification, the bidder shall so state and shall furnish with the bid a signed statement which sets forth in detail the reasons therefore. Where (1) (2) and (3) above have not been complied with, the bid shall not be considered for award nor shall any award be made unless the head of the purchasing unit of the State, public department or agency to which the bid is made, or his designee, determines that such disclosure was not made for the purpose of restricting competition. (4) The fact that a bidder (a) has published price lists, rates, or tariffs, covering items being procured, (b) has informed prospective customers of proposed or pending publication of new or revised price lists for such items, or (c) has sold the same. items to other customers at the same prices being bid, does not constitute, without more, a disclosure within the meaning of subparagraph (1). (5) Any bid hereafter made to any public authority or to any official of any public authority created by the State or any political subdivision, by a corporate bidder for work of services performed or to be performed or goods sold or to be sold where competitive bidding is required by statute, rule, regulation, or local law, and where such bid contains the certification referred to in the lead paragraph of this section, shall be deemed to have been authorized by the board of directors of the bidder and such authorization shall be deemed to include the signing and submission of the bid and the inclusion therein of the certificate as to non-collusion as the act and deed of the corporation. I affirm these statements under penalty of perjury. ~ DATE: ~ ~ ~~ BIDDER'S SIGNATURE: ~r. ~€?0 't2 J J J J