Merritt ConstructionSECTION 00310 -BID FORM
CONTRACT NO. 12-012
GENERAL CONSTRUCTION
BID FORM
TO: The Town Board of the Town of Wappinger.
~In com liance with your Advertisement for Bids, pu lishe~ in the
r d a •.~, dated ~~// 3 ,the
undersigned, v ving carefully examined the Contract
Documents and any Addenda thereto, proposes and agrees as follows:
1. To furnish all the equipment, and incidentals, and to furnish labor and do all
the work required, to construct, furnish, and complete the Contract No. 12-
012, Roberts Road Sewer Improvements -General Construction and
associated work in accordance with the prices so named in this bid in a
worker like manner, in accordance with the plans and specifications, all of
which are a part of the contract hereto annexed.
2. To complete all the work as shown and specified, on which this bid is based,
within the timeframe(s) specified in these Contract Documents and any
Addendum thereto.
3. To furnish the Town within five (5) calendar days from the date of the
request, if identified as the apparent low bidder and if requested by the
Town, a Statement of Qualifications.
4. To enter into a contract and to furnish, with suitable surety to be approved by
the Town Board, performance and labor and material payment bonds, the
amount of each of the bonds to be the full amount of the awarded bid price
as it appears in this proposal, within thirty (30) calendar days from the date
of acceptance of this bid
5. To comply with the Davis-Bacon Act and other federal labor standards or
provisions and to pay New York State prevailing wage rates applicable to
this contract.
In compliance with the Instructions to Bidders, the undersigned declares that
he/she has examined the site of the work and informed himself/herself fully in regard to
all conditions pertaining to the place where the work is to be done. He/she has
examined the plans and specifications for the work and the contract documents relating
BID FORM 00310-1
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thereto, has read all addenda furnished prior to the opening of bids, and has satisfied
himself/herself relative to the work to be performed.
If the undersigned fails to perform any of the promises made herein, the certified
check, which is herewith deposited with the Town Clerk, will be paid to the Town of
Wappinger or payment of the bond herewith deposited will be enforced for the benefit of
the Town of Wappinger as liquidated damages for such default; otherwise the check or
bond will be returned to the undersigned.
ADDENDA:
Receipt of the following addenda (if any) is hereby acknowledged and the
provision(s) thereof is (are) included in this bid:
ADDENDUM NO. DATE SIGNATURE
~~ ~ 2o~s 13 ~~~
The bidder proposes to perform the work required in accordance with the Contract
Documents for the sum of:
BASE BID (C~NERAL CONSTRUCTION)
_ ~TVC~
(in writing)
Dated: rvy ~
SIGN BID HERE
a~
'~ (and figures)
_, 20
,,,L~ ~~ / Ps, 4/k, ,~
authorized Signatuy~' Title
Print Name
Legal Company Name ~ ~ ¢
Address ~ ~5-AG'~~~o.~../
City, State, Zip 7`%G ~ ~ / z ~
Telephone No. 9 °~/ - ~~/~ - ~- / ~3_°
Federal I.D. # _ /yam l .-~ ~ C~(7
BID FORM
00310-2
E:\documents\T Wappingerla W2012\W21205 Roberts Rd Pump Station\Spec~cations\00310_General.doc
ITEM NO./DESCRIPTION
1. Furnish and install all materials,
supplies, equipment and other
facilities as required for construction
of Roberts Road Sewer
Improvements- General
Construction, including all
incidentals, as shown and as
specified in the Contract Documents.
2. Rock Excavation
3. Authorized Additional Excavation
4. Lift Station Abandonment
ALLOWANCE #1
Testing Services
ALLOWANCE #2
Contingency Allowance
a i
BASE BID SHEET
GENERAL CONSTRUCTION
CONSTRUCTION BID AND CONTRACT
ROBERTS ROAD SEWER IMPROVEMENTS
EST. PAYMENT UNIT PRICE BID
QTY. UNIT
WRITTEN AMOUNT IN FIGURES
~ L.S.
4z~<.-~_
~~ - 7
30 C.Y. w ~
30 C.Y. i...•,~ ~ s
~ EA
x -END OF SECTION-
~a
TOTAL BASE BID
TOTAL
PRICE BID
7 ov
$5, 000.00
$20, 000.00
~~Y~
a
!i~,,
'~~rra MAY ~;'
~. ';, 3
~; ~,~
t,
~ ~: v
~~ ~x~,
-_ ~~~~
1.
S1CTiON 0041a-BID BOND MAY ~ ~°, ~~";3
BID BOND FOR ~~ ~~' ;;.~,?~,g~~c°
NOW ALL PERSONS BY THESE PRESENTS, that TO~1;N '~~.i ~' ~ ~ `~ ~~~
K
* Merritt Construction, Inc., 6 Staghorn Drive, Saugerties, NY 12477. as
Principal; and
~. Travelers Casualty and Surety Company of America, 770 Pennsylvania Drive, SuitaS11~,~re(on, Pa @19341
hereby held ~~YY
and firmly bound unto the Town Board, Town of Wappinger, New York in the amount of:
**Five Percent (5%) of the Amount Bid** Dollars ($ **5% of Bid** _)
for the payment whereof Principal and Surety bi1~d ourselves, our heirs, executors,
administrators, successors and assigns, jointly and severally, firmly by these presents.
Signed this 1st day of Mav 2013
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 Roberts Road Sewer Improvements in the Town of
Wappinger, New York, as shown and specked in the contract, plans and specifications.
Project No. 12-012
NUW THEREFC3RE,
(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 the
Contract Agreement in the form attached hereto (properly completed in
accordance with said Bid) and furnish such performance bond and labor and
material payment bond as required,
lhc:n this obligation shall be void. Otherwise, the same shall remain in force and effect,
it being expressry understood and agreed that the liability of the Surety for any and all
clt~ims hereunder shall, in no event, exceed the amount afi this obligation as herein
-:tr~tt~d.
I ho Surety, for value received, hereby stipulates and agrees that the obligations of said
~~t.rrety and its band shall in no way be impaired or affiected by any extension of the time
within which the Principai may accept such bid; and said Surety does hereby waive
nr~tice of any such extension.
'Insert bidder's Name
"Insert Surety's Name
I~ID 130ND 00410-1
t` vi~fiummnt°lT Wappinget~a W2012~W2t205 Robe~ka Rd Pump Stationl5paoirieations~o041D.doc
'err
IN WITNESS WHEREOF, the Principal and the Surety have Itiereunto set their hands
and seals, and such of there 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. Merritt Construction, Inc.
(Seal of Principal if a Corporation)
~~~~~~
PRfNCIPAI.
Travelers Casual and a ompany of America
i3y,
Diana Toledo, Attorney-in-Fact
{Corporate Seal of Surety Co.)
(;Officer's/Partner's/Individual's) signature
(Officer'slPartner's/Individual's) name printed
(Garporation/Partnership/Individual) name panted
>TATE of < <~~ ~~ ~
(:OUNTY of ~,l ~htC ~ l ss:
On this _.,.1 ~ _ day of , 2D..~-~
before me .personally carne to me
known and known to to be the person described in and who executed the
t~regoing instrument, d he/she duly acknowledged that he/she executed the
Same.
otary Public, County
r,~n KATHLEEN G. WALDRON
NO Term EXpI~TARY PUBLIC, State of New York.
9ualified in Ulster County
- END OF SECTION- corom~ss~or-~ Fx~i~e< Jane ~5, zoo
l.~lfa EiQND O04'fO-2
t: vluurm,ums~7 Wappingarta W20121W21205 Roberts Rd Pump Statlonl5podheatron5~00410.doc
` ~~ POWER OF ATTORNEY
"?'RAVELERS J Farmington Casualty Company
Fidelity and Guaranty Insurance Company
Fidelity and Guaranty Insurance Underwriters, Inc.
St. Paul Fire and Marine Insurance Company
St. Paul Guardian Insurance Company
Attorney-In Fact No. 224438
St. Paul Mercury Insurance Company
Travelers Casualty and Surety Company
Travelers Casualty and Surety Company of America
United States Fidelity and Guaranty Company
Certificate No. 0 0 5 4 2 5 3 2 5
KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Mazine Insurance Company, St. Paul Guardian Insurance
Company, St. Pau] Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States
Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut, that Fidelity and Guaranty Insurance Company is a
corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guazanty Insurance Underwriters, Inc., is a corporation duly organized under the
laws of the State of Wisconsin (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint
Jeffrey P. Deldin, Raegan Guglielmo, Diana Toledo, Christopher Greene, Scott Hainey, and Stephen M. Cronin
of the City of ,State of t.T v r~_ ,their true and lawful Attorney(s)-in-Fact,
each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and
other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of
contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law.
IN WITNESS WHEREOF, the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this 26th
day of March 2013
Farmington Casualty Company
Fidelity and Guaranty Insurance Company
Fidelity and Guaranty Insurance Underwriters, Inc.
St. Paul Fire and Marine Insurance Company
St. Paul Guardian Insurance Company
St. Paul Mercury Insurance Company
Travelers Casualty and Surety Company
Travelers Casualty and Surety Company of America
United States Fidelity and Guaranty Company
,~..
~~,~}y ptRE6 ~N..I R$ +,NSUA JP~fY ANpe Hb 5101RM .(.~~1t,~
G~SUA~r W^"~ ~y ~,..~ ~y ,yam e~\'• G; `JP,...........44 ,,~t `e 6,D ggQ ~ ~W_
Off` ~~r `' CTS- ~ `"`^.^MVItED 4 m ~I~GF F_,RATf Cf W:'tAaNORATi''~ ~' i W w al it~grfQt~rl, ~ 1
t~ ~ D ~ 1951 ~ m : i'^ Z E ; n ~ wurwRO, t CONtt.
Z 119825 0 ~ 1977 g ~ ~r ~;SEALIo"1 ~~S81iL:~3° + CAN. 8 ~ e N'A1!
' 'RYEC~" J br s c0 mod.. .. 'a•! 'S•.'••. `e" d ~e~
bey ~ ~H ~ ~ ~~~~N~e 1SAN~ 1r.... ... *? ei ~p AIN
State of Connecticut
City of Hartford ss.
By:
Robert L. Raney, enior Vice President
On this the 26th day of March 2013 ,before me personally appeazed Robert L. Raney, who acknowledged himself to
be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaanty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., SL Paul
Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers
Casualty and Surety Company of America, and United States Fidelity and Guaanty Company, and that he, as such, being authorized so to do, executed the foregoing
instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer.
In Witness Whereof, I hereunto set my hand and official seal. ~G•~ ~ W ~
My Commission expires the 30th day of June, 2016. * 'OtIBUQ~ Marie C. Tetreault, Notary Public
I
58440-8-12 Printed in U.S.A.
WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company, Fideli*
and Guaranty Insurance Company, Fidelity and Guazanty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guazdian Insura~
Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States
Fidelity and Guaranty Company, which resolutions aze now in full force and effect, reading as follows:
RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice
President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretazy may appoint Attorneys-in-Fact and Agents to act for and on behalf
of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the
Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any
of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is
FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may
delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy
thereof is filed in the office of the Secretary; and it is
FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking
shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice
President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the
Company's seal by a Secretazy or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys-in-Fact and Agents pursuant to the power
prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is
FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President,
any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any
certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds
and undertakings and other writings obligatory in the nature thereof, and any such Power of Attomey or certificate bearing such facsimile signature or facsimile seal
shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on
the Company in the future with respect to any bond or understanding to which it is attached.
I, Kevin E. Hughes, the undersigned, Assistant Secretary, of Farmington Casualty Company, Fidelity and Guazanty Insurance Company, Fidelity and Guazanty Insurance
Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guazdian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and
Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company do hereby certify that the above and foregoing
is a true and correct copy of the Power of Attorney executed by said Companies, which 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 this day of ~ ` ~ , 20
lip'
Kevin E. Hughes, Assistant Sect tart'
? (~~SU,I~~L grimy ,' V F\RE 6 ~' eo~~N"'NSO9 Jp+ INSUgq~ ~ ~JP~TY ANO JG ~IYF pW(n, ~Y'~1'0
~~,opi°'~~t'i ~ ~ RAID ~ m ~IZoFV_,"A>F~~+ W~coa?OnArfm~ °P 9~ ~ ~ '~'`? x~cop~p~
° 1 9 8 2 0 19n ~' I E ° a HARTFORD HiRIF6RA '! <
~~s = ~ 1951 ~ Jt• S E A.1. lp`~ ~ it ~ CONN. ° $ ilk 1896 ~
~b +a ks c°~ ~~d'••........ !• ~ SSliL,a' ~d pe° 1"'~~^~"r''°t~
~y . ~~ ~ ~A ;m ~~' fS . ANNA !r ........ ~~ 4r 'N~ . 'M'1 Alp
~...
To verify the authenticity of this Power of Attorney, call 1-800-421-3880 or contact us at www.travelersbond.com. Please refer to the Attorney-In-Fact number, the
above-named individuals and the details of the bond to which the power is att ch d.
THE RED BORDER
1
TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA
HARTFORD, CONNECTICUT 06183
FINANCIAL STATEMENT AS pF DECEMBER 31, 2012
CAPITAL STOCK $ 8.480,000
ASSETS
CASH ANp INVESTED CASH $ 15
936
791
BONDS
SNVESTMENT INCOME UUF AND ACCRUED ,
,
3, 713,171,015
OTHER INVESTED ASSETS 50 798,732
PREMIUM BALANCES 280,730,697
Ntl UtFtKRkU tAXASSF.7 184,942,508
63
274
378
REINSURANCE RECOVFSRABLE ,
,
12
410
524
SECURITIES LENDING REINVESTED COLLATERAL ASSETS ,
,
7
7
9
Rf CEIVABLES FRpM PARENT. SUBSIDIARIES AND AFFILIATES ,
6
,155
11
080
470
UNDISTRIBUTED PAYMENTS ,
,
(1,439
585}
OTHER ASS: TS .
884 093
TDTAL ASSETS ~ 4,339..558.778
UNEARNED PREMIUMS $ '63
409
89.
L05SES
REINSURANCE PAYABIF ON PAtp LOSSES 8 LOSS ADJ
EXPENSE ,
,
901,058, 710
.
S
LOSS ApJUSTMENT EXPENSES 1446 021
caMMrssIONS 534:373.660
-
TAXES. LtCENSES AND FEES 29.2e1, r
79
OTHER EXPENSES 66.762.894
FUNDS HELP UNDER REINSURANCE TREATIES 35,588.967
CURRENT FEDERAL. AND FOREIGN INCOME TAXES 94,449,544
REMITTANCES ANp ITEMS NOT A1
t
OCA7ED 60,675, S73
.
.
AMOUNTS WITHHELp ! RETAINED BY COMPANY F 0R pTHF RS 19.770,931
79
Ogq
806
RE?ROnCTiV'E REIN~URANCC: RE9GR'VG A38UMGC ,
,
POLICYHOLDER DIYIDENpS y, Iqy iqy
PROVISION FOR REINSURANCE 6 730 121
,
ADVANCE PREMIUM 5,314,325
PAYABLE FOR SECURiTIE$ I
ENDlNG 726 898
.
CEDED REINSURANCE NET PREMIUMS PAYABLE 7.769,155
~sr_H~ar LL4®iurv {70 1303 744y
OTHER ACCRUED EXPENSES AND LlA81t
1T1lS sss,aoo
.
TOTAL LIABILi71E5 262.08,2
S 2. 559 106 95T
CAPITAL STOCK
PAID iN SURPLUS $ 6 480 000
OTHER SURPLUS 433.803. r'60
TOTAL SURPLUS TO POLlCYHOL
DE:RS i ,340.166 061
.
_ 5 1,760 451.8:1
TOTAL l3ABQ,ITIES & SU'RPLU5 S 4 33___~__9.~58,778_
STATE OF CONNECTICUT
COUNTY OF HARTFORD ! S5.
CITY OF HARTFORD t
MICHAEL J. GOODY. BEING DUt.Y SWORN, SAYS THAT HE IS SECOND VICE PRESIDENT, OF TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA,
nrt0 Ti Ih7 TO T7 I:_. UC:07 (7f 1113 !<FiCyWL,C.DQC hIJD DCI,.tG(', TtIC FOREClpiNfl la A ?RUE hIVO CORRL'C? 3TATtGMGNT p~ THG ~tMhhEGihL G(7NDITKjtV QP 3AIR
COMPANY ,4S OF THE 315'f pAY OF pECF..MBER, 2012.
SUBSCRiBtp AND SWORN TO BEFORE ME ±HtS
20TH CAY OF MARCH, 2013
v' .`°°~,
_ ~ ~ ~~ ~ y,
SECOND VICE PRE51t7LNT •
~~
,, .,
,, 3; ,
NOTARY PUBLIC .---_..._.__...~.__...~.~..__.___
--~"--
,V`«rarv t't+6fic
Alt•Crrrnrsricr+nn P.rpire.r.ti'nvr^ntber 3J! 'l7J7
rowrR or ~\'1"I'U{tyGY' ~\C(vy0\~LGUGC~IEN"I'
sTf\TC or New York
couN•rY or Putnam
on this 1st day or May 2013
- ,before me
personally cane Diana Toledo , la me known, who being
dul}' sworn, did depose and say Thal he is an attorney-in-fact of
Travelers Casualty and Surety Company of America
ll,e corporation
descr,bed ,n and which executed tl,e above instrument, that he knows the seal of
said such corporatiun; that the seal affixed to said instrument is such of said
corporate seal; that it vas so affixed by authority of tl,e Board of Directors of said
corporation b}' authority of I, is office under the Standing Resolutions thereof.
Notary Public
Nly Commission Fsl,ires
Nc~* i-~. ~.tg~/G,k
~'~ . fi
(`,,,:, ` ~ e.~
c.. u. ~ ...~ .~..... i ~, ~J'i ~
SECTION 00410-BID BOND
BID BOND FORM
KNOW ALL PERSONS BY THESE PRESENTS: that
Principal; and
**
hereby held
as
as Surety, are
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
WHEREAS,
day of
20
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 Roberts Road Sewer Improvements in the Town of
Wappinger, New York, as shown and specified in the contract, plans and specifications.
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 the
Contract Agreement in the form attached hereto (properly completed in
accordance with said Bid) and furnish such performance bond and labor and
material payment bond as required,
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.
*Insert Bidder's Name
**Insert Surety's Name
BID BOND 00410-1
E:\documentslT Wappinger\a W2012\W21205 Roberts Rd Pump Station\Specifications\00410.doc
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 of Principal if a Corporation)
PRINCIPAL
By:
(Corporate Seal of Surety Co.)
(Officer's/Partner's/Individual's) signature
(Officer's/Partner's/Individual's) name printed
(Corporation/Partnership/Individual) name printed
STATE of
COUNTY of ) ss:
On this day of , 20
before me personally came to me
known and known to me to be the person described in and who executed the
foregoing instrument, and he/she duly acknowledged that he/she executed the
same.
Notary Public, County
No.
Term Expires,
- END OF SECTION-
BID BOND 00410-2
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SECTION 00480-CERTIFICATION OF NON-COLLUSION MAY C ~j 2Q93
CERTIFICATION OF NON-COLLUSION BY BIDDER
The undersigned represents that pursuant to Sections 103-a and 103-b of the General
Municipal Law of the State of New York, no person referred to in the attached proposal
who is the bidder or who is or was a member, partner, director or officer of the bidding
firm or entity under this proposal has refused to sign a waiver of immunity or to answer
any relevant questions relating to any transaction or contract with the State of New
York, any political subdivision thereof, or any public authority, during the period of five
years prior to the date hereof. The undersigned agrees that any contract awarded as a
result of this bid may be canceled without penalty upon the grounds set forth in Sections
103-a and 103-b of the said General Municipal Law of the State of New York. The
names and addresses of all persons and parties interested in the foregoing bid are as
follows:
~~~uc~s rh d~.~r J!L
~A t4}oc+~+ bc-
~Ji~y(,al~ i ivs cJ `I l ~ ~ ??
C~ ~-~
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 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 by law, the prices which have been quoted in this bid
have not been knowingly disclosed by the bidder and will not knowingly be
disclosed by the bidder prior to opening, directly or indirectly, to any other bidder
or to any competitor; and
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
CERTIFICATION OF NON-COLLUSION 00480-1
E:\documents\T Wappingerla W20121W21205 Roberts Rd Pump Station\Spec~cations\00480.doc
the bid a signed statement which sets forth in detail the reasons therefore. Where I, 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
subdivision, public department, agency or official thereopto wh chghe bid ~s made, olr~h sl
designee, determines that such disclosure was not made for the purpose of restricting
competition.
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 (cj 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 one.
Any bid hereafter made to any political subdivision of the State or an
department, agency or official thereof by a corporate bidder for work or servube's
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 subdivision one 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.
/al9sltcrS Iyi ~rt.a.,; ~ ~_~~ urs ~r~ ~r~
wV ~..~
- END OF SECTION -
CERTIFICATION OF NON-COLLUSION
E:\documentslT Wappingerla W20121W21205 Roberts Rd Pump Station\Specifications\00480.doc 00480-2