HomeMy WebLinkAbout072516_ra01Department of Public Works
O Regular Agenda
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Jefferson County
Board of Commissioners
Agenda Request
To: Board of Commissioners
Philip Morley, County Administrator
From: Monte Reinders, P.E., Public Works Director/County EngineerA X, -
r
Agenda Date: July 25, 2016
Subject: Execution of Contract
Undie Road Emergency Relocation Project 180-2007-0
Statement of Issue: Execution of a contract with Interwest Construction, Inc. for
construction of the Undie Road Emergency Relocation Project 180-2007-0.
Analysis/Strategic Goals/Pro's £t Con's: Bids were duly advertised and sealed bids were
opened on July 11, 2016. The Board awarded this contract to the lowest responsive bidder
Interwest Construction, Inc. on July 18th. Construction is scheduled to begin on August 15t
Fiscal Impact/Cost Benefit Analysis: $905,310. Current proposal is to finance through a
combination of the Road Fund, PILT, and internal borrowing.
Recommendation: Sign all three (3) original contracts where indicated and return to Public
Works for further processing.
Department Contact: Monte Reinders, P.E., Project Manager, 385-9160
Reviewed By:
Philip Morley, to6nty AdAiinistrator Date
CONTRACT
JEFFERSON COUNTY, WASHINGTON
THIS AGREEMENT, made and entered into flus day of '20 16 , between the COUNTY
OF JEFFERSON, acting through the Jefferson County Commissioners and the Director of Public Works under and by
virtue of Title 36, RCW, as amended and Interwest Construction, Inc of Burlington. WA
hereinafter called the Contractor
WITNESSETH
That in consideration of the terms and conditions contained herein and attached and made a part of this agreement, the
parties hereto covenant and agree as follows
1 The Contractor agrees to furnish all labor and equipment and do certain work, to -wit That the Contractor herein
will undertake and complete the following described work
This Contract provides for the emergency relocation of Undie Road in West Jefferson County near Forks, Washm on by
constructing approximately 0.86 miles of new gravel road to avoid a landslide Work includes clearing and grubbing,
roadway excavation, embankment compaction. culvert installation, gravel base and surfacing, temporary erosion control,
guardrail, and other work all in accordance with the Contract 'Plans. Contract Provisions, and the Standard Specifications.
for the total sum of Nine Hundred and Five Thousand Three Hundred and Ten dollars ($905.310 00) in accordance
with and as described in the attached plans and specifications and the Standard Specifications of the Washington Department
of Transportation which are by this reference incorporated herein and made a part hereof The Contractor shall perform any
alteration in or addition to the work provided in this contract and every part thereof
The Contractor shall complete the described work as follows Within 70 Working Dates after the Notice to Proceed
The Contractor shall provide and bear the expense of all equipment, work and labor of any sort whatsoever that
may be required for the transfer of materials and for constructing and completing the work provided for in this contract and
every part thereof
2 The County of Jefferson hereby prorruses and agrees with the Contractor to employ, and does employ the Contractor
to furnish the goods and equipment described and to furnish the same according to the attached specifications and the terms
and conditions herein contained, and hereby contracts to pay for the same according to the attached specifications and the
schedule of unit or itemized pries hereto attached, at the time and in the manner and upon the condition provided for in
this contract The County further agrees to employ the Contractor to perform any alterations in or additions to the work
provided for in this contract that may be ordered and to pay for the same under the terms of this contract and the attached
specifications at the time and in the manner and upon the conditions provided for in flus contract
3 The Contractor for himself, and for his hens, executor, administrators, successors, and assigns, does hereby agree
to the full performance of all the covenants herein contained upon the part of the Contractor
4 Prior to commencmg work, the Contractor shall obtain at its own cost and expense the following insurance from
companies licensed 1n the State with a Best's rating of no less than A VII. The Contractor shall provide to the County Risk
Manager certificates of insurance with original endorsements affecting insurance required by tlus clause prior to the
commencement of work to be performed
The insurance policies required shall provide that thirty (30) days prior to cancellation, suspension, reduction or
material change in the policy, notice of same shall be given to the County Risk Manager by registered marl, return receipt
requested, for all of the following stated insurance policies
Revised 1/2016 Page l of 8
If any of the insurance requirements are not complied with at the renewal date of the insurance policy, payments to
the Contractor shall be withheld until all such requirements have been met, or at the option of the County, the County may
pay the renewal premium and withhold such payments from the moneys due The Contractor
All notices shall name the Contractor and identify the agreement by contract number or some other form of
identification necessary to inform the County of the particular contract affected
A Workers Compensation and Employers Liability Insurance The Contractor shall procure and maintain for
the life of the contract, Workers Compensation Insurance, including Employers Liability Coverage, in accordance
with the laws of the State of Washington
B General Liability(1) - with a minimum liniit per occurrence of one million dollars ($1,000,000) and an
aggregate of not less than two million dollars ($2,000,000) for bodily mjury, death and property damage unless
otherwise specified in the contract specifications This insurance coverage shall contain no limitations on the scope
of the protection provided and indicate on the certificate of insurance the following coverage
1 Broad Form Property Damage with no employee exclusion,
2 Personal Injury Liability, including extended bodily injury,
3 Broad Form Contractual/Commercial Liability including completed operations (contractors only),
4 Premises - Operations Liability (M&C),
5 Independent Contractors and Subcontractors, and
6 Blanket Contractual Liability
(1)Note The County shall be named as an additional insured party under this policy
C Automobile (2) - with a mimmum limit per occurrence of $1,000,000 for bodily injury, death and property
damage unless otherwise specified in the contract specifications This insurance shall indicate on the certificate of
insurance the following coverage
1 Owned automobiles,
2 Hired automobiles, and,
3 Non -owned automobiles
(2) Note The County shall be named as an additional insured party under this policy
Any deductibles or self-insured retention shall be declared to and approved by the County prior to the approval of
the contract by the County At the option of the County, the insurer shall reduce or eliminate deductibles or self-insured
retention or The Contractor shall procure a bond guaranteeing payment of losses and related investigations, claim
administration and defense expenses
The Contractor shall include all subcontractors as insured under its insurance policies or shall fumish separate
certificates and endorsements for each subcontractor All insurance provisions for subcontractors shall be subject to all of
the requirements stated herein
Failure of The Contractor to take out and/or maintain any required insurance shall not relieve The Contractor from
any liability under the Agreement, nor shall the insurance requirements be construed to conflict with or otherwise limit the
obligations concerning indemnification
It is agreed by the parties that insurers shall have no right of recovery or subrogation against the County (including
its employees and other agents and agencies), it being the intention of the parties that the insurance policies so affected shall
protect both parties and be primary coverage for any and all losses covered by the above described insurance It is further
agreed by the parties that insurance companies issuing the policy or policies shall have no recourse against the County
(including its employees and other agents and agencies) for payment of any premiums or for assessments under any form
of policy It is further agreed by the parties that any and all deductibles in the above described insurance policies shall be
assumed by and be at the sole risk of The Contractor
Revised 12016 Page 2 of 8
It is agreed by the parties that judgments for which the County may be liable, in excess of insured amounts provided
herein, or any portion thereof, may be withheld from payment due, or to become due, to The Contractor until such time as
The Contractor shall famish additional security covering such judgment as may be determined by the County
The County reserves the right to request additional insurance on an individual basis for extra hazardous contracts
and specific service agreements
Any coverage for third party liability claims provided to the County by a "Risk Pool" created pursuant to Ch
48 62 RCW shall be non-contnbutory with respect to any policy of insurance the Contractor must provide in order to
comply with this Agreement
If the proof of insurance or certificate of coverage Indicating the County is an "additional insured" to a policy
obtained by the Contractor refers to an endorsement (by number or name) but does not provide the full text of that
endorsement, then it shall be the obligation of the Contractor to obtain the full text of that endorsement and forward that
full text to the County within 30 days of the execution of this Agreement
The County may, upon the Contractor's failure to comply with all provisions of this contract relating to insurance,
withhold payment or compensation that would otherwise be due to the Contractor
5 The Contractor shall comply with all Federal, State, and local laws and ordinances applicable to the work to be
done under this Agreement This Agreement shall be interpreted and construed in accord with the laws of the State of
Washington and venue shall be in Jefferson County, WA
The Contractor shall indemnify and hold the County, and its officers, employees, and agents harmless from and
shall process and defend at its own expense, including all costs, attorney fees and expenses relating thereto, all claims,
demands, or suits at law or equity arising in whole or in part, directly or indirectly, from the Contractor's negligence of
breach of any of its obligations under this Agreement, provided that nothing herein shall require a Contractor to indemnify
the County against and hold harmless the County from claims, demands or suits based solely upon the conduct of the
County, its officers, employees and agents, and, provided further that if the claims or suits are caused by or result from the
concurrent negligence of (a) the Contractor's agents or employees, and, (b) the County, its officers, employees and
agents, this indemnity provision with respect to claims or suits based upon such negligence, and/or the costs to the County
of defending such claims and suits, etc , shall be valid and enforceable only to the extent of the Contractor's negligence, or
the negligence of the Contractor's agents or employees
Claims against the County shall include, but not be limited to assertions that the use and transfer of any software,
book, document, report, film, tape, or sound reproduction of material of any kind, delivered hereunder, constitutes an
infringement of any copyright, patent, trademark, trade name, or otherwise results in an unfair trade practice or an
unlawful restraint of competition
The Contractor specifically assumes potential liability for actions brought against the County by Contractor's
employees, including all other persons engaged in the performance of any work or service required of the Contractor
under this Agreement and, solely for the purpose of this mdemnification and defense, the Contractor specifically waives
any immunity under the state industrial insurance law, Title 51 R C W The Contractor recognizes that this waiver was
specifically entered into pursuant to provisions of R C W 4 24 1 l 5 and was subject of mutual negotiation
6 The Contractor's relation to the County shall be at all times as an independent Contractor, and nothing herein
contained shall be construed to create a relationship of employer-employee or master -servant, and any and all employees of
the Contractor or other persons engaged in the performance of any work or service required of the Contractor under this
Agreement shall be considered employees of the Contractor only and any claims that may anse on behalf of or against said
employees shall be the sole obligation and responsibility of the Contractor
7 The Contractor shall not sublet or assign any of the services covered by this contract without the express written
consent of the County or its authorized representative Assignment does not include printing or other customary
reimbursable expenses that may be provided in an agreement
Revised 1/2016 Page 3 of 8
8 Nothing in the foregoing clause shall prevent the County, at its option, from additionally requesting that the
Contractor deliver to the County an executed bond as security for the faithful performance of this contract and for
payment of all obligations of The Contractor
The Contractor will declare management option of the statutory retained percentage on Exhibit A
Revised 1/2016 Page 4 of 8
IN WITNESS WHEREOF, the Contractor has executed this instrument on the day and year first below written, and the
Board of County Commissioners has caused this instrument to be executed by and in the name of said County of Jefferson
the day and year first above written.
Executed by the Contractor July 19 20 16
Contractor: Interwest Construction, Inc.
(Please print)
M.
Eben Twaddle, President
(PI
(Signature)
(Signature)
INTERCI 121 OF
State of Washington, Contractor Registration Number
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COUNTY OF JEFFERSON
BOARD OF COMMISSIONERS
Kathleen Kler, Chair
Phil Johnson, Member
David W. Sullivan, Member
Approved as to form only:
Date
Deputy Prosecutin Attorney
ate Reinders, P.E. Date 4
Public Works Director/County Engineer
Revised 1/2016 Page 5 of 8
CERTIFICATION REGARDING
DEBARMENT, SUSPENSION, INELIGIBILITY, AND VOLUNTARY EXCLUSION
The Contractor certifies to the best of its knowledge and belief, that it and its principals
(1) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
covered transactions by any Federal department or agency,
(2) Have not within a 3 -year period preceding this proposal been convicted of or had a civil judgment rendered against
them for commission of fraud or a cnrrunal offense in connection with obtaining, attempting to obtain, or performing
a public (Federal, State, or local) transaction or contract under a public transaction, violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records,
making false statements, or receiving stolen property,
(3) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State,
or local) with comrmssion of any of the offenses enumerated in paragraph (2) of this certification, and
(4) Have not within a 3 -year period preceding this contract had one or more public transactions (Federal, State, or local)
terminated for cause or default
Where the Contractor is unable to certify to any of the statements in this certification, such Contractor shall attach an
explanation
Interwest Construction, Inc
Name of Contractor (Please print)
Eben Twaddle, President
Name and Title of Authorized Representative (Please print)
Signature of Authorize Representative
F1 I am unable to certify to the above statement An explanation is attached.
Revised 1/2016 Page 6 of 8
Bond No. 106534568
CONTRACT BOND
JEFFERSON COUNTY, WASHINGTON
KNOW ALL MEN BY THESE PRESENTS:
That Interwest Construction, Inc. , of Burlington, WA , as
Principal, and Travelers Casualty and Surety Company of America , as Surety, are jointly and severally held and bound
unto the COUNTY OF JEFFERSON, the penal sum of Nine Hundred and Five Thousand Three Hundred and Ten
Dollars ($905,310.00 ), for the payment of which we jointly and severally bind ourselves, or heirs, executors,
administrators, and assigns, and successors and assigns, firmly by these presents.
The condition of this bond is such that WHEREAS, on the 2 otlday of Ju l yk.D., 20 16___, the said Interwest
Construction, Inc. , Principal herein, executed a certain contract with the County of Jefferson, by the terms, conditions
and provisions of which contract the said Interwest Construction, Inc. , Principal herewith, agrees to fiumish all materials
and do certain work, to -wit:
That the said Principal herein will undertake and complete the following described work:
Emergency relocation of Undie Road in West Jefferson County near Forks, Washington by constructing approximately
0 86 miles of new gravel road to avoid a landslide. Work includes clearing and grubbing, roadway excavation,
embankment compaction culvert installation gravel base and surfacing temporary erosion control, guardrail, and other
work, in Jefferson County, Washington, as per maps, plans and specifications made a part of said contract, which contract as
so executed, is hereunto attached, and is now referred to and by this reference is incorporated herein and made a part hereof as
full for all purposes as if here set forth at length.
NOW THEREFORE, if the Principal herein shall faithfully and truly observe and comply with the terms, conditions
and provisions of said contract, in all respects and shall well and truly and fully do and perform all matters and things by the
said Principal undertaken to be performed under said contract, upon the terms proposed therein, and within the time prescribed
therein, and until the same is accepted, and shall pay all laborers, mechanics, subcontractors and materialmen, and all persons
who shall supply such contractor or subcontractor with provisions and supplies for the carrying on of such work, and shall in
all respects faithfully perform said contract according to law, then this obligation to be void, otherwise to remain in full force
and effect.
WITNESS our hands this may of ,1,, 1 y , 20 16 .
Interwest Construction, Inc. Travelers Casualty and Surety Company of America
PRINCIPAL
Lo
Eben Twaddle, President
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7981
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By: Theresa A. Lamb
Attorney-in-fact
Address of local office and agent
of surety company:
HUB International NW. LLC
Revised 1/2016 Page 7 of 8
P. O. Box 3018
Bothell, WA 98041-3018
This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casuaty Compay, 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, and United States
Fidelity and Guaranty Company, which resolutions are 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 Secretary 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 Secretary 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 Attorney 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 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, 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 2 0 th day of Ju 1 V 201-6.
oj�� ts�- - -
Kevin E. Hughes, Assistant Sec tary
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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 attached.
WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER
TRAVELERSJ�
POWER OF ATTORNEY
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. 230854
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 6 8 0 2 5 0 7
KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, 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, 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 Guaranty 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
Julie M. Glover, S.M. Scott, Michael A. Murphy, Jim W. Doyle, Andy D. Prill, Jim S. Kuich, Chad M. Epple, Steve Wagner, Theresa A. Lamb, Carl
M. Lovested III, Patti White, and Teresa Glombecki
of the City of Bothell , State of Washington , their true and lawful Attomey(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 pe®atted in aqy-}inions o Proceedings allowed by law.
18th
IN WITNESS WHEREOF, the Companies have caused this instrMeot tdPbe dtbeircot�porate seals to be hereto affixed, this
day of May 2016
Farmington Casualty Company -.a10 T St. Paul Mercury Insurance Company
Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company
Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company of America
St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company
St. Paul Guardian Insurance Company
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State of Connecticut
City of Hartford ss.
By:
Robert L. Raney, Senior Vice President
On this the 18th day of May 2016 before me personally appeared Robert L. Raney, who acknowledged himself to
be the Senior Vice President of 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, and United States Fidelity and Guaranty 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.
g
In Witness Whereof, I hereunto set my hand and official seal.
My Commission expires the 30th day of June, 2021.*+t
58440-5-16 Printed in U.S.A.
Marie C. Tetreault, Notary Public
EXHIBIT A
CONTRACTOR'S DECLARATION OF OPTION FOR MANAGEMENT OF
STATUTORY RETAINED PERCENTAGE
A I hereby elect to have the retained percentage of this contract held in a fund by the Owner until (30) days following
final acceptance of the work
Date
Signed
B I hereby elect to have the Owner deposit the retained percentage of this contract in an interest bearing account, not
subject to withdrawal until after final acceptance of the work
Date
Signed
C. I hereby elect to have the Owner invest the retained percentage of this contract from time to time as such retained
percentage accrues
I hereby designate
as the repository for the escrow of said funds
I hereby further agree to be fully responsible for payment of all costs or fees incurred as a result of placing said retained
percentage in escrow and investing it as authorized by statute The Owner shall not be liable in any way for any costs or
fees in connection therewith
Date
D Retainage Bond in lieu of retained funds
Date July 19, 2016
Signed
Signed
Revised 1/2016 Page 8 of 8
Local Agency Certification for Federal -Aid Contracts
The prospective participant certifies by signing and submitting
this bid or proposal, to the best of his or her knowledge and
belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on
behalf of the undersigned, to any person for influencing or attempting to
influence an officer or employee of any Federal agency, a Member of Congress,
an officer or employee of Congress, or an employee of a Member of Congress
in connection with the awarding of any Federal contract, the making of any
Federal grant, the making of any Federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment,
or modification of any Federal contract, grant, loan or cooperative agreement
(2) If any funds other than Federal appropriated funds have been paid or will be
paid to any person for influencing or attempting to influence an officer or
employee of any Federal agency, a Member of Congress, an officer or
employee of Congress, or an employee of a Member of Congress in connection
with this Federal contract, grant, loan, or cooperative agreement, the
undersigned shall complete and submit Standard Form -LLL, "Disclosure Form
to Report Lobbying," in accordance with its instructions
This certification is material representation of the fact upon which reliance was
placed when this transaction was made or entered into Submission of this
certification is a prerequisite for making or entering into this transaction imposed
by Section 1352, Title 31, U S Code Any person who fails to file the required
certification shall be subject to a civil penalty of not less than $10,000 and not
more than $100,000 for each failure
The prospective participant also agrees by submitting his or her bid or proposal
that he or she shall require that the language of this certification be included in
all lower tier subcontracts. which exceed $100,000 and that all such
subrecipients shall certify and disclose accordingly
SR
OOT Form 272-040A EF
07/2011
NON -COLLUSION DECLARATION
I, by signing the proposal, hereby declare, under penalty of
perjury under the laws of the United States that the following
statements are true and correct:
1. That the undersigned person(s), firm, association or corporation has
(have) not, either directly or indirectly, entered into any agreement,
participated in any collusion, or otherwise taken any action in restraint of
free competitive bidding in connection with the project for which this
proposal is submitted.
2. That by signing the signature page of this proposal, I am
deemed to have signed and to have agreed to the provisions
of this declaration.
INOXIIHA.s. __ _ .►.
To report rigging activities call.
1-800-424-9071
The U S Department of Transportation (USDOT) operates the above toll-free
"hotline" Monday through Friday, 8 00 a m to 5 00 p m , eastern time. Anyone
with knowledge of possible bid rigging, bidder collusion, or other fraudulent
activities should use the "hotline" to report such activities.
The "hotline" is part of USDOTs continuing effort to identify and investigate
highway construction contract fraud and abuse and is operated under the
direction of the USDOT Inspector General All information will be treated
confidentially and caller anonymity will be respected
SR
DOT Form 272-0381 EF
07/2011