Prescribed by State Board of
Accounts Form No. 96 (Revised 2000)
CONTRACTORS BID FOR PUBLIC WORK
PART I
(To be completed for all
bids)
(Please type or print)
____________________________________
Date:__________________________
1. Governmental Unit (Owner):_Vanderburgh County Drainage Board _____________
2. County :_______Vanderburgh County, Indiana______________________________
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 complete
the public works project of the Vanderburgh County Drainage Board (Governmental Unit) in accordance with plans and specifications prepared by the Vanderburgh County Surveyor and dated February 22, 2005 for the
sum of ___________________________________________________
$________________________________
Name of Regulated Drain: ____________________________________ _________________ lineal feet X $ _________________
per lineal foot = $ _______________________ (number
of feet) (price
per foot) (total
bid price)
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the notice. 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 as that shown in the original contract if accepted by the Governmental Unit. If the bid is to be awarded on a unit basis, 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 matter directly 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 statutory obligation to use steel products made in the United States. I.C. 5-16-8-2. I hereby certify that I and all subcontractors employed by me for this project will use U.S. steel products on this project if awarded. I understand that violations hereunder may result in forfeiture of contractual payments.
ACCEPTANCE
The above bid is accepted this _____________ day of _________________, ________, subject to the
following conditions: _______________________________________________________________________
________________________________________________________________________________________
Contracting Authority Members:
___________________________________ ___________________________________
___________________________________ ___________________________________
___________________________________ ___________________________________
PART II
(Complete sections I, II, III, and IV for all state and local public works projects as required
by statutes if project is one hundred thousand dollars ($100,000) or more. (IC 36-1-12-4)
Governmental Unit: ___Vanderburgh County Drainage Board_________________
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
QUESTIONNAIRE
1. What public works projects has your organization completed for the period of one (1) year prior to the date of the current bid?
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When Completed |
Name and Address of Owner |
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2. What public works projects are now in process of construction by your organization?
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Contract Amount |
Class of Work |
When to be Completed |
Name and Address of Owner |
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3. Have you ever failed to complete any work awarded to you? _______________ If so, where and why?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
4. List referenced from private firms for which you have performed work.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
SECTION II PLAN AND
EQUIPMENT QUESTIONNAIRE
1. Explain your plan or layout for performing proposed work. (Examples could include a narrative of when you could begin work, completed the project, number of workers, etc. and any other information which you believe would enable the governmental unit to consider your bid.)
2. 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 expect to require a bond. However, if you are unable to currently provide a listing, please understand a listing must be provided prior to contract approval.
3. What equipment do you have available to use for the proposed project? Any equipment to be used by subcontractors may also be required to be listed by the governmental unit.
4. Have you entered into contracts or received offers for all materials which substantiate the prices used in preparing your proposal? Otherwise, please explain the rationale used which would corroborate the prices listed.
SECTION III CONTRACTOR’S
FINANCIAL STATEMENT
Attachment of bidder’s financial statement is mandatory. Any bid submitted without said financial statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to the governing body awarding the contract must be specific enough in detail so that said governing body can make a proper determination of the bidder’s capability for completing the project if awarded.
SECTION IV OATH AND
AFFIRMATION
I hereby affirm under the penalties of perjury that the facts and information contained in the foregoing bid for public works are true and correct to the best of my knowledge and belief.
Dated at ____________________ this ______________ day of __________________, _______
__________________________________________________________
(Name of Organization)
By________________________________________________________
__________________________________________________________
(Title of Person Signing)
ACKNOWLEDGEMENT
STATE OF ______________________)
)
COUNTY OF_____________________)
_________________________________ being duly sworn, deposes and says that he is ____________
________________________________ of the above ______________________________________________
(Title) (Name
of Organization)
and that the answers to the questions in the foregoing questionnaires and all statements therein contained are
true and correct.
Subscribed and sworn to before me this ____________ day of ___________________, ________.
____________________________________________
Notary Public
My Commission Expires:_____________________
County of Residence:________________________
NON – COLLUSION AFFIDAVIT
The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to include anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding.
He further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee, gift, commission or thing of value on account of such sale.
OATH AND AFFIRMATION
I affirm under the penalties of perjury that the foregoing facts and information are true and correct to the best of my knowledge and belief.
Dated at ____________________ this ______________ day of __________________, _______.
__________________________________________________________
(Name of Organization)
By________________________________________________________
__________________________________________________________
(Title of Person Signing)
ACKNOWLEDGEMENT
STATE OF ______________________)
) SS:
COUNTY OF_____________________)
_________________________________ being duly sworn, deposes and says that he is ____________
________________________________ of the above ______________________________________________
(Title) (Name
of Organization)
and that the statements contained in the foregoing bid, certification and affidavit are true and correct.
Subscribed and sworn to before me this ____________ day of ___________________, ________.
____________________________________________
Notary Public
My Commission Expires:_____________________
County of Residence:________________________