TOWN OF WESTBROOK, CONNECTICUT866 BOSTON POST ROADWESTBROOK, CT 06498

NOTICE OF BIDREPLACEMENT OF HANDICAP ACCESSIBLE RAMPWESTBROOK FIRE DEPARTMENT HEADQUARTERS

Project Number: 21122Document Length: 18 pages

Issue Date: March 1, 2019Due Date: March 18, 2019, 12:00 p.m.

At 866 Boston Post Road, Westbrook CT 06498First Selectman’s Office

Opening of Bids: March 18, 2019 at 12:00 p.m.

TABLE OF CONTENTS

1 Introduction 3A Overview3 B Issuing Office – Contact Information 3 C Receipt of Proposals3D Changes and Interpretations3

2 Scope of Work 4A Scope of Services4B Pre-Bid Conference 4C Permits and Waiver of Local Fees 4

3 Information For Respondents 5A Submission Requirements 5B Site Examination and Execution 5C Proposal Period 5D Contract Term 5E Litigation 5

4 Selection Criteria 6A Bid Opening Procedures 6B Method of Award 6

5 Execution of the Agreement 6A Execution of the Agreement 6B Insurance Certificates 6C Supervision of Work and Safety 7D Access to the Site 7E “Or Equal” Clause 7F Project Guarantee 8G Information not Guaranteed 8H Laws and Regulations 8I Indemnification and Hold Harmless 8J Severability 9K Power of Attorney 9L Preparation of Contract Documents and Plans 9

6 Insurance Requirements 9

7 Additional Information 10 A Disclaimer 10B Additional Information 10

1. INTRODUCTIONA. OVERVIEW

The Town of Westbrook is requesting competitive sealed bids for the installation of a replacement handicap 2 #21122 2/28/2019

accessible ramp at the Fire Department Headquarters located at 18 South Main Street, Westbrook, CT 06498.

B. ISSUING OFFICEThis bid is issued by the Town of Westbrook, Connecticut. The First Selectman’s Office is the sole point of contact for this bid. Respondents are requested not to contact individual town officials regarding the process. All correspondence, questions, clarifications, or requests for additional information regarding this bid must be directed to:

Noel BishopTown of WestbrookWestbrook, CT 06498nbishop@westbrookct.us(860) 399-3040

C. RECEIPT OF PROPOSALSVendors are required to submit two (2) copies of sealed bids using the Form of General Bid contained in this document on or before 12:00pm on March 18, 2019 at:

Town of WestbrookAttn: Noel Bishop866 Boston Post RoadWestbrook, CT 06498

“Fire Headquarters Replacement Ramp” should be clearly marked on all packages.

The Instructions to Bidders, Form of General Bid, Agreement, Specifications, and other Contract Documents may be examined at the First Selectman’s Office, Town Hall, 866 Boston Post Road, Westbrook, CT 06498.

D. CHANGES AND INTERPRETATIONSAll questions by prospective bidders as to the interpretations of the Advertisement for Bids, Form of General Bid, Agreement, Drawings, Specifications or Bonds must be submitted in writing to the issuing office not less than seven (7) days prior to the final date of submittal of the bids. The person making the request shall be held responsible for its prompt delivery. An interpretation of all questions so raised which, in the Town’s opinion requires interpretation, will be e-mailed to prospective bidders at the addresses given by them not later than five (5) days before the date of opening of bids. No other form of communication in this regard will be considered legal and binding. Failure of any bidder to receive any such addendum or interpretation shall not relieve such bidder from any obligation under this bid as submitted. All addenda so issued shall be covered in the bid and shall become part of the contract documents.

2. SCOPE OF WORKA. SCOPE OF SERVICESThe contractor will provide a scope of work to be done under this contract to include the following:

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Contractor to furnish all labor and materials to construct an accessible ramp as per as Plans A1 by Wyeth Architects LLC dated 2/8/2019 and as per the 2018 CT State Building code to include the ICC A117.1-2009 with CT amendments.

1. Concrete: 3,500 PSI

2. Brick: Watsontown Philadelphia Brick, SW, FSB – to match existing.

3. New exposed brick joints to be tooled to match existing.

4. Railings: Provide steel handrails (prepped for paint) and anchors that meet all aspects of the current code.*

5. Railings: 42” tall, typical. 36” tall single pipe handrails where noted as “Handrails Only.”*

6. Removeable rail sections: Gravity set on pins with padlock loops, typ.*

7. Coordinate selected railing post anchors per manufacturer’s recommendations. Seal connections.

8. Ramp: Pitch away from building 1/8” per foot.

9. Ramp: Slope no greater than 1:12

10. Sidewalk: Slope no greater that 1:20

11. Ramp and sidewalk: Broom finish with tooled edgesgrating: Fibergrate composite structure’s ecograte 62 molding grating or approved equal. Load bar pattern runs parallel to building.

12. Coordinate door work by Town for threshold selection and seal.

13. Comply with ACI cold weather concrete placement if the outdoor temperature requires.

*Railings to bid as an alternate.

Demolition is not required. It will be performed by the Town. All landings, ramps, foundations, footing, railings will be removed prior to work.

The air conditioning unit will be moved by Wilcox Energy and all electrical work will be done by others, including the removal of existing lighting for reuse.

B. PRE-BID CONFERENCEThere is a pre-bid conference on March 11, 2019 at 10:00 am at the Westbrook Fire Department, 18 South Main Street, Westbrook, CT at the rear of the building. This conference is not mandatory.

C. PERMITS AND WAIVER OF LOCAL FEESThe Contractor must meet all applicable building codes and requirements as determined by the Building Official and is responsible for securing the necessary permits and coordinating all inspections with the Building Department. The Town shall waive permit and other local fees that are under its jurisdiction to so waive. Bids should reflect the waiver of such fees in the total price.

3. INFORMATION FOR RESPONDENTS

A. SUBMISSION REQUIREMENTSEach completed bid must include the following:

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1. Form of General Bid – this must be removed and submitted separately. All blank spaces for bid process must be filled in with the lump sum for which the bid is being submitted. The bid price for each item shall be stated in words and figures.

2. Contractor’s Qualification Statement

3. Affidavit

4. Certificate as to Corporate Bidder

5. Certificate of Non-Collusion

If delivered via mail or in person, vendor shall include items 1-5 in a sealed envelope. All proposals should be clearly labeled on the outside of the envelope: Fire Headquarters Replacement Ramp.

Failure to submit a bid that includes all of the information listed above may result in bidder’s disqualification by the Town. A bid which includes for any item a price that is abnormally low or high may be rejected as unbalanced.

B. SITE EXAMINATION AND EXECUTIONBy submitting a bid, the bidder warrants that they have had the opportunity to have examined the site of the work and specifications and is fully acquainted with all conditions and restrictions pertaining to the work and the execution thereof. No claim for extra work or extension of time will be allowed for failure to observe this requirement. Conditional bids will not be accepted.

C. PROPOSAL PERIODBidders may not withdraw or modify their bids, and proposal prices are to be firm for ninety (90) business days.

D. CONTRACT TERM All work related to the contract shall be completed within 30 calendar days of the execution of the contract.

E. LITIGATIONVendors must list and summarize all pending or threatened litigation, administrative or regulatory proceedings or similar matters. The Successful Bidder shall have a continuing obligation to disclose any such actions during the period of this bid process and any contract resulting from this bid.

G. ABILITY AND EXPERIENCEThe Town will not award a contract to any bidder who cannot furnish satisfactory evidence of their ability and experience in this type of work and that have sufficient plant and capital to enable them to execute and complete the work within the given time period. The Town may make such investigations as it deems necessary to determine the above and a bidder shall furnish any information requested in this regard and shall furnish under oath if required.

4. SELECTION CRITERIA

A. BID OPENING PROCEDURES

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1. Bid signatures and acknowledgement of the addenda will be checked

2. The total dollar amount of each bid will be read

3. The bid form attachments will be verified to be included with the bid signatures confirmed. The reviews of the bid form attachments will be completed following the opening.

Bids will be compared on the basis of the quantities and the lump sum prices stated on the form of general bid. In the event of a discrepancy between written and numerical figures, the written words be favored. Discrepancies between the indicated total of unit prices multiplied by the estimated quantities and the correct total will be resolved in favor of the correct total. Discrepancies between the indicated sum of any column of figures and the correct sum thereof will be resolved in favor of the correct sum.

B. METHOD OF AWARDThe contract will be awarded on the basis of the lowest responsible and responsive bid for the replacement of the handicap accessible ramp at Fire Headquarters as submitted by a qualified bidder if such bid does not exceed the amount of funds available to finance the contact. A Notice of Award shall be delivered to the successful bidder

The Town anticipates awarding a contract for this project within ten (10) days of the date of bid opening; however, this date is subject to change. Bidders shall be prepared to submit within four (4) working days all documents and information required for full execution of the Agreement. If the successful bidder fails to do so, the Town reserves the right to rescind the Contract Award.

5. EXECUTION OF THE AGREEMENT

A. EXECUTION OF THE AGREEMENTOnce the contract is awarded the successful bidder will receive an agreement for signature. Within ten (10) days of receipt of the agreement signed by the successful bidder, the Town shall sign the agreement and return a duplicate of the executed agreement.

The Notice to proceed shall be issued within ten (10) days of the execution of the agreement. This time period may be extended by mutual agreement between the Town and the successful bidder.

The successful bidder shall not award work to subcontractors without prior written approval of the Town. The successful bidder shall be fully responsible to the Town for the acts and omissions of his subcontractors, and of persons either directly or indirectly employed by them, as he is for the acts and omissions of persons directly employed by him. The successful bidder shall cause appropriate provisions to be inserted in all subcontracts relative to the work to bind subcontractors to the successful bidder by the terms of the contract documents insofar as applicable to the work of subcontractors and to give the successful bidder the same power as regards terminating any subcontract that the Town may exercise over the successful bidder under any provision of the contract documents. Nothing contained in this Contract shall create any contractual relation between any subcontractor and the Town.

B. INSURANCE CERTIFICATESThe successful bidder will not be permitted to start any construction work until they have submitted certificates of insurance acceptable to the Town. Certificates shall be submitted at the time of execution of the contract.

C. SUPERVISION OF WORK AND SAFETY

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The successful bidder (hereinafter known as the contractor) will supervise and direct the work. They will be solely responsible for the means, methods, techniques, sequences and procedures of construction and for completing the work in full compliance with the contract documents. The Contractor will employ and maintain on site a qualified supervisor or superintendent who shall have been designated in writing by the Contractor as his representative at the site. The supervisor shall have full authority to act on behalf of the Contractor and all communications given to the supervisor shall be as binding as if given to the Contractor. The supervisor shall be present on the site at all times during the progress of the work to perform adequate supervision and coordination of the work. When the Contractor’s supervisor or superintendent is temporarily absent from the site of the work, the Contractor or his supervisor or superintendent shall designate a responsible supervisory employee, fluent in the English language, to receive instructions and requests from the Town.

The Contractor shall have on the site at all times, while work is in progress, at least one person skilled in safety procedures and familiar with state and Federal safety and health regulations whose responsibility shall be to observe methods and procedures. He shall have the duty and authority to stop and/or correct all unsafe conditions.

The Contractor will be solely responsible for initiating, maintaining and supervising all safety precautions and programs in connection with the work. He will take all necessary precautions for the safety of, and will provide the necessary protection to prevent damage, injury or loss to all employees on the work and other persons who may be affected thereby, all the work and all materials or equipment to be incorporated therein, whether in storage on or off the site, and other property at the site or adjacent thereto, including trees, shrubs, lawns, walks, pavements, roadways, structures and utilities not designated for removal, relocation or replacement in the course of construction.

The Contractor will comply with all applicable laws, ordinances, rules, regulations and orders of any public body having jurisdiction. He will erect and maintain, as required by the conditions and progress of the work, all necessary safeguards for safety and protection. He will notify owners of adjacent utilities when prosecution of the work may affect them. The Contractor will remedy all damage, injury or loss to any property caused, directly or indirectly, in whole or in part, by the Contractor, any subcontractor or anyone directly or indirectly employed by any of them or anyone for whose acts any of them be liable, except damage or loss attributable to the fault of the contract documents or to the acts or omissions of the Town or anyone employed by either of them or anyone for whose acts either of them may be liable, and not attributable, directly or indirectly, in whole or in part, to the fault or negligence of the Contractor.

In emergencies affecting the safety of persons or the work or property at the site or adjacent thereto, the Contractor, without special instruction or authorization from the Town, shall act to prevent threatened damage, injury or loss. He will give the Town prompt written notice of any significant changes in the work or deviations from the contract documents caused thereby, and a change order shall thereupon be issued covering the changes and deviations involved.

D. ACCESS TO THE SITERepresentatives of the Town shall have access to the work wherever it is in preparation or progress and the contractor shall provide proper facilities for such access and inspection.

E. “OR EQUAL” CLAUSEWhenever the specifications define the material or article required by using the name of the proprietary product or of a manufacturer or vendor rather than by using descriptive detail of substance and function, the words "or equal" are to be understood to follow immediately the name of the maker, vendor, or proprietary product. The words, "or equal" shall be interpreted as including any material or article which, in the opinion of the Town, is equal in quality durability, appearance, strength, and design to the article named and which will perform adequately the functions imposed by the general design. Whenever in the specifications the names of manufacturers are mentioned as indicating that their products will comply with a particular specification, or when specific trade names or plate numbers or letters are mentioned,

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it is not intended to exclude products of other manufacturers whose names, trade names or symbols have not been mentioned, provided however, that such products otherwise comply, in the opinion of the Project Engineer, with the specification. The Project Engineer’s opinion in all cases mentioned in this section shall be final.

F. PROJECT GUARANTEEThe Contractor guarantees that the work and services to be performed under the Contract and all work, material, and equipment performed, furnished, used or installed in the construction of the same, shall be free from defects and flaws and shall be performed and furnished in strict accordance with the Drawings, Specifications, and other Contract Documents; that the strength of all parts of all manufactured equipment shall be adequate and as specified and that the performance test requirements of the Contract shall be fulfilled. This guarantee shall be for a period of one (1) year from and after the date of completion and acceptance of the work as stated in the final estimate. If part of the work is accepted by the Town, the guarantee for that part of the work shall be for a period of one (1) year from the date fixed for such acceptance.

If at any time within said period of guarantee any part of the work requires repairing, correction or replacement, the Town may notify the Contractor in writing to make the required repairs, correction or replacements. If the Contractor neglects to commence making such repairs, corrections or replacements to the satisfaction of the Town within three (3) days from the date of receipt of such notice, or having commenced fails to prosecute such work with diligence, the Town may employ other persons to make the same, and all direct and indirect costs of making said repairs, corrections or replacements, including compensation for additional professional services, shall be paid by the Contractor.

It is hereby, however, agreed and understood that this guarantee shall not include any repairs or replacements made necessary by any cause or causes other than improper, inadequate, or defective work, quality of the work, materials or design by the Contractor or those employed directly or indirectly by the Contractor.

G. INFORMATION NOT GUARANTEEDAll information given in the other Contract Documents relating to subsurface and other conditions, natural phenomena, existing pipes, and other structures is from the best sources available to the Town. All such information is furnished only for the information and convenience of bidders and is not guaranteed.

It is agreed and understood that the Town does not warrant or guarantee that the subsurface or other conditions, natural phenomena, existing pipes, or other structures encountered during construction will be the same as those indicated in the other Contract Documents.

It is agreed further and understood that no bidder or contractor shall use or be entitled to use any of the information made available to them or obtained in any examination made by them in any manner as a basis of or ground for any claim or demand against the Town, arising from or by reason of any variance which may exist between the information made available and the actual subsurface or other conditions, natural phenomena, existing pipes or other structures actually encountered during the construction work, except as may be otherwise be expressly provided for in the Contract Documents.

H. LAWS AND REGULATIONSThe bidder's attention is directed to the fact that all applicable Federal and State Laws, municipal ordinances, and the execution of the project shall apply to the contract throughout, as though herein written out in full.

I. INDEMNIFICATION AND HOLD HARMLESSThe Contractor will indemnify and hold harmless the Town and their officers, agents, representatives and employees from and against all claims, damages, losses and expenses including attorney's fees arising out of or resulting from the performance of the work, provided that any such claims, damage, loss or expense is attributable to bodily injury, sickness, disease or death, or to injury to or destruction of tangible property including the loss of use resulting therefrom, and is caused in whole or in part by an negligent or willful act or

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omission of the Contractor and any subcontractor, anyone directly or indirectly employed by any of them or anyone for whose acts any of them be liable.

In any and all claims against the Town, or any of their officers, agents, representatives, or employees, by any employee of the Contractor, any subcontractor, anyone directly or indirectly employed by any of them, or anyone for whose acts any of them may be liable, the indemnification obligation shall not be limited to in any way by any limitation on the amount or type of damages, compensation or benefits payable by or for the Contractor or any subcontractor under worker’s compensation acts, disability benefit acts, or other employee benefit acts.

J. SEVERABILITYIf any provisions of this Agreement or portion of such provision of the application thereof to any persons, entity, or circumstances is held invalid, the remainder of the Agreement (or remainder of such provision) and the application of such to other persons, entities, or circumstances shall not be affected thereby so long as such remaining or modified provisions reflect the intent of the parties.

K. POWER OF ATTORNEYAttorneys-in-fact who sign contract bonds must file with each bond a certified and effectively dated copy of their power of attorney.

L. PREPARATION OF CONTRACT DOCUMENTS AND PLANSBidders are herein directed to note that the Contract documents and specifications for this project have been prepared for the Town by various parties. They have been consolidated into a single bid package for the convenience of the Town and prospective Bidders.

The specifications for the work relating to this work have been prepared by the Replacement Ramp Committee.

6. INSURANCE REQUIREMENTSBased upon the outcome of this process, the final chosen contractor shall procure and maintain insurance against claims for injuries or losses to persons or property that are alleged to have arisen in connection with activities of the contractor and any agents, representatives, subcontractors or employees. Insurance companies must be licensed by the State of Connecticut or otherwise acceptable to The Town of Westbrook. The cost of such insurance, including required endorsements or amendments, shall be the sole responsibility of the consultant. Full disclosure of any nonstandard exclusion is required for all required coverage.

Selected respondent(s) shall carry Commercial General Liability Insurance (Bodily Injury, Property Damage, Products and Completed Operations) in an amount of not less than one million dollars ($1,000,000) per occurrence with a two million dollar ($2,000,000) aggregate, combined single limits.  Such coverage shall also include coverage for operations, completed operations, products and contractual liability insurance.  Such policy shall name the Town of Westbrook as additional insured and shall be primary and noncontributory to any valid and collectible insurance carried by the Town. 

Selected respondent (s) shall provide commercial auto liability insurance covering owned, hired and non-owned automobiles, in the amount of one million dollars ($1,000,000) combined single accident.

Selected respondent (s) shall provide workers compensation insurance coverage subject to Connecticut statute.  Such coverage shall meet the statutory requirements under section A, and for Employer Liability, be subject to $100,000 each accident, $500,000 Disease-Policy Limit, and $100,000 Disease-Each employee. The policy must provide coverage for benefits payable under the Connecticut Workers Compensation Act, and include the Voluntary Compensation endorsement. Selected respondent(s) shall provide the Town with a certificate

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verifying such coverage before commencing services.  Such policy shall require thirty (30) days’ notice to the Town in writing prior to alteration, cancellation, termination or expiration of any kind. 

Selected respondents (s) shall provide Public Liability insurance for bodily injury and property damage. The Public Liability insurance shall be written on a comprehensive form and include, without limitation, coverage for premises and operations, completed operations, independent contractors, broad form property damage, blanket contractual and personal injury. The required limits of liability are: $2,000,000- General Aggregate, $2,000,000- Product-Completed Operations Aggregate, $1,000,000- Personal and Advertising Injury, $1,000,000- Each Occurrence, $100,000- Fire Damage/Fire, $5,000- Medical Expense/Person.An Insurance certificate shall be required to be filed with the TOWN, certifying coverage and limits of automobile, bodily injury liability, property damage liability and Worker’s Compensation. The Town should be named as Additional Insured on the Insurance coverage named herein for the claims arising out of the COMPANY’S performance of the contract herein.

Any person contracting with the Town must, to the fullest extent permitted by law, indemnify, defend and hold harmless the Town and its agents and employees from and against all claims, damages, loss or expense including reasonable attorney’s fees arising out of or resulting from the performance of the contract.  Selected respondents shall pay any and all attorneys’ fees incurred by the Town, its agents, or its employees, in enforcing any of the selected respondents’ defense or indemnification obligations.  In any and all claims against the Town, or any of its agents or employees, by any employee of a selected respondent, or anyone directly or indirectly employed by a selected respondent, or anyone for whose acts as a selected respondent is liable, the indemnification obligation shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable by or a selected respondent under Workers’ Compensation Acts, disability benefits acts or other employee benefit acts. 

7. ADDITIONAL INFORMATION

A. DISCLAIMER1. The Town of Westbrook reserves the right to amend, cancel or withdraw the Request for Bids at any

time if it is deemed in the best interests of the Town to do so. The Town reserves the right to reject any, or any part of, or all bids, to waive informalities and technicalities, and to accept that bid proposal which the Town of Westbrook deems to be in the best interest of the Town.

2. The Town of Westbrook is not responsible for any costs/expenses incurred by anyone submitting a bid for this project. Costs/expenses are the sole responsibility of the parties submitting proposals.

B. ADDITIONAL INFORMATION

1. All proposals submitted and information included therein or attached thereto shall become public records upon delivery to the Town. All documents created by the respondent during the completion of their contract requirements shall become the property of the Town, including any databases and information systems that are created.

2. The respondent in performing under this agreement shall not discriminate against any workers, employee or applicant or any member of the public because of race, creed, color, religion, age, sex, marital status, national origin, mental retardation or physical disability, including but not limited to blindness, unless it is shown by Respondent that such disability prevents performance of the work involved, in any manner prohibited by the laws of the United States or the State of Connecticut, nor otherwise commit an unfair employment practice. Respondent will take affirmative action to

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insure that applicants are employed and that employees are treated during employment without regard to their race, creed, color, religion, age, sex, marital status, national origin mental retardation or physical disability, including but not limited to blindness, unless it is shown by Respondent that such disability prevents performance of the work involved, in any manner prohibited by the laws of the United States or the State of Connecticut, nor otherwise commit an unfair employment practice. Respondent agrees that this non-discrimination clause will be incorporated in all contracts entered into by it with suppliers of services or materials, contractors and sub-contractors and all labor organizations furnishing skilled, unskilled and craft unions skilled labor or whom may perform any such labor or services in connection with this agreement.

FORM OF GENERAL BID

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Page

1

Proposal of (hereinafter called "Bidder")

To the TOWN OF WESTBROOK, CONNECTICUT (hereinafter called “Town”)

The Bidder, in compliance with your invitation for bids for the Replacement of Handicap Accessible Ramp at the Westbrook Fire Department Headquarters having examined the specifications with related documents, and being familiar with all of the conditions surrounding the furnishing of the proposed equipment including the availability of materials and labor, hereby proposes to furnish all labor, materials, and supplies, and to provide the equipment within the time set forth below, and at the prices stated below. These prices are to cover all expenses incurred in performing the work required under the contract documents, of which this proposal is a part.

The Bidder hereby agrees to commence work under this contract on or before a date to be fixed in the written “Notice to Proceed” given by the Town to the Bidder and to fully complete all work related to the Contract within thirty (30) calendar days of the execution of the Contract or the Notice to Proceed, whichever is later.

The Bidder agrees to provide perform the work described in the Contract Documents for the following lump sums:

[BIDDER: INSERT COMPLETE DESCRIPTION OF THE WORK FOR TASKS set forth in section 2]

PRICE PROPOSAL ITEM PRICE Masonry $

Railing Bid $

TOTAL BID $

All entries shall be made clearly in ink or computer generated. Discrepancies between the indicated prices and the correct total will be resolved in favor of the correct total.

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The above price shall include all labor, materials, bailing, shoring, removal, overhead, profit, insurance, etc., to cover the finished work called for.

The contract will be awarded to the lowest eligible and responsible bidder on the basis of the lowest bid.

The Bidder understands that the Town reserves the right to reject any or all bids and to waive any informalities in the bidding.

The Bidder agrees that this bid shall be good and may not be withdrawn for a period of ninety (90)days, Saturdays, Sundays and legal holidays excluded, after the opening of bids.

The undersigned offers the following information as evidence of its qualifications to perform the work as bid upon according to all the requirements of the plans and specifications.

The undersigned certifies under penalties of perjury that this bid is in all respects bona fide, fair and made without collusion or fraud with any other person. As used in this paragraph the word "person" shall mean any natural person, joint venture, partnership, corporation or other business or legal entity.

Respectfully submitted:

Date By(Signature)

(Name – Typed or Printed)

(SEAL - if bid is by a corporation)(Title) (Business Name) (Federal ID Number) (Business Address) (City and State)

(Telephone Number)

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CONTRACTOR’S QUALIFICATION STATEMENT

TO: TOWN WESTBROOK, CONNECTICUT (hereinafter called the “Town”)

Pursuant to bidding requirements for the Work titled:

PROJECT: INSTALLATION OF A REPLACEMENT HANDICAP ACCESSIBLE RAMP AT THE WESTBROOK FIRE DEPARTMENT HEADQUARTERS

The Bidder is qualified to complete the Work as stated below:

ORGANIZATION If your organization is a corporation, provide the following:

Date of incorporation:

State of incorporation:

President’s name:

Vice-president’s name(s):

Secretary’s name:

Treasurer’s name:

If your organization is a partnership, answer the following:

Date of organization:

Type of partnership:

Name(s) of general partner(s):

If your organization is individually owned, answer the following: Date of organization:

Name of owner:

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If the form of your organization is other than those listed above, describe it and name the principals:

EXPERIENCE

List the categories of work that your organization normally performs with its own forces.

Claims and Suits. (If the answer to any of the questions below is yes, please attach details.)

NO YES QUESTION

Has your organization ever failed to complete any work awarded to it?Are there any judgments, claims, arbitration proceedings or suits pending or outstanding against your organization or its officers?

Has your organization filed any lawsuits or requested arbitration with regard to contracts within the last five years?Within the last five years, has any officer or principal of your organizationever been an officer or principal of another organization when it failed to complete a contract?

Signature Date

Printed Name

Title

AFFIDAVIT

To the Town of WESTBROOK, CONNECTICUT:

This is to certify that in submitting this bid, BIDDER represents that this Bid is not made in the interest of or on behalf of any undisclosed person and is not submitted in conformity with any agreement or rules of any group, association, organization, or corporation; BIDDER has not directly or indirectly induced or solicited any other Bidder to submit a false or sham Bid; BIDDER has not solicited or induced any person, firm, or corporation to refrain from bidding; and BIDDER has not sought by collusion to obtain for himself any advantage over any other Bidder or over OWNER; and the BIDDER or any person in his behalf, has not agreed, connived, or colluded to produce a deceptive show of competition in the matter of the bidding or award of the referenced contract.

Signature to be by signer of Bid Form.

Signature

Printed Name

Title

Subscribed and sworn to before me this day of , 201 .

Notary Public

My commission expires on:

CERTIFICATE AS TO CORPORATE BIDDER

Project: INSTALLATION OF A REPLACEMENT HANDICAP ACCESSIBLE RAMP FOR THE WESTBROOK FIRE DEPARTMENT HEADQUARTERS

I, , certify that I am the of the (Name) (Title)

corporation named as the Bidder in the attached Bid Form; that , (Name)

who signed the said Bid Form on behalf of the Bidder was then (Title)

of said corporation, that his/her signature thereto is genuine, and that said Bid Form was duly signed,

sealed, and executed for and on behalf of said corporation by authority of its governing body.

Dated: (Corporate Seal)

By:

CERTIFICATE OF NON-COLLUSION

The undersigned certifies under penalties of perjury that this bid or proposal has been made in good faith and without collusion or fraud with any other persons. As used in this certification, the word “person” shall mean any natural person, business, partnership, corporation, union, committee, club, or other organization, entity, or group of individuals.

By: Signature of Authorized Individual

Name of Business

Address

City, State, Zip Code

Date