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HomeMy WebLinkAbout00-6100-Project-Forms_Rev_1Dennis Yarmouth Intermediate Middle School January 19, 2021 Dennis Yarmouth Regional School District 100% Construction Documents Perkins Eastman DPC, project #71011 PROJECT FORMS 00 6100 - 1 DOCUMENT 00 6100 PROJECT FORMS 1.1 FORM OF AGREEMENT AND GENERAL CONDITIONS A. The following form of Owner/Contractor Agreement and form of the General Conditions shall be used for Project: 1. AIA Document A101, "Standard Form of Agreement between Owner and Contractor, Stipulated Sum" are separately prepared and included in the Project Manual. 2. The General Conditions for Project are AIA Document A201, "General Conditions of the Contract for Construction" are separately prepared and included in the Project Manual. 3. The Supplementary Conditions for Project are separately prepared and included in the Project Manual. 4. Statutory Requirements for Project are separately prepared and included in the Project Manual. 1.2 ADMINISTRATIVE FORMS A. Administrative Forms: Additional administrative forms are specified in Division 01 General Requirements. B. Copies of AIA standard forms may be obtained from the American Institute of Architects; http://www.aia.org/contractdocs/purchase/index.htm; docspurchases@aia.org; (800) 942-7732. C. Information and Modification Forms: 1. Form of Request for Proposal: AIA Document G709, "Work Changes Proposal Request." 2. Change Order Form: AIA Document G701, "Change Order." 3. Form of Architect's Memorandum for Minor Changes in the Work: AIA Document G707, "Architect's Supplemental Instructions." 4. Form of Change Directive: AIA Document G714, "Construction Change Directive." D. Payment Forms: 1. Schedule of Values Form: AIA Document G703, "Continuation Sheet." 2. Payment Application: AIA Document G702/703, "Application and Certificate for Payment and Continuation Sheet." 3. Form of Contractor's Affidavit: AIA Document G706, "Contractor's Affidavit of Payment of Debts and Claims." 4. Form of Affidavit of Release of Liens: AIA Document G706A, "Contractor's Affidavit of Payment of Release of Liens." 5. Form of Consent of Surety: AIA Document G707, "Consent of Surety to Final Payment." 1.3 CERTIFICATES AND OTHER FORMS A. The following certificates and forms shall be used for Project and are bound in this Project Manual as attachements to this Document: 1. Bid Bond Affidavit. 2. Certificate of Non-Collusion. 3. Certificate of Vote. 4. Certificate of Authority (Corp). Dennis Yarmouth Intermediate Middle School January 19, 2021 Dennis Yarmouth Regional School District 100% Construction Documents Perkins Eastman DPC, project #71011 PROJECT FORMS 00 6100 - 2 5. Certificate of Authority (LLC). 6. Tax Compliance Certification. 7. Certificate of Non Debarment. 8. Affidavit of Prevailing Wage Compliance. 9. Certificate of No Conflict of Interest. 10. Affidavit of Compliance c156B c181 c180. 11. Statement of Management. 12. Certificate of COVID-19 Acknowledgment. 13. Certificate of Compliance with EEO. END OF DOCUMENT Bid Bond Affidavit This document is an affidavit form that is drafted to serve as a statement wherein the person (Bidder) who signs it swears under penalty of perjury that the facts and information that are identified in this affidavit are true. This affidavit is in lieu of an insurance Bid Bond certificate. Bidders submitting the Bid Bond Affidavit form and the 5% Bid Deposit in the form of cash, certified check, treasurer’s or cashier’s check issued by a responsible bank or trust company shall ensure that these documents are received by the Awarding Authority prior to the closing of the electronic bid. Both the completed Bid Bond Affidavit form and the Bid Deposit shall be enclosed in a sealed envelope with the following information plainly marked on the outside: DO NOT OPEN BEFORE BID DEADLINE: Project Name: Projectdog Project Number: Bidder's Name: Business Address: Phone Number: It is the Bidder’s responsibility to ensure that the completed Bid Bond Affidavit form and Bid Deposit are submitted as stated above and received by the Awarding Authority prior to the closing of electronic bids. The completed Bid Bond Affidavit form must also be uploaded via the project E-bid “Bid Bond” link at www.Projectdog.com. The Bidder understands and consents that any failure to do so whether his own or other fault may result in the rejection of said bid. The Bidder is solely responsible for the accuracy and value of the Bid Deposit. In the event that the Bid Deposit is less than the required amount as outlined in the project specifications the bid may be rejected. Bid Deposit Amount (in figures): CASH or Certified, Treasurer’s, or Cashier’s Check Date: Bidder’s Name: Business Address: Signature: Projectdog, Inc. 18 Graf Road Suite 8, Newburyport, MA 01950 www.Projectdog.com Phone: (978) 499-9014 Attachment: Bid Bond Affidavit © Copyright by Projectdog.com, All rights reserved. (THIS PAGE IS BLANK) Certificate of Non-Collusion The undersigned certifies under penalties of perjury that this bid or proposal has been made and submitted in good faith and submitted in good faith and without collusion or fraud with any other person. 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 or individuals. Signature of Individual Date Name of Business – Please Print (THIS PAGE IS BLANK) CERTIFICATE OF VOTE (to be filed if Contractor is a Corporation) I, , hereby certify that I am a duly qualified and (Secretary of the Corporation) acting Secretary of (Name of Corporation) and I further certify that a meeting of the Directors of said company, duly called and held on , at which time all Directors were present and voting, the (Date of Meeting) following vote was unanimously passed: VOTED: To authorize and empower anyone acting singly, to execute Forms of General Bid, Contracts or bonds on behalf of the Corporation. I further certify that the above is still in effect and has not been changed or modified in any respect. By: _ (Secretary of Corporation) True Copy: Attest: (Notary Public) My commission expires: (THIS PAGE IS BLANK) Certificate of Authority (Corporations Only) Instructions: Complete this form and sign and date where indicated below. 1. I hereby certify that I, the undersigned, am the duly elected Clerk/Secretary of . (Insert Full Name of Corporation) 2. I hereby certify that the following individual (Insert the Name of Officer who Signed the Contract and Bonds) is the duly elected (Insert the Title of the Officer in Line 2) of said Corporation. 3. I hereby certify that on (Insert Date: Must be on or before Date Officer Signed Contract/Bonds) at a duly authorized meeting of the Board of Directors of said corporation, at which a quorum was present, it was voted that (Insert Name of Officer from Line 2) (Insert Title of Officer from Line 2) of this corporation be and hereby is authorized to make, enter into, execute, and deliver contracts and bonds in the name and on behalf of said corporation, and affix its Corporate Seal thereto, and such execution of any contract of obligation in this corporation’s name and on its behalf, with or without the Corporate Seal, shall be valid and binding upon this corporation; and that the above vote has not been amended or rescinded and remains in full force and effect as of the date set forth below. 4. ATTEST: Signature: _______________________________________ AFFIX CORPORATE SEAL HERE (Clerk of Secretary) Printed Name: ____________________________________ Printed Title: _____________________________________ Date: ____________________________________________ (THIS PAGE IS BLANK) Certificate of Authority (Limited Liability Companies Only) Instructions: Complete this form and sign and date where indicated below. 1. I, the undersigned, being a member or manager of , (Complete Name of Limited Liability Company) a limited liability company (LLC) hereby certify as to the contents of this form for the purpose of contracting with the Town of Saugus. 2. The LLC is organized under the laws of the state of: . 3. The LLC is managed by (check one) a ____ Manager or by its ___ Members. 4. I hereby certify that each of the following individual(s) is: • a member/manager of the LLC; • duly authorized to execute and deliver this contract, agreement, and/or other legally binding documents relating to any contract and/or agreement on behalf of the LLC; • duly authorized to do and perform all acts and things necessary or appropriate to carry out the terms of this contract or agreement on behalf of the LLC; and • that no resolution, vote, or other document or action is necessary to establish such authority. Name Title Signature: ______________________________________________ Printed Name: ___________________________________________ Printed Title: ____________________________________________ Date: ______________________ (THIS PAGE IS BLANK) Tax Compliance Certification Pursuant to M.G.L. c. 62C, §49A, I certify under the penalties of perjury that, to the best of my knowledge and belief, I am in compliance with all laws of the Commonwealth relating to taxes, reporting of employees and contractors, and withholding and remitting child support, as well as paid all contributions and payments in lieu of contributions pursuant to MGL 151A, § 19A(b). Signature: _________________________________________________ (Duly Authorized Representative of Vendor) Name of Business or Entity: ___________________________________ Social Security Number or Federal Tax ID#: _______________________ Date: ______________________________ (THIS PAGE IS BLANK) PUBLIC CONTRACTS - DEBARMENT Chapter 550, Acts of 1991 The undersigned certifies under penalties of perjury that the said undersigned is not presently debarred from doing public construction work in the Commonwealth of Massachusetts under the provisions of Section 29F of Chapter 29 of the General Laws, or any other applicable debarment provisions of any other Chapter of the General Laws, or any Rules or Regulations promulgated thereunder. Date __________ Name of Bidder ___________________________ By:_______________________________________ Signature _______________________________________ Print Name & Title of Person Signing _______________________________________ Address _______________________________________ City, State, ZIP (THIS PAGE IS BLANK) Affidavit of Prevailing Wage Compliance (c. 149, s. 26 and 27) I, , ______________________________ , of the Name Title , with a principal office is located at Offeror’s Company Name do hereby certify that the above named corporation will comply with the prevailing wage laws as set forth in Sections 26 and 27 of the Massachusetts General Laws. SIGNED UNDER THE PENALTIES OF PERJURY this __ day of , 20__. Signature of Duly Authorized Corporate Officer (THIS PAGE IS BLANK) CERTIFICATE OF NO CONFLICT OF INTEREST __________________________ ("Respondent") hereby certifies that it is acting solely on its own behalf without connection with, or obligation to, any undisclosed person or firm and in full compliance with the provisions of M.G.L. c. 268A, as amended, and any other applicable conflict of interest law. Respondent further certifies that it presently-has no financial interest, and shall not acquire any such interest, direct or indirect, that would conflict in any manner or degree with this contract or that would violate M.G.L c, 268A, as amended. Executed as of this_______ day of ________________, 20___. _______________________ (Name of Respondent) By: ____________________________ Its: _____________________________ (THIS PAGE IS BLANK) Affidavit of Compliance Massachusetts Business Corp. Foreign Corp. Non-Profit Corp. I, , President Clerk of , principal office is located at I do hereby certify that the above named corporation has filed with the State Secretary all certificates and annual reports required by Chapter 156B Sec. 109 (business corporation), by Chapter 181, Sec. 4 (foreign corporation) or by Chapter 180, Sec. 26A (non-profit corporation) of the Massachusetts General Laws. SIGNED UNDER THE PENALTIES OF PERJURY this __ day of , 20___. Signature of Duly Authorized Corporate Officer (THIS PAGE IS BLANK) Statement of Management (for Contracts over $100,000) In accordance with M.G.L. Chapter 30, Section 39R, the undersigned successful bidder states that its system of internal accounting controls and that of its subsidiaries reasonably assure (1) that transactions are executed in accordance with management’s general and specific authorization; (2) that transactions are recorded as necessary to permit preparation of financial statements in conformity with generally accepted accounting principles, and to maintain accountability for assets; (3) that access to assets is permitted only in accordance with management’s general or specific authorization, and (4) that the recorded accountability for assets is compared with the existing assets at reasonable intervals and appropriate action was taken with respect to any difference. Executed this day of , On behalf of (Name of Successful Bidder) (Address and telephone of Successful Bidder) (Name and title of person signing statement) By: (Signature) CERTIFIED PUBLIC ACCOUNTANT STATEMENT In accordance with M.G.L. 30, Section 39R I, a certified public accountant, state that I have examined the above Statement of Management on internal accounting controls, and that in my opinion (1) the representations of management are consistent with the result of management’s evaluation of the system of internal accounting controls; and (2) that such representations of management are, in addition, reasonable with respect to transactions and assets in amounts which would be material when measured in relation to the above referenced successful bidder’s financial statements. (Signature) (Business name, address and telephone number) (THIS PAGE IS BLANK) CERTIFICATE OF CORONAVIRUS-2019 (COVID-19) ACKNOWLEDGEMENT The Responder hereby certifies that it is presently aware of the ongoing Coronavirus-2019 (COVID-19) Pandemic. The Responder hereby certifies that in its bid it has fully accounted for the cost of compliance with all state and federal orders, guidelines and recommendations in place at the time thereof in order both to achieve a safe working environment and to meet the substantial completion deadline set forth in the bid documents. Name of Responder Address of Responder Telephone Number By: (Signature) Printed Name Printed Title Date (THIS PAGE IS BLANK) CONTRACTOR’S CERTIFICATION ______________________________________________________________certifies that they: (Contractor Name) 1. Will not discriminate in their employment practices; 2. Intend to use the following listed construction trades in the work under the contract __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ _______________________________________________________________________; and 3. Will make good faith efforts to comply with the minority employee and women employee workforce participation ratio goals and specific affirmative action steps contained herein; and 4. Are in compliance with all applicable federal and state laws, rules, and regulations governing fair labor and employment practices; and 5. Will provide the provisions of the “Supplemental Equal Employment Opportunity, Non- Discrimination and Affirmative Action Program” to each and every subcontractor employed on the Project and will incorporate the terms of this Section into all subcontracts and work orders entered into on the Project. 6. Agree to comply with all provisions contained herein. ___________________________________________________________________________ (Signature of authorized representative of Contractor) Date ___________________________________________________________________________ (Printed name of authorized representative of Contractor) (THIS PAGE IS BLANK)