HomeMy WebLinkAboutColVico Bid Documents t�itv�t�
.--_ -_----�''��' ��i nl��'��:� � ��
Highlands Generator Replacement and Radio Equipment Relocation
1NTR-27-03759
Proposal & Combined Affidavit & Certificate Form
TO TNE CITY OF RENTON
RENTON,WASHINGTON
Ladies andjor Gentlemen:
The undersigned hereby certify that the bidder has examined the site of the proposed work and have
read and thoroughly understand the plans, specifications and contract governing the work embraced in
this improvement,and the method by which payment will be made for said work,and hereby propose to
undertake and complete the wark embraced in this improvement, or as much thereof as can be
completed with the money available, in accordance with the said plans, specifications and contract and
the schedule of prices.
The undersigned further certifies and agrees ta the fallowing provisions:
NON-COLLUSION AFFIDAVIT
Being duly sworn, deposes and says, that he is the identical person who submitted the foregoing
proposal or bid, and that such bid is genuine and not sham or collusive or made in the interest or on
behalf of any person not therein named, and further, that the deponent has not directly induced or
solicited any ather Bidder on the foregoing work or equipment to put in a sham bid, or any other person
or corporation to refrain from bidding, and that deponent has not in any manner sought by collusion to
secure to himself or to any other person any advantage over other eidder or Bidders.
AND
CERTIFICATION RE: ASSIGNMENT OF
ANTI-TRUSTCLAIMSTO PURCHASER
Vendor and purchaser recognize that in actual economic practice overcharges resulting from anti-trust
violations are in fact usually borne by the purchaser. Therefore,vendor hereby assigns to purchaser any
and all claims for such over-charges as to goods and materials purchased in connection with this order or
contract, except as to overcharges resulting from anti-trust violations cammencing after the date of the
bid, quotation, or other event establishing the price under this order or contract. In addition, vendor
warrants and represents that such of his suppliers and subcontraetors shall assign any and all such claims
to purchaser, subject to the aforementioned exception.
AND
Page 12 Proposal&Combined Affidavit&Certificate Form
Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com-Always Verify Scale
MINIMUM WAGE AFFIDAVIT FORM
I, the undersigned, having been duly sworn, deposed, say and certify that in connection with the
performance of the work of this project, I wili pay each classificatian of laborer, workman, or mechanic
employed in the performance of such work; not less than the prevailing rate of wage or not less than the
minimum rate of wages as specified in the principal contract.
I have read the above and foregoing statements and certificate, know the contents thereof and the
substance as set forth therein is true to my knowledge and belief.
FOR: PROPOSAL, NON COLLUSION AF�IDAVIT, ASSIGNMENT OF ANTI-TRUST CLAIMS TO PURCHASER
AND MINIMUM WAGE AFFIDAVIT
�Ivicd , �VIC.
Name of Bidder's Firm
��_�_»� —
Signature of Autharized Representative of Bidder*:
Printed Name; � W�NIVL T�t��: I�ruid�w�
Address:_��_J�C��21ht'�f �'• S��t' L�� �/l�i� /°�Z��
Contact Name(please print): __ � W�V f Vl
Phone: �0�1 25Z ' S�2(.e Email: ���COLV��Cc�(VJC - COW►
*The abave signature must be notarized using the applicable notary language faund on pages 3 and 4.
!f business is a CORPORAT(ON,please complete this section:
Name af President of Corporation _� W�V I V�
Name af Secretary of Corporation �� �� V�"�
Corporation Organized under the laws of w����q��
With Main Office in State of Washington at �,�'{�,� (1'� �170�.L�1/l,�_
If business is a PARTNERSNIP or LIMI7ED ttABlLITY COMPANY,please tomplete this section: •
Name: Title (Partner, Member, Manager}:
Praposal&Affidavit/Certificate Page 2 of 4
Page 13 Minimum Wage Affidavit Form
Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com-Always Verify Scale
INDIVIDUAL FORM
STATE OF WASH(NGTCIN )
: S5
County of__ _ )
On this day of before me personally appeared
to me knawn to be the individual{s) described in and who executed the foregoing instrument,
and acknowledged under oath that (he/she/they) signed and sealed the
same as (his, her, their) free and voluntary act and deed, for the
uses and purposes therein mentioned.
GIVEN under my hand and official seal the day and year last above written.
{SEAL)
Notary Public in and for the State of
Washington, residing at_
Print Name:
My commission expires:
CORPORATION FORM
STATE OF WASHINGTON }
: ss
County of�S'iQ�Kl,nt. )
On this ��`�' day of V 0/ before me personally appeared C0� C0�1�6fL '
to me known to be the R S/c�,Cn.f' (President, Secretary, Treasurer) of the
corporation that executed the foregning instrument, and acknowledged said instrument to be
the free and valuntary act and deed of said corporation, for the uses and purposes therein
mentioned, and on oath stated that � (heJsheJthey) are authorized tt� execute said
instrument.
GIVEN under my hand and official seal the day and year fast above written;
����f�tiilitlllltllltlllllllllltllllltl►Illll❑ (�titary Pub ic in and for the State af
_ Notar� Public =
= State of Washington = Washington, res' ing at a9/�A�R�fs�ttr�S�S�(�pr,�,� t.•�/L
_ �
= ANGELA E. GILBFRT = Print tvame: E. �l�e,tf-
= MY COMMISSION EXPIRES =
= December 07,2ots — My commission expires: / 07 d 0/G
�IIIIIIIIIIIIIIIIIItllltllfllllllllllllllllltl❑
Proposal&Affidavit/Certificate Page 3 af II
4
Page 14
Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see Hiww.bxwa.com-Always Verify Scale
� . . � . .` . :
. . r
. . _«,, . . .. . . _ .
, � . � � , � �
. • . � • [����i;�i�:SiiliGt:tl1: i�:tt�iifl�iif�::ftitillt�
PARTNERSHIP FORM
STATE OF WASHINGTON )
: ss
County of __ )
On this day af before me personally appeared
ta me known to be a Generai Partner of the partnership known as
that executed the foregoing instrument, and acknowledged said
instrument to be the free and voluntary act and deed of said partnership, for the uses and
purposes therein mentioned, and on oath stated that (he/she/they) are authorized
to execute said instrument.
GIVEN under my hand and afficial seal the day and year last above written.
(SEAL) u
Natary Public in and for the State of
Washington, residing at �
Print Name:
My commission expires;
LIMITED LIABILITY COMPANY{LLC) FORM
STATE OF WASHINGTON )
: ss
County of )
On this day af , 20_, befare me persc�nally appeared
to me known to be a Managing Member of the Limited Liability
Cc�mpany known as and that he/she/they executed the
faregoing instrument, and acknowledged said instrument to be the free and valuntary act and
deed of said Limited Liability Company, for the uses and purposes therein mentioned, and on
aath stated that (he/she/they} are authorized to execute said instrument.
GIVEN under my hand and official seal the day and year last above written.
{SEAL)
Notary Public in and for the State of
Washington, residing at
Print Name:
My commission expires:
Proposal&Affidavit/Certificate Page 4 of 4
Page 15
Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com-Always Verify Scale
Department of Labo�• and Industries
Certificate of Registration
Name on Registration: � 1 V1 C• —
Re�istrltion Nuinber: �j35 ( �- (�Z
�,xpiration Date: �� _
Note: r�copy of die certificate�vill Ue requested as part af coiitract eyecution«h�n pr�ject is 1�-arded.
Page 16 Certificate of Registration
Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com-Always Verify Scale