MCHENRY COUNTY CONSERVATION DISTRICT REQUEST FOR BIDS FOR Herbicide Application SERVICES Invasive Brush and Weeds, Countywide

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1 MCHENRY COUNTY CONSERVATION DISTRICT REQUEST FOR BIDS FOR Herbicide Application SERVICES Invasive Brush and Weeds, Countywide The purpose of the project is to control invasive plants in order to aid in the reestablishment of native natural communities. I. PROPOSED BID: Rate for Herbicide Application Services as specified under Technical Provisions below. Areas to be completed are countywide $ PER Hour for Labor II. NAME OF CONTRACTOR: Name of Firm Signature Printed Name Title Address, Street, City State, Zip Code Phone Number FEIN #: 1 P a g e

2 III. TECHNICAL PROVISIONS Technical provisions for Herbicide Application Services. The Work of this project shall include all labor, materials and equipment to complete control of select invasive plants, including, but not limited to: TARGET SPECIES Target species include, but are not limited to: Reed Canary Grass Cattails Common Reed Grass Teasel Oriental Bittersweet Leafy spurge Crown vetch Purple Loosestrife Canada thistle Japanese knotweed Cool Season Grasses Common Buckthorn Glossy Buckthorn Japanese Honeysuckle Multiflora rose Phalaris arundinacea Typha x glauca and T. angustifolia Phragmites australis Dipsacus spp. Celastrus orbiculatus Euphorbia esula Coronilla varia Lythrum salicaria Cirsium arvense Polygonum cuspidatum Multiple Species Rhamnus cathartica Frangula alnus Lonicera sps. Rosa multiflora Control measures are at various DISTRICT Conservation Areas in McHenry County. Many of the Work sites include State of Illinois Nature Preserves and other high quality natural areas. The Work shall be performed at numerous District sites throughout McHenry County including, but not limited to: Lake Elizabeth, Kishwaukee Corridor, and Glacial Park Work shall include selective foliar spray and wick application of herbicide with backpack sprayers and wick applicators, hand swiping, wick barring, and chemical treatment of small woody vines / resprouts. Use of an ATV for access may be necessary. Broadcast application is a method used infrequently, but may be necessary, including application from a boom apparatus attached to an ATV. The contractor will provide herbicides, surfactants, water conditioners, and dye. Contractors shall provide all labor and equipment, including vehicles, sprayers, wick applicators, trailers, ATV s, other equipment, and time for travel and mixing of herbicide (off-site), etc., based on an hourly rate, to complete the projects. Hourly rate shall include any project management, herbicide mixing and preparation, herbicide application reporting, and or over sight of the field crew deemed necessary by the contractor. Contractors shall have the capacity to provide a crew of up to three people and any equipment listed above requested by the DISTRICT within 48 hours of the DISTRICT s request. 2 P a g e

3 The DISTRICT is seeking to hire a crew that meets the specifications described above to complete several 2018 invasive plant management projects. It is anticipated that the invasive plant management crew shall focus the majority of their work at Lake Elizabeth Nature Preserve and the Kishwaukee Corridor sites, but may spent time on project sites located throughout the county. The DISTRICT reserves the right to assign the contractor(s) to any invasive plant management project, regardless of location. 1. Tire Ruts CONTRACTOR will not take any trucks or tractors into project area without approval by the DISTRICT. Any debris generated during work activities must be removed. 2. Desirable Species Native plant species are NOT to be treated unless otherwise marked. Care is to be taken to insure that drift and/or overspray does not impact desirable species. 3. Washed Equipment All equipment will be washed by CONTRACTOR prior to use on site to eliminate the potential for the spread of exotic or problem plant species onto DISTRICT lands. IV. PROJECT TIMING This work is to be conducted when soil and weather conditions are suitable. Specifically, work may be initiated by April 23, 2018 and must be completed by October 1, The DISTRICT reserves the right to adjust start and finish dates based on weather conditions. V. IMPORTANT DATES & CONTACT NUMBERS 1. Pre-Project Meeting Monday, April 23, 2018 at 10 a.m. at the Lost Valley Visitor Center, Glacial Park, Richmond, Illinois. 2. Bids Due Thursday, March 15, 2018, 9 a.m. at the Lost Valley Visitor Center, 6316 Harts Road, Ringwood, IL Bids shale be placed in a sealed envelope and labeled Herbicide Services and delivered to the address above. 3. Contact Information Brad Woodson, Natural Resources Manager McHenry County Conservation District Lost Valley Visitor Center 7210 Keystone Road Richmond, IL Cell BWoodson@ 3 P a g e

4 VI. CONTRACT PROVISIONS: In consideration of the mutual covenants and agreements herein contained, and other good and valuable consideration received and to be received, the CONTRACTOR hereby agrees: 1. CONTRACTOR will perform herbicide application services in accordance with industry standard practices and in the manner prescribed by the DISTRICT. 2. In performing herbicide application services for the DISTRICT, the CONTRACTOR agrees to comply with all applicable laws, regulations, and rules promulgated by any Federal, State, County, Municipal and or other governmental unit or regulatory body now in effect during the performance of the work. By way of example, the following are included within the scope of the laws, regulations and rules referred to in this paragraph, but in no way to operate as a limitation on the laws, regulations and rules with which CONTRACTOR must comply, are all forms of Workers Compensation Laws, all terms of the Equal Employment Opportunity Clause of the Illinois Fair Employment Practices Commission, the Illinois Preference Act, the Social Security Act,, the Substance Abuse Prevention on Public Works Act; the Fair Labor Standards Act; any statutes regarding qualification to do business; any statutes requiring preference to laborers of specified classes; any statutes prohibiting discrimination because of or requiring affirmative action based on race, creed, color, national origin, age, sex or other prohibited classification, included without limitation, the Americans with Disabilities Act of 1990, 42 U.S.C et seq., the Illinois Human Rights Act, 775 ILCS 5/1-101 et seq.; and the Discrimination in Public Contracts Act, 775 ILCS 10/1 et seq. ; and any statutes regarding safety or the performance of the Work, including but not limited to the Occupational Safety and Health Act. Statutes relating to contracts let by units of government, all applicable Civil Rights and Anti-Discrimination Laws and Regulations, and traffic and public utility regulations. CONTRACTOR agrees, without additional compensation other than the actual cost of reproduction, to maintain the records and documents for projects of the DISTRICT in compliance with the Freedom of Information Act, 5 ILCS 140/1 et seq. In addition, CONTRACTOR shall produce records which are responsive to a request received by the DISTRICT under the Freedom of Information Act so that the DISTRICT may provide records to those requesting them within the time frames required by law. If additional time is necessary to compile records in response to a request, then CONTRACTOR shall so notify the DISTRICT and if possible, the DISTRICT shall request an extension so as to comply with the Act. In the event that the DISTRICT is found to have not complied with the Freedom of Information Act based upon CONTRACTOR's failure to produce documents or otherwise appropriately respond to a request under the Act, then CONTRACTOR shall indemnify and hold the DISTRICT harmless, and pay all amounts determined to be due including but not limited to fines, costs, attorneys' fees and penalties. 3. Indemnification: The CONTRACTOR agrees that, to the fullest extent permitted by law, it shall waive any and all rights of contribution against the DISTRICT and to indemnify and hold harmless the DISTRICT and its officers, officials, employees, volunteers and agents from and against all claims, 4 P a g e

5 damages, losses and expenses, including, but not limited to, legal fees (attorney's and paralegal's fees, expert fees and court costs) arising out of or resulting from the performance of the CONTRACTOR's work, provided that any such claim, damage, loss or expense is attributable to bodily injury, sickness, disease or death, or injury to or destruction of property, other than the work itself, including the loss of use resulting therefrom, or is attributable to misuse or improper use of trademark or copyright protected material or otherwise protected intellectual property, to the extent it is caused in whole or in part by any wrongful or negligent act or omission 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. Such obligation shall not be construed to negate, abridge or otherwise reduce any other right to indemnity, which the DISTRICT would otherwise have. The CONTRACTOR shall similarly, protect, indemnify and hold and save harmless, the DISTRICT, its officers, officials, employee, volunteers and agents against and from any and all claims, costs, causes, actions and expenses, including, but not limited to, legal fees, incurred by reason of CONTRACTOR's breach of any of its obligations under, or CONTRACTOR's default of any provisions of the Contract. The indemnification obligations under this paragraph shall not be limited 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 Workers' Compensation or Disability Benefit Acts or Employee Benefit Acts. Any limitation of liability, including but not limited to limitation on the nature of the claims that may be pursued or the amount that may be recovered, that is set forth in Exhibit A is hereby deleted. 4. Insurance: The CONTRACTOR shall, to the satisfaction of the DISTRICT, keep in force and effect insurance coverage of the types and amounts listed below at all times during the performance of the Work: A. Commercial General and Umbrella Liability Insurance CONTRACTOR shall maintain commercial general liability (CGL) and, if necessary, commercial umbrella insurance with a limit of not less than $1,000,000 each occurrence. If such CGL insurance contains a general aggregate limit, it shall apply separately to this location. CGL insurance shall be written on Insurance Services Office (ISO) occurrence form CG , or a substitute form providing equivalent coverage, and shall cover liability arising from premises, operations, independent CONTRACTORs, products-completed operations, personal injury and advertising injury, and liability assumed under an insured contract (including the tort liability of another assumed in a business contract). DISTRICT shall be included as an insured under the CGL, using ISO additional insured endorsement CG or a substitute providing equivalent coverage, and under the commercial umbrella, if any. This insurance shall apply as primary insurance with respect to any other insurance or self-insurance afforded to DISTRICT. There shall be no 5 P a g e

6 endorsement or modification of the CGL limiting the scope of coverage for liability arising from pollution, explosion, collapse, or underground property damage. There shall be no endorsement or modification of the CGL limiting the scope of coverage for liability arising from pollution, explosion, collapse, or underground property damage. B. Professional Liability Insurance CONTRACTOR shall maintain professional liability and, if necessary, commercial umbrella liability insurance with a limit of not less than $1,000,000 each wrongful act arising out of the performance or failure to perform professional services. C. Business Auto and Umbrella Liability Insurance CONTRACTOR shall maintain business auto liability and, if necessary, commercial umbrella liability insurance with a limit of not less than $1,000,000 each accident. Such insurance shall cover liability arising out of any auto including owned, hired and nonowned autos. Business auto insurance shall be written on Insurance Services Office (ISO) form CA 00 01, CA 00 05, CA 00 12, CA 00 20, or a substitute form providing equivalent liability coverage. If necessary, the policy shall be endorsed to provide contractual liability coverage equivalent to that provided in the 1990 and later editions of CA D. Workers Compensation Insurance CONTRACTOR shall maintain workers compensation and employers liability insurance. The commercial umbrella and/or employers liability limits shall not be less than $1,000,000 each accident for bodily injury by accident or $1,000,000 each employee for bodily injury by disease. If DISTRICT has not been included as an insured under the CGL, using ISO additional insured endorsement CG under the Commercial General and Umbrella Liability Insurance required in this Contract, the CONTRACTOR waives all rights against the DISTRICT and its officers, officials, employees, volunteers, and agents for recovery of damages arising out of or incident to the CONTRACTOR s work. E. General Insurance Provisions 1. Evidence of Insurance Prior to beginning its work, CONTRACTOR shall furnish the DISTRICT with a certificate(s) of insurance and applicable policy endorsement(s), executed by a duly authorized representative of each insurer, showing compliance with the insurance requirements set forth above. 6 P a g e

7 All certificates shall provide for 30 days written notice to DISTRICT prior to the cancellation or material change of any insurance referred to therein. Written notice to DISTRICT shall be by certified mail, return receipt requested. Failure of DISTRICT to demand such certificate, endorsement or other evidence of full compliance with these insurance requirements or failure of DISTRICT to identify a deficiency from evidence that is provided shall not be construed as a waiver of CONTRACTOR s obligation to maintain such insurance. The DISTRICT shall have the right, but not the obligation, of prohibiting CONTRACTOR from entering the project site until such certificates or other evidence that insurance has been placed in complete compliance with these requirements is received and approved by the DISTRICT. CONTRACTOR waives all rights against the DISTRICT and its officers, officials, employees, volunteers and agents for recovery of damages arising out of or incident to the CONTRACTOR s use of the premises. Failure to maintain the required insurance may result in termination of this agreement at the DISTRICT s option. CONTRACTOR shall provide certified copies of all insurance policies required above within 10 days of the DISTRICT s written request for said copies. 2. Acceptability of Insurers For insurance companies which obtain a rating from A.M. Best, that rating should be no less than A VII using the most recent edition of the A.M. Best s Key Rating Guide. If the Best s rating is less than A VII or a Best s rating is not obtained, the DISTRICT has the right to reject insurance written by an insurer it deems unacceptable. 3. Cross-Liability Coverage If CONTRACTOR s liability policies do not contain the standard ISO separation of insured s provision, or a substantially similar clause, they shall be endorsed to provide cross-liability coverage. 4. Deductibles and Self-Insured Retentions Any deductibles or self-insured retentions must be declared to the DISTRICT. At the option of the DISTRICT, the CONTRACTOR may be asked to eliminate such deductibles or self-insured retentions as respects the DISTRICT, its officers, officials, employees, volunteers and agents or required to procure a bond guaranteeing payment of losses and other related costs including but not limited to investigations, claim administration and 7 P a g e

8 defense expenses. 5. Subcontractors CONTRACTOR shall cause each subcontractor employed by the CONTRACTOR to purchase and maintain insurance of the type specified above. When requested by the DISTRICT, CONTRACTOR shall furnish copies of certificates of insurance evidencing coverage for each subcontractor. 5. The CONTRACTOR shall furnish any affidavit or Certificate in connection with the work covered by this agreement as required by law. 6. Prevailing Wage: Where and to the extent that the Prevailing Wage Act applies, CONTRACTOR shall not be required to pay prevailing wages on work performed for soil and water conservation on agricultural lands. 7. Independent Contractor: It is mutually understood and agreed that the CONTRACTOR shall have the full control of the ways and means of performing the work referred to above and that the CONTRACTOR or its employees, representatives or subcontractors are in no sense employees of the DISTRICT, it being specifically agreed that the CONTRACTOR bears the relationship of an independent contractor to the DISTRICT. CONTRACTOR agrees that all services and work performed under this Agreement are being performed by CONTRACTOR as an independent contractor and not as an employee or agent of DISTRICT. This Agreement is not intended to constitute, create, give rise to or otherwise recognize a joint venture agreement or relationship, partnership or formal business organization of any kind or create an employer/employee relationship between DISTRICT and CONTRACTOR, CONTRACTOR s employees, subcontractors, subcontractors employees or any person supplied by CONTRACTOR in the performance of CONTRACTOR s obligations under this Agreement and does not entitle said persons to rights or benefits from DISTRICT normally associated with an employment relationship, such as, but not limited to, civil service, retirement, personnel rules which accrue to such persons, health insurance, motor vehicle insurance, life insurance, workers compensation, sick leave or any other fringe benefits. CONTRACTOR and subcontractors shall have total responsibility for all salaries, wages, bonuses, retirement, withholdings, worker s compensation, occupational disease compensation, unemployment compensation, other employee benefits and all taxes and premiums appurtenant thereto concerning such persons and shall indemnify, hold harmless and defend DISTRICT with respect thereto, including payment of reasonable attorney s fees and costs in the defense of any claim made under the Fair Labor Standards Act or any other federal or state laws. Such indemnity shall be required by CONTRACTOR from its subcontractors, if any, on behalf of DISTRICT. 8. Waiver: Failure or delay on the part of either party to exercise any right, power, privilege, or remedy 8 P a g e

9 under this Agreement shall not constitute a waiver thereof. No modification or waiver by either party of any provision shall be deemed to have been made unless in writing. Waivers of a specific failure or delay shall not be construed as general waiver. 9. Miscellaneous: A. Any defective designs, specifications, or studies furnished by the CONTRACTOR will be corrected by the CONTRACTOR at no cost to the DISTRICT. The DISTRICT s approval, acceptance, use of, or payment for, all or part of the CONTRACTOR s services hereunder, or of the Project itself, shall in no way alter the CONTRACTOR s obligations or the DISTRICT s rights hereunder. B. The DISTRICT and CONTRACTOR agree that the CONTRACTOR s preparation of all studies, drawings, designs, specifications, notes and other elements of the Contract Documents and other services rendered in the performance of this Agreement is a service work done for hire and that the ownership of such documents vests in the DISTRICT. C. CONTRACTOR and any subcontractor shall keep and maintain accurate books of record and account, in accordance with sound accounting principles, of all expenditures made and all costs, liabilities and obligations incurred under this Agreement, and all papers, files, accounts, reports, cost proposals with backup data and all other material relating to work under this Agreement and shall make all such materials available at the office of the DISTRICT at any reasonable time during the term of this Agreement and for the length of time established by law or five (5) years, whichever is longer from the date of final payment to CONTRACTOR or termination of this Agreement for audit, inspection and copying upon DISTRICT s request. D. CONTRACTOR will submit photocopies of reimbursable expense bills to support the CONTRACTOR s billing for reimbursable expense. E. Notwithstanding anything to the contrary contained in this Agreement, the DISTRICT s review and acceptance (or approval) of any and all documents or other matters required herein shall be for the sole purpose of furnishing the CONTRACTOR with information as to DISTRICT s objectives and goals with respect to the Project. Such review and acceptance (or approval) shall not be for determining the propriety, accuracy or completeness of the CONTRACTOR s work, other than as they relate to the DISTRICT s general programming goals, and therefore shall not create any liability on the part of the DISTRICT for errors, omissions or inconsistencies or other fault in the CONTRACTOR s work. However, DISTRICT s approval at the end of each phase shall represent approval for the CONTRACTOR to move to the next phase of work and DISTRICT shall be liable for additional compensation due under the terms hereof for DISTRICT initiated changes. F. To the extent the following applies, CONTRACTOR shall reasonably comply with all federal, state and local laws, rules and regulations applicable to the work including 9 P a g e

10 without limitation all building codes, the Americans With Disabilities Act, the requirements of the Equal Employment Opportunity Clause of the Illinois Human Rights Act, (775 ILCS 5/2-105), the rules and regulations of the Illinois Department of Human Rights, the Public Works Employment Discrimination Act (775 ILCS 5/10 et. seq.), and all laws and regulations pertaining to occupational and work safety. The CONTRACTOR s signature on this document herein certifies that it had a sexual harassment policy in effect which complies with 775 ILCS 5/ G. In the event of the CONTRACTOR s non-compliance with the provisions of the forgoing Equal Employment Opportunity Clause, the Illinois Human Rights Act, or the rules and regulations of the Illinois Department of Human Rights, the CONTRACTOR may be declared ineligible for future contracts or subcontracts and this Agreement may be canceled and voided in whole or in part and such other sanctions or other penalties may be imposed as provided by statute or regulation. However, any forbearance or delay by the DISTRICT in canceling this contract shall not be constituted as and does not constitute the DISTRICT s consent to such a violation or the DISTRICT s waiver of any rights it may have. H. Any suit or action arising under this Agreement shall be commenced in the Circuit Court of the 22 nd Judicial Circuit, County of McHenry, Illinois, but only after exhausting all possible contractual or administrative remedies. I. This Agreement shall be governed by the law of the State of Illinois. 10. Severability: The provisions of this Agreement shall be severable and the invalidity of any provision or portion thereof shall not affect the enforceability of the remaining provisions. 11. Non-Assignability: CONTRACTOR shall not assign this Agreement or transfer, convey or otherwise dispose of any part therein or its right, title or interest therein or its power to execute the same, to any other person, company or corporation without the previous written consent of DISTRICT, which consent the DISTRICT may grant or withhold in its sole discretion. 12. Fee: The CONTRACTOR s fee for the services described in Appendix E shall be a fixed cost not to exceed $35, Term: This agreement shall be in full force and effect from the 20 th Day of April 2018 to October 1, 2018, or until such time it is terminated by the DISTRICT. VII. DOCUMENTS REQUIRED WITH BID 1. Executed Herbicide Services Bid Form 2. Attachment A Certificate Regarding Substance Abuse 3. Attachment B Certificate of Compliance with Human Rights Act 10 P a g e

11 4. Attachment C Certificate of Compliance with Freedom of Information Act 5. Attachment D Certificate of Anti-collision Compliance Affidavit 6. Request for Taxpayer Identification Number and Certification 7. Certificate of Insurance naming McHenry County Conservation District as Additionally Insured. 11 P a g e

12 ATTACHMENT A SUBSTANCE ABUSE PREVENTION PROGRAM CERTIFICATION TO MCHENRY COUNTY CONSERVATION DISTRICT The Substance Abuse Prevention on Public Works Projects Act, 820 ILCS 265/1 et seq., ("Act") prohibits any employee of the Contractor or any Subcontractor on a public works project to use, possess or be under the influence of a drug or alcohol, as those terms are defined in the Act, while performing work on the project. The Contractor/Subcontractor [circle one], by its undersigned representative, hereby certifies and represents to the McHenry County Conservation District that [Contractor/Subcontractor must complete either Part A or Part B below]: A. The Contractor/Subcontractor [circle one] has in place for all employees not covered by a collective bargaining agreement that deals with the subject of the Act a written substance abuse prevention program, a true and correct copy of which is attached to this certification, which meets or exceeds the requirements of the Substance Abuse Prevention on Public Works Projects Act, 820 ILCS 265/1 et seq. [Contractor/Subcontractor must attach a copy of its substance abuse prevention program to this Certification.] Name of Contractor/Subcontractor (print or type) Name of Authorized Representative (print or type) Title of Authorized Representative (print or type) Signature of Authorized Representative Dated: B. The Contractor/Subcontractor [circle one] has one or more collective bargaining agreements in effect for all of its employees that deal with the subject matter of the Substance Abuse Prevention on Public Works Projects Act, 820 ILCS 265/1 et seq. Name of Contractor/Subcontractor (print or type) Name of Authorized Representative (print or type) Title of Authorized Representative (print or type) Signature of Authorized Representative Dated: 12 P a g e

13 ATTACHMENT B CONTRACTOR S CERTIFICATION FORM CERTIFYING COMPLIANCE WITH THE SEXUAL HARASSMENT PROVISION OF THE ILLINOIS HUMAN RIGHTS ACT MCHENRY COUNTY CONSERVATION DISTRICT The undersigned Contractor hereby certifies that as part of his/her/its bid/proposal on the above referenced Contract, that he/she/it has enacted and has in full force and effect a written sexual harassment policy in accordance with the Illinois Human Rights Act, 775 ILCS 5/2-105 et seq. ( ACT ) which includes, at a minimum, the following information: 1. A statement on the illegality of sexual harassment; 2. The definition of sexual harassment under State law; 3. A description of sexual harassment utilizing examples; 4. An internal complaint process, including penalties; 5. The legal recourse, investigation and complaint process available through the IL. Dept. of Human Rights ( Department ) and the Illinois Human Rights Commission ( Commission ); and 6. Protection against retaliation as provided by Section of the Act. A copy of the policy shall be provided to the IL. Dept. of Human Rights upon request. The undersigned Contractor further certifies that such policy shall remain in full force and effect throughout the term of the contract. Name of Contractor/Subcontractor (print or type) Name of Authorized Representative (print or type) Title of Authorized Representative (print or type) Signature of Authorized Representative Dated: 13 P a g e

14 ATTACHMENT C SPECIAL PROVISION FOR FREEDOM OF INFORMATION ACT CERTIFICATE OF COMPLIANCE WITH FREEDOM OF INFORMATION ACT MCHENRY COUNTY CONSERVATION DISTRICT Contractor agrees to maintain the records and documents for projects of the Public Body in compliance with the Freedom of Information Act, 5 ILCS 140/1 et seq. In addition, Contractor shall produce records which are responsive to a request received by the Public Body under the Freedom of Information Act so that the Public Body may provide records to those requesting them within the time frames required by law. If additional time is necessary to compile records in response to a request, then Contractor shall so notify the Public Body and if possible, the Public Body shall request an extension so as to comply with the Act. In the event that the Public Body is found to have not complied with the Freedom of Information Act based upon Contractor's failure to produce documents or otherwise appropriately respond to a request under the Act, then Contractor shall indemnify and hold the Public Body harmless, and pay all amounts determined to be due including but not limited to fines, costs, attorneys' fees and penalties. Name of Firm Signature Printed Name and Title Title Date 14 P a g e

15 ATTACHMENT D ANTICOLLUSION COMPLIANCE AFFIDAVIT COUNTY OF MCHENRY, ILLINOIS _ BEING FIRST DULY SWORN, DEPOSES AND SAYS: That he is of (Partner, Officer, Owner, etc.) (Company Name) The party making the foregoing proposal or bid/proposal, that such bid/proposal is genuine and not collusive, or sham; that said vendors has not colluded, conspired, connived or agreed directly or indirectly, with any vendors or person, to put in a sham bid/proposal or to refrain from bid/proposal, and has not in any manner, directly or indirectly, sought by agreement or collusion, or communication or conference with any person; to fix the bid/proposal price element of said bid/proposal, or of that of any other vendors, or to secure any advantage against any other vendors or any person interested in the proposed contract. Name of Vendor if Vendor is an INDIVIDUAL Name of Vendor if Vendor is a PARTNERSHIP Name of Vendor if Vendor is a CORPORATION The above statements must be subscribed and sworn to before a notary public. Subscribed and sworn to me this day of By: Signature of Authorized Representative {SEAL} 15 P a g e

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