The following documentation is an electronicallysubmitted vendor response to an advertised solicitation from the West Virginia Purchasing Bulletin

Transcription

1 The following documentation is an electronicallysubmitted vendor response to an advertised solicitation from the West Virginia Purchasing Bulletin within the Vendor Self Service portal at wvoasis.gov. As part of the State of West Virginia s procurement process, and to maintain the transparency of the bid opening process, this documentation submitted online is publicly posted by the West Virginia Purchasing Division at WVPurchasing.gov with any other vendor responses to this solicitation submitted to the Purchasing Division in hard copy format.

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3 Purchasing Division 2019 Washington Street East Post Office Box Charleston, WV State of West Virginia Solicitation Response Date issued Proc Folder : Solicitation Description : Addendum 01 City of War Portals Proc Type : Central Purchase Order Solicitation Closes Solicitation No Version :30:00 SR 0313 ESR VENDOR A&A ENERGY INC FOR INFORMATION CONTACT THE BUYER Beth Collins (304) beth.a.collins@wv.gov Signature X FEIN # DATE All offers subject to all terms and conditions contained in this solicitation Page : 1 FORM ID : WV-PRC-SR-001

4 1 Mobilization & Demobilization LS $8, $8, (Cannot be more than 10% of Total Amount Bid) 2 Construction Layout LS $4, $4, (Cannot be more than 5% of Total Amount Bid) 3 Quality Control LS $2, $2, (Cannot be more than 3% of Total Amount Bid) 4 Site Preparation LS $6, $6, (Cannot be more than 10% of Total Amount Bid) Page : 2

5 5 Gravel Trail Rehabilitation (6' wide x 3" deep) TON $ $12, Gravel Trail Rehabilitation (6' wide x 3" deep) 6 Silt Fence Sediment Control LF $ $1, Silt Fence Sediment Control 7 Stabilized Construction Entrances 70' x 12' width) TON $ $2, Stabilized Construction Entrances 70' x 12' width) 8 Revegetation LS $2, $2, Revegetation Page : 3

6 9 Low Water Crossing EA $2, $0.00 Inactive Line no longer a bidable line item 10 4' x 4' Splash Pad EA $ $ ' x 4' Splash Pad 11 Dry MineSeal with Gravel Bulkhead (Portals 5, 8, 11) EA $3, $9, Dry MineSeal with Gravel Bulkhead (Portals 5, 8, 11) 12 Mine Seal Bulkhead for Bat Gate Seal (Portals 3,6,7 & 9) EA $3, $12, Mine Seal Bulkhead for Bat Gate Seal (Portals 3,6,7 & 9) Page : 4

7 13 Mine Seal Bulkhead for Bat Gate Seal (Portal 10) EA $4, $4, Mine Seal Bulkhead for Bat Gate Seal (Portal 10) 14 36" HDPE Bat Gate Mine Seal Pipe (Portals 3,6,7, & 9) LF $ $6, " HDPE Bat Gate Mine Seal Pipe (Portals 3,6,7, & 9) 15 60" HDPE Bat Gate Mine Seal Pipe (Portal 10) LF $ $6, " HDPE Bat Gate Mine Seal Pipe (Portal 10) 16 36" HDPE Mine Seal Bat Gate EA $1, $6, " HDPE Mine Seal Bat Gate Page : 5

8 17 60" HDPE Mine Seal Bat Gate EA $3, $6, " HDPE Mine Seal Bat Gate Page : 6

9 ADDENDUM ACKNOWLEDGEMENT FORM SOLICITATION NO.: Instructions: Please acknowledge receipt of all addenda issued with this solicitation by completing this addendum acknowledgment form. Check the box next to each addendum received and sign below. Failure to acknowledge addenda may result in bid disqualification. Acknowledgment: Ihereby acknowledge receipt of the following addenda and have made the necessary revisions to my proposal, plans and/or specification, etc. Addendum Numbers Received: (Check the box next to each addendum received) [vf Addendum No.1 Addendum No.2 Addendum No.6 Addendum No.7 Addendum No.3.[ Addendum No.8 Addendum No.4 Addendum No.9 [ Addendum No.5 Addendum No. 10 Iunderstand that failure to confirm the receipt of addenda may be cause for rejection of this bid. I further understand that any verbal representation made or assumed to be made during any oral discussion held between Vendor's representatives and any state personnel is not binding. Only the information issued in writing and added to the specifications by an official addendum is binding. -~-,----L()-15 Date NOTE: This addendum acknowledgement should be submitted with the bid to expedite document processing. Revised 6/812012

10 WV-73 Rev. 08/2013 State of West Virginia DRUG FREE WORKPLACE CONFORMANCE AFFIDAVIT West Virginia Code 21-1D-S STATE OF WEST VIRGINIA, COUNTY OF ~, TO-WIT: I, ~ 'N A/o.,t.dllcc!,..,o ir----, after being first duly sworn, depose and state as follows: 1. I aman em ployee of _-'-f\--'12~:..l~'------\e""'nel...llo.1llil------; and, (~ny Name) 2. I do hereby attest that ~--'E-...",rr.-"-'-Di1l-'+-'= ~YName) maintains a valid written drug free workplace policy and that such policy is in compliance with West Virginia Code 21-1D. COmpanYName:~~~~~t~n~~~P4 Date: _q--=------l'_cll-----=-'i::::>=.- Taken, subscribed and sworn to before me this ~day of.&.p.\e.mtef, At)(5 By Commission expires ~M.Ptr \~. do JO (Seal OFFICIAL SEAL STATE OF WEST VIRGINIA NOTARY PUBLIC NICOLE L. HICKS McBRIDE ACCOUNTING 151 STEWART ST. WELCH, WV ~cl,gtlkcll.t. (N tary Public) ITHI::I.UIS~~EWWal3a:l:x:l'~~ ED WITH THE BID IN ORDER TO COMPLY WITH WV CODE PROVISIONS. FAILURE TO INCLUDE THE AFFIDAVIT WITH THE BID S.HALL RESULT IN DISOUALIFICATION OF THE BID. Rev. August 2013

11 STATE OF WEST VIRGINIA Purchasing Division PURCHASING AFFIDAVIT MANDATE: Under W. Va. Code 5A-3-10a, no contract or renewal of any contract may be awarded by the state or any of its political subdivisions to any vendor or prospective vendor when the vendor or prospective vendor or a related party to the vendor or prospective vendor is a debtor and: (1) the debt owed is an amount greater than one thousand dollars in the aggregate; or (2) the debtor is in employer default. EXCEPTION: The prohibition listed above does not apply where a vendor has contested any tax administered pursuant to chapter eleven of the W. Va. Code, workers' compensation premium, permit fee or environmental fee or assessment and the matter has not become final or where the vendor has entered into a payment plan or agreement and the vendor is not in default of any of the provisions of such plan or agreement. DEFINITIONS: "Debt" means any assessment, premium, penalty, fine, tax or other amount of money owed to the state or any of its political subdivisions because of a judgment, fine, permit violation, license assessment, defaulted workers' compensation premium, penalty or other assessment presently delinquent or due and required to be paid to the state or any of its political subdivisions, including any interest or additional penalties accrued thereon. "Employer default" means having an outstanding balance or liability to the old fund or to the uninsured employers' fund or being in policy default, as defined in W. Va. Code 23-2c-2, failure to maintain mandatory workers' compensation coverage, or failure to fully meet its obligations as a workers' compensation self-insured employer. An employer is not in employer default if it has entered into a repayment agreement with the Insurance Commissioner and remains in compliance with the obligations under the repayment agreement. "Related party" means a party, whether an individual, corporation, partnership, association, limited liability company or any other form or business association or other entity whatsoever, related to any vendor by blood, marriage, ownership or contract through which the party has a relationship of ownership or other interest with the vendor so that the party will actually or by effect receive or control a portion of the benefit, profit or other consideration from performance of a vendor contract with the party receiving an amount that meets or exceed five percent of the total contract amount. AFFIRMATION: By signing this form, the vendor's authorized signer affirms and acknowledges under penalty of law for false swearing (w. Va. Code ) that neither vendor nor any related party owe a debt as defined above and that neither vendor nor any related party are in employer default as defined above, unless the debt or employer default is permitted under the exception above. WITNESS THE FOLLOWING Vendor's Name: SIGNATURE: !..> -'--'---#---\..,., ~~'f-- ::iiji ' ~~ State of Date: _Q~--'-I_')L...--'-/='5' _ -l~~~ -\Ll4-1.IJLU.A County of MCOo,I1U I ' to-wit: Taken, subscribed, and sworn to before me this ~ay My Commission expires~{yl.bif \3 AFFIX SEAL HERE Of\..~""""'~~: -l~i'i\""h("'i,l(, 2~ NOTARY PUBL~... r.opfi~ial SeA\. STATe OF WEST VIRGINIA NOTARY PUBLIC NICOLE L. HICKS McBRIDE ACCOUNTING ';51 STEWART ST. WELCH WV M'Ycommission expi;es September 13,2020 ' 20j5 ~OOMM~i})~Purchasing Affidavit (Revised )

12 cljic an RU Company Contractors Bonding and Insurance Company P.O. Box 3967 Peoria IL Phone: (309) Fax: (309) POWER OF ATTORNEY Contractors Bonding and Insurance Company Bond No. LSM Know All Men by These Presents: That the Contractors Bonding and Insurance Company, a corporation organized and existing under the laws of the State of Illinois, and authorized and licensed to do business in all states and the District of Columbia does hereby make, constitute and appoint: Luther Ernest McFaddin Jr. in the City of Honaker, State of Virginia, as Attorney In Fact, with full power and authority hereby conferred upon him/her to sign, execute, acknowledge and deliver for and on its behalf as Surety, in general, any and all bonds, undertakings, and recognizances in an amount not to exceed Ten Million and 00/100 Dollars ( $10,000, ) for any single obligation, and specifically for the following described bond. Principal: A & A Energy, Inc. Obligee: West Virginia Department of Administration Purchasing Div Bond Amount: ~5u~~o~o~f~T~o~t~a~I~A~m~o~u~n~t~B~id~ _ The Contractors Bonding and Insurance Company further certifies that the following is a true and exact copy of a Resolution adopted by the Board of Directors of Contractors Bonding and Insurance Company, and now in force to-wit: "All bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation shall be executed in the corporate name of the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or Agents who shall have authority to issue bonds, policies or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may be printed by facsimile." IN WITNESS WHEREOF, the _----'C:::..o;::.;n::.t;:.:r-=a""c~to::..:r:..:s'_'B=on=d;:.:in;:.zg:o...:::a:.:n_=d...:I:.:;n""s_=u"'_r::.a:.:n.;;.ce~C,-,o:..::m=-o::cp.:; has caused these presents to be executed by its Vice President with its corporate seal affixed this 16th day of September 2015 ATTEST: Contractors Bonding and Insurance Company ssistant Secretary Barton W. Davis Vice President On this ~ day of September, 2015 before me, a Notary Public, personally appeared Barton W. Davis and Cherie L. Montgomery, who being by me duly sworn, acknowledged that they signed the above Power of Attorney as Vice President and Assistant Secretary, respectively, ofthe said Contractors Bondinl: and Insurance Company, and acknowledged said instrument to be the voluntary act and deed of said corporation.

13 Agency WV DEP REQ.P.O#_1_72_64 _ BID BOND KNOW ALL MEN BY THESE PRESENTS, That we, the undersigned, _A_&_A_E_n_e_r_gy_,_I_nc_. _ of 151 Stewart Street Welch, WV 24801, as Principal, and Contractors Bonding and Insurance Company of Peoria Illinois, a corporation organized and existing under the laws of the State of_ Illinois with its principal office in the City of Peoria, as Surety, are held and firmly bound unto the State of West Virginia, as Obligee, in the penal sum of 5 % of bid ($ 5% ) for the payment of which, well and truly to be made, we jointly and severally bind ourselves, our heirs, administrators, executors, successors and assigns. The Condition of the above obligation is such that whereas the Principal has submitted to the Purchasing Section of the Department of Administration a certain bid or proposal, attached hereto and made a part hereof, to enter into a contract in writing for DEP17264 City of War Portals NOW THEREFORE, (a) If said bid shall be rejected, or (b) If said bid shall be accepted and the Principal shall enter into a contract in accordance with the bid or proposal attached hereto and shall furnish any other bonds and insurance required by the bid or proposal, and shall in all other respects perform the agreement created by the acceptance of said bid, then this obligation shall be null and void, otherwise this obligation shall remain in full force and effect. It is expressly understood and agreed that the liability of the Surety for any and all claims hereunder shall, in no event, exceed the penal amount of this obligation as herein stated. The Surety, for the value received, hereby stipulates and agrees that the obligations of said Surety and its bond shall be in no way impaired or affected by any extension of the time within which the Obligee may accept such bid, and said Surety does hereby waive notice of any such extension. IN WITNESS WHEREOF, Principal and Surety have hereunto set their hands and seals, and such of them as are corporations have caused their corporate seals to be affixed hereunto and these presents to be signed by their proper officers, this 16th day of September, 20~. A & A Energy, Inc. ~~..L----- (Name of Principal) h'. (Must be President or Vice President) President (Title) Surety Corporate Seal Contractors Bonding and Insurance Company (Name of Surety)..,..._ ~~~j.-~ _.~~~.r= ~~J v - '"; <:.../ ~~~.L7!;/~ Attorney-i n-~ _ i!c;-~~~::.,/,-<:~::\ ---'g ~ z: :IMPQ.RtANT --SuretY:e e@ting bonds must be licensed in West Virginia to transact surety insurance. Raised corporate seals :: :: :must b~f!~ed,.ilpo:,,~ ~ attorney must be attached. - ~....., - '-' ;"'" ~." , v ~ ~ v...,.,. ~ -...,;-- '"..., ~. 'to......;'v J

14 Instructions for Completing AML Contractor Form OMB #1029..(J11!J! Part A: General Information., Part B: Legal Strudnre. Part A should be completed by the AM.,Contractor. Part B sbould be'completed by the AML Cu1raetor. Part C: Certifying and updating information in the ApplicantlViofJItorSystem (AVS). Part C should be completed by the AML Cootractor, selecting the statement that best deserfbes their situation, If information is accurate, complete and up-to-date, then check the fint state~ent and sign and date. Attacb the Entity OFf printout to the OMB # form and snl:nnittile form and attacbment to the AML Contracting Officer your business i.sworking with. 1. Upon reviewing an Entity OFf printont, ilyou discover the information contained in AVS is Dot accurate, complete and up-to-date, then cheek the second statemelt ud complete Part D to provide missing or corrected idfol'dultionthat needs reflected in AVS. Auacl!ilieEntity OFf printout toth!j OMB # form and submit the form and attadunent to the AMLContracling Officer your business is work:ing with.. H your bosiness does not appear to have any iid'ormation in AVS, tlleu elieek the third stammeut and complete Part D. Submit the OMB # form to tbe AML Colltracting Oftieeryour business is working with. PartD: H eoitent Entity OFT information for your business is incomplete, ileorreet, or if you believe there is no information eiureoily in the AVS for your business, you IIlSt complete Part D. Submit the OMB # form to the AML Contracting Officer your bllsillessis working with. lfyou need any assistance comp[~ OMB # , please contact the AVSOffice1lt You may obtain your business' Entity OFT for certificalion purposes two ways. flle way is to mntant the AVS Office at and request the information. The second way is to access the AVS from}'ollt personal COmputer by visiting hw:llavss.osmre.gov. Click "Access AVS". and then Login as Guest. Place YOUl"C1lISQrOllihe "Entity" Module and ''Click''. Type your business name in search box and press enter key. If more Ibllll oneentity record appears, select your company and then "Cliclr' on the ''relationship'' tab to display your Entity OFT inful1llatin. Print the Entity OFT from AVS. I 2

15 OMB # Expiration Date: 1131/16 AML CONTRACTOR INFORMATION FORM You must complete this form for your AMI.. contracting oftker to request an eligibility evaluation from the Office of Surface Mining to determine if you are eligible to receive an AML contract. Thjs requirement applies to contractors and their sub-c::outractors and is found under OSM's regulatiods at 30 CFR When pos.sible, please type your infofdlation onto this form to reduce errors on ouren.ct. NOTE:' Sign.ture.iid date ihisform is signed must be recent (within tile last mttnth) to be considetedfor a.current bid Part A: Generalln.formation Business Name: ---e~'h'-.l:l'~""-a..!~~---- TaxPayer ID No.: 06- D'JOO I :?>/ Address:.~\5~l,----"...,QI.~I:J..L..'~U".l..I"T'"lr""'l ---"'-:-::-_---:-_-=-_-:=-::-~ City: \J\lkh State: Zip Code:~~c-...,.;Phone:.2df- Q.Q.t>-~ lij FaxNO::&&42i Q.;5\ II address: 1.(tJ-M. Part B: Legal Structure ( ) Corporation () Sole Proprietorship ( ) Partnership ( )LLC ( ) Other (please specify) _ Part C: Certifying and updating information in the ApplicantNiolator System (AVS). Select only one of the following options, follow the instructions for that option, and sign below. 1,.s...bMJ,j,~ \o~'),,llq.da lr,have the express authority to certify that: (print name) 1.,/ Information on the attached Entity Organizational Family Tree (OFT) from AVS is accurate, --complete, and up-to-date. If you select this option, you must a.ttach an Entity OFT from AVS to this form. Sign and date below and do D.Q!complete Part D. 2. Part of the information on the attached Entity OFT from A VS is missing or incorrect and must --be updated. If you select this option, you must attach an Entity OFT from AVS to this form. Use Part D to provide the missing or corrected information. Sign.and date below and complete PartD. 3. Our business currently is not listed in AVS. If you select this option, you must provide all information required in P. Sign and date below and complete Part D. 9-{IJ-\'o ~. Drt)\dw- Date SIgnature. Title IMPORTANT! In or,v certify in Part C to the accuracy of existijlg information in AVS, you must obtain a copy of your business' Entity OFf. To obtain an Entity OFf, contact the AVS Office, toll-free, at or from the AVS website at I

16 PartD. Contractor's Business Name:..fu A r'f(9j-j~t\l..itle--a----- If the current Entity OFT information for your business is incomplete or incorrect in AVS, or ifthere is no information in A VS for your business, you must provide all of the following information as it applies to your business. Please make as many copies of this page as you require. Every officer (President, Vice President, Secretary, Treasurer, etc.); All Directors; All persons performing a function similar to a Director; Every person or business that owns 10% or more of the voting stock in your business; Every partner, if your business is a partnership; Every member and manager, if your business is a limited liability company; and Any other person(s) who has the ability to determine the manner in which the AML reclamation project is being conducted. Name Address Begin Date: Name Address Begin Date: Name Address Begin Date: Name Address Begin Date: Position/Title Telephone # % of Ownership Ending Date: PositiontTitle Telephone # % of Ownership Ending Date: PositiontTitle Telephone # % of Ownership Ending Date: Position/Title Telephone # % of Ownership Ending Date: PAPERWORK REDUCTION STATEMENT The Paperwork Reduction Act of 1995 (44 U.S.C. 3501) requires us to inform you that: Federal Agencies may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. This information is necessary for all successful bidders prior to the distribution of AML funds, and is required to obtain a benefit. Public reporting burden for this form is estimated to range from 15 minutes to 1 hour, with an average of 22 minutes per response, including time fur reviewing instructions, gathering and maintaining data, and completing and reviewing the form. You may direct comments regarding the burden estimate or any other aspect of this fonn to the Information Collection Clearance Officer, Office of Surface Mining Reclamation and Enforcement, Room 202 SIB, Constitution Ave., NW, Washington, D.C

17 AVS OFT Report - 5/28/2015 8:30:41 AM All OFT's where the selected entity is listed as an entity or related entity Entity Selected (132480) A & A Energy Inc Parent Entity Description ExtDesc Related Entity % Begin Date Ownership (132480) A & A Energy Inc Director (132481) James Wesley Addair 9/9/1993 End Date (132480) A & A Energy Inc Owner (132481) James Wesley Addair 100% 8/1/1990 (132480) A & A Energy Inc President (132481) James Wesley Addair 9/1/1993 (132480) A & A Energy Inc Secretary (132482) Kimberly K Addair 9/1/1993 (132480) A & A Energy Inc Treasurer (132482) Kimberly K Addair 9/8/ of 1