To: Richmond University Medical Center 355 Bard Avenue Staten Island, New York 10310 BID FORM In compliance with your Invitation for Bids, the undersigned, (Name of firm, partnership or Corporation) hereby proposes to furnish all labor and materials and perform all work for the construction of the Replacement Emergency Department Early Demolition / Make-Ready in strict accordance with the Project Manual dated April 5, 2016, and the Drawings mentioned therein, and including any subsequently issued addenda for consideration of the following Guaranteed Maximum Price amount: Base Bid Dollars ($ ) Additionally, we propose to furnish all labor and materials and perform all work for the construction of the separate packages prepared by Bohler Engineering in strict accordance with those documents, and including any subsequently issued addenda for consideration of the following amounts: Demolition of Fitzpatrick Building: Base Bid _ Dollars $ ) Demolition of Villa Building: Base Bid _ Dollars $ ) Demolition of EMS Cottage Building: Base Bid _ Dollars $ ) Hereby the total of the four aggregate prices above for consideration is: Total Base Bid Dollars $ ) If written notice of the acceptance of this Bid is mailed, telegraphed, or delivered to the undersigned at any time prior to the date set for the expiration of the Bid Security, the undersigned will, within ten (10) days after the notice, execute and deliver a contract in accordance with the required Form of the Agreement and give Performance and Payment Bond, if so required, in accordance with the Bid as accepted. The undersigned hereby designates as his office to which such notice of acceptance may be mailed, telegraphed or delivered: This Bid may be withdrawn at any time prior to the scheduled time for the opening of Bids or any authorized postponement thereof. Caution: This Bid may be rejected if not accompanied by a guarantee in the specified amount. Any certified check may be held uncollected at risk of Bidders submitting them. Bids must be submitted in DUPLICATE. Addendum Receipt: The receipt of the following addenda to the Specifications is acknowledged: Addendum No. Date Addendum No. Date Addendum No. Date Addendum No. Date BID FORM 004100-1
Addendum No. Date Addendum No. Date Submittals, as required by the Instructions/Supplementary Instructions to Bidders, shall be completed and delivered to the Architect, by the three (3) low bidders, within three working days after the Bid opening. Dated, 2016 (Sign Bid Here) By: Legal Business Address: Legal name of person, partnership or corporation Name and Title Street Address City and State IF BIDDER IS A FIRM OR PARTNERSHIP, COMPLETE THE FOLLOWING: Name of Members or Partners Legal Residence IF BIDDER IS A CORPORATION, COMPLETE THE FOLLOWING: State of Incorporation: Name and Title President Vice President Secretary Legal Residence BID FORM 004100-2
DIRECTION FOR MAILING Envelopes containing Bids, Guarantees, etc., must be sealed, marked and addressed in lower left hand corner as follows: Bid For: Replacement Emergency Department Early Demolition/Make-Ready Address: Richmond University Medical Center 355 Bard Avenue Staten Island, New York 10310 Attention: Jorge Negron END OF BID FORM BID FORM 004100-3
CONFIRMATION OF ATTENDANCE AT A PRE-BID CONFERENCE OR SITE VISIT This will confirm my attendance at the Pre-Bid Meeting held at 10:00 A.M. on April 18 19, 2016 in Villa Buildingthe Fitzpatrick Conference Room, Richmond University Medical Center, 355 Bard Avenue, Staten Island, New York NAME OF FIRM ADDRESS CONTACT PERSON TELEPHONE NUMBER FAX NUMBER EMAIL ADDRESS NAME(S) OF ATTENDEES THIS FORM SHOULD BE FAXED TO: 718-818-2034 ATTN: Jorge Negron Purchasing and Supply Chain Management Richmond University Medical Center 355 Bard Avenue Staten Island, NY 10310 BID FORM 004100-4
NON-COLLUSIVE BIDDING CERTIFICATION Firm Name Business Address Telephone Number Date of Bid In accordance with Section 139-d of the State Finance Law, if this contract was awarded based upon the submission of bids, Contractor affirms, under penalty of perjury, that its bid was arrived at independently and without collusion aimed at restricting competition. Contractor further affirms, that, at the time Contractor submitted its bid, an authorized and responsible person executed and delivered to RUMC a non-collusive bidding certification on Contractor s behalf. 1. The prices of this bid have been arrived at independently, without collusion, consultation, communication, or agreement, for the purposes of restricting competition, as to any manner relating to such prices with any other Bidder or with any competitor; 2. Unless otherwise required by law, the prices which have been quoted in this bid have not knowingly been disclosed by the Bidder and will not knowingly be disclosed by the Bidder prior to opening, directly or indirectly, to any other Bidder or to any competitor; and 3. No attempt has been bake or will be made by the Bidder to induce any other person, partnership or corporation to submit or not to submit a bid for the purpose of restricting competition. 4. No attempt has been made or will be made by the Bidder to improperly communicate or consult with any employee or agent of RUMC, or to induce any agent or employee of RUMC, to gain an advantage which would restrict competition. A bid shall not be considered for award not shall any award by made where 1., 2.., 3., and 4. above have not been complied with; provided however, that if in any case the bidder(s) cannot make the foregoing certification, the Bidder shall so state and shall furnish below a signed statement which sets forth in detail the reasons therefore. Subscribed tounder penalty of perjury under the law of the State of New York, this day of, 2016 as the act and deed of said corporation / partnership. IF BIDDER(S) (ARE) A CORPORATION, COMPLETE THE FOLLOWING: NAME President Secretary Treasurer LEGAL RESIDENCE BID FORM 004100-5
Identifying Data: Potential Contractor: Address: Telephone: If applicable, Responsible Corporate Officer Name: Signature: Joint or combined bids by companies or firms must be certified on behalf of each participant. Legal Name of Person or Corporation: By: Address: City, ST: Legal Name of Person or Corporation: By: Address: City, ST: Legal Name of Person or Corporation: By: Address: City, ST: BID FORM 004100-6
AFFIRMATION Offeror affirms that it understands and agrees to comply with the procedures of Richmond University Medical Center relative to permissible Contacts as required by New York State Finance Law section 139-j and section 139j (6)(b). By: Date: Name: Title: Contractor Name: Contractor Address: BID FORM 004100-7
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