HomeMy WebLinkAbout2026 Pioneer Trail Rebid Grant Forms_Redacted BUILD AMERICA, BUY AMERICA CERTIFICATION
CONTRACTOR/APPLICANT:
The Contractor acknowledges to and for the benefit of the District ("Owner") and the California
Drinking Water State Revolving Fund (DWSRF) Program (the "Funding Authority") that it
understands the goods and services under this Agreement are being funded with federal
monies and have statutory requirements commonly known as "Build America, Buy America;"
that requires all of the iron and steel, manufactured products, and construction materials used in
the project to be produced in the United States ("Build America, Buy America Requirements")
including iron and steel, manufactured products, and construction materials provided by the
Contactor pursuant to this Agreement.
1, The'Contractor hereby represents and warrants to and for the benefit of the Owner and
Funding Authority:
a) The Contractor has reviewed and understands the Build America, Buy America
Requirements,
b) All of the iron and steel, manufactured products, and construction materials used in the
project will be and/or have been produced in the United States in a manner that
complies with the Build America, Buy America Requirements, unless a waiver of the
requirements is approved, and
c) The Contractor will provide any further verified information, certification or assurance
of compliance with this paragraph, or information necessary to support a waiver of the
Build America, Buy America Requirements, as may be requested by the Owner or the
Funding Authority.
CERTIFICATION
1, the official named below, hereby swear that I am duly authorized legally to bind the contractor
or loan recipient to the above described certification. I am fully aware that this certification,
executed on the date and in the county below, is made under penalty of perjury under the laws
of the State of California.
OFFICIAL'S NAME: Avst7,7 V,'4
DATE EXECUTED: EXECUTED IN COUNTY OF:
CONTRACTORJAPPLICANT SIGNATURE`
TITLE° ppes I-Cfe"i-
THIS PAGE LEST INTENTIONALLY BLANK
AMERICAN IRON AND STEEL CERTIFICATION
CONTRACTO R/APP LI CANT:
1. Identification of Amedcan-made Iron and Steel Consistent with the terms of the Purchasers bid solicitation,the
Bidder certifies that this bid reflects the Bidders best,good faith effort to identify domestic sources of iron and steel
for every component contained in the bid solicitation where such American-made components are available on the
schedule and consistent with the deadlines prescribed in or required by the bid solicitation.
2.Verification of U.S. Production:The Bidder certifies that all components contained in the bid solicitation that are
American-made have been so identified, and if this bid is accepted,the Bidder agrees that it will provide reasonable,
sufficient,and timely verification to the Purchaser of the U.S. production of every component so identified,
3, Documentation Regarding Non-American-made Iron and Steel:The Bidder certifies that for any component or
components that are not American-made and are so identified in this bid,the Bidder has included in or attached to
the bid one or both of the following, as applicable:
a. Identification of and citation to a categorical waiver published by the U.S. Environmental Protection Agency in the
Federal Register that is applicable to such component or components, and an analysis that supports its
applicability to the component or components.
b. Verifiable documentation sufficient to the Purchaser, as required in the bid solicitation or otherwise,that the
Bidder has sought to secure American made components but has determined that such components are not
available on the schedule and consistent\With the deadlines prescribed in the bid solicitation,with assurance
adequate for the Bidder under the applicable conditions stated in the bid solicitation or otherwise.
4. Information and Detailed Justification Regarding Non-American-made Iron and Steel:The Bidder certifies that for
any such component or components that are not so available,the Bidder has also provided in or attached to this bid
information, including but not limited to the verifiable documentation and a full description of the bidder's effort to
secure any such American-made component or components,that the Bidder believes are sufficient to provide and as
far as possible constitute the detailed justification required for a waiver under section 1605 with respect to such
component or components. The Bidder further agrees that, if this bid is accepted, it will assist the Purchaser in
amending, supplementing, or further supporting such information as required by the Purchaser to request and, as
applicable, implement the terms of a waiver with respect to any such component or components.
CERTIFICATION
1, the official named below, hereby swear that I am duly authorized legally to bind the contractor
or loan recipient to the above described certification. I am fully aware that this certification,
executed on the date and in the county below, is made under penalty of perjury under the laws
of the State of California.
OFFICIAL'S NAME� Aus C7!1
DATE EXECUTED- 6/4?19,6 EXECUTED IN COUNTY OF•
CONTRACTOR/APPLICANT SIGNATURE:
TITLE:
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CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND
VOLUNTARY EXCLUSION
CONTRACTOR/APPLICANT: 14#1 C_
(1) The contractor certifies, by submission of this proposal, that it and its principals:
(a)Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded by any Federal agencies-,
(b) Have not within a three year period preceding this proposal been convicted of or had a civil
judgment rendered against them for commission of fraud or a criminal offense in connection
with obtaining, attempting to obtain, or performing a public(Federal, State or local)transaction
or contract under a public transaction', violation of Federal or State antitrust statutes or
commission of embezzlement, theft;
forgery, bribery, falsification or destruction of records,
making false statements, or receiving stolen property-,
(c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental
entity (Federal, State or local)with commission of any of the offenses enumerated in paragraph
(1)(b) of this certification; and
(d) Have not within a three year period preceding this application/proposal had one or more
public transactions(Federal, State or local)terminated for cause or default.
(2)Where the contractor is unable to certify to any of the statements in this certification, such
contractor shall attach an explanation to this proposal*.
*Exceptions will not necessarily result in denial of award, but will be considered in determining
bidder responsibility. For any exception noted, indicate to whom it applies, initiating agency,
dates of action, and the type of violation,
CERTIFICATION
1, the official named below, hereby swear that I am duty authorized legally to bind the contractor
or loan recipient to the above described certification. I am fully aware that this certification,
executed on the date and in the county below, is made under penalty of perjury under the laws
of the State of California.
OFFICIAL'S NAME,
DATE EXECUTED: 1 4WA C, EXECUTED IN COUNTY OF:
CONTRACTORIAPPLICANT SIGNATURE
TITLES� 7res,-den
THIS IMAGE LEFT INTENTIONALLY I I
AD-1048 ONS No,0505-0027
Expiration Date:093012925
USDA Certification Regarding Debarment,%spension,Ineligibility and Voluntary Exclusion
Lower Tier Coiered Transactions
(bidwarg came rmt is made fn=OrdanCe Wad the Privacy Act of 1974(5 US 5629,as Omended),Tar.,cortifirabon is required by the regulaffOnO
iniina,manbkq Executive,Order 12549,Debamient and Suspension,and 2 CFR ff 18&3M f 80,33,5, The o9gulaIMS WOM
amended and pubfishad on Attguat 31,2005,in 70 r-ed,Reg,a 1 g65-5f 880,0itijea at the regiviabiris may be obtained by coritading the 00partmerd of
Agpeu?,uns-agency of ertreg the proposed covered traltsacgon
AccordmV to the Paperwork Redudiarr ACI of 1995,ag agency may not conduct possessor,eird a peopn o:not requ"d to rezpond b a col4ecton at
mrormabon unless 9 ditplays a vabd OMB control number,The valid OMB cordra number for this Inn irmaban cogerhoil is 0505-0027 7 ire Iline require dto
complete 671s kdonnatforr collsetton is estirmtedto avefage,0 mlnutesW raspanze,aidudirig ft vine farreverkag instructions,Searching existing data
scarres,gamemig andirravilarning Vie.data needed,and compipting andreviewing the collectionof nVormation-
cram fraud,privacy,and shier statutes may be apphcable to the n1ofmallon provided,
(Read instructions on page No before complefing CePtiflerI110".)
A, The prospective lower tier participant certifies,by suilinussion ofthis proposal,that neither it nor its principals is
presently debarred,suspended,proposed for debitt-went,declared ineligible,or voluntarily exchided from participation
m this transaction by any Federal deputment or agency-,
13 Where the pmspective lower to ParticiPant is juiable to certify to any of the state merits in fts certification,such
praspective participant Shall attach an explanation to tins proposal-
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(1) By signing and subtrutting this fonn-the Prospective lower tier Participant is providing the certificition set out on page I in
accordance with these instructions,
f 2) The certification in this clause is a material representation of fact upon which reliance was placed when this transaction Wa';
entered into,if it is later determined that the prospective lower tier participant knowingly rendered an erroneous rcertification.in
addition to other remedies available to the Federal the Departratem or agency with which this transaction ongimated
zaky pursue available remedies,urcluding suspension or debarment.
(3) The prospective lower tier participant must provide taunediate written notice to the person(s)to which this proposal is submitted
if at any time the prospective lower tier participant learns that its certification was erroneous when%mbutatied or his become
erroneous by reason of changed circunistaaces,
tit The,terms"covered transaction.""debarred,""suspeadeC'"ineligible-""low-er tier covered transaction,'"participant.""persoa,
."printary covered transaction,","principal,""proposal."and"voluntarily excluded."as used in this clause,have the meanings get
out in the Definitions and Coverage,sections of the roles implemendkq Executive Order 12549.,3t 2 CFR Pairs 180 and 417-Yon
inay contact the Department or agency to which this proposal is being submitted for assistance in obtaining a copy of those
regulations,
t'aa 1— e prospective lower tier p atti cipant agrees lay stAirni tting this fo no that,should the pi opo sed c overed tran sac ti on beentered
ono,it inay not Iratowinglyy enter into any lower tier covered transaction with a'person uho is debarred suspended.declared
ineligible,or voluntarily excluded fican participation in this covered transaction.unless authorized by the Departinew or agency
with which this transaction oirginate'd,
467 The piospective lower ties-participarn fitither agrees by submitting this form,that it will mclude this clait-W,titled"Certification
Regarding Debarment,Suspension,Ineligibility and Volmta*-Exclusion,-Lower Tier Covered Transactions,"without
modification,in all lower tier covered transactions and in all solicitations for lower tier covered transactions-
(7) A participant in a covered transaction may rely upon ace rtification of a prospective participant in a lower tier covered trarrsaction
that is not debarred.suspended,ineligible,or voluntarily excluded horn the covered transaction-unless it knows that the
cenification is erroneous,A participant may decide ffie itiethod and frequency by which it determines the eligibility of its
principals,Each participant may.but is not required to.check the General S-Mices Adminustration's System for Award
Management Exclusions database,
Nodmig contained in the foregoing shall be construed to require establishment of a system of records totender in good faith the
certification required b this clause,The lawsyledge,and information of a partic ipam is not required to exceed that which is
normally-possessed by a ltnxlein person in the ordinary cmse of busittess dealings-
(9) Except for tra,usaction s authorized tinder paragmph(5)of these instructions,if a participant na a covered transaction knowingly
enters into a lower tier covered transacts on with a person who is suspended,debarred.ineligible.or voluntarily excluded from
participation in this transaction,in addition to other remedies available to the Federal Governinent-the Dtp,,Wment or agracy
with which this transaction originated may pursue available remedies.including suspension and.)or debarment,
TEAS PAGE LEFT INTENTIONALLY BLANK
CERTIFICATION REGARDING LOBBYING
\ P
CONTRACTOR/APPLICANT: PI C-I a Qe-rf2N— C,,2,'1,$ C--f-v C92-On—t-X-n C
-J
The undersigned certifies to the best of his or her knowledge and belief that:
No federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee of
an agency, a Member of Congress, an officer or employee of Congress, or an employee of a
Member of Congress in conjunction with the awarding of any Federal contract, the making of
any Federal grant, the making of any Federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment, or modification of any
Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with this Federal contract, grant, loan or cooperative agreement, the
undersigned shall complete and submit Standard Form LLL, Disclosure Form to Report
Lobbying, in accordance with its instructions.
CERTIFICATION
1, the official named below, hereby swear that I am duly authorized legally to bind the contractor
or loan recipient to the above described certification. I am fully aware that this certification,
executed on the date and in the county below, is made under penalty of perjury under the laws
of the State of California.
OFFICIAL'S NAME: Aosrm
DATE EXECLITED� �H5Z-6 EXECUTED IN COUNTY OF
CONTRACTOR/APPLICANT SIGNATURE-,o-o-:::;��<'
TITLE: CcVe
DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB
Complete this form to disclose lobbying activities pursuant to 31 LIS-C. 1352 0349-0046
(See reverse for public burden disci ure.)
I Type of Federal Action: 2.Status of Federal Action: 3. Report Typo:
a. contract-I a.bid/offerlapplication a, initial filing b. grant 17b. initial award 11,111,11, b. material change
c. cooperative agreement G.post-award For Material Change Only:
. loan year_quarter
e. loam guarantee date of last report
f. loan insurance
4. Name and Address of Reporting Entk: 5.If Reporting Entity in No.4 is a Subaward e, Enter Name
Prime [:]Subawardee and Address of Prime:
Tier if known: 7
Congressional District, if known: Congressional District, i�known:
G. Federal DepartmentlAg ear cy: 7. Federal Program Narnelbescription:
CFDA Nurnber, if licebte:
8. Federal Action Number, if known: 9.Award Amou t if known:
$
10. a. Name and Address of Lobbying Registrant b. Individu a Performing Servioes(including address if
(if individual, last name, first name, Ml): differeM from No. I Oa
(la llnarne, first name, Ml):
z
11 lffomzlion roqu,:mt&d through this form is zuthalzed by Wo 31 U�S.0-motion 1362 Signature:
Tins dsotowre of k),b[tying wivities is s matwai represeritation of fao
mmich re1janco was placed by the ter above Oien this transadk)n was mad or
onts,red into. This dio;Josura is roquir6d purwu-arft to 31 U&t_ �13�152�. This Print Name:
irformatiori Will be reposed to the Congress semi-arinvally arrd)Niff pit av' bet for
publicirispecticn.Any person who faffs to fle Me rat disclosure s�rall o subject Title:
. I I
tale m Telephone No.: t)ate:
z
Authorized for Local Reproduction
Federal Use O my:
Standard Form LLL(Rev.7-97)
INSTRUCTIONS FOR COMPLETION OF SF-LLL,DISCLOSURE OF LOBBYING
ACTIVITIES
This disclosure form shall be completed by the reporting entity,whether subawardee or prime Federal reciipfenf,at the initiation or receipt of
a covered Federal action,or a material change to a previous filing,pursuant to title 31 U,S,C,section 1352,The filing of a form is required for
each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any
agency,a Member of Congress,an officer or employee of Congress,or an employee of a Member of Congress in connection with a covered
Federal action.Complete all items that apply for both the initial filing and material change report.Refer to the implementing guidance
published by the Office of Management and Budget for additional intimeation,
I, identify the type of covered Federal action for which lobbying activity is andlor has been secured to influence the outcome of a covered
Federal action.
2. Identify the status of the covered Federal action,
1 Identify the appropriate classification of this report. If this is a friflowup report caused by a material change to the information previously
reported,enter the year and quarter in which the change occurred,Enter the date of the last previously submitted report by this reporting
entity for this covered Federal action.
4, Enter the full name,address,city,State and zip code of the reporting entity,Include Congressional District, if known,Check the appropriate
classification of the reporting entity that designates if it is,or expects to be,a prime or subaward recipient.Identify the tier of the subawardee,
e,g.,the first subawardee of the prime is the 1 st tier.Subawards include but are not limited to subcontracts,subgrants and contract
awards under grants,
5, If the organization filing the report in item 4 checks"Subawardee,"then enter the full name,address,city,State and zip code of the prime
Federal recipient.Include Congressional District,if known,
6, Enter the name of the Federal agency making the award or loan commitment.Include at least one organizational level below agency narne,if
known,For example,Department of Transportation,United States Coast Guard.
7, Enter the Federal program name or description for the covered Federal action(item 1).If known,enter the full Catalog of Federal Domestic
Assistance(CFDA)number for grants,cooperative agreements,loans,and loan commitments,
& Enter the most appropriate Federal identifying number available for the Federal action identified in item I (e,g,,Request for Proposal
(RFP)number-,Invitation for Bid(1FS)number,grant announcement number;the contract,grant,or loan award number"the
applicationiproposal control number assigned by the Federal agency),Include prefixes,e.g,,"RFP-DE-90-001,"
9, For a covered Federal action where there has been an award or loan commitment by the Federal agency,enter the Federal amount of the
award/loan commitment for the prime entity identified in item 4 or 5,
10. (a)Enter the full name,address,city,State and zip code of the lobbying registrant under the Lobbying Disclosure Act of 1995 engaged by
the reporting entity identified in item 4 to influence the covered Federal action.
(b)Enter the full names of the individual(s)performing services,and include mil address if different from 10(a),Enter Last Name,First
Name,and Middle Initial(MI),
11, The certifying official shall sign and date the form,print his/her name,title,and telephone number,
According to the Paperwork Reduction Act,as amended,no persons are required to respond to a collection of information unless it displays a valid OMB Control
Number. The valid OMB control number for this information collection is 0108 No, 0348,-0046, Public reporting burden for this collection of information is
estimated to average 10 minutes per response,including time for reviewing instructions,searching existing data sources,gathering and maintaining the data
needed,and completing and revievAng the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of
information,including suggestions for reducing this burden,to the Office of Management and Budget,Paperwork Reduction Project(0348-0046),Washington,
DC 20503,
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CERTIFICATION OF NON-SEGREGATED FACILITIES
CONTRACTOR/APPLI CANT,
Environmental Protection Agency Region IX
75 Hawthorne Street
San Francisco, California 94105
(Applicable to federally assisted construction contracts and related subcontracts exceeding $10,000
which are not exempt from the Equal Opportunity Clause.)
The federally assisted construction contractor certifies that he does not maintain or provide for
his employees any segregated facilities at any of his establishments, and that he does not permit his
employees to perform their services at any location, under his control, where segregated facilities are
maintained. The federally assisted construction contractor certifies further that he will not maintain or
provide for his employees any segregated facilities at any of his establishments, and that he will not
permit his employees to perform their services at any location, under his control, where segregated
facilities are maintained. The federally assisted construction contractor agrees that a breach of this
certification is a violation of the Equal Opportunity Clause in this contract. As used in this certification,
the term "segregated facilities" means any waiting rooms, work areas, restrooms and wash rooms,
restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas,
transportation, and housing facilities provided for employees which are segregated by explicit directive
or are in fact segregated on the basis of race, creed, color, or national origin, because of habit, local
custom, or otherwise. The federally assisted construction contractor agrees that (except where he has
obtained identical certifications from proposed subcontractors for specified time period) he will obtain
identical certifications from proposed subcontractors prior to the award of subcontracts exceeding
$10,000 which are not exempt form the provisions of the Equal Opportunity Clause, and that he will
retain such certifications in his files.
CERTIFICATION
1, the official named below, hereby swear that I am duly authorized legally to bind the contractor or loan
recipient to the above described certification. I<am fully aware that this certification, executed on the
date and in the county below, is made under penalty of perjury under the laws of the State of California.
OFFICIAL'S NAME: AvsT7 fl Vi'*i r-t' fv"%.
DATE EXECUTED- EXECUTED IN COUNTY OF: CL� Do ro-do
CONTRACTOWAPPLICANT SIGNATURE,
TITLE: pra
NoteJhe penalty for making false statements in offers is prescribed in 18 U S.C. 1001
DRUG-FREE WORKPLACE CERTIFICATION
CONTRACTOR/APPLICANT:
The contractor or applicant named above hereby certifies compliance with Government Code Section
8355 in matters relating to providing a drug-free workplace. The above named contractor or applicant
will:
. Publish a statement notifying employees that unlawful manufacture, distribution, dispensation,
possession, or use of a controlled substance is prohibited and specifying actions to be taken against
employees for violations, as required by Government Code Section 8355(a).
2. Establish a Drug-Free Awareness Program as required by Government Code Section 8355(b), to
inform employees about all of the following:
to The dangers of drug abuse in the workplace,
(b) The person's or organization's policy of maintaining a drug-free workplace,
(c)Any available counseling, rehabilitation and employee assistance programs, and
(d) Penalties that may be imposed upon employees for drug abuse violations,
3, Provide as required by Government Code Section 8355(c), that every employee who works on
the proposed contract or loan,
to Will receive a copy of the compan)(s drug-free policy statement, and
(b) Will agree to abide by the terms of the company's statement as a condition of employment on
the contract or loan.
CERTIFICATION
1, the official named below, hereby swear that I am duty authorized legally to bind the contractor or loan
recipient to the above described certification. I am fully aware that this certification, executed on the
date and in the county below, is made under penalty of perjury under the laws of the State of California.
OFFICIAL'S NAME.,
DA E CUTER IN COUNTY OTE EXECUTED F,F 0
�Pp
CONTRACTOR/A LICANT SIGNATURE.
TITLE: Preil e-i+-
NON-DISCRIMINATION CLAUSE
CONTRACTOR/APPLICANT. t
t. Curing the performance of this contract, contractor and its subcontractors shall not unlawfully
discriminate against any employee or applicant for employment because of sex, race, religion,
color, notional origin; ancestry, physical disability (including HIV and AIDS), mental disability,
medical condition (cancer); marital status, age(over`40) or denial of family care leave.
Contractors and subcontractors shall insure that the evaluation and treatment of their employees
and applicants for employment are free of such discrimination and harassment. Contractors and
subcontractors shall comply with'the provisions of the Fair Employment and dousing Act
(Government Code Section 12900(a-fi et seq. and the applicable regulations promulgated
thereunder (California Administrative Code, Title 2, Section 7285.0 et sect.). The applicable
regulations of the Fair Employment and dousing Commission implementing Government code,
Section 12900(a-�, set forth in Chapter 5 of Division 4 of'Title 2 or the California Administrative
Code are incorporated into this contract by reference and made a peat hereof as if set forth in
full, Contractor and its subcontractor shall gigs written notice of their obligations under this
clause to labor organizations with which they have a collective bargaining or other agreement.
1 The contractor shall include:the nondiscrimination and compliance provisions of this clause in all
subcontracts to perform work under the contact.
CERTIFICATION
1,the official named below, hereby swear that I am duly authorized legally to bind the contractor or loan
recipient to the above described certification. l hereby certify that the Contractor will abide by the above
requirements. I am fully aware that this certification, executed on the date and in the county below, is
made under penalty of perjury under the laves of the Mate of California.
OFFICIAL'S IMAM
ATE EXECUTE EXECUTED IN COUNTY OF.
CONTRACTO
TITLE: