HomeMy WebLinkAboutEntrance Road Rehabilitation Project
NEW YORK STATE DEPARTMENT OF LABOR
Bureau of Public Work -Debarment List
2019 AC 150/5370-1OH
ASTM G153 Standard Practice for Operating Enclosed Carbon Arc Light Apparatus for
Exposure of Nonmetallic Materials
ASTM G154 Standard Practice for Operating Fluorescent Ultraviolet (UV) Lamp
Apparatus for Exposure of Nonmetallic Materials
ASTM G155 Standard Practice for Operating Xenon Arc Light Apparatus for Exposure
of Nonmetallic Materials
Federal Specifications (FED SPEC)
FED SPEC RR-F-191/3 Fencing, Wire and Post, Metal (Chain-Link Fence Posts, Top Rails and
Braces)
FED SPEC RR-F-191/4 Fencing, Wire and Post, Metal(Chain-Link Fence Accessories)
FAA Standard
FAA-STD-019 Lightning and Surge Protection, Grounding, Bonding and Shielding
Requirements for Facilities and Electronic Equipment
FAA Orders
5300.38 AIP Handbook
END OF ITEM F-162
Item F-162 Chain-Link Fence TS F-162-6
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COMPANIESO
CONTRACT D I
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UNV , FORT E TR TI F
AIRPORT NTRANC ROAD R ABI ITATION
QUANTITIES FOR CANVAS OF BIDS
ITEM FAA
NO SPEC DESCRIPTION QUANTITY UNITS I AB T Fl D AIRPORT
1 C-105 MOBILIZATION (8% MAX) 1 LS
2 C-106 SAFETY, SECURITY AND MAINTENANCE OF TRAFFIC 1 LS
3 P-152 UNCLASSIFIED EXCAVATION 625 CY
4 P-209 SEPARATION GEOTEXTILE 1,500 SY OB8
5 P-214 CRUSHED AGGREGATE BASE COURSE 500 CY
6 P-403 BITUMINOUS SURFACE COURSE 450 TON
7 P-603 BITUMINOUS TACK COAT 75 GAL TOWN OF SOUTHOLD
8 P-605 JOINT SEALING 900 LF
9 D-751 DRAINAGE STRUCTURES TO BE CLEANED 5 EACH
10 D-751 CONCRETE GUTTERS TO BE CLEANED WI81LF FISHERS ISLAND, NEWYORK
11 F-162 24-FOOT DOUBLE SWING GATE 1 1 EACH
FAA AIP PROJECT NO.: 3-36-0029-023-18 (D)
3-36-0029-XXX-20 (C)
NYSDOT PIN: 0913.23 (D)
0913.XX (C)
C&S PROJECT: 211.019.001
0
MAY 2020
0
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CONNECTICUT I
RHODE ISLANDBID DOCUMENTS
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DRAWING LIST
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SHEET NO. SHEET NAME
GI-001 TITLE SHEET
- GI-002 GENERAL NOTES, LEGEND, ABBREVIATIONS & SITE PLAN ���� �5 J�0in
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ELIZABETH ISLAND GC-101 GENERAL AND CONSTRUCTION SAFETY PHASING PLAN * ���
CG-101 GRADING PLAN & PROFILE
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° FIELD BLOCK ISLAND CG-102 DRAINAGE IMPROVEMENT PLAN � 1\
W LONG ISLAND SOUND AIRPORT CG-501 ENTRANCE ROAD TYPICAL SECTION & DETAILS �A��FESSI01�
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TO THE BEST OF OUR KNOWLEDGE,INFORMATION AND BELIEF
c THE PLANS AND SPECIFICATIONS FOR THIS PROJECT ARE IN
LONG ISLAND COMPLIANCE WITH THE NEW YORK STATE ENERGY
CONSERVATION CONSTRUCTION CODE AND THE BUILDING
CODE OF NEW YORK STATE
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N NO ALTERATION PERMITTED HEREON EXCEPT AS PROVIDED
ATLANTIC OCEAN UNDER SECTION 7209 SUBDIVISION 2 OF THE NEW YORK
0 STATE EDUCATION LAW
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Copyright
2 3 4
—R— EXISTING AIRPORT PROPERTY LINE
EXISTING EDGE OF WATER
EXISTING EDGE OF WOODS Cl
EXISTING CONIFEROUS TREE COS
COMPANIES
EXISTING DECIDUOUS TREE
• ••••••••• 19 ••••••••• EXISTING CONTOUR LINE 1. THESE DRAWINGS HAVE BEEN PREPARED,IN PART,BASED UPON RECORD DRAWINGS AND/OR CAD FILES
FURNISHED BY OTHERS. WHILE THIS INFORMATION IS BELIEVED TO BE RELIABLE,THOSE UTILIZING THE C&S Engineers Inc.
— —24"RCP— — EXISTING DRAINAGE LINE INFORMATION ON THESE DRAWINGS ARE ADVISED TO OBTAIN INDEPENDENT VERIFICATION OF ITS
ACCURACY BEFORE USING IT FOR ANY PURPOSE. ��P`��' 499 COI. Eileen Collins Blvd.
— — 6"UD — — EXISTING UNDERDRAIN �\�\S�� Syracuse, New York 13212
Phone: 315-455-2000
0 C EXISTING UNDERDRAIN CLEANOUT 2. EXISTING UTILITIES WERE TAKEN FROM PLANS OF RECORD&TOPOGRAPHIC SURVEY. THEY HAVE BEEN UP Fax. 315-455-9667
SHOWN TO THE EXTENT KNOWN AND ARE OFFERED IN GOOD FAITH SOLELY FOR INFORMATIONAL www.cscos.com
®CB 91 EXISTING CATCH BASIN PURPOSES. THEY MAY NOT REFLECT ACTUAL LOCATIONS AND MAY NOT BE INCLUSIVE. IT IS THE
CONTRACTOR'S RESPONSIBILITY TO LOCATE ALL UTILITIES PRIOR TO THE START OF CONSTRUCTION. EPQ\
@DMH EXISTING DRAINAGE MANHOLE ti
EXISTING HEADWALL 3. THE ACTUAL LOCATION AND ELEVATION OF ALL UTILITIES SHALL BE FIELD VERIFIED BY THE / ti OF NEW
CONTRACTOR PRIOR TO THE START OF CONSTRUCTION. NS J. Hp 10
u EXISTING PIPE END SECTION C�
—W-6" EXISTING WATER LINE
4. IN THE EVENT OF DAMAGE TO EXISTING UTILITIES OR CABLES CAUSED BY THE CONTRACTOR'S
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CONSTRUCTION OPERATIONS,THE ENGINEER AND OWNER SHALL BE NOTIFIED IMMEDIATELY. UP/ w
AD\ EXISTING HYDRANT �
®WV EXISTING WATER VALVE 5. THE CONTRACTOR SHALL REPAIR ALL DAMAGE TO UTILITIES OR CABLES CAUSED BY THE CONTRACTOR'S lj �p 0820 1\ w�Cti
CONSTRUCTION OPERATIONS,AS DIRECTED BY THE ENGINEER,IMMEDIATELY AND AT THE ���FES S 10' �
12 AN EXISTING SANITARY LINE CONTRACTOR'S SOLE EXPENSE. /
@SMH EXISTING SANITARY MANHOLE 6. ALL AREAS DISTURBED AS A RESULT OF THE CONTRACTOR'S STAGING AND CONSTRUCTION
— OHE — — — —OHE — EXISTING OVERHEAD ELECTRIC LINE OPERATIONS SHALL BE RESTORED EQUAL TO OR BETTER THAN ORIGINAL CONDITION AT THE / �``0` SU(/lyo
CONTRACTOR'S SOLE EXPENSE. `'� '7
SUP EXISTING UTILITY POLE � �� lO
7. ALL DIRT,DUST,STONES AND LOOSE DEBRIS SHALL BE CONTINUOUSLY REMOVED FROM ALL PAVED / UP
EXISTING GUY WIRE AND ANCHOR SURFACES DURING THIS CONTRACT.
® EXISTING BOLLARD OR POST
/ • �O
�- EXISTING SINGLE POST TRAFFIC SIGN 8. THE CONTRACTOR SHALL RECONSTRUCT AND MAINTAIN EXISTING ACCESS ROADS AS REQUIRED FOR � COI'
ACCESS TO THE WORK AREAS,PARTICULARLY WHISTLER AVE.&THE VEHICLE PARKING LOT. �/ U
n EXISTING DOUBLE POST TRAFFIC SIGN / PROPOSED WORK LIMITS
9. ALL OF THE CONTRACTOR'S OPERATIONS SHALL REMAIN ON AIRPORT PROPERTY AT ALL TIMES.UNDER �
oIR-2 EXISTING SURVEY BASELINE POINT NO CIRCUMSTANCES WILL THE CONTRACTOR BE ALLOWED ON ADJACENT PROPERTY.
EXISTING SURVEY CONTROL POINT 10. THIS CONTRACT DOES NOT ALLOW FOR PRICE INCREASES DUE TO ESCALATION IN COST OF UNIT BID O
EXISTING BENCHMARK LOCATION ITEMS. THE CONTRACTOR SHALL TAKE THIS INTO CONSIDERATION WHEN PREPARING UNIT PRICES FOR
+BM BID.
443 PROPOSED CONTOUR LINE CD
UP
443.2 PROPOSED INTERMEDIATE CONTOUR LINE 11. ALL SPOIL SHALL BE DISPOSED OF OFF-SITE AT THE CONTRACTORS EXPENSE. M
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443.2 PROPOSED SPOT ELEVATION 12. ITEMS OF SPECIFIC MANUFACTURE SHALL BE INSTALLED IN STRICT ACCORDANCE WITH AIRPORT DRIVE o�� _ m
MANUFACTURER'S PRINTED INSTRUCTIONS AND OR MANUFACTURER'S REPRESENTATIVE DIRECTIONS. _ _ — _ O Q Q
PROPOSED HMA PAVEMENT 0 — CLW J 0
13. THE CONTRACTOR'S SPECIAL ATTENTION IS DIRECTED TO THE PROTECTION OF EXISTING PAVED _ /
MUNICIPAL ROADS LEADING TO THE PROJECT SITE FROM DAMAGE CAUSED BY CONSTRUCTION VEHICLE j O
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EXISTING CONCRETE ACTIVITY.DAMAGE CAUSED BY THE CONTRACTOR'S CONSTRUCTION VEHICLES TO LOCAL AND/OR r \ /
8 a a PAVEMENT TO REMAIN AIRPORT ROADS AND PARKING AREAS DURING THE COURSE OF CONSTRUCTION SHALL BE REPAIRED AT r _ CI Q = W
THE CONTRACTOR'S SOLE EXPENSE.
J O O W
———————— WORK AREA LIMITS I \ \ / Z
� — � \ \ UP � SPOIL AREA (n
14. SURVEY AND MAPPING BASED ON FIELD INSTRUMENT TOPOGRAPHIC SURVEY BY THEW ASSOCIATES, \ \ J — — — \ ..
CONTRACTOR'S STAGING AREA CANTON,NEW YORK,FEBRUARY.2020. \ \� / — — — — //� _ _ \ P JI I = WC) Z
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CONTRACTOR'S HAUL ROUTE
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PROPOSED 24 DOUBLE _ — \ 3=
SWING GATE ITEM F-162 m Cn
SEE DETAIL B3/CG-501
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LEGEND GENERAL NOTES
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REVISIONS
o, ABAN.-ABANDONED PC-POINT OF CURVATURE \ \ i / PROJECT NO: 211,019.001
m APPROX.-APPROXIMATE PCC-PORTLAND CEMENT CONCRETE PAVEMENT
ASPH.-ASPHALT PI-POINT OF INTERSECTION p� DATE: MAY 2020
t BASELINE f� PROPERTY LINE AIRPORT ENTRANCE ROAD CENTERLINE ALIGNMENT \\ y / �oF
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0 BLDG.-BUILDING PT-POINT OF TANGENCY \\ AIRCRAFT \ ! DRAWN BY: J. POTTER
BM-BENCH MARK PVI-POINT OF VERTICAL INTERSECTION STATION NORTHING EASTING \ \\
m � TIE-DOWN � ' PROPOSED SIDEWALK, ITEM DESIGNED BY: J. POTTER
c �-CENTERLINE PVC-POINT OF CURVATURE(VERTICAL CURVE) POB: 0+00 402,737.54 1,525,873.29 \ �\� APRON
E! CIP-CAST IRON PIPE PVC-POLYVINYL CHLORIDE PIPE i i / 402.1273 PAID FOR UNDER ITEM
TANGENT LENGTH:429.17' y i \\ SP 5\ CHECKED BY: J. DOLAN
C CMP-CORRUGATED METAL PIPE PVT-POINT OF TANGENCY(VERTICAL CURVE) i \\ P-403. SEE DETAIL C2 &C31CG-501 wok ����
CONC.-CONCRETE R-RADIUS PC: 4+29.17 402,344.86 1,526,046.44 \ i INNOALTERATION PERMITTED HEREON
V- CSP-CORRUGATED STEEL PIPE RCP-REINFORCED CONCRETE PIPE i \ i EXCEPT AS PROVIDED UNDER SECTION
a DIA.-DIAMETER ROFA-RUNWAY OBJECT FREE AREA PI: 402,310.27 1,526,061.69 , \ / Sp. 7209 SUBDIVISION 2 OF THE NEW YORK
L_
EAPL-EXISTING AIRPORT PROPERTY LINE RSA-RUNWAY SAFETY AREA PT: 4+99.19 402,301.96 1,526,098.56 \\ i i EDUCATION LAW
ELEV.-ELEVATION ROW-RIGHT OF WAY RADIUS:75' \\ \ 9f\ p _1A /1
A FND.-FOUNDATION RPZ-RUNWAY PROTECTION ZONE LENGTH:70.02' \\ �9\ �oF - �7
HP-HIGH POINT RT-RIGHT
rn INV.-INVERT RW-RUNWAY POE: 6+18.08 402,275.79 1,526,214.53
o LT-LEFT SHDR.-SHOULDER TANGENT LENGTH: 118.89' / \ \ \ / \ - GENERALNOTES,
LP-LOW POINT SICPP-SMOOTH INTERIOR CORRUGATED i
MAX.-MAXIMUM POLYETHYLENE PIPE i \ /
o MIN.-MINIMUM STA.-STATION LEGEND,
5 MISC.-MISCELLANEOUS TOFA-TAXIWAY OBJECT FREE AREA
NA-NOT APPLICABLE TSA-TAXIWAY SAFETY AREA
N OFA-OBJECT FREE AREA TW-TAXIWAY _ _ \\ O / \ Q� o / ABBREVIATIONS
& SITE PLAN
LL_ O.C.-ON CENTER TYP.-TYPICAL
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ABBREVIATIONS HORIZONTAL ALIGNMENT SITE PLAN
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WORK
AHEAD , - C&S Engineers, Inc.
RETROREFLECTIVE BAND - 499 COI. Eileen Collins Blvd.Syracuse, New York 13212
RETROREFLECTIVE CONES, SEE CW20-1 kP�
DETAIL C1, THIS SHEET " " Phone: -455- 667
315-455-9667
(TYP.) (36 x 36 ) / Fax. 315
PAID FOR UNDER ITEM C-106 www.cscos.com
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IONS, SEE DETAIL B1 THIS SHEET.
SIGN NOTES: PAID FOR UNDER ITEM C-106 \ \
1. ALL SIGNS SHALL BE IN ACCORDANCE WITH ' \ /
ROAD \
THE NEW YORK STATE MANUAL ON UNIFORM \ Z
TRAFFIC CONTROL DEVICES(MUTCD). WORK WORK AREA UP
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ROAD WORK AHEAD, AHEAD ' \
(36"x 36")cw2o-1 � \ \ CONTRACTOR'S STAGING & 0
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UP
04
MARK DATE DESCRIPTION
UP REVISIONS
o CONTROL POINTS �pFP +BM-1 gP PROJECT NO: 211.019.001
DATE: MAY 2020
o NUMBER NORTHING FASTING ELEV.: \ AUTO 0.�
o I y DRAWN BY: J. POTTER
1 401,644.28 1,525,815.74 4.97 / PARKING gP
2 402,566.73 1,525,247.45 38.39 \� / ' �/ LOT DESIGNED BY: ,J. POTTER
`c 3 402,376.04 1,526,128.34 19.71
4 402,733.72 1,525,924.42 18.50 (D
CHECKED BY: J. DOLAN
NO ALTERATION PERMITTED HEREON
n / / SP EXCEPT AS PROVIDED UNDER SECTION
_ _ 7209 SUBDIVISION 2 OF THE NEW YORK
a \y / / ' — \ I / �pFP �gP �p� EDUCATION LAW
A BENCHMARKS AIRCRAFT / v
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0 NUMBER NORTHING EASTING ELEV.: \ APRON /
01 402,183.63 1,526,209.61 6.96 y / - / / - \\ pF P 951>1 GENERALAND
r 2 402,341.22 1,525,992.56 20.58
% 3 402,680.95 1,525,788.19 20.34 / / / / , pFQ
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SCALE:NOT TO SCALE SCALE: 1"=120' SHEET 3 OF 6
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499 Col. Eileen Collins Blvd.
30" E IDUOUSITREE SAWCUT
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/ p I N: 402,735.42 625CY UNCLASSIFIED O
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KEYING DETAIL, 1 \ EXCAVATION P-152 SEE N: 402 462.24 /
\ Catch Basin `" NI I I I I I \ / / / /
A4/CG-501 1 \ Rim Elevation 17.94 W SECTION, Al/CG-501 2"CHERRY W E- 1,525,991.27 �I SAWCUT
1 No grate,full of debris
Drainage Manhole 10"CHERRY Drainage Manhole
,,b \ N Rim Elevation 19.26 I N: 402,372.60 I Rim Elevation 18.06 1 \ KEYING DETAIL
/ C ® \ Heavy silt inverts inaccessible 6 M13)
Top of Debiris Elevation=10.31' O O A4/CG-501
cA� 7' I E: 1,526,044.87 I
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N: 402 723.72
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— Rim Elevation 19.13 /
192 192 I 19.a s.z s—
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Rim Elevation 18.91 E: 1,526,032.76
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PROPOSED BITUMIN US N I \ N. 402 439.92
ASPHALT PAVEMENT, 1 0 / I E: 1,525,987.28 , ^' I SAWCUTLLJ / I I i A / '` • �O
~ 4"ELM SEE SECTION, Al/C@-501 1, x I� �\ ' o I N: 402,363.73
Catch Basin 36"MAPLE
Rim Elevation 17.95 ^` \ I�� l Q) �\ E: 1,526,020.64
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PROJECT NO: 211.019.001
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DATE: MAY 2020
L=100.00' L=50.00'
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DRAWN BY: J. POTTER
K=114.93 K=26.17 DESIGNED BY: ,J. POTTER
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CHECKED BY: J. DOLAN
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BE CLEANED, (TYP.) ITEM D-751 .� O` 1 C&S Engineers Inc.
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Q) o TO BE CLEANED OF ALL SILT AND v 0`� �I 1 Syracuse New York 13212
0 0 0C V Phone- 315-455-2000
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Rim Elevation 17.94I � '17.9412"CHERRY I� �
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Drainage Manhole 10"CHERRY 1 Drainage Manhole
Q� Rim Elevation 19.26 y.r 1 1 Rim Elevation 18.06
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T Top of Debiris Elevation=10.31'
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EXISTING CONCRETE GUTTER TO o / /� ° \F Q • COQ
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1. ALL DEBRIS AND SILT TO BE REMOVED FROM DRAINAGE MANHOLES �Q) N O
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2. ALL DEBRIS AND SILT TO BE REMOVED FROM CONCRETE GUTTERS W
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4 Copyright
PROPOSAL
FOR CONSTRUCTION OF THE
AIRPORT ENTRANCE ROAD REHABILITATION
AT
ELIZABETH FIELD AIRPORT
FISHERS ISLAND
TOWN OF SOUTHOLD, NEW YORK
TO: Southold Town Clerk's Office
53095 Route 25
Southold,New York 11971
The undersigned, as bidder, hereby declares that he/she has examined the site of the work and informed
himself/herself fully in regard to all conditions pertaining to the place where the work is to be done; that
he/she has examined and read the Contract Documents and Contract Drawings for the work and all addenda
relative thereto furnished prior to the opening of bids; that he/she has satisfied himself/herself relative to
the work to be performed.
The bidder understands that the advertisement, located in the front of these Contract Documents, contains
the location and a description of the proposed construction,as well as indicates the place, date, and time of
the proposal opening; information about a Pre-Bid conference, if scheduled, is contained in the
advertisement;a listing of estimated quantities is located in the front of these Contract Documents;the time
in which the work must be completed shall be in accordance with the subsection titled FAILURE TO
COMPLETE ON TIME of Section 80. If the bidder considers that the time to complete the work is
inadequate,they should not submit a bid.
The bidder understands the quantities for bid items listed on the proposal sheets are estimated quantities
only for the purpose of comparing bids; any difference between these estimated quantities and actual
quantities required for construction shall not be taken as a basis for claims by the Contractor for extra
compensation; compensation will be based upon the unit prices and actual construction quantities.
The bidder understands that the description under each item,being briefly stated, implies, although it does
not mention, all incidentals and that the prices stated are intended to cover all such work, materials and
incidentals as constitute bidder's obligations as described in the specifications and any details not
specifically mentioned, but evidently included in the Contract shall be compensated for in the item which
most logically includes it.
The bidder understands that proposal guaranty shall be in the form of a bid bond in the amount of
five percent (5%) of this bid in accordance with the subsection titled BID GUARANTEE of Section
20; the proposal guaranty shall become the property of the Owner in the event the Contract and
bond(s) are not executed within the time above set forth, as liquidated damages for the delay and
additional expense to the Owner caused thereby.
The bidder agrees that upon receipt of written notice of the acceptance of this proposal,bidder will execute
the Contract attached within 15 days and deliver a Surety Bond or Bonds as required by the subsection
titled REQUIREMENTS OF CONTRACT BONDS OF Section 30.The bidder further agrees to commence
construction with an adequate work force, plant and equipment on the date stated in the written notice to
proceed and will progress therewith to its completion within the time stated, and in accordance with this
Contract and Specification.
2018 PROPOSAL-1
ELIZABETH FIELD AIRPORT - FISHERS ISLAND
AIRPORT ENTRANCE ROAD IMPROVEMENTS
ITEM UNIT
NO SPEC DESCRIPTION QUANTITY UNITS PRICE TOTAL
BASE BID
1 C-105 MOBILIZATION (8+/-) 1 LS
2 C-106 SAFETY, SECURITY AND MAINTENANCE OF TRAFFIC 1 LS
3 P-152 UNCLASSIFIED EXCAVATION 625 CY
4 P-209 SEPARATION GEOTEXTILE 1,500 SY
5 P-214 CRUSHED AGGREGATE BASE COURSE 500 CY
6 P-403 BITUMINOUS SURFACE COURSE 275 TON
7 P-603 BITUMINOUS TACK COAT 75 GAL
PROPOSAL-2
ELIZABETH FIELD AIRPORT - FISHERS ISLAND
AIRPORT ENTRANCE ROAD IMPROVEMENTS
ITEM UNIT
NO SPEC DESCRIPTION QUANTITY UNITS PRICE TOTAL
8 P-605 JOINT SEALING 900 LF
9 D-751 DRAINAGE STRUCTURES TO BE CLEANED 5 EACH
10 D-751 CONCRETE GUTTERS TO BE CLEANED 810 LF
11 F-162 24-FOOT DOUBLE SWING GATE 1 EACH
TOTAL CONTRACT
PROPOSAL-3
Elizabeth Field Airport Airport Entrance Road Rehabilitation
The bidder states that this proposal is based upon prevailing wages in Suffolk County,NY and in no case
are wages considered less than those predetermined by the State and Federal Departments of Labor,
schedules of which are contained in the Contract Documents.
The bidder proposes and agrees, if this Proposal is accepted, to contract in the form of contract specified
with the Town of Southold/Fishers Island Ferry District (Owner), to furnish all necessary materials,
equipment, machinery, tools, apparatus, means of transportation and labor necessary to complete the
construction of the Airport Entrance Road Rehabilitation project in full and complete accordance with the
shown, noted, described and reasonably intended requirements of the Contract Documents and Contract
Drawings,to the full and entire satisfaction of the above said Owner,with a definite understanding that no
money will be allowed for extra work except as set forth in the attached Contract Documents, for the unit
prices listed for each item.
BIDDER,IF AN INDIVIDUAL:
BY:
(Printed Name)
(Signature)
COMPANY NAME:
ADDRESS:
PHONE NO:
DATE:
2018 PROPOSAL-4
Elizabeth Field Airport Airport Entrance Road Rehabilitation
BIDDER,IF A PARTNERSHIP (GIVE NAMES AND ADDRESSES OF EACH PARTNER):
BY:
(Printed Name)
(Signature)
COMPANY NAME:
ADDRESS:
PHONE NO:
DATE:
PARTNER'S PARTNER'S
NAME: NAME:
BUSINESS BUSINESS
ADDRESS: ADDRESS:
PARTNER'S PARTNER'S
NAME: NAME:
BUSINESS BUSINESS
ADDRESS: ADDRESS:
2018 PROPOSAL-5
Elizabeth Field Airport Airport Entrance Road Rehabilitation
BIDDER,IF A CORPORATION:
BY:
(Printed Name &Title)
(Signature)
CORPORATION
NAME:
ADDRESS: (SEAL)
STATE OF CORPORATION
CHARTER:
PHONE NO:
DATE:
PRESIDENT'S
NAME:
BUSINESS
ADDRESS:
SECRETARY'S TREASURER'S
NAME: NAME:
BUSINESS BUSINESS
ADDRESS: ADDRESS:
2018 PROPOSAL-6
Elizabeth Field Airport Airport Entrance Road Rehabilitation
ATTACHMENTS TO PROPOSAL
BIDDER and his/her surety, where appropriate, have completed and executed the attached documents,
which are identified below.
Non-Collusive Bidding Certificate
Resolution for Corporate Bidders
Buy American Certification
Certifications:
- Certification of Non-Segregated Facilities
- Debarment& Suspension Certification
- Lobbying and Influencing Federal Employees
- Certification of Offeror/Bidder Regarding Tax Delinquency and Felony Convictions
- Trade Restriction
Bidder's Statement of Previous Contracts Subject to EEO Clause as Described in Section 70-21
Certification for Receipt of Addenda
Statement of Surety's Intent
Iranian Energy Sector Divestment Statement
Certification of Compliance with the Iran Divestment Act
Disadvantaged Business Enterprise (DBE) and Small Business Element(SBE) Statement
Bidder's List Collection Form (Bidder's Information)
Bidder's List Collection Form (Subcontractor's Information)
Safety Plan Compliance Document(SPCD) Certification
2018 PROPOSAL-7
Elizabeth Field Airport Airport Entrance Road Rehabilitation
NON-COLLUSIVE BIDDING CERTIFICATE
The Signer of this Bid declares:
A. That he/she has carefully examined the annexed form of the Agreement and Contract.
B. Pursuant to Section 103-d of the General Municipal Law, by submission of this Bid, each Bidder and
each person signing on behalf of any Bidder certifies, and in the case of a joint Bid each party thereto
certifies as to its own organization,under penalty of perjury,that to the best of knowledge and belief:
1. The prices in this Bid have been arrived at independently without collusion, consultation,
communication or agreement, for the purpose of restricting competition, as to any matter 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 been
knowingly 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 made 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.
I hereby affirm under the penalties of perjury that the foregoing statement is true.
Affix Seal BIDDER:
if Principal
is Corporation BY:
TITLE:
STATE OF NEW YORK)
SS:
COUNTY OF )
On the day of 20 ,before me personally came
to me known,who,being by me duly sworn, did swear and affirm that he/she resides at
;that he/she is the
of the Bidder herein and signs the foregoing Non-Collusive Certification on behalf of such Bidder; that
he/she executed the foregoing Non-Collusive Certification;and that,to the best of his knowledge and belief,
the statement made in the foregoing Non-Collusive Certification is true.
NOTARY PUBLIC
MY COMMISSION EXPIRES:
(This form must be completed and submitted with the Proposal.)
2018 PROPOSAL-8
Elizabeth Field Airport Airport Entrance Road Rehabilitation
RESOLUTION FOR CORPORATE BIDDERS
RESOLVED,that be authorized
(Name of Officer)
to sign and submit the bid or proposal of this corporation for the following project:
Airport Entrance Road Rehabilitation
and to include in such bid or proposal the certificate as to non-collusion required by section one hundred
three-d of the General Municipal Law as the act and deed of such corporation, and for any inaccuracies or
misstatements in such certificate this corporate bidder shall be liable under penalties of perjury.
The foregoing is a true and correct copy of the resolution adopted by
Corporation at a meeting of its Board of
Directors held on the day of_, 20
(Secretary)
(Seal)
(This form must be completed and submitted with the Proposal.)
2018 PROPOSAL-9
Elizabeth Field Airport Airport Entrance Road Rehabilitation
BUY AMERICAN CERTIFICATION
The Contractor agrees to comply with 49 USC § 50101, which provides that Federal funds may not be
obligated unless all steel and manufactured goods used in AIP funded projects are produced in the United
States,unless the Federal Aviation Administration has issued a waiver for the product;the product is listed
as an Excepted Article,Material Or Supply in Federal Acquisition Regulation subpart 25.108;or is included
in the FAA Nationwide Buy American Waivers Issued list.
A bidder or offeror must complete and submit the Buy America certification included herein with their bid
or offer. The Owner will reject as nonresponsive any bid or offer that does not include a completed
Certificate of Buy American Compliance.
CERTIFICATE OF BUY AMERICAN COMPLIANCE FOR TOTAL FACILITY
As a matter of bid responsiveness, the bidder or offeror must complete, sign, date, and submit this
certification statement with its proposal. The bidder or offeror must indicate how it intends to comply
with 49 USC § 50101 by selecting one of the following certification statements. These statements are
mutually exclusive. Bidder must select one or the other (i.e. not both) by inserting a checkmark (✓) or
the letter"X".
❑ Bidder or offeror hereby certifies that it will comply with 49 USC. 50101 by:
a) Only installing steel and manufactured products produced in the United States; or
b) Installing manufactured products for which the FAA has issued a waiver as indicated by
inclusion on the current FAA Nationwide Buy American Waivers Issued listing; or
c) Installing products listed as an Excepted Article, Material or Supply in Federal
Acquisition Regulation Subpart 25.108.
By selecting this certification statement,the bidder or offeror agrees:
1. To provide to the Owner evidence that documents the source and origin of the steel and
manufactured product.
2. To faithfully comply with providing US domestic products.
3. To refrain from seeking a waiver request after establishment of the contract, unless
extenuating circumstances emerge that the FAA determines justified.
❑ The bidder or offeror hereby certifies it cannot comply with the 100%Buy American Preferences
of 49 USC § 50101(a) but may qualify for either a Type 3 or Type 4 waiver under 49 USC §
50101(b). By selecting this certification statement,the apparent bidder or offeror with the apparent
low bid agrees:
1. To submit to the Owner within 15 calendar days of the bid opening, a formal waiver
request and required documentation that support the type of waiver being requested.
2. That failure to submit the required documentation within the specified timeframe is
cause for a non-responsive determination that may result in rejection of the proposal.
3. To faithfully comply with providing US domestic products at or above the approved
US domestic content percentage as approved by the FAA.
4. To furnish US domestic product for any waiver request that the FAA rejects.
5. To refrain from seeking a waiver request after establishment of the contract, unless
extenuating circumstances emerge that the FAA determines justified.
2018 PROPOSAL-10
Elizabeth Field Airport Airport Entrance Road Rehabilitation
Required Documentation
Type 3 Waiver-The cost of components and subcomponents produced in the United States is more than
60%of the cost of all components and subcomponents of the "facility". The required documentation for
a Type 3 Waiver is:
a) Listing of all manufactured products that are not comprised of 100% US domestic content
(Excludes products listed on the FAA Nationwide Buy American Waivers Issued listing and
products excluded by Federal Acquisition Regulation Subpart 25.108;products of unknown origin
must be considered as non-domestic products in their entirety)
b) Cost of non-domestic components and subcomponents,excluding labor costs associated with final
assembly and installation at project location.
c) Percentage of non-domestic component and subcomponent cost as compared to total "facility"
component and subcomponent costs, excluding labor costs associated with final assembly and
installation at project location.
Type 4 Waiver — Total cost of project using US domestic source product exceeds the total project cost
using non-domestic product by 25%. The required documentation for a Type 4 Waiver is:
a) Detailed cost information for total project using US domestic product
b) Detailed cost information for total project using non-domestic product
False Statements: Per 49 USC §47126,this certification concerns a matter within the jurisdiction of the
Federal Aviation Administration and the making of a false,fictitious or fraudulent certification may render
the maker subject to prosecution under Title 18, United States Code.
Date Signature
Company Name Title
(Buy American form(s) must be completed and submitted with the Proposal.)
2018 PROPOSAL-11
Elizabeth Field Airport Airport Entrance Road Rehabilitation
CERTIFICATIONS
BIDDER'S NAME:
ADDRESS:
TELEPHONE NO.: FAX NO.
IRS EMPLOYER IDENTIFICATION NUMBER:
NOTICE OF NONSEGREGATED FACILITIES REQUIREMENT
Notice to Prospective Federally Assisted Construction Contractors
1. A Certification of Non-segregated Facilities shall be submitted prior to the award of a federally assisted
construction contract exceeding $10,000, which is not exempt from the provisions of the Equal
Opportunity Clause.
2. Contractors receiving federally-assisted construction contract awards exceeding$10,000 which are not
exempt from the provisions of the Equal Opportunity Clause will be required to provide for the
forwarding of the following notice to prospective subcontractors for supplies and construction contracts
where the subcontracts exceed $10,000 and are not exempt from the provisions of the Equal
Opportunity Clause.
3. The penalty for making false statements in offers is prescribed in 18 U.S.C. § 1001.
Notice to Prospective Subcontractors of Requirements for Certification of Non-Segregated
Facilities
1. A Certification of Non-segregated Facilities shall be submitted prior to the award of a subcontract
exceeding $10,000,which is not exempt from the provisions of the Equal Opportunity Clause.
2. Contractors receiving subcontract awards exceeding$10,000 which are not exempt from the provisions
of the Equal Opportunity Clause will be required to provide for the forwarding of this notice to
prospective subcontractors for supplies and construction contracts where the subcontracts exceed
$10,000 and are not exempt from the provisions of the Equal Opportunity Clause.
3. The penalty for making false statements in offers is prescribed in 18 U.S.C. § 1001.
CERTIFICATION OF NON-SEGREGATED FACILITIES
The federally-assisted construction contractor certifies that she or he does not maintain or provide, for his
employees, any segregated facilities at any of his establishments and that she or 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 that she or he will not maintain or
provide, for his employees, segregated facilities at any of his establishments and that she or 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 washrooms, restaurants and other eating areas,time clocks, locker rooms and other storage
or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and
2018 PROPOSAL-12
Elizabeth Field Airport Airport Entrance Road Rehabilitation
housing facilities provided for employees which are segregated by explicit directives or are, in fact,
segregated on the basis of race, color, religion, or national origin because of habit, local custom, or any
other reason. The federally-assisted construction contractor agrees that (except where she or he has
obtained identical certifications from proposed subcontractors for specific time periods) she or he will
obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding
$10,000 which are not exempt from the provisions of the Equal Opportunity Clause and that she or he will
retain such certifications in his files.
CERTIFICATION OF OFFEROR/BIDDER REGARDING DEBARMENT
By submitting a bid/proposal under this solicitation, the bidder or offeror certifies that neither it nor its
principals are presently debarred or suspended by any Federal department or agency from participation in
this transaction.
CERTIFICATION OF LOWER TIER CONTRACTORS REGARDING DEBARMENT
The successful bidder, by administering each lower tier subcontract that exceeds $25,000 as a "covered
transaction", must verify each lower tier participant of a "covered transaction" under the project is not
presently debarred or otherwise disqualified from participation in this federally assisted project. The
successful bidder will accomplish this by:
1. Checking the System for Award Management at website: http://www.sam.gov
2. Collecting a certification statement similar to the Certificate Regarding Debarment and Suspension
(Bidder or Offeror), above.
3. Inserting a clause or condition in the covered transaction with the lower tier contract
If the FAA later determines that a lower tier participant failed to disclose to a higher tier participant that it
was excluded or disqualified at the time it entered the covered transaction, the FAA may pursue any
available remedies,including suspension and debarment of the non-compliant participant.
CERTIFICATION REGARDING LOBBYING
The bidder or offeror certifies by signing and submitting this bid or proposal, to the best of his or her
knowledge and belief,that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the Bidder or
Offeror, 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 connection 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
2018 PROPOSAL-13
Elizabeth Field Airport Airport Entrance Road Rehabilitation
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.
(3) The undersigned shall require that the language of this certification be included in the award
documents for all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under
grants, loans, and cooperative agreements) and that all sub-recipients shall certify and disclose
accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction
was made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required
certification shall be subject to a civil penalty of not less than$10,000 and not more than $100,000 for each
such failure.
CERTIFICATION OF OFFERER/BIDDER REGARDING TAX DELINQUENCY
AND FELONY CONVICTIONS
The Contractor must complete the following two certification statements. The Contractor must indicate its
current status as it relates to tax delinquency and felony conviction by inserting a checkmark or"X"in the
space followingthe applicable response. The Contractor agrees that, if awarded a contract resulting from
this solicitation, it will incorporate this provision for certification in all lower tier subcontracts.
Certifications:
1) The Contractor represents that it is (__)is not(__) a corporation that has any unpaid Federal tax
liability that has been assessed, for which all judicial and administrative remedies have been
exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement
with the authority responsible for collecting the tax liability.
2) The Contractor represents that itis( )is not( )a corporation that was convicted of a criminal
violation under any Federal law within the preceding 24 months.
Note:
If a Contractor responds in the affirmative to either of the above representations,the Contractor is ineligible
to receive an award unless the sponsor has received notification from the agency suspension and debarment
official (SDO)that the SDO has considered suspension or debarment and determined that further action is
not required to protect the Government's interests. The Contractor therefore must provide information to
the owner about its tax liability or conviction to the Owner,who will then notify the FAA Airports District
Office, which will then notify the agency's SDO to facilitate completion of the required considerations
before award decisions are made.
Term Definitions
Felony conviction: Felony conviction means a conviction within the preceding twenty four(24)months of
a felony criminal violation under any Federal law and includes conviction of an offense defined in a section
of the U.S. code that specifically classifies the offense as a felony and conviction of an offense that is
classified as a felony under 18 U.S.C. § 3559.
2018 PROPOSAL-14
Elizabeth Field Airport Airport Entrance Road Rehabilitation
Tax Delinquency: A tax delinquency is any unpaid Federal tax liability that has been assessed, for which
all judicial and administrative remedies have been exhausted, or have lapsed, and that is not being paid in
a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability.
TRADE RESTRICTION CERTIFICATION
By submission of an offer, the Offeror certifies that with respect to this solicitation and any resultant
contract,the Offeror-
a. is not owned or controlled by one or more citizens of a foreign country included in the list of
countries that discriminate against U.S.firms as published by the Office of the United States Trade
Representative (U.S.T.R.);
b. has not knowingly entered into any contract or subcontract for this project with a person that is a
citizen or national of a foreign country included on the list of countries that discriminate against
U.S. firms as published by the U.S.T.R; and
c. has not entered into any subcontract for any product to be used on the Federal on the project that is
produced in a foreign country included on the list of countries that discriminate against U.S. firms
published by the U.S.T.R.
This certification concerns a matter within the jurisdiction of an agency of the United States of America
and the making of a false,fictitious,or fraudulent certification may render the maker subject to prosecution
under Title 18, United States Code, Section 1001.
The Offeror/Contractor must provide immediate written notice to the Owner if the Offeror/Contractor learns
that its certification or that of a subcontractor was erroneous when submitted or has become erroneous by
reason of changed circumstances. The Contractor must require subcontractors provide immediate written
notice to the Contractor if at any time it learns that its certification was erroneous by reason of changed
circumstances.
Unless the restrictions of this clause are waived by the Secretary of Transportation in accordance with 49
CFR 30.17,no contract shall be awarded to an Offeror or subcontractor:
(1) who is owned or controlled by one or more citizens or nationals of a foreign country included on
the list of countries that discriminate against U.S. firms published by the U.S.T.R. or
(2) whose subcontractors are owned or controlled by one or more citizens or nationals of a foreign
country on such U.S.T.R. list or
(3) who incorporates in the public works project any product of a foreign country on such U.S.T.R.
list;
Nothing contained in the foregoing shall be construed to require establishment of a system of records in
order to render,in good faith,the certification required by this provision. The knowledge and information
of a contractor is not required to exceed that which is normally possessed by a prudent person in the ordinary
course of business dealings.
2018 PROPOSAL-15
Elizabeth Field Airport Airport Entrance Road Rehabilitation
The Offeror agrees that, if awarded a contract resulting from this solicitation, it will incorporate this
provision for certification without modification in in all lower tier subcontracts. The contractor may rely
on the certification of a prospective subcontractor that it is not a firm from a foreign country included on
the list of countries that discriminate against U.S. firms as published by U.S.T.R, unless the Offeror has
knowledge that the certification is erroneous.
This certification is a material representation of fact upon which reliance was placed when making an
award. If it is later determined that the Contractor or subcontractor knowingly rendered an erroneous
certification,the Federal Aviation Administration may direct through the Owner cancellation ofthe contract
or subcontract for default at no cost to the Owner or the FAA.
Printed Name &Title:
Signature:
Date:
(These certifications must be completed and submitted with the Proposal.)
2018 PROPOSAL-16
Elizabeth Field Airport Airport Entrance Road Rehabilitation
BIDDER'S STATEMENT OF PREVIOUS CONTRACTS SUBJECT TO EEO CLAUSE AS
DESCRIBED IN SECTION 70-21
The Bidder shall complete the following statement by checking the appropriate boxes.
The Bidder has has not participated in a previous contract subject to the Equal
Opportunity Clause prescribed by Executive Order 11246, as amended, of September 24, 1965.
The Bidder has has not submitted all compliance reports in connection with any such
contract due under the applicable filing requirements; and that representations indicating submission of
required compliance reports signed by proposed subcontractors will be obtained prior to award of
subcontracts.
If the Bidder has participated in a previous contract subject to the Equal Opportunity Clause and
has not submitted compliance reports due under applicable filing requirements, the Bidder shall submit a
compliance report on Standard Form 100, "Employee Information Report EEO-1", attached to this
proposal.
CERTIFICATION FOR RECEIPT OF ADDENDA
Receipt of the following Addenda is acknowledged:
ADDENDUM NO.: DATED:
ADDENDUM NO.: DATED:
ADDENDUM NO.: DATED:
(Firm or Corporation Making Bid)
(Signature of Authorized Person)
P.O. Address:
Dated:
(This form must be completed and submitted with the Proposal.)
2018 PROPOSAL-17
Elizabeth Field Airport Airport Entrance Road Rehabilitation
STATEMENT OF SURETY'S INTENT
TO: Town of Southold
We have reviewed the bid of
(Contractor)
of
(Address)
for the Airport Entrance Road Rehabilitation
project for which bids will be received on:
(Bid Opening Date)
and wish to advise that should this Bid of the Contractor be accepted and the Contract awarded to him,it is
our present intention to become surety on the performance bond and labor and material bond required by
the Contract.
Any arrangement for the bonds required by the Contract is a matter between the Contractor and ourselves
and we assure no liability to you or third parties if for any reason we do not execute the requisite bonds.
We are duly authorized to do business in the State of New York.
ATTEST:
Surety's Authorized Signature(s)
(Corporate seal,if any. If no seal,write "No Seal" across this place and sign.)
ATTACH PROPOSAL GUARANTEE
ATTACH POWER OF ATTORNEY
(This form must be complete and submitted with the Proposal.
Copies of this form may be filled out and attached to this page.)
2018 PROPOSAL-18
Elizabeth Field Airport Airport Entrance Road Rehabilitation
IRANIAN ENERGY SECTOR DIVESTMENT STATEMENT
1. Contractor/Proposer hereby represents that said Contractor/Proposer is in compliance with New
York State General Municipal Law Section 103-g entitled "Iranian Energy Sector Divestment", in
that said Contractor/Proposer has not:
(a) Provided goods or services of $20 Million or more in the energy sector of Iran
including but not limited to the provision of oil or liquefied natural gas tankers or
products used to construct or maintain pipelines used to transport oil or liquefied
natural gas for the energy sector of Iran; or
(b) Acted as a financial institution and extended $20 Million or more in credit to another
person for forty-five days or more, if that person's intent was to use the credit to
provide goods or services in the energy sector in Iran.
2. Any Contractor/Proposer who has undertaken any of the above and is identified on a list created
pursuant to Section 165-a (3)(b) of the New York State Finance Law as a person engaging in
investment activities in Iran, shall not be deemed a responsible bidder pursuant to Section 103 of
the New York State General Municipal Law.
3. Except as otherwise specifically provided herein, every Contractor/Proposer submitting a
bid/proposal in response to this Request for Bids/Request for Proposals must certify and affirm the
following under penalties of perjury:
(a) `By submission of this bid, each bidder and each person signing on behalf of any
bidder certifies,and in the case of a joint bid,each parry thereto certifies as to its own
organization,under penalty of perjury,that to the best of its knowledge and belief,that
each bidder is not on the list created pursuant to NYS Finance Law Section 165-a
(3)(b)."
4. Except as otherwise specifically provided herein,any Bid/Proposal that is submitted without having
complied with subdivision (a) above, shall not be considered for award. In any case where the
Bidder/Proposer cannot make the certification as set forth in subdivision (a) above, the
Bidder/Proposer shall so state and shall furnish with the bid a signed statement setting forth in detail
the reasons therefore. The Owner reserves its rights, in accordance with General Municipal Law
Section 103-g to award the Bid/Proposal to any Bidder/Proposer who cannot make the certification,
on a case-by-case basis under the following circumstances:
(1) The investment activities in Iran were made before April 12, 2012, the investment
activities in Iran have not been expanded or renewed after April 12, 2012, and the
Bidder/Proposer has adopted, publicized and is implementing a formal plan to cease
the investment activities in Iran and to refrain from engaging in any new investments
in Iran; or
(2) The Owner has made a determination that the goods or services are necessary for the
Owner to perform its functions and that, absent such an exemption,the Owner would
be unable to obtain the goods or services for which the Bid/Proposal is offered. Such
determination shall be made by the Owner in writing and shall be a public document.
5. Bidder or Proposer shall sign and notarize the attached "Certification of Compliance with
the Iran Divestment Act" form with your proposal.
2018 PROPOSAL-19
Elizabeth Field Airport Airport Entrance Road Rehabilitation
CERTIFICATION OF COMPLIANCE WITH THE IRAN DIVESTMENT ACT
As a result of the Iran Divestment Act of 2012 (the "Act"), Chapter 1 of the 2012 Laws of New York, a
new provision has been added to State Finance Law(SFL) § 165-a and New York General Municipal Law
§ 103-g,both effective April 12,2012. Under the Act,the Commissioner of the Office of General Services
(OGS) will be developing a list of"persons"who are engaged in "investment activities in Iran" (both are
defined terms in the law) (the "Prohibited Entities List"). Pursuant to SFL § 165-a(3)(b),the initial list is
expected to be issued no later than 120 days after the Act's effective date at which time it will be posted on
the OGS website.
By submitting a bid in response to this solicitation or by assuming the responsibility of a Contract awarded
hereunder,each Bidder/Contractor,any person signing on behalf of any Bidder/Contractor and any assignee
or subcontractor and, in the case of a joint bid, each party thereto, certifies, under penalty of perjury,that
once the Prohibited Entities List is posted on the OGS website,that to the best of its knowledge and belief,
that each Bidder/Contractor and any subcontractor or assignee is not identified on the Prohibited Entities
List created pursuant to SFL § 165-a(3)(b).
Additionally, Bidder/Contractor is advised that once the Prohibited Entities List is posted on the OGS
Website, any Bidder/Contractor seeking to renew or extend a Contract or assume the responsibility of a
Contract awarded in response to this solicitation must certify at the time the Contract is renewed, extended
or assigned that it is not included on the Prohibited Entities List.
During the term of the Contract, should the Owner receive information that a Bidder/Contractor is in
violation of the above-referenced certification,the Owner will offer the person or entity an opportunity to
respond. If the person or entity fails to demonstrate that he/she/it has ceased engagement in the investment
which is in violation of the Act within 90 days after the determination of such violation, then the Owner
shall take such action as may be appropriate including, but not limited to, imposing sanctions, seeking
compliance, recovering damages or declaring the Bidder/Contractor in default.
The Owner reserves the right to reject any bid or request for assignment for a Bidder/Contractor that appears
on the Prohibited Entities List prior to the award of a contract and to pursue a responsibility review with
respect to any Bidder/Contractor that is awarded a contract and subsequently appears on the Prohibited
Entities List.
1, being duly sworn, deposes and says
that he/she is the of the
Corporation and that neither the Bidder/Contractor nor any proposed subcontractor is identified on the
Prohibited Entities List.
SIGNED
SWORN to before me this
day of 20
Notary Public:
(This form must be completed and submitted with the Proposal.)
2018 PROPOSAL-20
Elizabeth Field Airport Airport Entrance Road Rehabilitation
DISADVANTAGED BUSINESS ENTERPRISE (DBE) STATEMENT
The requirements of 49 CFR Part 26, Regulations of the U.S. Department of Transportation, apply to this
contract. It is the policy of the Sponsor to practice nondiscrimination based on race,color, sex,or national
origin in the award or performance of this contract.
DISADVANTAGED BUSINESS ENTERPRISE:
The requirements of 49 CFR Part 26, Regulations of the U.S. Department of Transportation, apply to this
contract. It is the policy of the Sponsor to practice nondiscrimination based on race,color, sex,or national
origin in the award or performance of this contract. All firms qualifying under this solicitation are
encouraged to submit proposals. Award of this contract will be conditioned upon satisfying the DBE
requirements of this contract. These requirements apply to all bidders, including those who qualify as a
DBE. An overall DBE goal of 2.63 percent will be utilized for this contract. The bidder shall make good
faith efforts, as defined in Appendix A, 49 CFR Part 26,to meet the contract goal for DBE participation in
the performance of this contract. Excerpts from 49 CFR Part 26 are included in Section 70-21.13.
As a matter of responsibility,within 5 days after the opening of bids,all Bidders or Offerors shall submit
the "Contractor's DBE Plan", and"DBE Letter of Intent Forms"from each of the DBE firms the Bidder or
Offeror intends to use. If the DBE goal is not met, Bidder or Offeror shall include documentation of good
faith efforts with its DBE Plan.
The Contractor's DBE Plan Form and DBE Letter Of Intent Form are located in Section 200. The website
for the Unified Certification Program directory in the state of New York is: http://www.nysucp.net/.
CERTIFICATION OF BIDDER/OFFEROR: The undersigned Bidder or Offeror will satisfy the DBE
requirements of these specifications in the following manner(please check the appropriate space):
The Bidder or Offeror is committed to meeting or exceeding the DBE utilization goal stated
above on this contract.
The Bidder or Offeror, is unable to meet the DBE utilization goal stated above. However,
we are committed to a minimum of % DBE utilization on this contract, and include
documentation demonstrating good faith efforts.
SMALL BUSINESS PARTICIPATION:
This Contract does not have a Small Business Element(SBE) set-aside.
IRS Number:
Signature and Title
2018 PROPOSAL-21
Elizabeth Field Airport Airport Entrance Road Rehabilitation
BIDDER'S LIST COLLECTION FORM
(Bidder's Information)
The sponsor is required by CFR Title 49, Subtitle A, Part 26, Subpart A, Section 26.11 to collect the
following information from the bidder. As such, it is the responsibility of the bidder to complete the
following information as a condition of submitting a proposal for this project. The sponsor will consider
incomplete information to be an irregular proposal.
Airport Name: Elizabeth Field Airport AIP No. 3-36-0029-023-2018
Project Name: Airport Entrance Road Rehabilitation
Bidder's Information
Firm Street Address, DBE/Non
Firm Name City, State,Zip Code, DBE Age of Firm Annual Gross
Phone No. Status Receipts
❑ Less than 1 year ❑ Less than$500K
❑ 1-3 years ❑ $500K-$1M
❑ DBE
❑ 4-7 years ❑ $142M
❑ Non-DBE
❑ 8-10 years ❑ $2-$5M
❑ More than 10 yrs. ❑ More than$5M
(This form must be completed and submitted with the Proposal.)
2018 PROPOSAL-22
Elizabeth Field Airport Airport Entrance Road Rehabilitation
BIDDER'S LIST COLLECTION FORM
(Subcontractor's Information)
The sponsor is required by CFR Title 49, Subtitle A, Part 26, Subpart A, Section 26.11 to collect the
following information from each subcontractor submitting a quote,bid or proposal to the bidder. As such,
it is the responsibility of the bidder to complete the following information as a condition of submitting a
proposal for this project. The sponsor will consider incomplete information to be an irregular proposal.
Please note that the information requested below must be filled out for each quote received by the bidder,
regardless of DBE status. For example, if the bidder requests quotes from three contractors for electrical
work, the information requested below must filled out for the three subcontractors. It is important to note
that providing the information does not commit the bidder to using any one of the three subcontractors in
the work.
Airport Name: Elizabeth Field Airport AIP No. 3-36-0029-023-2018
Project Name: Airport Entrance Road Rehabilitation
Subcontractor's Information
Firm Street Address, DBE/Non
Firm Name City, State,Zip Code, DBE Age of Firm Annual Gross
Phone No. Status Receipts
❑ Less than 1 year ❑ Less than$500K
❑ DBE ❑ 1-3 years ❑ $500K-$1M
114-7 years 11 $1-$2M
11 Non-DBE
❑ 8-10 years ❑ $2-$5M
❑ More than 10 yrs. ❑ More than$5M
❑ Less than 1 year ❑ Less than$500K
❑ DBE ❑ 1-3 years ❑ $500K-$1M
❑ Non-DBE
❑ 4-7 years ❑ $142M
❑ 8-10 years ❑ $2-$5M
❑ More than 10 yrs. ❑ More than$5M
❑ Less than 1 year ❑ Less than$500K
❑ DBE ❑ 1-3 years ❑ $500K-$1M
❑ Non-DBE
❑ 4-7 years ❑ $142M
❑ 8-10 years ❑ $2-$5M
❑ More than 10 yrs. ❑ More than$5M
2018 PROPOSAL-23
Elizabeth Field Airport Airport Entrance Road Rehabilitation
Firm Street Address, DBE/Non
Firm Name City, State,Zip Code, DBE Age of Firm Annual Gross
Phone No. Status Receipts
❑ Less than 1 year ❑ Less than$500K
❑ DBE ❑ 1-3 years ❑ $500K-$1M
❑ Non-DBE
❑ 4-7 years ❑ $142M
❑ 8-10 years ❑ $2-$5M
❑ More than 10 yrs. ❑ More than$5M
❑ Less than 1 year ❑ Less than$500K
❑ DBE ❑ 1-3 years ❑ $500K-$1M
❑ Non-DBE
❑ 4-7 years ❑ $142M
❑ 8-10 years ❑ $2-$5M
❑ More than 10 yrs. ❑ More than$5M
❑ Less than 1 year ❑ Less than$500K
❑ DBE ❑ 1-3 years ❑ $500K-$1M
114-7 years 11 $1-$2M
11 Non-DBE
❑ 8-10 years ❑ $2-$5M
❑ More than 10 yrs. ❑ More than$5M
❑ Less than 1 year ❑ Less than$500K
❑ DBE ❑ 1-3 years ❑ $500K-$1M
❑ Non-DBE
❑ 4-7 years ❑ $142M
❑ 8-10 years ❑ $2-$5M
❑ More than 10 yrs. ❑ More than$5M
(Copy this form and submit with your original proposal if more space is needed.)
(This form must be completed and submitted with the Proposal.)
2018 PROPOSAL-24
Elizabeth Field Airport Airport Entrance Road Rehabilitation
SAFETY PLAN COMPLIANCE DOCUMENT (SPCD) CERTIFICATION
Project Location:
Project Name:
Contractor's Official Name:
Contact Person: Telephone:
Street Address:
City: State: Zip:
Certification Statement:
I certify that I have reviewed the General and Construction Safety and Phasing Plan(CSPP)included in the
Contract Drawings section of the Contract Documents and if awarded this Contract, I will abide by its
requirements as presented in the Contract Drawings.
I certify that I have read the Safety Plan Compliance Document(SPCD)included in the Contract Documents
and if awarded this Contract, I will abide by its requirements as written;
I certify that I will provide the information required in the SPCD prior to the start of construction work, if
awarded this Contract, and that I will provide any additional information requested by the Owner.
Printed Name of Signer Signature
Title Date
END OF PROPOSAL
2018 PROPOSAL-25