State of Rhode Island and Providence Plantations Department of Administration Division of Purchases RIVIP BIDDER CERTIFICATION COVER FORM SECTION 1 - BIDDER INFORMATION Bidder must be registered as a vendor on the RIVIP system at www .purchasing. ri . gov to submit a bid proposal. Solicitation Number: Solicitation Title: 7598610 REMOVAL AND REPLACEMENT OF CONCRETE WALKWAY AT BLACKSTONE RIVER PARK VISITOR CENTER (19pg) Bid P~oposal Sub~ission 311512019 Deadline Date & Time: 10:30 AM RIVIP Vendor ID #: Bidder Name: Address: Telephone: Fax: Contact Name: Contact Title: Contact Email: 36290 Northern Landscape Corp. 601 Putnam Pike Chepachet , RI 02814-1457 USA 401 -949-2330 none Sean Patrick Condon President [email protected]SECTION 2 - DISCLOSURES Bidders must respond to every statement. Bid proposals submitted without a complete response may be deemed non responsive. fndilj<Jte "Y" (Yes) or "N" (No) for Disclosures 1-4, and if "Y es," provide details below .f!__ 1. State whether the Bi dder, or any officer, director, manager, stockholder, member, partner, or other owner or principal of the Bidder or any parent, subsidiary, or affiliate has been subject to suspension or debarment by any federal, state, or municipal governmental authority, or the subject of criminal prosecution, or convicted of a criminal offense within the previous 5 years. If "Yes,• provide details / below. _N_ 2. State whether the Bidder, or any officer, director, manager, stockholder, member , partner, or other owner or principal of the Bidder or any parent, subsidiary, or affili ate has had any contracts with a federal, state, or municipal governmental authority terminated for any reason within the previous 5 years. If ' Yes," provide details below. 3. State whether the Bidder, or any officer, director, manager , stockholder, member, partner, or other owner or principal of the Bidder or any parent, subsidiary, or affili ate has been fined more than $5000 for violation(s) of any Rhode Island environmental law(s) by the Rhode Island Department of Environmental Management within the previous 5 years. If "Yes," provide details below. 4. State whether any officer, director, manager, stockholder, member, partner, or other owner or principal of the Bidder is serving or has served within the past two calendar years as either an appointed or elected official of any state governmental authority or quasi-public corporation, including without limitation, any entity created as a legislative body or public or state agency by the general assembly or constitution of this state.
Transcript
State of Rhode Island and Providence Plantations Department of Administration
Division of Purchases
RIVIP BIDDER CERTIFICATION COVER FORM
SECTION 1 - BIDDER INFORMATION
Bidder must be registered as a vendor on the RIVIP system at www.purchasing.ri.gov to submit a bid proposal.
Solicitation Number:
Solicitation Title:
7598610
REMOVAL AND REPLACEMENT OF CONCRETE WALKWAY AT BLACKSTONE RIVER PARK VISITOR CENTER (19pg)
Bid P~oposal Sub~ission 311512019 Deadline Date & Time: 10:30 AM
Bidders must respond to every statement. Bid proposals submitted without a complete response may be deemed non responsive.
fndilj<Jte "Y" (Yes) or "N" (No) for Disclosures 1-4, and if "Yes," provide details below
.f!__ 1. State whether the Bidder, or any officer, director, manager, stockholder, member, partner, or other owner or principal of the Bidder or any parent, subsidiary, or affiliate has been subject to suspension or debarment by any federal, state, or municipal governmental authority, or the subject of criminal prosecution, or convicted of a criminal offense within the previous 5 years. If "Yes,• provide details
/ below.
_N_ 2. State whether the Bidder, or any officer, director, manager, stockholder, member, partner, or other owner or principal of the Bidder or any parent, subsidiary, or affiliate has had any contracts with a federal, state, or municipal governmental authority terminated for any reason within the previous 5 years. If 'Yes," provide details below.
3. State whether the Bidder, or any officer, director, manager, stockholder, member, partner, or other owner or principal of the Bidder or any parent, subsidiary, or affiliate has been fined more than $5000 for violation(s) of any Rhode Island environmental law(s) by the Rhode Island Department of Environmental Management within the previous 5 years. If "Yes," provide details below.
4. State whether any officer, director, manager, stockholder, member, partner, or other owner or principal of the Bidder is serving or has served within the past two calendar years as either an appointed or elected official of any state governmental authority or quasi-public corporation, including without limitation, any entity created as a legislative body or public or state agency by the general assembly or constitution of this state.
Disclosure details (continue on additional sheet if necessary):
SECTION 3 - OWNERSHIP DISCLOSURE
Bidders must provide all relevant information, Bid proposals submitted without a complete response may be deemed nonresponslve.
If the Bidder is publicly held, the Bidder may provide owner information about only those stockholders, members, partners, or other owners that hold at least 10% of the record or beneficial equity interests of the Bidder; otherwise, complete ownership disclosure is required.
List each officer, director, manager, stockholder, member, partner, or other owner or principle of the Bidder, and each intermediate parent company and the ultimate parent company of the Bidder. For each individual, provide his or her name, business address, principal occupation, position with the Bidder, and the percentage of ownership, if any, he or she holds in the Bidder, and each intermediate parent company and the ultimate parent company of the bidder.
- crt/ /Jt.£
SECTION 4 - CERTIFICATIONS
Bidders must respond to every statement. Bid proposals submitted without a complete response may be deemed nonresponsive.
Indicate "Y" (Yes) or "N" (No), and if "No,• provide details below.
THE BIDDER CERTIFIES THAT:
}/_ 1.
+2. The Bidder will immediately disclose, in writing, to the State Purchasing Agent any potential conflict of interest which may occur during the term of any contract awarded pursuant to this solicitation.
The Bidder possesses all licenses and anyone who will perform any work will possess all licenses required by applicable federal, state, and local law necessary to perform the requirements of any contract awarded pursuant to this solicitation and will maintain all required licenses during the term of any contract awarded pursuant to this solicitation. In the event that any required license shall lapse or be restricted or suspended, the Bidder shall immediately notify the State Purchasing Agent in writing. r i 3. The Biddec .au m,;,,.;, all ceq"lrad lrnaunmce duri,g !he te,m of "'I '°"""°' pura,,a,rt to !his sollcitmo,. 1, the """" Iha! any ,oq,;rad insurance shall lapse or be canceled, the Bidder will immediately notify the State Purchasing Agent in writing.
4 . The Bidder understands that falsification of any information in this bid proposal or failure to notify the State Purchasing Agent of any changes in any disclosures or certifications in this Bidder Certification may be grounds for suspension, debarment, andfor prosecution for fraud. f- 5.
2013-4
The Bidder has not paid and will not pay any bonus, commission, fee, gratuity, or other remuneration to any employee or official of the State of Rhode Island or any subdivision of the State of Rhode Island or other governmental authority for the purpose of obtaining an award of a contract pursuant to this solicitation. The Bidder further certifies that no bonus, commission, fee, gratuity, or other remuneration has been or will be received from any third party or paid to any third party contingent on the award of a contract pursuant to this solicitation.
Page 2of3 12121/17
This bid proposal is not a collusive bid proposal. Neither the Bidder, nor any of its owners, stockholders, members, partners, principals, directors, managers, officers, erTl)loyees, or agents has in any way colluded, conspired, or agreed, cirectly or incirectly, with any other bidder or person to submit a collusive bid proposal in response to the solicitation or to refrain from sub~ng a bid proposal in response to the solicitation, or has in any manner, cirectly or indirectly, sougit by agreement or collus,on or other communication with any other bidder or person to fix the price or prices in the bid proposal or the bid proposal of~ other bidder, or to fix any overhead, profit, or cost corTl)onent of the bid price in the bid proposal or the bid proposal of any other bidder, or to secure through any collusion, conspiracy, or unlawful agreement any advantage against the State of Rhode Island or any_ person _with an interest in the contract awarded pursuant to this solicitation. The bid price in the bid proposal is fair and proper and 1s not tainted by any collusion, conspiracy, or unlawful agreement on the part of the Bidder, its owners, stockholders, members, patners, principals, directors, managers, officers, employees, or agents.
7. The Bidder: (i) is not identified on the General Treasurer's list created pursuant to RI. Gen. Laws§ 37-25-3 as a person or entity engaging in investment activities in Iran described in§ 37-2.5-2(b); and (ii) is not engaging in any such investment activities in Iran.
8. The Bidder will cofl'l)ly with all of the laws that are incorporated into an~or applicable to o11y contract with the State of Rhode Island.
9. Bidder certifies that it is not currently engaged in and shall not during the duration of the contract (if aw .. ded) engage in the boycott of any person, firm, or entity based in or doing business with any jurisdiction with whom the State of Rhode Island can enjoy open trade. Nor shall bidder participate in the boycott of any public agencies, entities, or instrumentalities of any jurisciction with whom the State of Rhode Island can enjoy open trade. For the purposes of this certification "jurisdiction with whom the State of Rhode Island can enjoy open trade" means national governments who are members of the World Trade Organization.
_ij_ 10 .. Bidder has corTl)lied with and, if awarded a contract with the State of Rhode Island shall promptly comply with, the reporting _ {. _ requirements of the "Reporting of Political Contributions by State Vendors Act", R. I. Gen. Laws§ 17-27-1 , et seq.
Ceitificat,on details (continue on additional sheet if necessary):
Submission by the Bidder of a bid proposal pursuant to this solicitation constitutes an offer to contract with the State of Rhode Island through the Division of Purchases on the terms and conditions contained in this solicitation and the bid proposal. The Bidder certifies that: (1) the Bidder has reviewed this solicitation and agrees to comply with its terms and conditions; (2) the bid proposal is based on this solicitation; and (3) the information submitted in the bid proposal (including this Bidder Certification Cover Form) is accurate and complete. The Bidder acknowledges that the terms and conditions of this solicitation and the bid proposal will be incorporated into any contract awarded to the Bidder pursuant to this solicitation and the bid proposal. The person signing below represents, under penalty of perjury, that he or she is fully informed regarding the preparation and contents of this bid proposal and has been duly authorized to execute and submit this bid proposal on behatf of the Bidder.
BIDDER
Date: 6 - / {- 11
Prirted narre ard tile of pefSOf1 signing on behalf of Bidder
2013-4 Page 3of3 12/21/17
Solicitation#: 7598610 Solicitation Title: Removal and Replacement of Concrete Walkway at the
Blackstone River Park Visitor Center
BID FORM
To: The State of Rhode Island Department of Administration Division of Purchases, 2nd Floor One Capitol Hill, Providence, RI 02908-5855
Bidder: ,',1012..--.,.-+-I~ 1,..,&!'JDS,c:..Af'iL c..0n...p oa.-t"\-T1 of\./ Legal name of entity
t.eul e. ,r,Nrt:r'.1 t?o--.lG I c:d'i2&c+1(<-r- (t.,\ o ~'6 "1 Address (sire Ucity/state/zip) r 1
' -~~"'°i\J l.i: 1\JDON ry c11-....-1-1~\t-Nvi<I-N-,<;t-4f~ec.c,c: ,N1...,;,
The Bidder submits this bid proposal to perform all of the work (including labor and materials) described in the solicitation for this Base Bid Price (including the costs for all Allowances, Bonds, and Addenda):
(base bid price in figures printed electronically, typed, or handwritten legibly in ink) , ", ---rtu.v ,·:::.~o - 1c.1 '7+--1 - F-1.•J(L- Tt-t o 1.H ~ D O c.,, \.,ri/l-S
(base bid price in words printed e ectronically, typed, or handwritten legibly in ink)
• Allowances
There are no allowances.
Bonds
The Base Bid Price includes the costs for all Bid and Payment and Performance Bonds required by the solicitation.
• Addenda
The Bidder has examined the entire solicitation (including the following Addenda), and the Base Bid Price includes the costs of any modifications required by the Addenda.
All Addenda must be acknowledged.
2014-12 (Bid Form) Page 1 of 3 7/29/2014
Solicitation#: 7598610 Solicitation Title: Removal and Replacement of Concrete Walkway at the
2. ALTERNATES (Additions/Subtractions to Base Bid Price)
There are no Alternates.
3. UNIT PRICES
The Bidder submits these predetermined Unit Prices as the basis for any change orders approved in advance by the State. These Unit Prices include a// costs, including labor, materials, services, regulatory compliance, overhead, and profit.
Unit Price No. 2: Restore gravel base S-5,--$ ______ /cy
4. CONTRACT TIME
The Bidder offers to perform the work in accordance with the timeline specified below:
• Start of construction: To be determined.
• Substantial completion: To be determined.
• Final completion: To be determined
5. LIQUIDATED DAMAGES
2014-12 (Bid Form) Page 2 of 3 7/29/2014
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Solicitation#: 7598610 Solicitation Title: Removal and Replacement of Concrete Walkway at the
Blackstone River Park Visitor Center
The successful bidder awarded a contract pursuant to this solicitation shall be liable for and pay the State, as liquidated damages and not as a penalty, the following amount for each calendar day of delay beyond the date for substantial completion, as determined in the sole discretion of the State: $_800.00_.
This bid proposal is irrevocable for 60 days from the bid proposal submission deadline.
If the Bidder is determined to be the successful bidder pursuant to this solicitation, the Bidder will promptly: (i) comply with each of the requirements of the Tentative Letter of Award; and (ii) commence and diligently pursue the work upon issuance and receipt of the purchase order from the State and authorization from the user agency.
The person signing below certifies that he or she has been duly authorized to execute and submit this bid proposal on behalf of the Bidder.
Date: ~ - 1 I - I 4
2014-12 (Bid Form) Page3of3
BIDDER
N OC2.--f'l1~11\.1 £/~J>~c'4r?(.. Cu tZ.- f ,
Nameci~ ti_ if'.---Pmted rane a1d title of person siglng on behaf ci Bixler # 805?~ Bidder's Cootractor Registration Number
7/29/2014
Western Surety Company POWER OF ATTORNEY - CERTIFIED COPY
Bond No. 6 4 5 5 9 4 3 6
Know All Men By These Presents, that WESTERN SURETY COMPANY, a corporation duly organized a nd existing under the laws of the State of South Dakota, and having its principal office in Sioux Falls, South Dakota (the "Company"), does by these presents make, constitute and appoint Antonella Ricciot ti
its true and lawful attorney(s)•in•fact, with full power and authority hereby conferred, to execute, acknowledge and deliver for and on its behalf as Surety, bonds for:
Principal: Northern Landscape Corporation
Obligee: State of Rhode Island - Division of Purchases
Amount: $1 , 000 , 000.00
and to bind the Company thereby as fully and to the same extent as if such bonds were signed by the Vice President, sealed with the corporate seal of the Company a nd duly attested by its Secretary, hereby ratifying and confirming all that the said attorney(s)•in• fact may do within the above stated limitations. Said appointment is made under a nd by authority of the following bylaw of Western Surety Company which remains in full force and effect.
"Section 7. 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, a ny Assistant Secretary. or the Treasurer may appoint Attorneys in Fact or agents who shall have a uthority 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."
If Bond No. 64 5594 36 is not issued on or before midnight of June 13th, 2019 , all authority conferred in this Power of Attorney shall ex--pire a nd terminate.
In Witness Whereof, Western Surety Company has caused these presents to be signed by its Vice President, Paul T. Bruflat, and itscorporatesl!a)to beaffixedthis 15th dayof March 2019
.. D . ..,_ On 't'Mitm11-i>B'tn day of March , in the year 2019 , before me, a notary public. personally appeared
Paul T. Bruflat, who being to me duly sworn, acknowledged that he s igned the above Power of Attorney as the aforesaid officer of WESTERN SURETY COMPANY and acknowledged said ins trument to be the voluntary act and deed of said corporation · :i: ................................................ ♦ .
i J. MOHR : I I }~NOTARY PUBLIC® ~ , SOUTH DAKOTA , I I
Notary Public • South Dakota ................................................ My Commission Expires June 23 , 2021
I the undersigned officer of Western Surety Company, a stock corporation of the State of South Dakota, do hereby certify that the attached Power of Attorney is in full force and effect and is irrevocable. and furthermore, that Section 7 of the bylaws of the Compa ny as set forth in the Power of Attorney is now in force.
In testimony whereof, I have hereunto set my hand a nd seal of Western Surety Company this 15th day of March , 2019 . ---~~~---
To validate bond authenticity, go to www.cnasurety.com > Owner/Obligee Services> Validate Bond Coverage.
Form F5306-10-2017
Bond No . 64559436
BID BOND (Percentage)
KNOW ALL PERSONS BY THESE PRESENTS, That we Northern Landscape Corporation of 601 Putnam Pike , Chepachet , RI 02814 -------------------------, hereinafter referred to as the Principal, and
WESTERN SURETY COMPANY
as Surety, are held and firmly bound unto State of Rhode Island - Division of Purchases
:Qt _____________________________________ _
_____________________ , hereinafter referred to as the Obligee, in the amount of Five Percent of the Amount Bid ________ ( 5 % ), for the payment of which we bind ourselves, our legal representatives, successors and assigns, jointly and severally, firmly by these presents.
WHEREAS, Principal has submitted or is about to submit a proposal to Obligee on a contract for _____ _ Remove and Replace Cement Walkway at Blackstone River Park Visitor Center
NOW, THEREFORE, if the said contract be awarded to Principal and Principal shall , within such time as may be specified, enter into the contract in writing and give such bond or bonds as may be specified in the bidding or contract documents with surety acceptable to Obligee; or if Principal shall fail to do so, pay to Obligee the damages which Obligee may suffer by reason of such failure not exceeding the penalty of this bond, then this obligation shall be void; otherwise to remain in full force and effect.
SIGNED, SEALED AND DATED this -~l ~St=h~ _ day of --~Ma=r~c=h'----- 2019
Principal
Northern
Surety
BY:
Form F4595-8-2001
AND LICENSING BOARD
C _,..,.--- Cut along dotted line . ,--- --------------------------------------------,
I. ' :
State of Rhode Isla11d a11d Providence Plantat/011s ...... ContractQi;s' Rnistra(,ion a11d Lice11sjqg Board ~
Nortlfern Lanascape corp. Sean Condon
has met the requirements of the law and has been granted this certificate of registration as an
IDENTIFICATION N FAILURE TO PROVIDE THIS PAYER IDENTIFICATION NUMBER TO US. SE PROVIDE US WITH YOUR
THE IRS REQUIRES THAT You F't!Nf,~Jf~8~~E IRS. IF you ARE AN INCf/!~~A~, 6~tA,,ANY OR A CORPORATION,
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::;g,:f~~gaR~::' :i:~~ '7~N) IN r:v~:~ii:r:~g1;~6!DN~t~°e!·(E!~) ~HERE INDICATED. PLEASE PROVIDE US WITH YOUR EMPL
Taxpayer Identification Number fT.I.N.J
Enter your taxpayer identificat,?n ,:r~m r in . . be • Social Security No. (SSN) Employer ID No. (EIN) the appropriat~ box. F~r most mdiv,duals, .----,r--.
1 ____ 7
1 this is your soctal secunty number. LI __ __,_ __ __._.__ ____ _ /0 7 / o:J")33b3 /
NAME NO IZ--f'Hf<.-t/1-N l--~D .Sc..4:f ~ c og....po~+T·0 N ADDRESS (f O I f U-n..J o\'"M p I ~'c.-
CITY, STATEANDZIPCODE C...,..., fi:. f '4 C. rl,._;;-, fl- I · o2.-e l'f
I PAYMENT REMITTANCE ADDRESS, IF DIFFERENT FROM THE ADDRESS ABOVE
ADDRESS
CITY, STATE AND ZIP CODE
CERTIFICATION: Under penalties of perjury, I certify that:
(1) The number shown on this form is my correct Taxpayer Identification Number (or I am waiting for a number to be issued to me), and (2) I am oot - to backup '""'holdmg because eithe,, (A) I am e,empt Worn backup ...,,ho/ding, o, (BJ I have not been no•lied by
u.e Jntemal Re,~,. Sen,/ce (IRS) that I am '"biect lo backup wllhholding as a"""'" of a fa/lun, to n,port a// lnJe,est o, dw/dends, or (C) the IRS has notified me that I am no longer subject to backup withholding. (3) I am a U.S. citizen or other U.S. person (as defined by the IRS).
C.!lfflcal/on l~py<tions -- Yoo,,.,,,"""' 001 nem (2) abo,e If you ha,e been notified by the IRS U.at you an, CUm,nffy subject lo backup withholdmg because you ha,e /a,led to ""'°" all mte""' and d"'1emJs on you, lax """m- Fo, <ea/ -I• bansactX>ns, ••m (2) does not apply.
Please sign here and provide title, date and tBlephor» numb9r:
SIGNATURE~ '7C:i';;z'.=:-~:--,~;::::,,,:~ ~--,- nTLEp -es, P€.,v, DATE_3 - , 1-1 '7 TEL N0'10 1-a,-1,-? n·o 'ital Signature Not Aceeptable) BUSINESs DESIGNATION:
nPS:
Please Check One: Individual O Corporation ef r rust/Estate 0 Partnership O Medical Services Corporation O
LLC Tax Classification: Single Member (Individual) □ NAME: Be sure to enter your full and correct le
In .
Government/Nonprofit Corporation
Legal Services Corporation
Partnership O Corporation 0
D D
ADDRESs, CITY, STA TE AND z,p CODE, W:. .:::::t::. ~~n on you, •ncome lax ,etum to, lhe SSN o,- EIN provided
'
1 = EIN _with mo,-e than one location - attach a r,s, of,,::::;,':;:;:.,."':; one 1-tlon, •dhe,e lo U.e folloONlng; · 2/ Dfffe..,,""';fm::::,,:,nd lax lnt-a>on ,etum should be malled_ ilh ,em,ifance address to, each location and Indicate lo ..,,,,erent location -- subm,t a comp/et d W
return Will be reported for each EIN and itt~-- e -9 form for each EIN and location (One . Mall Completed Form To: rem .. ...,M: address.) · year-end tax mformation SupPIJer Coordinator Purchasing Department One Capitol HIil, 2nd Floor Prov,dence RI 02908
