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STADIUM IMPROVEMENTS – PHASE 1 ADDENDUM TWO

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Item 07. Revision, Yard Hydrant Replacement: Replace existing non-frost proof yard hydrant at front of stadium with new frost-proof yard hydrant. Provide Murdock Model #M-NP75 yard hydrant with 3/4” hose connection end. Provide new 24” by 24” concrete pad at hydrant 4” thick. Provide 2-foot minimum bury depth. Provide all necessary piping and connections for a fully functional unit.

Item 08. Revision, Slab Removal at Northeast Corner: Demolish and remove 15’-0”

by 16’-0” (approximately), concrete slab and footings at former restroom location along north wall of stadium. Remove all slab and footings to a depth of 24 inches below grade, minimum. Remove existing plumbing in slab to a depth of 24 inches below grade and permanently cap in a code compliant manner. Provide compacted backfill, grade to drain, and provide new sod. Contractor shall protect stadium foundation footings from damage or movement.

Item 09. Revision, Keynote D11, Sheet A-1.2: Keynote D11 was omitted from the

drawing. Add verbiage to read, “Keynote D11, Prepare existing CMU and steel structure for installation of new stud framing, foam insulation and siding. Repair openings and defects in masonry that cannot be filled with foam insulation in accordance with Specification Sections 04 01 00 and 04 27 31.”

Item 10. Revision, Existing Surface Light Fixtures and Electrical: Contractor shall

provide code-compliant extensions to existing electrical junction boxes, provide covers and install siding trim. Remove and reinstall existing light fixtures at new siding. Light fixtures will be replaced in a future phase.

Item 11. Clarification, Roof at Stadium South End: Contractor shall provide all

necessary flashing, trim, closures, and sealants at new siding and existing roof to make existing roof weather tight.

Item 12. Clarification, Detail References: Refer Sheet A-4.1, Details F, G, and H.

These details apply to the building attached to the Stadium south end. Item 13. Clarification, Concrete Curb Footing at Stadium West Side: The Bidder’s

attention is directed to the Footing Section shown on drawing 2/S2.1. The contractor is required to provide this footing between the west side columns on the west side of the existing portion of the stadium and the new additions for wheelchair spaces. The purpose of this footing is to support the studs backing the new metal siding.

Item 14. Clarification, Concrete Mow Strip: Refer to Drawing A/A-4.2. The concrete

slab strip shown at the base of the wall is a 24” wide by 4” thick concrete mow strip on 4” sand or granular base material. Provide continuous mow strip along north wall, at northeast corner, and along the south wall where paving is not currently present. Provide control joints 5’-0” on center. Provide expansion joints at 20’-0” on center. Provide 3/4" joint and sealant between concrete footing and mow strip. Key end of mow strip at northeast corner for future mow strip addition.


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Item 15 Clarification, Concrete Repair Scope: A bidder asked if the minor honeycombing present on vertical surfaces is included in the repair work. Architect’s Response: The existing minor honeycombing on riser surfaces under the deck toe may remain as long as proper traffic coating adhesion can be achieved as recommended by the coating manufacturer. Concrete repair to correct honeycombing and other defects in horizontal deck surfaces and vertical/horizontal toe services shall be included in the project scope. If proper traffic coating adhesion cannot be achieved on the honeycombed riser surfaces, the bidder shall include concrete repair of these areas in the bid amount.

Item 16 Clarification, Project Sequencing / Schedule: As stated in the Pre-Bid

Conference and noted on the Bid Form, the first football home game of the season is scheduled for Friday, September 12, 2014. The Owner and School would like to have the project fully complete by that date. However, it is our understanding that the stadium seating and bleachers have a lead time that may prevent full completion from occurring by September 12th. Work may proceed on the project with the knowledge that stadium seating and bleachers may not arrive in time for the first game, but the following schedule and safety requirements will apply. Failure to comply with these will result in a Liquidated Damages being applied.

1. Stadium must be made safe and ready for occupancy and use no later

than the day prior to the home game. Fans typically start arriving for games early in the day of the game. Contractor must coordinate with Planning & Development and Cherokee Nation Risk Management.

2. As stated at the Pre-Construction Conference, the upper and lower

railings remain in place. The end rails are required to be replaced. The new railing location is inside of the existing railings. It will be possible to leave the existing end rails in place while new railings are being installed. Either existing or new railings must be in place for public occupancy.

3. Concrete repair, coating installation, and other work may proceed

during off game times. But stadium shall be ready for occupancy the day prior to home football games.

4. Contractor will have extended weekday and weekend access to

perform the work. 5. Contractor shall provide fencing and barricades as needed to protect

the public, students and staff from any storage, staging areas or hazardous conditions. Refer to Section 01 50 00.


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Item 17. Pre-Bid Conference Attendance: Representatives from the companies attended the mandatory Pre-Bid Conference held on July 15, 2014. The meeting sign in sheets are attached for reference.

Maska Builders Cherokee Restoration Oklahoma Waterproofing Mid-Continental Restoration MTS Contracting MRoss Construction Inc. Schilt Management Services Bronze Oak Construction LLC Cherokee CRC Taylor Painting NEO Cabinet Inc. ABBCO Roofing

End of Addendum Two

SCRIMMAGES: 5:00pm August 22 Sallisaw AWAY

August 29 @ Checotah, & v. Muldrow AWAY

VARSITY: All District Games start at 7:00pm

September 5 @ Okemah AWAY

September 12 Roland HOME

September 19 Broken Bow HOME

*September 26 Inola HOME

*October 3 Jay HOME

*October 10 @ Westville AWAY

*October 16 (Thurs.) @ Locust Grove AWAY

*October 24 Keys (Senior Night) HOME

October 31 @ Lincoln Christian AWAY

*November 7 @ Claremore Sequoyah AWAY

*District Games

JUNIOR VARSITY: Games at 6:30

September 8 @ Keys AWAY

September 15 Keys HOME

September 16 @ Westville (9th grade only) AWAY

September 29 @ Roland AWAY

October 6 @ Jay AWAY

October 13 Westville HOME

October 20 Locust Grove HOME

October 27 Fort Gibson HOME

School of Choice

Stadium Improvements - Phase 1Sequoyah Schools - Cherokee NationTahlequah, Oklahoma

E13-19 INSTRUCTIONS TO BIDDERS00 21 13 - 1

SECTION 00 21 13

INSTRUCTIONS TO BIDDERS

INVITATION

1.01 BID SUBMISSION

A. Bids signed and under seal, executed and dated will be received by the Cherokee Nation for theStadium Improvements - Phase 1 Project at Sequoyah Schools, Tahlequah, Oklahoma before2:00 PM local time on July 22, 2014.

B. Bids submitted via mail or overnight courier will be received at the offices of Eastern OklahomaTribal Schools, located at 3500 South Boulevard - Suite 15B, Edmond, Oklahoma 73013-5487before 5:00 PM local time on July 21, 2014.

1.02 INTENT

A. The intent of this Bid request is to obtain an offer to perform work to complete the StadiumImprovements - Phase 1 Project located at Sequoyah Schools - Tahlequah, Oklahoma for aStipulated Sum contract, in accordance with the Contract Documents.

1.03 WORK IDENTIFIED IN THE CONTRACT DOCUMENTS

A. The Work includes repair and restoration of concrete, installation of new pedestrian trafficcoating, modification of existing and installation of new steel hand and guard railings, installationof new fixed stadium & bleacher seating and installation of metal panel siding.

1.04 CONTRACT TIME

A. Identify Contract Time in the Bid Form. The completion date in the Agreement shall be theContract Time added to the Notice to Proceed date.

BID DOCUMENTS AND CONTRACT DOCUMENTS

2.01 DEFINITIONS

A. Bid Documents: Contract Documents supplemented with Invitation To Bid, Instructions toBidders, Information Available to Bidders, Bid Form, Supplements To Bid Forms andAppendices identified.

B. Contract Documents: Defined in AIA A201-2007, Article 1 including issued Addenda.

C. Bid, Offer, or Bidding: Act of submitting an offer under seal.

D. Bid Amount: Monetary sum identified by the Bidder in the Bid Form.

2.02 CONTRACT DOCUMENTS IDENTIFICATION

A. The Contract Documents are identified as Stadium Improvements - Phase 1 Project (E13-19),as prepared by the Architect, with contents as identified in the Table of Contents or the ProjectManual and the Table of Contents of the Drawings..

2.03 AVAILABILITY

A. Bid documents may be obtained at the office of Eastern Oklahoma Tribal Schools, located at3500 South Boulevard Street - Suite 15B, Edmond, Oklahoma 73013-5487.

B. One sets of Bid Documents can be obtained by bidders upon receipt of a refundable deposit,by certified check, in the amount of $80.00 for one set.

C. Deposit will be refunded if Bid Documents are returned complete, undamaged, unmarked andreusable, within 10 days of bid submission. Failure to comply will result in forfeiture of deposit.

D. Bid Documents are made available only for the purpose of obtaining offers for this project. Their use does not grant a license for other purposes.

2.04 EXAMINATION

A. Bid Documents may be viewed at the office of Eastern Oklahoma Tribal Schools, located at3500 South Boulevard Street - Suite 15B, Edmond, Oklahoma 73013-5487.



B. Bid Documents are on display at the offices of: Cherokee Nation Bid Center – Tahlequah 17675 S. Muskogee Tsa-La-Gi Annex – Room 116 Tahlequah, OK 74464 Phone (918) 453-5536 Fax: (918) 458-4295 Cherokee Nation Bid Center – Claremore 23205 South Highway 66 Claremore, OK 74018 Phone: (918) 342-6807 Fax: (918) 342-2682

C. Bid Documents are on display at the offices of the following construction plan rooms:1. Southwest Construction News Planroom.2. McGraw-Hill / Dodge Reports Planroom.3. Bid News / iSQFT Planroom.4. Reed Construction News Planroom

D. Upon receipt of Bid Documents verify that documents are complete. Notify Eastern OklahomaTribal Schools should the documents be incomplete.

E. Immediately notify Eastern Oklahoma Tribal Schools upon finding discrepancies or omissions inthe Bid Documents.

2.05 INQUIRIES/ADDENDA

A. Addenda may be issued during the bidding period. All Addenda become part of the ContractDocuments. Include resultant costs in the Bid Amount.

B. Verbal answers are not binding on any party.

C. Clarifications requested by bidders must be in writing not less than July 16, 2014 at 5:00 PMLocal Time. The reply will be in the form of an Addendum, a copy of which will be forwarded toknown recipients and will be posted on www.cherokeebids.org. Written requests forclarifications shall be directed to the office of the Architect, fax: 405-330-9261 or email: [email protected].

2.06 PRODUCT/ASSEMBLY/SYSTEM SUBSTITUTIONS

A. Substitute products will be considered if submitted as on Substitution Form included in the BidDocuments. Substitutions must be submitted in writing no later than July 16, 2014 at 5:00 PMLocal Time

B. The submission shall provide sufficient information to determine acceptability of such products.

C. When a request to substitute a product is made, the Architect, may approve the substitution andwill issue an Addendum to known bidders.

D. Provide products as specified unless substitutions are submitted in this manner and accepted.

E. All requests for substitution shall be accompanied by a fully completed Substitution Requestform included at the end of this Section or CSI Substitution Request Form 1.5C. Requests notaccompanied by a fully completed Substitution Request form will be rejected.

F. See Section 01 60 00 - Product Requirements for additional requirements.

SITE ASSESSMENT

3.01 SITE EXAMINATION

A. The bidder is required to inspect the project site prior to bid.

B. In submitting a bid, the bidder is certifying that he or representatives from his company haveinspected the project site and are thoroughly familiar with the project scope, ContractDocuments and all other requirements for construction.



3.02 PREBID CONFERENCE - MANDATORY

A. A MANDATORY pre-bid conference is scheduled for July 15, 2014 at 2:00 PM. Location ofconference is Sequoyah Schools Gymnasium, Recreation Room 131. A walking tour of theproject site will be conducted at the conclusion of the pre-bid conference.

B. All general contract bidders are required to attend the pre-bid conference and thewalking tour in order to have their bids considered. Suppliers and subcontract bidders areinvited, but not required, to attend.

C. Representatives of Sequoyah Schools, Cherokee Nation and Eastern Oklahoma Tribal Schoolswill be in attendance.

D. Information relevant to the Bid Documents will be recorded in an Addendum, issued to BidDocument recipients and posted on www.cherokeebids.org.

QUALIFICATIONS

4.01 EVIDENCE OF QUALIFICATIONS

A. To demonstrate qualification for performing the Work of this Contract, bidders may berequested to submit AIA Form 305.

4.02 SUBCONTRACTORS/SUPPLIERS/OTHERS

A. Cherokee Nation reserves the right to reject a proposed subcontractor for reasonable cause.

B. Refer to AIA A201-2007 Articvle 5 of the General Conditions

BID SUBMISSION

5.01 SUBMISSION PROCEDURE

A. Bidders shall be solely responsible for the delivery of their bids in the manner and timeprescribed.

B. Submit one copy of the executed offer on the Bid Forms provided, signed and sealed with therequired security in a closed opaque envelope, clearly identified with bidder's name, projectname and Cherokee Nation on the outside.

5.02 BID FORMAT

A. Bidders shall submit bids in strict accordance with the following requirements. Failure to complywith the format requirements may result in rejection of bid.1. All bid information shall be submitted in either a three-ring binder, comb bound book with

cover, or spiral bound book with cover. Bidder’s name, address and phone number shallbe printed or otherwise labeled on cover.

2. Provide separate tabs for each item submitted as a part of the bid. The individual tabsshall include the name of the document or the information.

3. The bid submittal shall be arranged in the following order:a. Bid Formb. Schedule of Valuesc. Supplement A (list of Subcontractors)d. Bid Bonde. Non Collusive Affidavitf. Business Relationship Formg. Payroll Affidavith. Certification of Non-Segregated Facilitiesi. Completed Cherokee Nation W-9 Formj. Past Performance & AIA A305 Documentk. Similar Construction Experiencel. Proposed Management Planm. Experience in Native American Contractingn. Proposed Time Schedule



o. Indian Preference documentation or TERO Certification

5.03 BID INELIGIBILITY

A. Bids that are unsigned, improperly signed or sealed, conditional, illegible, obscure, containarithmetical errors, erasures, alterations, or irregularities of any kind, may at the discretion of theCherokee Nation, be declared unacceptable.

B. Bid Forms, Appendices, and enclosures that are improperly prepared may, at the discretion ofOwner, be declared unacceptable.

C. Failure to provide security deposit, bonding or insurance requirements may, at the discretion ofOwner, invalidate the bid.

BID ENCLOSURES/REQUIREMENTS

6.01 SECURITY DEPOSIT

A. Bids shall be accompanied by a security deposit as follows:1. Bid Bond of a sum no less than 5 percent of the Bid Amount.

B. Endorse the Bid Bond in the name of the Cherokee Nation as obligee, signed and sealed by theprincipal (Contractor) and surety.

C. The security deposit will be returned after delivery to the Cherokee Naiton of the requiredPerformance, Maintenance and Payment Bond(s) by the accepted bidder.

D. Include the cost of bid security in the Bid Amount.

E. If no contract is awarded, all security deposits will be returned.

6.02 TAXES

A. This Project is taxable. Include all sales taxes in the bid amount.

6.03 CONSENT OF SURETY

A. Submit with the Bid.

6.04 PERFORMANCE ASSURANCE

A. Accepted Bidder: Provide Performance, Maintenance (Defect) and Payment bonds and includethe cost of these bonds in the bid amount.

6.05 TERO

A. TERO requirements apply to this project, including a fee of 1/2 of 1% of contract award. Successful bidder must complete TERO Labor Agreement and pay all applicable fees, including$25 per day, per non-Indian employee working on this project, in compliance with Legislative ActLA 01-14, dated 02/19/2014.

6.06 FEES FOR CHANGES IN THE WORK

A. Include the fees for overhead and profit on own Work and Work by subcontractors, identified inthe General and Supplementary Conditions.

B. Include in the Bid Form, the overhead and profit fees on own Work and Work bysubcontractors, applicable for Changes in the Work, whether additions to or deductions fromthe Work on which the Bid Amount is based.

6.07 BID FORM SIGNATURE

A. The Bid Form shall be signed by the bidder, as follows:1. Sole Proprietorship: Signature of sole proprietor in the presence of a witness who will also

sign. Insert the words "Sole Proprietor" under the signature. Affix seal.2. Partnership: Signature of all partners in the presence of a witness who will also sign.

Insert the word "Partner" under each signature. Affix seal to each signature.3. Corporation: Signature of a duly authorized signing officer(s) in their normal signatures.

Insert the officer's capacity in which the signing officer acts, under each signature. Affixthe corporate seal. If the bid is signed by officials other than the president and secretary of



the company, or the president/secretary/treasurer of the company, a copy of the by-lawresolution of their board of directors authorizing them to do so, must also be submitted withthe Bid Form in the bid envelope.

4. Joint Venture: Each party of the joint venture shall execute the Bid Form under theirrespective seals in a manner appropriate to such party as described above, similar to therequirements of a Partnership.

6.08 ADDITIONAL BID INFORMATION

A. Submit the following Supplements with bid submission:1. Document 00 43 10 - Supplement A - Subcontractors: Include the names of all

Subcontractors listed2. Document 00 44 00 - Non Collusive Affidavit3. Document 00 44 10 - Business Relationship Form4. Document 00 44 20 - Payroll Affidavit5. Document 00 44 30 - Certification of Non-Segregated Facilities6. Completed Cherokee Nation W-9 Form7. Document AIA A305 - Contractors Qualification Statement

6.09 SELECTION AND AWARD

A. Selection of successful contractor will be based on the following point evaluation system:1. Price: 20%2. Past Performance (in terms of meeting schedule) 20%3. Similar Construction Experience (Includes major subcontractors): 20%4. Construction Completion Time Schedule: 20%5. Proposed Management Plan (Including Proposed Job Site & Home Office Personnel):

10%6. Experience in Native American Contracting: 5%7. Indian Preference 5% - Submit copy of current Cherokee Nation TERO Certification for

entity submitting the bid.

B. The work to be performed under this Agreement is on a project subject to Section 7(b) of theIndian Self-Determination and Education Assistance Act (25 U.S.C. 45e(b)). Section 7(b)requires the following to be provided to the greatest extent feasible:1. Preference and opportunities for the training and employment shall be given to Indians,

and2. Preference in the award of contracts and subcontracts shall be given to Indian

organizations and Indian-owned economic enterprises.

The parties to this Agreement shall comply with the provisions of Section 7(b) of the Indian SelfDetermination and Education Assistance Act in the award of any subcontracts. In connectionwith the Agreement, the Contractor shall to the greatest extent feasible, give preference in theaward of any subcontracts to Indian organizations and Indian-owned enterprises, andpreferences and opportunities for training and employment to Indian and Alaska Natives.

The Contractor shall include this Section 7(b) in every subcontract awarded in connection withthis Agreement and shall, at the direction of the Nation, take appropriate action pursuant to thefinding by the Nation of a violation of Section 7(b) by a contractor or subcontractor.

6.10 DAVIS BACON ACT

A. The Contractor is required to comply with all provisions of the Davis-Bacon Act. Wage rateinformation for the project location is included in this Project Manual. Refer to the SupplementalConditions of the Contract.

OFFER ACCEPTANCE/REJECTION

7.01 DURATION OF OFFER

A. Bids shall remain open to acceptance and shall be irrevocable for a period of thirty (30) daysafter the bid closing date.



7.02 ACCEPTANCE OF OFFER

A. The Cherokee Nation reserves the right to accept or reject any or all offers.

END OF SECTION

Stadium Improvements – Phase 1 Sequoyah Schools – Cherokee Nation Tahlequah, Oklahoma

E13-19 SUBSTITUTION REQUEST FORM

SUBSTITUTION REQUEST FORM Project Name: Company or Firm Proposing Substitution: Specified Item: (Section, Page, Paragraph, Plan Sheets, Detail, Description) Proposed Substitution – The undersigned requests consideration of the following: The undersigned certifies that the following paragraphs, unless modified or clarified and initialed on this form, are correct: 1. The proposed substitution does not affect plan dimensions or spaces provided for equipment, millwork,

furnishings or other appurtenances. 2. The undersigned will reimburse the Owner for review or redesign services associated with or cause by

the substitution. 3. The proposed product will meet or exceed the quality, appearance, and performance of the specified

product. 4. The warranty of the proposed product will meet or exceed the warranty of the specified product. 5. All coordination and installation changes to other Work as a result of the proposed product will be

completed with no additional cost to the Owner. 6. Maintenance and service parts will be locally available for the proposed substitution. 7. Additional costs or time extension claims will be waived as a result of installation or delivery of the

proposed product. Submitted by: Date: Typed Name and Signature: Company or Firm: Address: Telephone: Fax: Email address: List of Attachments:


E13-19 BID FORM 00 41 00 - 1

BID FORM PROPOSAL

Proposal for: Stadium Improvements – Phase 1 Sequoyah Schools Tahlequah, Oklahoma 74465

Owner: Cherokee Nation P.O. Box 948 Tahlequah, Oklahoma 74465

Architect: Eastern Oklahoma Tribal Schools (E.O.T.S.)

Tracy Hartman, Architect 3500 South Boulevard Street – Suite 15B Edmond, Oklahoma 73013 – 5487

BID FORM SHALL BE COMPLETED IN INK OR TYPEWRITTEN Bidder: (Company name)

(Address) (City, State, Zip) (Type of Entity)

To Whom It May Concern: Having carefully studied and examined the Bidding Documents for the above referenced Project and having visited the Project Site and examined the bid documents, and being familiar with all conditions surrounding the project, including the availability of materials and labor, the undersigned hereby proposes to furnish all labor, materials and supplies, and to construct the project in accordance with the Contract Documents, and at the prices stated below. These prices to cover all expenses and taxes incurred in performing the work required under the Contract Documents, of which this proposal is a part. BID ITEMS:

ALL WORK WILL BE AWARDED TO A SINGLE PRIME CONTRACTOR Bid – Stadium Improvements – Phase 1: Patch and repair horizontal & vertical concrete surfaces, renovate or replace metal railings as indicated, provide and install new pedestrian traffic and waterproofing coating system, new foamed-in-place insulation and metal wall panel siding system and new fixed bleacher bench and backed stadium seating.

To furnish all labor and materials in accordance in the Bidding Documents for the Work, complete, for the sum of:

Dollars. (written)

($ ) in lawful money of the United States of America. (numbers)


E13-19 BID FORM 00 41 00 - 2

The above base bid includes square feet of concrete repairs. The Unit Price below shall be used to determine payment for any concrete repairs in excess of the amount included in the base bid and for credit back to the Owner for any amounts of concrete repairs made less than the amount included in the base bid. UNIT PRICES Unit Price No. 1:

Concrete Repairs: per Square Foot. Subject to the requirements of the Project Manual CONTRACT TIME If Awarded the Contract, the undersigned Bidder agrees to Substantially Complete the work in

calendar days from Notice to Proceed. The first home football game is scheduled to be (state number) played at the stadium on Friday, September 12, 2014 at 7:00 PM. The Contractor agrees to have the stadium ready and safe for public use for the purposes of event spectating for the game noted above and subsequent home football games as scheduled. The Bidder also acknowledges that Liquidated Damages in the amount of Two Hundred Dollars ($200.00) for each calendar day beyond the number of days indicated above, or any extension hereof that may be granted per the General Conditions, that the work is not substantially complete, will be assessed. CHANGE ORDERS The undersigned bidder agrees to the following maximum overhead and profit percentages for all executed change orders for the project: 10% Overhead & 5% Profit. ADDENDA The undersigned Bidder acknowledges the receipt of Addenda, issued during the time of bidding, and the clarifications, modifications and changes included therein are included in this Proposal. In submitting the Bid, the undersigned agrees that his Proposal will not be withdrawn for the period of thirty (30) calendar days from the date hereof and it is understood that the right is reserved by the Owner to reject and all Bids and to waive formalities and irregularities. ADDITIONAL PROVISIONS Bidder understands the Owner reserves the right to reject any and all bids and to waive any formalities in the bidding. Bidder understands award of this contract shall be subject to available funding. This Bid Form must be submitted with a fully executed Non-Collusion Affidavit, Business Relationship Affidavit, Payment Affidavit, Non-Segregation Certification, Contract-Grant Certification, 5% Bid Bond, Attachment A-Subcontractor’s Particulars, completed Cherokee W9 Form and all items detailed in Section 00 10 00 – Invitation for Bid. Indian preference will be given on this project to firms certified as Indian-owned by the Cherokee Nation Tribal Employment Rights Office (TERO). Proof of certification must accompany all bids.


E13-19 BID FORM 00 41 00 - 3

Respectfully submitted,

Bidder’s Signature and Title Date Seal: (If bid by Corporation)

By:

END OF SECTION

Cherokee Nation Substitute W-9 Form Request For Taxpayer Identification Number and Certification

NOTE: Your United States TAXPAYER IDENTIFICATION NUMBER MUST be provided regardless of your tax status. Name must be the same as that filed with the IRS or the Social Security administration as applicable. Failure to return this form in a timely manner will delay the order and/or payment. By Federal Law, the following information needs to be completed and returned to your procurement contact person at Cherokee Nation.

PRINT OR TYPE LEGAL NAME (As entered with IRS) If Sole Proprietorship, enter your LAST. FIRST. Ml

TRADE NAME If doing business as (D/B/A) or business name of Sole Proprietorship

Vendor Entity Type: (Select only one box) I ] Individual/Sole Proprietor • Corporation • Partnership • Government • Non-Profit • Other • Limited Liability Company: Enter the tax classification (D=disregarded

entity, C=corporation. P=partnership)

PRIMARY ADDRESS (For return of 1099 Form) PO Box or number and street

City, State, Zip + 4

Minority Certification: (Select all if apply) • Other Minority Owned • Veteran

(attach certificate if checked) • Small Disadvantage • Disabled Veteran

(attach certificate if checked) • Woman Owned • Cherokee Owned

(attach certificate if checked) • Small Business • Indian Owned (Tribe):

O R D E R A D D R E S S (Where order should be sent, if different than above) PO Box or number and street


Contact Name: Email Address: Contact Title: Phone Number:

Fax Number:

R E M I T A D D R E S S (Where check should be sent, if different than above) PO Box or number and street


Contact Name: Email Address: Contact Title: Phone Number:

Fax Number: TAXPAYER IDENTIFICATION NUMBER (TIN) (Provide One Only) If sole proprietorship provide SSN & FEIN if applicable

Social Security Number (SSN) OR

Federal Employer Identification No. (FEIN)

NAICS/SIC Industry Code

Code:

Industry Title:

WHAT WILL YOU BE PROVIDING?

• Goods • Services • Both

Does any owner, sales/service representative, or employee, have a personal relationship with a CN employee (includes all tribal locations)?

• Yes (if yes, please attach a letter of explanation) • No

Has your firm and/or is your firm involved in Federal debarment process? • Yes (if yes, please attach a letter of explanation) • No

NAICS/SIC Industry Code

Code:

Industry Title:

WHAT WILL YOU BE PROVIDING?

• Goods • Services • Both

Does any owner, sales/service representative, or employee, have a personal relationship with a CN employee (includes all tribal locations)?

• Yes (if yes, please attach a letter of explanation) • No

Has your firm and/or is your firm involved in Federal debarment process? • Yes (if yes, please attach a letter of explanation) • No

FOR CN USE ONLY

1099 • Yes • No

VEND EH Addition CH Change C E R T I F I C A T I O N : Under penalties of perjury, I declare that the information I provided is correct and complete

Signature Phone ( )

Title Date Please Print

FOR CN USE ONLY

1099 • Yes • No

VEND EH Addition CH Change