MADISON COUNTY COMMISSION Finance Department

100 Northside Square Room 700

Huntsville, AL 35801

INVITATION TO BID

Bid Date Bid Number Bid Title Bid Opening Date

and Time

09/26/2019

2019-66 Inspection and Evaluation of Madison

County Water Storage Tanks 10/18/2019

2:00 PM

Please submit a sealed price quotation of the items listed herein. (Faxed bids will not be accepted.) The submissions will be addressed to Madison County Purchasing; 100 Northside Square,7th Floor; Huntsville, AL 35801 until the date and time shown above, and publicly opened on date specified above.

The Madison County Commission reserves the right to award this bid on an all-or-none or item by item basis, to refuse all bids, and to waive technicalities.

Technical questions regarding this bid should be directed to Vince Moody at vince.moody@madisoncountyal.gov or (256) 783-1547.

Procurement questions should be directed to Jennie Weatherly at jweatherly@madisoncountyal.gov.

Vendor Name must show on envelope along with the bid number and opening date.

Each numbered bid must be in a separate envelope.

 

 

 

 

 

 

All documents submitted to Madison County will be subject to Alabama's Open Records Laws (Code of

Alabama, Title 36-12-40 and 41, as last amended). Due to the provisions of the Open Records Laws and the

Competitive Bid Laws, the Madison County Commission cannot assure any Bidder that any information

submitted with the bid, even though marked "Proprietary" will not be open to public inspection and

copying.

Terms of payment _____________________

I hereby affirm that I have not been in any agreement or collusion among vendors or prospective vendors in

restraint of freedom of competition, by agreement to bid at a fixed price or to refrain from bidding, or

otherwise.   

 

COMPANY NAME: _____________________________________

THIS BID MUST BE NOTARIZED.

SIGNATURE: __________________________________________

PRINT NAME: _________________________________________

STREET ADDRESS: ____________________________________

CITY: _________________STATE: ______ ZIP CODE: _________

PHONE #: ____________________ FAX #: ___________________

EMAIL ADDRESS: _____________________________________

FEDERAL ID#: _________________________________________

                       

                      

Subscribed and sworn to before

Me this______________ day of

__________________20_____.

 

 

Jennie Weatherly Purchasing Department

Madison County Commission Awarding Authority

DATE: 09/26/2019

GENERAL CONDITIONS AND INSTRUCTIONS

1. Bid number must appear on the outside of the bid envelope.

2. No oral, telephonic, facsimile, e-mailed modifications or alternate bids will be considered. Bids from firms, individuals, or the same owners of separate companies submitting more than one bid will not be considered.

3. Bidders must submit an original and one (1) copy of its bid. Incomplete and/or irregular bids may be subject to rejection. The following forms must be submitted:

a) Invitation to Bid Response Form (included in bid packet)- must be completed in its entirety, signed by an authorized agent of the company and notarized. Bid forms that are not signed will be disqualified. All submissions must be printed or written in ink.

b) Bid Detail Form (if included in bid packet) – must be signed by person completing form.

c) Bid Specification Sheet (included in bid packet) – each specification must be initialized to indicate acknowledgement.

d) Business License – a copy of a current City of Huntsville business and Madison County Business License, if required by law, and shall be current on payment of all city and county sales taxes. If vendor is not required to have a City of Huntsville Business License or a Madison County Business License, vendor must specify why a license is not required.

e) Sworn Affidavit of Employer Regarding Unauthorized Aliens (included in bid packet)

f) Sworn Affidavit of Subcontractor Regarding Unauthorized Aliens (included in bid packet)

g) E-Verify Forms – (included in bid packet)

h) E-Verify Memo of Understanding (available on E-Verify website after registration)

i) Certificate of Insurance

4. Shipping shall be F.O.B., Destination. Delivery address will be specified in the awarded Purchase Order.

5. Vendors having a place of business within the legal boundaries of Madison County may be given a 5% preference over vendors located outside of the legal boundaries of Madison County.

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INSPECTION AND EVALUATION OF MADISON COUNTY WATER STORAGE TANKS

SPECIFICATIONS AND SPECIAL CONDITIONS SEPTEMBER 2019

1. GENERAL.

1.1 SCOPE OF WORK SUMMARY. The contractor shall thoroughly inspect theinterior and exterior of thirteen storage tanks in the Madison County Water System. A detailed report with the results of the inspections will be submitted. The inspections shall be performed per the specifications listed in Section 2. To the extent possible, the storage tanks will remain in service during the inspection. A brief description of each tank is presented below. Photographs are presented in Attachment A and a map showing tank locations is shown in Attachment B.

1.2 BOBO NORTHWEST HYDROPILLAR

Diameter: 120’ Overflow Height: 155’ Capacity: 3,000,000 gallons Year of Completion: 2000 Location: Tank is located at the end of Tank Road in northwest Madison County.

1.3 CHASE TANK

Diameter: 72’ Overflow Height: 31.5’ Capacity: 1,000,000 gallons Year of Completion: 1990 Location: Tank is located at the end of Sandy Road in Huntsville, Alabama.

1.4 WATER TREATMENT PLANT CLEARWELL

Dimensions: 135’ x 135’ reinforced concrete Depth: 15’ (below grade) Capacity: 2,000,000 gallons Year of Completion: 2002 Location: Tank is located on the grounds of the Mountain Fork Water Treatment

Facility near New Market, AL.

1.5 ESSLINGER TANK

Diameter: 42’ Overflow Height: 48’

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Capacity: 500,000 gallons Year of Completion: 1982 Location: Tank is located at the end of Bridgette Ln in Gurley, AL.

1.6 HAZEL GREEN TANK

Diameter: 81’ Overflow Height: 130’ Capacity: 5,000,000 gallons Year of Completion: 1998 Location: Tank is located on Agua Dr., off Hwy 231, in Hazel Green, AL.

1.7 HORSE COVE TANK

Diameter: 19’ Overflow Height: 23.5’ Capacity: 50,000 gallons Year of Completion: 1988 Location: Tank is located on Horse Cove Rd near Keel Mountain in southeast

Madison County.

1.8 KEEL MOUNTAIN TANK

Diameter: 42.7’ Overflow Height: 74’ Capacity: 1,000,000 gallons Year of Completion: 2012 Location: Tank is located on Keel Mountain Road near Keel Mountain in southeast

Madison County.

1.9 KILLINGSWORTH COVE TANK

Diameter: 43’ Overflow Height: 24’ Capacity: 250,000 gallons Year of Completion: 1982 Location: Tank is located off Gurley Pike in Gurley, AL.

1.10 LEWIS MOUNTAIN TANK

Diameter: 73’ Overflow Height: 32’ Capacity: 1,000,000 gallons Year of Completion: 1994

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Location: Tank is located at the end of Lewis Mountain Rd in New Market, AL.

1.11 NEW MARKET TANK

Diameter: 106’8” Overflow Height: 48’ Capacity: 3,000,000 gallons Year of Completion: 1994 Location: Tank is located on Billy Smith Rd in New Market, AL.

1.12 PLEVNA TANK

Diameter: 18” Overflow Height: 24’ Capacity: 50,000 gallons Year of Completion: 19986 Location: Tank is located on Old Winchester Road in Northeast Madison County.

1.13 RAINTREE TANK

Diameter: 40” Overflow Height: 32’ Capacity: 300,000 gallons Year of Completion: 1986 (currently out of service) Location: Tank is located on Raintree Road east off Dug Hill Road in Brownsboro.

1.14 QUARTER MOUNTAIN TANK

Diameter: 74’ Overflow Height: 32’ Capacity: 1,000,000 gallons Year of Completion: 1987 Location: Tank is located at the end of Bollweevil Ln in Toney, AL.

2. SPECIFICATIONS.

The inspection and inspection reports will be performed in accordance with AWWA M-42 Inspecting and Repairing Steel Water Tanks, Standpipes, Reservoirs, and Elevated Tanks, for Water Storage. Inspector shall meet the qualifications expressed in said AWWA M-42 and prepare a written report with captioned photographs and results of test and observations in accord with AWWA M-42. Familiarity with and adherence to the applicable state and federal guidance and industry best practices is required. Other applicable guidance may include: American

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Concrete Institute (ACI) 201.1R-95 Guide for Making a Condition Survey of Concrete in Service; and Ten State Standards Recommended Standards for Water Works 2012 Edition; AWWA Manual M42 Appendix C Inspecting and Repairing Steel Water Tanks and Elevated Tanks for Water Storage (formerly AWWA Standard D101).

To the extent possible, storage tanks will remain in service during the inspection. As such, divers or Remotely Operated Vehicles (ROV) will likely be required to perform inspection of the tank interior. The work shall include proper disinfection, chlorination or sterilization as required during or following the inspection, in order to provide continual use of the reservoir within the water supply system.

2.1 Inspection

The overall condition of the tank exterior, appurtenances, and site should be examined to ensure compliance with applicable guidelines. Any aspect of the tank or tank site that may be a threat to life or safety should be brought to the owner’s attention immediately. Security, sanitary, safety, structural, and coating conditions of the tank and tank site will be evaluated.

Security features to be inspected include: gates, fencing, ladders, and locks. Any deficiencies in the site security should be noted and recommendations made to bring the site into compliance with AWWA and other applicable guidance.

Sanitary conditions to be inspected include: roof openings, access hatches, roof low spots, vents (mesh), overflows, and cleanouts. The roof and side walls should be water tight with no unprotected openings. Evidence of animals entering the tank or any other deficiencies that may impact the sanitary conditions of the tank should be noted and corrective actions recommended.

Key structural features to be inspected include: anchor bolts, wind rods, foundation settlement, site grading and erosion, roof trusses, welds and seams, rust & corrosion of any structural elements. Concrete tanks (Mountain Fork Clearwell) should include inspection of cracking, spalling, or exposed reinforcement. Areas suspected of leaking or where leaking has been identified should be documented. The need for cathodic protection at all tanks, and the suitability of any protection systems (if any) currently installed should also be evaluated in accordance with NACE standards.

Safety features to be inspected include: ladders, fall prevention systems, handrails, toeboards, and access (manholes).

The coating system should be inspected to determine: general type and condition, percentage and type of failure (peeling, blistering, etc.), adhesion, thickness, and pitting damage. Deficiencies should be noted and corrective actions recommended.

2.2 Report

The inspection report and its observations shall be of a narrative format and shall not be of checklist or fill-in-the-blank type format. Color photographs and/or video will be used along with the report to document all the observations of the inspector. The photographs shall include

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captions and be referenced to and support the inspector’s observations. The report shall include recommendations for correcting all deficiencies found during the evaluation. Projected life of the tank and present coatings will also be included. The general categories of items to be inspected are discussed above.

3. DETERMINATION OF LOW BIDDER. The determination of the low bidder will be based on the base bid. If the base bid of the lowest bidder is within the funds available, the lowest bidder will be determined by considering the lowest price that completes the work described in Section 2. Bids shall be placed on the Bids Form found in Attachment D.

4. SCHEDULING.

4.1 PERIOD OF PERFORMANCE. The contractor shall perform the work within sixty (60) days. The period of performance will begin with the date on the Notice to Proceed. The Notice to Proceed will be issued post award.

5. SOURCE OF PROJECT FUNDING. Local funds are available for the proposed work.

6. SPECIAL CONDITIONS.

6.1 SPECIAL PRECAUTIONS.

• Because the tanks will remain in use during the inspection, the contractor must take all necessary precautions to ensure that any material used in the inspection that may come in contact with the water in the tank be properly cleaned and sterilized in accordance with AWWA C652 Section 5.

• The tank at Raintree Road is not currently in service but may be placed back in service in the near future. Attention should be paid to any repairs that may be necessary to bring the tank back in service, in compliance with applicable AWWA, EPA, and NFPA guidelines. A list of deficiencies and recommendations for placing the tank back in service shall be included in the final report for the Raintree Tank.

• Water is available at each tank through a hose bib; however, water pressure at the hose bib is only a few pounds per square inch. If needed, the contractor is permitted to use water from a hydrant near the site to fill up equipment needed to complete the work. The contractor shall provide appropriate backflow prevention or utilize an air gap.

6.2 PRECONSTRUCTION CONFERENCE. The contractor shall schedule a preconstruction conference at his or her discretion. The conference may be scheduled in advance prior to the beginning of work or during the first day of work.

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6.3 SECURITY REQUIREMENTS. The gates at the tank sites must remain locked at all times when the site is not occupied by contractor personnel. Gate keys will be provided and are expected to be returned upon completion of the work.

6.4 COORDINATION.

• The contract will be administered by representatives of the Madison County Water Department. Therefore, all submittal, correspondence, requests for information and applications for payment should be sent to the Madison County Water Department to the attention of Mr. Vince Moody at 246 Shields Rd Huntsville, AL 35811.

• The primary point of contact for the project is Mr. Vince Moody, cell phone (256) 783-1547. The alternate point of contact is Ms. Bailee Robinson, cell phone (256) 698-5841.

• Mr. Rod Payne will serve as the primary inspector for the project. He can be reached at (256) 759-1799.

6.5 INSURANCE. The contactor shall provide the following insurance:

Worker’s Compensations as required by statue.

Employer’s Liability Insurance

Bodily Injury by Accident $1,000,000

Bodily Injury by Disease $1,000,000

Commercial General Liability Insurance

General Aggregate $1,000,000 per project

Products, Completed Operations Aggregate $1,000,000 per project

Personal and Advertising Injury $1,000,000 per occurrence

Each Occurrence $1,000,000

Commercial Business Automobile Insurance ($1,000,000 combined single limits for each occurrence)

Commercial Umbrella Liability Insurance

$2,000,000 per occurrence

$2,000,000 per project

6.6 PROTECTION OF PERSONS AND PROPERTY. The contractor shall be solely and completely responsible for conditions at the project site, including safety of all persons (including employees) and property. The contractor shall create, maintain and supervise conditions and programs to facilitate and promote safe performance.

6.7 PAYMENT.

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The contractor shall be paid based on the bid amount provided for the tank(s) on the Bid Form.

The contractor must submit to the Madison County Water Department an invoice showing the bid limit and amount to be paid for the final invoice.

The contractor certification will be included on all invoices.

“The Contractor certifies that, to the best of the Contractor’s knowledge, information, and belief, the Work covered by the invoice has been completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous invoices were issued, and payments received from the Owner, and that the current payment shown in the invoice has not yet been received.”

Madison County shall review the invoice or correctness prior to authorizing for payment.

The contractor will be paid when all work is complete. Substantial Completion is defined as final acceptance of the work.

6.8 PREREQUISITES TO FINAL PAYMENT. The following conditions are prerequisites to final payment:

• Final Invoice

• Completion of an Advertisement for Completion. The Contractor, immediately after being notified by the Owner that all other requirements of the Contract have been completed, shall give public notice of completion of the Contract by having an Advertisement for Completion published one time in a newspaper of general circulation, published in the county in which the Owner is located and shall post notice of completion of the Contract on the Owner’s bulletin board for one week, and shall certify under oath that all bills have been paid in full. Final payment may be made at any time after the notice has been posted for one entire week.

• Delivery by the Contractor to the Owner of a completed Lien Waiver and Release of Claims as provided in Attachment G.

6.9 INDEMNIFICATION. To the fullest extent permitted by law, the Contractor shall defend, indemnify, and hold harmless the Owner, Owner’s consultants and their agents, employees, and consultants (hereinafter collectively referred to as the “Indemnities”) from and against all claims, damages, losses and expenses, including but not limited to attorneys’ fees, arising out of, related to, or resulting from the performance of the Work, provided that such claim, damage, loss or expense is attributable to bodily injury, sickness, disease or death, or to injury to or destruction of tangible property, including loss of use resulting there from, and is caused in a whole or in part by negligent acts or omissions of the Contractor, a

8

Subcontractor, anyone directly or indirectly employed by them, or anyone for whose acts they may be liable, regardless of whether such claim, damage, loss or expense is caused in part, or is alleged but not legally established to have been caused in whole or in part by the negligence or other fault of a party indemnified hereunder. This indemnification shall extend to all claims, damages, losses and expenses for injury or damage to adjacent or neighboring property, or persons injured thereon, that arise out of, relate to, or result from performance of the Work. This indemnification does not apply to the extent of the sole negligence of the Indemnitees.

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Attachment A: Tank Photos

Figure 1 - Bobo Northwest Hydropillar

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Figure 2 - Chase Tank

Figure 3 – Mountain Fork Water Treatment Facility Clearwell

11

Figure 4 - Esslinger Tank

12

Figure 5 - Hazel Green Tank

13

Figure 6 - Horse Cove Tank

14

Figure 7 - Lewis Mountain Tank

15

Figure 8 - Keel Mountain Tank

16

Figure 9 - Killingsworth Cove Tank

Figure 10 - New Market Tank

17

Figure 11 - Plevna Tank

18

Figure 12 - Raintree Tank

19

Figure 13 - Quarter Mountain Tank

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Attachment B: Tank Location Map

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Attachment C: Lien Waver and Release of Claims

(Completed at end of Contract as Condition of Final Payment)

Tank Inspection Bid 2019 – Madison County Water Tanks Project Various locations in Madison County, AL Job Address

• The undersigned, being first duly sworn, deposes and says that he is over the age of 21 years and resides at .

• (Check One) ____ He is the contractor referred to herein.

_____ He is the general partner in _________________________, a partnership composed of the undersigned and carrying on business at ______________________________, City of ____________________.

_____ He holds the title of ___________________, in _____________________, a corporation organized under the laws of the State of ________________, carrying on business at _________________________________________, City of ____________________, State of ____________________, which corporation is the contractor referred to herein. The undersigned is authorized to execute this instrument on its behalf.

• Contractor is a contractor for the performance of certain work and/or the furnishing of certain materials or supplies (the "Project") pursuant to an agreement (hereinafter the "Contract") between Madison County, Alabama and (hereinafter the "Contractor") for the improvements or project known as , County of Madison, State of Alabama (hereinafter the "Property").

• This instrument is delivered in consideration of and for the purpose of inducing Madison County to make final payment to Contractor under the Contract subject to collection of any check given as payment, Contractor acknowledges that upon receipt of this final payment, Contractor has been paid in full the total Contract price of _________________ for all of the work performed under the Contract, including retainage, if any.

• Contractor warrants and represents: o All materials delivered to said Project by and for the

Contractor are for use therein only; o Title to all work, material and equipment covered by said

payment, whether or not incorporated in the Property, has passed to Madison County, free and clear of all liens, claims, security interest or encumbrances (hereinafter all referred to as "Liens");

o All taxes applicable to the materials furnished and the work performed under the Contract have been fully paid; and

o All laborers, mechanics, subcontractors, materialmen and suppliers for all work done and for all materials, machinery, equipment, fixtures, tools, scaffolding and appliances furnished for the performance of the Contract and

22

for any other indebtedness connected therewith for which Madison County might be responsible have been paid in full. Contractor, for itself, its successors and on behalf of all persons able to claim through or under Contractor: (i) waives, relinquishes and releases all liens and rights for claim to a lien for labor or materials furnished in the construction, improvement, alteration or repair involved in performance under the Contract; (ii) agrees to save Madison County harmless from all liability, cost and expenses, including reasonable attorneys' fees, to: (a) discharge (by bond or otherwise) or to defend suit to enforce, any mechanics' or materialmen's lien, claim to or right of action for such lien, which may be filed and (b) satisfy any claims or demands arising out of, due or which may be made, directly or indirectly attributable to the Contract, any work performed or supplies furnished thereunder, or in furtherance of the construction or completion of the Contract work; and (iii) hereby releases Madison County, the Property and any lender who may now or hereafter have a security interest therein from all claims, causes of action, liability or liens which may be filed or asserted in connection with the Contract. Dated this the _____ day of .

____________________________________ By: ________________________________ Its: _____________________________

STATE OF ALABAMA COUNTY OF MADISON

I, the undersigned, a Notary Public in and for said County and State, do hereby certify that , whose name as ______________________ of , is signed to the foregoing instrument, and who is known to me, acknowledged before me on this day that, being informed of the contents of the said Agreement, he/she as such officer, and with full authority, executed the same voluntarily for and as the act of the said corporation.

Given under my hand and official seal this the _____ day of .

____________________________________ Notary Public

My Commission Expires:

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Attachment D: BID FORM

To: Madison County Commission, Date:

In compliance with the Advertisement for Bids and subject to all the conditions thereof, the undersigned

(Legal Name of Bidder)

hereby proposes to furnish all labor and materials and perform all work required for the Work

Inspection and Evaluation of Madison County Water Storage Tanks, Project MCWD 19-XX, dated September 2019.

The Bidder, which is organized and existing under the laws of the State of _________________, having its principal offices in the City of ________________________________________, is a:

__ Corporation, __ Partnership __ Individual , ___ (Other) ____________

LISTING OF PARTNERS OR OFFICERS: If Bidder is a Partnership, list all partners and their addresses; if Bidder

is a Corporation, list the names, titles, and business addresses of its officers:

BIDDER’S REPRESENTATION: The Bidder declares that it has examined the site of the Work, having become

fully informed regarding all pertinent conditions, and that it has examined the Specifications (including all Addenda

received) for the Work and the other Bid and Contract Documents relative thereto, and that it has satisfied itself

relative to the Work to be performed.

ADDENDA: The Bidder acknowledges receipt of Addenda Numbers._______ through ______ inclusively.

BASE LUMP SUM BID: Tank Inspection Capacity Height Amount Bobo Northwest Hydropillar 3,000,000 155 $ Chase Mountain Tank 1,000,000 31.5 $ WTP Clearwell 2,000,000 15 $ Esslinger Tank 500,000 48 $ Hazel Green Tank 5,000,000 130 $ Horse Cove Tank 50,000 23.5 $ Keel Mountain Tank 1,000,000 74 $ Killingsworth Cove Tank 250,000 24 $ Lewis Mountain Tank 1,000,000 32 $ New Market Tank 3,000,000 48 $ Plevna Tank 50,000 24 $ Quarter Mountain Tank 1,000,000 32 $ Raintree Tank 300,000 32 $

TOTAL $

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TOTAL FOR BASE BID:

For the Work complete as specified, the sum of Dollars ($_________________) is bid.

BID SECURITY: The undersigned agrees to enter into a Construction Contract and furnish the prescribed Performance and Payment Bonds and evidence of insurance within fifteen calendar days, or such other period stated in the Bid Documents, after the contract forms have been presented for signature, provided such presentation is made within 60 calendar days after the opening of bids, or such other period stated in the Bid Documents. As security for this condition, the undersigned further agrees that the funds represented by the Bid Bond (or cashier’s check) attached hereto may be called and paid into the account of the Awarding Authority as liquidated damages for failure to so comply. Attached hereto is a: (Mark the appropriate box and provide the applicable information.)

Bid Bond, executed by __________________________________________as Surety, cashier’s check on the______________________ Bank ______________________, for the sum of _____________________________________________________Dollars

($ ___________________________) made payable to the Awarding Authority. _____________________

BIDDER’S ALABAMA LICENSE:

____________________ ________________ _________________________ License Number Bid Limit Type(s) of Work

CERTIFICATIONS: The undersigned certifies that he or she is authorized to execute contracts on behalf of the Bidder as legally named, that this proposal is submitted in good faith without fraud or collusion with any other bidder, that the information indicated in this document is true and complete, and that the bid is made in full accord with State law. Notice of acceptance may be sent to the undersigned at the address set forth below.

The Bidder also declares that a list of all proposed major subcontractors and suppliers will be submitted at a time subsequent to the receipt of bids as established by the Owner in the Bid Documents but in no event shall this time exceed twenty-four (24) hours after receipt of bids.

Legal Name of Bidder _______________________________________________________

Mailing Address _______________________________________________________

* By (Legal Signature) _______________________________________________________

* Name (type or print) _______________________________________________________

*Title _______________________________________________________

Telephone Number _______________________________________________________

* If other than the individual proprietor, or an above-named member of the Partnership, or the above named president, vice-president, or secretary of the Corporation, attach written authority to bind the Bidder. Any modification to a bid shall be over the initials of the person signing the bid, or of an authorized representative.

INCOMPLETE AND IRREGULAR BIDS

A bid that is not accompanied by data required by the Bid

Documents, or a bid which is in any way incomplete, may be

rejected. Any bid which contains any uninitiated alterations or

erasures, or any bid which contains any additions, alternate bids, or

conditions not called for, or any other irregularities of any kind, will

be subject to rejection. Bids may also be rejected for any of (but not

limited to) the following causes:

A. Failure to utilize bid forms provided by Madison County.

B. Failure of non-enrollment of E-Verify and requireddocumentation.

C. Lack of signature on all notarized document(s) by authorized

representative on the bid forms.

D. Failure to properly complete the bid.

E. Evidence of collusion among bidders.

F. Unauthorized alteration of bid/proposal form.

G.Failure to submit other forms and documents as required.

H.Failure to print and submit bid forms on letter size paper(make sure no portion of the bid documents are cut off)

DOCSHSV\204047\1\

SWORN AFFIDAVIT OF EMPLOYER REGARDING UNAUTHORIZED ALIENS

1. The undersigned hereby attests by this sworn affidavit signed before a notary that

it does not knowingly employ, hire for employment, or continue to employ an unauthorized

alien.

2. The undersigned hereby attests that it is enrolled in the Federal E-Verify program.

A true and correct copy of the undersigned's fully executed Federal E-Verify Memorandum of

Understanding is attached hereto.

3. The Federal E-Verify Memorandum of Understanding attached hereto is the

operative Memorandum of Understanding under which the undersigned is currently participating

in the Federal E-Verify Program. Must provide E-Verify Company ID: ________________

4. This sworn affidavit is provided to comply with Alabama Act No. 2011-535,

known as the "Beason-Hammon Alabama Taxpayer and Citizen Protection Act."

Name:

______________Company Name_____________

By: ___________Signature___________________

Printed Name:______________________________

Position:__________________________________

STATE OF __________________________

COUNTY OF ________________________

I, the undersigned, Notary Public in and for said County in said State, hereby certify that

______Employee_______, whose name as __Job Title__________ of _Name of Organization,

is signed to the foregoing instrument and who is known to me, acknowledged before me on this

day that, being informed of the contents of the instrument, he, as such __Job Title________ and

with full authority, executed the same voluntarily for and as the act of said

__Name of Organization/Company_______.

Given under my hand this the _____ day of _____________, 20___.

Notary Public

My Commission Expires:

DOCSHSV\204047\1\

SWORN AFFIDAVIT OF EMPLOYER REGARDING UNAUTHORIZED ALIENS

1. The undersigned hereby attests by this sworn affidavit signed before a notary that it does not knowingly employ, hire for employment, or continue to employ an unauthorized

alien.

2. The undersigned hereby attests that it is enrolled in the Federal E-Verify program. A true and correct copy of the undersigned's fully executed Federal E-Verify Memorandum of

Understanding is attached hereto.

3. The Federal E-Verify Memorandum of Understanding attached hereto is the operative Memorandum of Understanding under which the undersigned is currently participating

in the Federal E-Verify Program. Must provide E-Verify Company ID: ___________________

4. This sworn affidavit is provided to comply with Alabama Act No. 2011-535, known as the "Beason-Hammon Alabama Taxpayer and Citizen Protection Act."

Name:

__________________________________________

By:_______________________________________

Printed Name:______________________________

Position:__________________________________

STATE OF ___________________

COUNTY OF _________________

I, the undersigned, Notary Public in and for said County in said State, hereby certify that

__________________, whose name as _____________________ of__________________, is

signed to the foregoing instrument and who is known to me, acknowledged before me on this

day that, being informed of the contents of the instrument, he, as such _____________________

and with full authority, executed the same voluntarily for and as the act of said

_______________________.

Given under my hand this the _____ day of _____________, 20___.

Notary Public

My Commission Expires:

SWORN AFFIDAVIT OF SUBCONTRACTOR

REGARDING UNAUTHORIZED ALIENS

1. The undersigned subcontractor hereby attests by this sworn affidavit signed before a notary that it does not knowingly employ, hire for employment, or continue to employ

an unauthorized alien.

2. The undersigned subcontractor hereby attests that it is enrolled in the Federal E-

Verify program. A true and correct copy of the undersigned's fully executed Federal E-Verify

Memorandum of Understanding is attached hereto.

3. The Federal E-Verify Memorandum of Understanding attached hereto is the operative Memorandum of Understanding under which the undersigned is currently participating

in the Federal E-Verify Program. Must provide Company ID: ______________________

4. This sworn affidavit is provided to comply with Alabama Act No. 2011-535, known as the "Beason-Hammon Alabama Taxpayer and Citizen Protection Act."

Name:

__________________________________________

By:_______________________________________

Printed Name:______________________________

Position:__________________________________

STATE OF __________________________

COUNTY OF ________________________

I, the undersigned, Notary Public in and for said County in said State, hereby certify that

__________________, whose name as _____________________ of__________________, is

signed to the foregoing instrument and who is known to me, acknowledged before me on this

day that, being informed of the contents of the instrument, he, as such _____________________

and with full authority, executed the same voluntarily for and as the act of said

_______________________.

Given under my hand this the _____ day of _____________, 20___.

Notary Public

My Commission Expires:

Company ID Number:

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Company Name

Company Facility Address

Company Alternate Address

County or Parish

Employer Identification Number

North American Industry Classification Systems Code

Parent Company

Number of Employees

Number of Sites Verified for Sample