181-26 Exhibit B-Reggio Construction_compressed.pdf

PROPOSAL AND SCHEDULE OF BIDS BID DOCUMENT SUBMISSION CHECKLIST - TOWNSHIP OF WEST ORANGE NJDOT MA 2025 HELEN AVE., LAWRENCE AVE., FLORENCE PL, AND LOWELL AVE. IMPROVEMENT PROJECT (Name of Construction/Public Works Project) (Project Or Bid Number) A. Failure to submit the following documents is a mandatory cause for the bid to be rejected. (NJSA 40A:11-23.2) Required With Initial Each Item Submission of Bid Submitted With Bid (Owner's checkmarks) (Bidder's initials) X_|+ Bid guarantee as required, by NJSA 40A: 11-21 QV X_|e Certificate from a surety company, pursuant to NJSA 40A: 11-22 Ss X_|e Statement of corporate ownership, pursuant to NJSA 52:25-24 2 & X_| Listing of Subcontractors as required by NJSA 40A: 11- 16 a X |e If applicable, Bidder's acknowledgment of receipt of any notice(s) or re-vision(s) or A addenda to an advertisement, specifications or bid document(s) B. Failure to submit the following documents may be a cause for the bid to be rejected. (NJSA 40A: 11-23.1b.) Required with Initial Each Item Required with Initial Each Item Submission of Bid Submitted with Bid Submission of Bid Submitted with Bid (Owner's checkmarks) (Bidder's initials) (Owner's checkmark) (Bidder's initials) A Certified Financial Statement Consent of surety as to maintenance bond prepared within the last 12 months as required by NJSA 40: 11 - 16.3b Consent of Surety as to a Labor and X | Submission of a Non-Collusion Affidavit (this Sp Material Payment Bond form must be notarized) fe Statement of compliance with NJSA X | Certification of Bidder showing that Bidder “5 45: 14C-2(h) (licensed master owns, leases, or controls any necessary plumber) equipment iS X | Affirmative Action Program Information |_| X | Qualification Questionnaire ie) Disclosure of Political Contributions X | Disclosure of Investment Activities in Iran a> X | Business Registration Certificate X | Certificate of Registration required if this is a “Public Work" project as defined in the Public hie Work Contractor Registration Act (PL 1999,C.238) Ch X | Business Registration Certificate for all X | Certificate of Registration required if this is a subcontractors > "Public Work" project as defined in the Public Work Contractor Registration Act (PL 1999,C.238) for all subcontractors ro X | Statement of Non-Debarment for X | Certification of Non-Involvement in Prohibited |” ” Federal Government

d in the Public Work Contractor Registration Act (PL 1999,C.238) for all subcontractors ro X | Statement of Non-Debarment for X | Certification of Non-Involvement in Prohibited |” ” Federal Government Contracts Activities in Russia or Belarus a Lowest Bidder Prevailing Wage iy X | SAM Number, Cage Code Number and Certification DUNS Numbers th X | Certificate of Insurance - All parties to X | Americans with Disabilities Act of 1990 the Contract must be named as Acknowledgement additional insured/co-insured Oo Zig E. CENTRAL BLVD. C. SIGNATURE: The undersigned ind has su the above listed requirements. Name of Bidder: i le By Authorized Representative: RK, NJ 07650 Signature: a1 —— Print Name and Title: oN a oa Date: ~~ 6 Jaz fag THIS FORM MUST BE EXECUTED BY THE BIDDER (ALL ren’, mudt BE COMPLETED IN INK.) P-1