Ml 33 736, - Montgomery County, Pennsylvaniawebapp02.montcopa.org/openrecords/contracts/... · //ml...

//Ml 33 736,

1) VENDOR ACCOUNT NAME Q

2) VENDOR NUMBER - CURRENT

3) VENDOR NUMBER - PREVIOUS IF APPLICABLE

4) RESOLUTION NUMB

5) RESOLUTION DATE

6) PROCUREMENT (RFP/SPEC/OTHER)

7) PURCHASE ORDER NUMBER

8) REQUEST FOR PROPOSAL (RFP)

9) PERFORMANCE BOND

10) PERFORMANCE BONDING COMP

11)" SPECIFICATION NUMBER

12) CONTRACT START DATE

13) CONTRACT END DATE

14) CONTRACT EXTENSION

15) CODE/TYPE

16) LABOR & MATERIALS BOND

17) L & M BONDING COMPANIES

18) BUDGET NUMBER

19) DEPARTMENT SERVED

20) SERVICE PROVIDED

21) STORAGE

22) DESTROY DATE

23) OTHER NOTES

24) TO ARCHIVES DATE

^

«SPECIFICATIONS

FOREQUIPMENT RENTALS

FOR ROAD AND TRAIL MAINTENANCE

Montgomery County CommissionersCourt House

Norristown, Pennsylvania

Joshua D Shapiro, ChairLeslie S Richards, Vice-Chair

Bruce L Castor, Jr., Commissioner

SolicitorRaymond McGarry

ControllerStewart J Greenleaf, Jr.

Director of PurchasingJoseph Coco

610-278-3037

Director of Assets & InfrastructureKenneth Starr610-278-3044

Deputy Director of Parks, Trails & Historic SitesRonald H Ahlbrandt

610-278-3555

Official correspondence will be addressed to:

Company: j^JUXj d 6. pC JrSk cf^

'"" 'rkrl-d £• (VarContact:

Title:

Idress:

zipTelephone:

Fax:

E-mail Address:

Federal ID No. Z--3

Opening Date: June 13, 2013Specification #111376-6211-KW/rn

#11 1376-62 11-KW/rn

PROPOSAL FORM

Submitted By P/lWontractor's

0 -(Contracor's Name)

Date /Y\

To:Commissioners of Montgomery CountyCourt HouseNorristown, Pennsylvania

Gentlemen:

This proposal is submitted in accordance with your advertisement inviting proposals to bereceived for the project identified as:

FURNISHING, DELIVERING AND PROVIDING VARIOUS TYPESOF EQUIPMENT RENTALS

Having carefully examined the "Advertisement for Bids", "Bidding Instructions", "Scopeof the Work", etc., hereinafter referred to as "Specifications", together with all addenda, errata,bulletins applying thereto and being familiar with the various conditions affecting the work, theundersigned hereby agrees to furnish all materials, perform all labor, and do all else necessary tocomplete the work in strict accordance with the specifications, for prices quoted on the followingschedules.

In case this proposal is accepted, the undersigned is hereby bound to enter into contractwithin ten (10) days after receipt of notice of acceptance of the above, in accordance with suchspecifications.

ACH (Automatic Clearing House) payments are not requested

Prompt Payment Discount Terms. <M 1 f\E #1

TYPE OF SERVICE AND/OR EQUIPMENT RENTAL FOR YEAR ROUND WORKPRICING IN THIS ITEM SHALL INCLUDE OPERATOR

ITEM #1 - GRADERS SELF PROPELLED PNEUMATIC TIRES

PRICE PER HOUR

1. Minimum Blade 8 ft.2. Minimum Blade 10 ft.3. Minimum Blade 12 ft.

(7)

ITEM #2 DOZER CRAWLER TRACTOR WITH ANGLE DOZER OR BULL DOZERPRICING PER HOUR SHALL INCLUDE OPERATOR

PRICE PER HOURfi /)z' &*

1. Min imum Blade 6 ft.2. Minimum Blade 8 ft.3. Minimum Blade 10 ft.4. Minimum Blade 12 ft.

ITEM #3 - BACKHOE CRAWLER - PULL SHOVELPRICING PER I IQUR SHALL INCLUDE OPERATOR

PRICE PER HOUR

1. '/2 Cubic Yard f AJ5**2. 3/4 Cubic Yard * HO*3. 1 Cubic Yard4. 1 !/2 Cubic Yards5. 2 Cubic Yards

ITEM #3A - LOADER AND 2 CU. FT. BACKHOE (WHEEL MOUNTED PNEUMATICTIRES PRICING PER HOUR SHALL INCLUDE OPERATOR

FRONT BUCKET PRICE PER HOUR

1. 3/4 Cubic Yard2. I Cubic Yard3. 1 '/2 Cubic Yard

TYPE OF SERVICE AND/OR EQUIPMENT RENTAL FOR YEAR ROUND WORKITEM #3B - GRADEALL - ALL PURPOSE EXCAVATOR TRUCK OR CRAWLER

MOUNTED HYDRAULICALLY OPERATED TELESCOPIC FULL-ROTATING BOOMPRICING PER HOUR SHALL INCLUDE OPERATOR

PRICE PER HOUR

1. Bucket Size !/2 cubic yd.2. Bucket Size 5/8 cubic yd.3. Bucket Size 3/4 cubic yd.4. Bucket Size 1 cubic yd.

ITEM #3C - GRADEALL - ALL PURPOSE EXCAVATOR TRUCK OR CRAWLERMOUNTED HYDRAULICALLY OPERATED TELESCOPIC FULL-ROTATING BOOM

WITH POWER RAM PRICING PER HOUR SHALL INCLUDE OPERATOR

PRICE PER HOUR

1. Vi cubic yard2. 3/4 cubic yard ^—3. 1 cubic yard x-""

(7-1)

ITEM #4 - FRONT END LOADER (WHEEL MOUNTED PNEUMATIC TIRES')PRICING PER HOUR SHALL INCLUDE OPERATOR

PRICE PER HOUR

1. lyard f/ #"2. 2 yard 9 (f^*3. 4 yard4. 6 yard

ITEM #4A - FRONT END LOADER (CRAWLER)PRICING PER HOUR SHALL INCLUDE OPERATOR

PRICE PER HOUR

1. lyard2. 2 yards3. 4 yards4. 6 yards

TYPE OF SERVICE AND/OR EQUIPMENT RENTAL FOR YEAR ROUND WORKITEM #5 - ROLLERS - STATIC PRICING PER HOUR SHALL INCLUDE OPERATOR

PRICE PER HOUR

1. 2 Ton Tandem2. 5 Ton Tandem3. 8 Ton Tandem4. 10 Ton Tandem5. 12 Ton Tandem

ITEM #5A - ROLLERS - VIBRATORYPRICING PER HOUR SHALL INCLUDE OPERTOR

VIBRATORY STEEL DRUM (DUAL- MANUALLY GUIDED)

PRICE PER HOUR

1. 2 Ton Tandem ^j 72. 8 Ton Tandem3. 10 Ton Tandem tlSg**4. 15 Ton Tandem5. 20 Ton Tandem

TAMPING SHEEPSFOOT (TOWED TYPE) DRUM SIZE (SINGLE DRUM)

PRICE PER HOUR

1. 2 Ton Tandem2. 4 Ton Tandem3. 10 Ton Tandem —--

(7-2)

*

VIBRATORY SHEEPSFOOT (SELF PROPELLED PNEUMATIC TIRED PRIME MOVER)

1. 2 Ton Tandem2. 4 Ton Tandem3. 10 Ton Tandem

PRICE PER HOUR

ITEM #6 SPREADER (SELF PROPELLED CHIP SPREADER)PRICING PER HOUR SHALL INCLUDE OPERATOR

1. Spreader width 8 ft. to 1 2 f t .

ITEM #6A

1 . Mill ing Machine (self-propelled) minimum6 to 10 foot milling width

2. Minimum 10 to 12 feet Milling Width

3. Curb Side Milling Machine _ —2 foot to 4 foot width

ITEM #6B - BLACK. TOP SPREADERS AND PAVERSPRICING PER HOUR SHALL INCLUDE OPERATOR

1 . BITUMINOUS (BLACK TOP FINISHERS CRAWLER)PAVING WIDTHS

8' -12'8' -16'8' -20'10'- 16'10' -20'

2. BITUMINOUS (BLACK TOP FINISHER WHEEL MOUNTED PNEUMATIC(TIRES)

PAVING WIDTHS

8* -12'8' -16'8' -20'10'- 16'10' -20'

ITEM #7 - TRUCKS FOR MAINTENANCEPRICING PER HOUR SHALL INCLUDE OPERATOR

1. 8 Ton Truck

2. 10 ton Truck

3. 15 Ton Truck

4. 22 Ton Truck

(7-3)

ITEM #7 cont'd5. 24 Ton Tri-Axel

6. 25 Ton Truck

7. Truck Mounted Lift Platform 20 ft. Lift Bucket

8. Truck Mounted Lift Platform 48 ft. Lift Bucket

9. Truck Mounted Lift Platform 90 ft.Lift Bucket

10. Line Truck Digger/Derrick 14,000 IbBoom 1 8' Auger

1 1. Aerial Bucket Truck 40' Working Height

12. Snooper Crane (Bridge Work)

13. Water Truck for Refilling Rollers w/County *to provide water

13A. Price w/Contractor to provide water I^ff

14. Tri-Axle w/plow ' ̂ -ClQ

NOTE: ALL TRUCK AND TRAILERS TONNAGE TO BE BY STATE WEIGHT STICKERONLY.

ITEM #8 - TRACTOR/TRAILER LOW BOY & TAG-A-LONG TRAILERSPRICING PER HOUR SHALL INCLUDE OPERATOR

1. 5 Ton Tag-A-Long /Q>2. 10 Ton Tag-A-Long3. 15 Ton Low Boy4. 25 Ton Low Boy5. 30 Ton Low Boy

NOTE: ALL TRUCKS AND TRAILERS TONNAGE TO BE BY STATE WEIGHTSTICKER ONLY.ITEM #8A - CRANES CRAWLER OR TRUCK MOUNTED - LIFTING SWINGING BOOM

PRICING PER HOUR SHALL INCLUDE OPERATOR

1. Minimum 10 Ton2. Minimum 20 Ton3. Minimum 40 Ton4. Minimum 60 Ton5. Minimum 75 Ton6. Minimum 100 Ton

ITEM #8B - CRANES - TRUCK MOUNTED HYDRAULIC TELESCOPING SWINGBOOM PRICING PER HOUR SHALL INCLUDE OPERATOR

1. 10 Ton2. 20 Ton3. 30 Ton4. 45 Ton

(7-4)

ITEM #8B cont'd5. 60 Ton6. 75 Ton

ITEM #9 - TREE REMOVAL/LANDSCAPING SERVICENOTE: PRICING PER HOUR TO INCLUDE OPERATORI. Grass Mower-Tractor Sickle Bar ——

2. Grass Mower other than Sickle Barspecify w/operator

3. Weed Wacker ?&9

4. Wood Chipper Machine 7_g

5. Auger Drill Root Remover

6. Stump Grinding

7. Log Wood Splitter ? ffi*2

8. Tree removal/prunig * /^^

9. Certified Pesticide Right-of-Way VegetationSprayer **~

10. Landscaping Tractor Rear Rake and/or Disc. * //5

1 1 . Each Seeder

12. Hydro Seeder w/contractor's grade & mulchingPer Square Yard

13. Bucket Truck and/or High Reach

ITEM #10 - MISCELLANEOUSNOTE: PRICING PER HOUR TO INCLUDE OPERATOR IN NUMBERS 1 THRU 40

1. Shoulder Widener (sidewinder)

2. 2 Gun Air Compressor $ //&

2A. Without operator

3. Portable Welding Unit ? / '

4. Welder for County Portable Welding Unit

5. In-Shop Maintenance Welding ^ I/O

6. In-Shop Mechanic

1. Form Carpenter y r^

8. Storm Pipe Helper $ ~ffi$

9. Stone Raker ~

10. Foreman

1 1 . Power driven Guiderail Post Hammer

(7-5)

ITEM#10-cont'd. -12. Self-Powered Jumping Jack Tamper

13. Vibratory Plate }

14. Self-Powered Portable Tamper */6$

15. Hydro Hammer Tamper and Breaker "

16. Post Hole Auger Drill

1 7. Grace Street Broom

18. Concrete Saw

ISA. Extra Saw Blades, per Blade

19. Gasoline Auxiliary Power Unit

20. Power Street Sweeper w/water and(Min. 3 cu. yd. pickup)

2 1 . Vac-All 6 cu. yd. - 1 ,200 gallon water capacity catchbasin in Inlet Cleaner Pipe Cleaner

22. Self-Powered Pipe Cleaner Auger_ size

23. Spider Work Platform

24. Stone Mason

25. Brick Layer

26. Concrete and Cement Finisher

27. Concrete Saw w/water

39A. Extra Saw Blades, per blade

28. Concrete Drilling Unit w/water

NOTE: PRICING PER HOUR/EQUIPMENT ONLYIN NUMBERS 29 THRU 31

jn H i it29. Water Pump 5 Cl inch self-powered

30. Generator- 120 volt self-powered

3 1 . Generator-220 volt self-powered ^ ®

BLACK TOP PAVING AND SEALINGNOTE: PRICING PER HOUR TO INCLUDE OPERATORS IN NUMBERS

32 THRU 41 BELOW

32. Each Raker

33. Each Screed

34. Each Squeegee

35. Each Pour Pot Man J / ̂

(7-6)

ITEMtflOcont 'd

36. Black Top Cuter (Knife)

37. Bituminous Distributer Truck

38. Asphalt Curb Machine (self-propelled)

GU1DERAIL INSTALLATION

39. Hydraulic Guiderail Post Pounder

40. Guidrail Layout Person

41. Where helper is required on any item within thisschedule and such meets with the approval ofRoads & Bridges Dept., we propose to charge thehourly rate of.

ITEM #11 -PNEUMATIC APPLICATION OF CONCRETE

42.

43.

44.

45.

46.

GUNITE IN PLACE

Gunite Truck

Gunite Foreman

Gunite Laborer

Gunite in Place

Arial Platform

/hour

*" /hour

~" " /hour

/cubic yard

"*~~~* /hour

SCHEDULE #2

TYPE OF SERVICE AND/OR EQUIPMENT RENTAL FOR WINTER WORKITEM #11 - TRUCKS FOR SNOW PLOWING

NOTE: PRICING PER 1 IQUR TO INCLUDE OPERATORS IN NUMBERS1 THRU 5 BELOW

MINIMUM 10 FOOT PLOW

1 . 3/4 to 1 ton pick-up with operator with minimum7 ft. vendor's plow

2.5 ton truck, with operator (vendor's plow) *3. 10 ton truck, with operator (vendor's plow)4. 15 ton truck, with operator (vendor's plow)5. 20 ton truck, with operator (vendor's plow)

NOTE: ALL TRUCK TONNAGE TO BE BY STATE WEIGHT STICKERS ONLY.

ITEM #12 -TRUCKS FOR ANTI-SKID MATERIAL AND SALTINGNOTE: PRICING PER HOUR TO INCLUDE OPERATIONS IN NUMBERS

1 THRU 5 BELOW

truck, with operator and vendor's hydraulic , //^/Pspreader [\(J

(7-7)

2. 9 ton truck, with operator and vendor's hydraulicspreader



5. 20 ton truck, with operator and vendor's hydraulic «i-\J l\Jll II UV.IN., V V 1 L 1 1 \_/JJ\»l C11AJ1 CIIIU WI1UW1 o 11 _y VJ1 uu 1 IV, Jf ^,, j tt*~f

spreader / jO

NOTE: ALL TRUCKS TONNAGE TO BE BY STATE WEIGHT STICKERS ONLY.

TYPE OF SERVICE AND/OR EQUIPMENT RENTAL FOR WINTER WORKPRICING PER HOUR SHALL INCLUDE OPERATOR

ITEM #13 - TRUCKS FOR SNOW REMOVAL

1. 9 ton truck2. 10 ton truck x-—"3. 15 ton truck4. 20 ton truck5. 24 ton tri-axel

ITEM #14 - LOADER AND 2 CU. FT. BUCKET BACKHOE (WHEEL MOUNTEDPNEUMATIC TIRES

PRICING PER HOUR SHALL INCLUDE OPERATOR

1 . 3/4 cubic yards2. \c yard3. 1 !/2 cubic yards

ITEM #15 - FRONT END LOADER (WHEEL MOUNTED PNEUMATICPRICING PER HOUR SHALL

1.2.3.4.5.

3A cubic yards1 cubic yard1 '/2 cubic yards2 cubic yards2 '/2 cubic yards

INCLUDE OPERATOR

L2L2£?•> —̂~

—<~*

ITEM #16 - SNOW BLOWERPRICING PER HOUR SHALL INCLUDE OPERATOR

1. WIDTH 2 FEET5 HP

10 HP

Where helper is required on any item within this Schedule, and such meets with theapproval of the Department of Roads and Bridges, we propose to charge the hourly rate of:

(7-8)

SCHEDULE #3PARKS, TRAILS & HISTORIC SITE WORK INCLUDES, BUT NOT LIMITED TO:CONSTRUCTION AND REPAIR OF PAVED AND UNPAVED TRAIL SURFACES,

EROSION AND DRAINAGE REPAIRS, BUILDING DEMOLITION, DEBRIS REMOVAL,MATERIAL HAULING AND WATERWAY/CANAL CLEARING. PRICING PER HOUR

SHALL INCLUDE OPERATOR

Vendor to provide list of equipment, with size and hourly rates that would coincide withthe tasks as listed. Due to nature of some repairs, vendor may be asked to complete specificprojects as a design/build.

Construction & Repair of Paved Trail Surfaces

Equipment Price Pc.r_Hou_r

Construction & Repair of Unpaved Trail Surfaces

Equipment Price Per Hour

&UI

Erosion and Drainage Repairs

Equipment Price Per Hour.1 . R

$

$

Building Demolition


(7-9)

Debris Removal


$

$

Material Hauling

Equipment Price Per Houri I

$

$Ufr

Waterwav/Canai Clearing


o

Discounts for: daily

weekly_

% discount

% discount

Monthly ^ % discount

(7-10)

Floyd G. Hersh, Inc. Bid Equipment Rentals for Road and Trail Maintenance #111376-6211-KW/rn

CROPTS

1

234567891011121314

SCHEDULE #3 ATTACHMENT

Construction & Repair of Paved Trail SurfacesPaver 8'-1 6' w/ OperatorForemanAsphalt Screed LaborAsphalt Raker LaborVibratory Plate w/ LaborerWater Truck w/ Operator2 Ton Vib Asphalt Roller w/ Operator1 0 Ton Vib Aspalt Roller w/ OperatorBackhoe 3/4 CY Bucket w/ OperatorTrack Hoe 1/2 CY bucket w/ OperatorTrim Milling Machine 2' Width w/ OperatorTack Distributor w/ OperatorStreet Broom w/ OperatorDozer 8' Blade w/ Operator

HRHRHRHRHRHRHRHRHRHRHRHRHRHR

$ 200.00$ 90.00$ 84.00$ 84.00$ 87.75$ 120.00$ 97.50$ 105.00$ 125.00$ 138.50$ 150.00$ 122.25$ 112.50$ 135.00


SCHEDULE #3 ATTACHMENTGROUTS Construction & Repair of Unpaved Trail Surfaces

12

3

4

5

6

7

8

9

10

Paver 8'-16' w/ Operator

Foreman

Screed Labor

Stone Raker laborer

2 Ton Vib Roller w/ Operator

10 Ton Vib Roller w/ Operator

Backhoe 3/4 CY Bucket w/ Operator

Track Hoe 1/2 CY bucket w/ Operator

Track Loader 1 yrd w/ Operator

Dozer 8' Blade w/ Operator

HR

HR

HR

HR

HR

HR

HR

HR

HR

HR

$ 200.00

$ 90.00

$ 84.00

$ 78.50

$ 97.50

$ 105.00

$ 125.00

$ 138.50

$ 165.00

$ 135.00


ED&R

1

2

3

4

5

6

7

8

9

10

11

12


Erosion & Drainage Repair

Foreman

Storm Pipe Helper

Stone Raker laborer

Jumpin Jack w/Laborer

Vib. Trench Compactor w/ Operator


Track Hoe 1/2 CY bucket w/ Operator



Seeder And Mulch Equipment w/ Operator

Landscape Laborer

Landscape Rake w/ Operator

HR

HR

HR

HR

HR

HR

HR

HR

HR

HR

HR

HR

$ 90.00

$ 78.50

$ 78.50

$ 89.00

$ 105.70

$ 125.00

$ 138.50

$ 165.00

$ 135.00

$ 105.00

$ 67.35

$ 115.00

Floyd G. Hersh, Inc. Bid Equipment Rentals for Road and Trail Maintenance #111376~6211--KW/rn

BD

1

2

3

4

5

6

7

8

9

10

11

12


Building Demolition

Track Hoe w/ Mechanical Thumb and Operator

Hydro Hammer Tamper Breaker w/ Operator

Foreman

Demo Concrete Saw w/Laborer

Extra Saw Blades




15 Ton Truck w/ Operator


Dust Control Water Truck w/ Operator

20 CY Dump Trailer Tractor w/Operator

HR

HR

HR

HR

EA

HR

HR

HR

HR

HR

HR

HR

$ 145.00

$ 232.50

$ 90.00

$ 87.75

$ 150.00

$ 165.00

$ 135.00

$ 125.00

$ 95.00

$ 110.00

$ 120.00

$ 125.00


DR

1

2

3

4

5

6

7

8


Debris Removal

Track Hoe w/ Thumb and Operator




1 5 Ton Truck w/ Operator


Foreman

Laborer

HR

HR

HR

HR

HR

HR

HR

HR

$ 145.00

$ 165.00

$ 125.00

$ 135.00

$ 90.00

$ 110.00

$ 90.00

$ 84.00


MH

12

3


Material Hauling15 Ton Truck w/ Operator22 Ton Truck w/ Operator20 CY Dump Trailer Tractor w/Operator

HRHRHR

$ 90.00$ 110.00$ 125.00

Floyd G. Hersh, inc. Bid Equipment Rentals for Road and Trail Maintenance #111376-6211-KW/rn

WACC

1

2

3

7

8

9

10


Waterway and Canal Clearing

Track Hoe w/ Thumb and Operator



Foreman

Laborer w/ Chain Saws

Wood Chipping Machine w/ Operator

Landscape Laborer

HR

HR

HR

HR

HR

HR

HR

$ 145.00

$ 125.00

$ 135.00

$ 90.00

$ 87.75

$ 98.35

$ 67.35

SIGNATURE PAGE

In case this proposal is accepted, the undersigned is hereby bound to commence and complete all of thework included under his contract in such time and such manner as designated for the various items he hascontracted to supply.

In submitting this proposal, it is understood that the unrestricted right is reserved by the County to rejectany and all proposals or parts thereof, or to waive any informalities or technicalities in said proposals, and it isagreed that this proposal may not be withdrawn for a period of at least sixty (60) days from date of opening thereof.

The undersigned hereby certifies that this proposal is genuine, and not a sham or collusive, or made in theinterest or in behalf of any person, firm or corporation not herein named; that the undersigned has not directly orindirectly induced or solicited any bidder to refrain from bidding, and that the undersigned has not, in any manner,sought by collusion to secure fqrjiimself an advantage over any other bidder

1*-- I . . rt f . I I ^f iff- \M N A M E

SIGNATURE

PRINT/TYPE SI

TITLE

OFFICIAL ADDRESS

TAX IDENTIFICATION NUMBER

Bidder will state below whether the bid is by an individual^partnership, LLC or corporation.

(_ QiTpQr CT? feK.Bidder will state below the name of the Bonding Company to be used in case of award, and name and

address of local agent thereof.

BONDING COMPANY

NAME OF AGENT

ADDRESS

In the amount of$

Accompanying this proposal is:

IMP'* based on a total lump sum bid of$

ADDENDA: Bidder agrees that the following Addenda(s) issued during the bid period have been received andconsidered in preparing this Proposal; and, agrees that failure to acknowledge such Addenda(s) may be a basisfor rejection of bid.

Addenda No. Date Addenda No Date

B I D M U S T B E S I G N E D F O R C O N S I D E R A T I O NABSOLUTE ADHERENCE TO PROPOSAL FORM CLAUSE IS REQUIRED

Rev. 11/08

(7-11)

NONCOLLUSION AFFIDAVIT

I hereby affirm that(Nam^ of Bidder)

has ( ) has not ( ) been convicted or found liable for any act prohibited by Federal or State law inany jurisdiction involving conspiracy or collusion with respect to bidding on any public contractwithin the last three years.

NAMEOF BIDDER

(Title)

The bidder's statement on this Affidavit that (he) (she) (it) has been convicted or foundliable for any act prohibited by Federal or State law in any jurisdiction involving conspiracy orcollusion with respect to bidding on any public contract within the last three years does notprohibit the County of Montgomery from accepting a bid from or awarding a contract to thatperson, but it may be grounds for administrative suspension or debarment in the discretion of theCounty under the rules and regulations adopted by County Ordinance No. 99-1.

VERIFICATION

verify that the statements made in the(Name of Affiant)

foregoing Noncollusion Affidavit are true and correct to the best of my knowledge orinformation and belief. I understand that false statements herein are made subject to thepenalties of 18 PA C.S. §4904 relating to unsworn falsification to authorities.

/'

Date:

03-17-99

AUTHORIZATION FOR RELEASE OFCREDIT INFORMATION

1 hereby authorize the County of Montgomery to verify and further investigate any ofthe information hereby provided. I understand and agree that the County mayconduct credit checks and review with federal, state and local public sources toobtain such verification and to obtain further information, and that any sourcesnamed herein may be contacted in order to obtain verification and furtherinformation I certify that all information provided is true, correct and complete to thebest of my knowledge and belief.

Name Title

Company/ Agenc Name

Address

JSociai Socurity-JUtmTEeTor Tax Id Number

Ml 33 736, - Montgomery County, Pennsylvaniawebapp02.montcopa.org/openrecords/contracts/... · //ml...

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Transcript of Ml 33 736, - Montgomery County, Pennsylvaniawebapp02.montcopa.org/openrecords/contracts/... · //ml...