Minneapolis Public Housing Authority

BID FORM

MPHA Contract # PH-15.36

MINNEAPOLIS PUBLIC HOUSING AUTHORITY

WOMEN AND MINORITY-OWNED (W/MBE)

EQUAL OPPORTUNITY POLICY STATEMENT

CONTRACTOR will provide Equal Opportunity to all employees and applicants for employment in accordance with all applicable Equal Opportunity/Affirmative Action laws, directives and regulations of Federal, State and local governing bodies.

CONTRACTOR will not discriminate against any employee or applicant for employment because of race, color or creed, sex, religion, ancestry, national origin, gender, affectional preference, disability, age, marital status, veteran status or public assistance status.

CONTRACTOR will take affirmative action to ensure that all employment practices including hiring, upgrading, demotion, transfer, recruitment, termination, lay-off, rates of pay and other compensation and selection for training and apprenticeship are non-discriminatory.

CONTRACTOR will prohibit the harassment of any employee or job applicant because of gender, national origin or race.

CONTRACTOR shall commit the necessary time and financial and human resources to achieve the goals of Equal Employment Opportunity and Affirmative Action.

CONTRACTOR shall evaluate its management and supervisory personnel’s performance in achieving Affirmative Action objectives. Contractor also agrees that its employees or employees of its subcontractors who do not comply with the Equal Employment Opportunity Policies and Procedures in this statement shall be subject to disciplinary action. An employee or applicant for employment who believes he/she has been discriminated against should contact the Minneapolis Department of Civil Rights.

CONTRACTOR shall use its best efforts to afford women and minority-owned business enterprises (W/MBE’s) the maximum practicable opportunity to participate in performing the contract. Goals are as follows: 20% of the value of any construction contract or non-construction contract which exceeds $50,000 be awarded to minority-owned business enterprises (MBE) and 7% of the value of the construction contract or non-construction contract which exceeds $50,000 be awarded to women-owned business enterprises (WBE).

______

(Signature of Bidder or Authorized Representative) (Date)

______

(Name of Firm)

MINNEAPOLIS PUBLIC HOUSING AUTHORITY

Notice to Bidders

WOMEN AND MINORITY–OWNED BUSINESS

AND SECTION 3 BUSINESS PARTICIPATION CERTIFICATION

Failure to Complete this W/MBE and Section 3 Participation Certification May Disqualify Your Bid

MPHA has established minimum Women and Minority-Owned Business (W/MBE) and Section 3 Business goals. MPHA's participation goals are based upon the contract amount and are 7% for women-owned businesses, 20% for minority-owned businesses and 10% for Section 3 businesses. To the greatest extent feasible, bidders shall attempt to reach or, if possible exceed, these goals.

Bidder shall document their efforts to meet the W/MBE and Section 3 participation goals by completing this Certification form. Bidder shall solicit quotes from W/MBE and Section 3 businesses or explain in detail why quotes were not received. Bidder will also list the W/MBE and Section 3 businesses that it intends to contract with and state the percentage of their work based upon the total bid amount.

The Bidder solicited the followingWBE, MBE and Section 3 Businesses for quotes in preparing this bid.

WBESubcontractor or Supplier Address & Phone Number Type of Trade/Material

______

MBESubcontractor or Supplier Address & Phone Number Typeof Trade/Material

______

Section 3 Subcontractor or Supplier Address & Phone Number Type of Trade/Material

______

Rev. June 13, 2011

If awarded the contract, Bidder intends to subcontract work to or buy materials from the following W/MBE and Section 3 businesses.

WBESubcontractor or Supplier Address & Phone Number Type of Trade/Material

______

MBESubcontractor or Supplier Address & Phone Number Typeof Trade/Material

______

Section 3 Subcontractor or Supplier Address & Phone Number Type of Trade/Material

______

A person who submits false or inaccurate information to MPHA regarding this Form or compliance with goals may lose an awarded contract or be declared non-responsive for future contracting opportunities with MPHA. Also, MPHA may report misconduct to HUD for further sanctions. Before or after awarding a contract, MPHA may verify the use of the W/MBE and Section 3 businesses listed on this Form.

Under penalty of perjury I certify, that Bidder has solicited the above quotes and to the greatest extent feasible will take affirmative action to contract with the businesses listed above.

Legal Name of Bidder______

Signature ______

Printed Name ______

Title ______

Date______

EQUAL EMPLOYMENT OPPORTUNITY / EQUAL HOUSING OPPORTUNITY

June 13, 2011

BID FORM

MPHA Contract #PH-15.36

MINNEAPOLIS PUBLIC HOUSING AUTHORITY

CERTIFICATE OF ACKNOWLEDGEMENT

The Principal(s) of the company submitting the Bid is/are (list each):

Name:______Name:______

Address:______Address:______

______

(City, State, Zip Code)(City, State, Zip Code)

Name:______Name:______

Address:______Address:______

______

(City, State, Zip Code)(City, State, Zip Code)

______

(Name of Bidder/Company)

______

(Official Business Address Including Zip Code + 4)

______

(Signature of Bidder/Principal)(Title)

Federal Tax I.D.#:______Telephone #: ( )______

LICENSE # ______LICENSE # ______

(City of Minneapolis)(State of Minnesota)

Certificate of Acknowledgement Must Be Completed and Properly Notarized

(Form continue next page)

BID FORM

MPHA Contract #PH-15.36

CERTIFICATE OF ACKNOWLEDGEMENT OF CORPORATION

STATE OF ______)

COUNTY OF ______) ss On this ____ day of ______, 20___

before me, a Notary Public for the county, personally appeared ______and ______, to me personally known, who, being by me duly sworn, did say that they are respectively the ______and the ______of ______, the corporation named in the foregoing instrument. The seal affixed to the instrument is the corporate seal of the corporation, and that the instrument was signed and sealed in behalf of the corporation by authority of its Board of ______and the ______acknowledges the instrument to be the free act and deed of the corporation.

My Commission Expires______Notary Public ______

County of ______

CERTIFICATE OF ACKNOWLEDGEMENT BY PARTNERSHIP

STATE OF ______)

COUNTY OF ______) ss On this ____ day of ______, 20____

before me, a Notary Public for the county, personally appeared______and ______, to me personally known to be all of the Partners doing business under the Partnership name of ______, who, being by me duly sworn, who executed the foregoing instrument and acknowledge that the seal affixed to the instrument is the seal of the partnership, and that the instrument was signed and sealed in behalf of the partnership and the partners acknowledge the instrument to the free act and deed of the partnership.

My Commission Expires______Notary Public ______

County of ______

CERTIFICATE OF ACKNOWLEDGEMENT BY INDIVIDUAL

STATE OF______)

COUNTY OF______) ss On this ____ day of ______, 20____

before me, a Notary Public for the county, personally appeared ______, to me known to be the person ______described in and who executed the foregoing instrument and acknowledges to me that he/she executed the same as his/her own free act and deed.

My Commission Expires______Notary Public ______

County of ______

MINNEAPOLISPUBLICHOUSINGAUTHORITY

FORM OFBlDBOND

KNOW ALL MEN BY THESE PRESENTS, that we, the undersigned

______

(Name of Principal)

as Principal, and ______

(Name of Surety)

AS SURETY are held and firmly bound unto to Minneapolis Public Housing Authority in and for the City of Minneapolis, Minnesota, hereinafter called the "Local Agency", in the penal sum of:

______dollars...($______), Lawful

Money of the United States of America for payment of which sum will and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns jointly and severally, firmly by these presents.

THE CONDITION OF THIS OBLIGATION IS SUCH that whereas the Principal has submitted the accompanying bid,

dated______, 20______,for______

______

NOW THEREFORE, if the Principal shall not withdraw said bid within the period specified therein after the opening of the same, or, if no period be specified, within sixty (60) days after the said opening, and shall with in the period specified therefore, or if no period be specified, within ten (10) days after the prescribed forms are presented to him for signature, the principal shall enter into a written Contract with the Local Agency in accordance with the bid as accepted, and give bond and sufficient surety or surety, as may be required, for thefaithful performance and proper fulfillment of such Contract. Or in the event of the withdrawal of said bid within the period specified, or the failure to enter into such Contract and give such bond within the time specified, if the Principal shall pay the Local Agency the difference between the amount specified in said bid and amount for

which the Local Agency may procure the required work of supplies or both, if the latter be in excess of the former, then the above obligation shall be void and of no effect, otherwise to remain in full force and virtue.

IN WITNESS WHEREOF, the above-bounden parties have executed this instrument under their several seals the______day of______20 , the name and corporate seal of each corporate party being hereto affixed and these presents duly signed by its undersigned representative, pursuant to authority of its governing body.

EXECUTED IN PRESENCE OF:

______(seal)

(Witness As To Principal) CONTRACTOR(Type or Print)

By:______

(Witness As To Surety)(Type or Print)______(seal)

(Type or Print)

By:______

(Type or Print)

Form of Bid Bond

Page 2

(Power-of-Attorney of person signing for Surety Company must be attached and certified to as in effect on date of bond acknowledgement by Surety)

CERTIFICATE OF ACKNOWLEDGEMENT OF CORPORATE SURETY

STATE OF______)

COUNTY OF______)ssOn this______day of______),20______

before me, a Notary Public for the county, personally appeared______and______to me personally known, who, being by me duly sworn, did say that they are respectively the ______and the______of ______,the corporation named in the foregoing instrument. The seal affixed to the instrument is the corporate seal of the corporation, and that the instrument was signed and sealed in behalf of the corporation by authority of its Board of ______and the______acknowledges the instrument to the freeact and deed of the corporation.

Notary Public,______

County______

CERTIFICATE OF ACKNOWLEDGEMENT OF CORPORATION

STATE OF______)

COUNTY OF______)ssOn this______day of______),20______

Notary Public, ______

County______

CERTIFICATE OF ACKNOWLEDGEMENT OF PARTNERSHIP

STATE OF______)

COUNTY OF______)ssOn this______day of______),20______

Notary Public, ______

County______

CERTIFICATE OF ACKNOWLEDG EM ENT OF BY INDIVIDUAL

STATE OF______)

COUNTY OF______)ssOn this______day of______),20______

before me, a Notary Public for the county, personally appeared______to me known to be the person______described in and who executed the foregoing instrument acknowledges to me that he/she executed the same as his/her own freeact and deed. Notary Public,______

County______

MINNEAPOLIS PUBLIC HOUSING AUTHORITY

BID FORM

NON-COLLUSION Affidavit OF PRIME BIDDER

{Applies to bids exceeding $50,000)

State of Minnesota )

)

County of Hennepin)

______being first duly sworn deposes and says that:

1) He/She is______

(Owner, Partner, Officer, Representative or Agent)

of______, the bidder that has submitted the attached bid;

2) He/She is fully informed respecting the preparation and contents of the attached bid and of all pertinent circumstances respecting such bid;

3) Such bid is genuine and is not a collusive or sham bid;

4) Neither the said bidder nor any of its officers, partners, owner, agents, representatives,employees or parties in interest, including this affiant, has in any way colluded, conspired , connived or agreed, directly or indirectly, with any other bidder, firm or person to submit a collusive or sham bid in connection with the contract for which the attached bid has been submitted or to refrain from bidding in connection with such contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other bidder, firm or person tofix the price or prices in the attached bid or of any other bidder, or to fix any overhead, profit or cost element of the bid price of any other bidder, or to secure through any collusion, conspiracy,

connivance

or unlawful agreement any advantage against the Minneapolis Public Housing Authority in and for the City of Minneapolis or any person interested in the proposed contract; and

5) The price or prices quoted in the attached bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the bidder or any of its agents,representatives, owner, employees, or parties in interest, including this affiant.

______

(Signature)

Subscribed and Sworn to Before me

this______dayof______20______

(Title)

______

(NotaryPublic)

County______

My Commission Expires:______

EQUAL EMPLOYMENT OPPORTUNITY/EQUAL HOUSING OPPORTUNITY

MINNEAPOLIS PUBLIC HOUSING AUTHORITY

STATEMENT OF CONTRACTOR'S QUALIFICATIONS

Contractor must clearly and completely answer all questions. Contractor may supplement answer on separate sheets of paper and may submit additional relevant information. Contractor must sign statement before a notary.

1. Contractor’s legal name:______

2. Complete address of Contractor's permanent main office including city, state and zip code.

3. Names of Contractor's principal members and corporate officers.

4. Place and date of organization start up or corporation.

5. Number of years that Contractor has done business under its present name,______

6. General description of Contractor's work or business.______

______

7. If Contractor has ever defaulted on a contract, explain the circumstances, when, where and why.

8. If Contractor has ever failed to complete any work on a contract, explain the circumstances, when, where and why?

9. List Contractor's recent important and completed contracts. State the type of work performed, approximate gross cost of the contract, the month and year the contract was completed and the name, address, telephone number of the contact person for the other contracting parties.

______

10. List the major equipment available for this contract and state whether Contractor owns or will lease the equipment.

______

11. Describe Contractor's experience in completing work similar to the work required under this contract.

______

12. Describe the background and experience of Contractor's principal members and corporate officers.

______

13. State the amount of available line of credit $______

14. State the name and address of a bank reference, the name, address and telephone number of a bank contact person.

______

15. If Contractor is or has been a party to a complaint, grievance, action, or legal or administrative proceeding involving any charge of discrimination, describe the charges and outcome of the proceeding and state the file number and venue of the proceeding and the name and address of the charging parties.

______

16. If Contractor is or has been a party to any federal, state or local agency investigation arising out of Contractor's work, describe the charges and outcome of the proceeding and state the file number, agency, venue and the name and address of the charging parties.

______

17. If Contractor is or has been a party to or otherwise involved in any action or proceeding arising out of an allegedviolation of the Copeland Act, Federal Labor Standards, Davis-Bacon Act or Federal Labor Standards, describe the charges and outcome of the proceeding and state the file number, agency, venue and the name and address of the charging parties.

______

The undersigned authorizes any person, firm or corporation to provide any information or documents, which Minneapolis Public Housing Authority may request to verify the Contractor's qualifications or information provided in this Statement. The undersigned affirms under penalty of perjury that the answers, information and documents provided in response to this Statement are true and correct.

Date:______,20__

Legal Name of Contractor

By:______Type Name

______Signature

Its:______

Subscribed and sworn to before me

On______,20__

(Notary Public)

State of______,County of______

My Commission Expires:______

A prime contractor or subcontractor (Contractor) must meet the minimum criteria in Minn. Stat. § 16C.285 to be eligible to be awarded a Construction Contract as the lowest responsible bidder or the vendor or contractor offering the best value. A construction contractor does not include a material supplier. The minimum criteria are briefly listed below. See § 16C.285 for definitions and further explanations.

Regardless of contract value, Contractor verifies that Contractor is currently:

is in compliance with workers’ compensation and unemployment insurance requirements;

is registered with the MN Department of Revenue and the Department of Employment and Economic Development, if it has employees;

has a valid federal tax identification number or if an individual, a valid Social Security number; and

has filed a certificate of authority to transact business in Minnesota with the secretary of state, if a foreign corporation or cooperative;

For contracts estimated in excess of $50,000, Contractor verifies that Contractor:

for the last three years from July 1, 2014, has not violated Minnesota laws 177.24 minimum wage, 177.25 overtime, 177.41 prevailing wage, 177.42 to 177.44 for state projects; 181.13, prompt payment of wages, 181.14 settlement of disputes; 181.722 misrepresentation of employment, Chapter 326B construction codes and licensing; 363A.36 revoked or suspended certificate of compliance or United States Code, title 40 Fair Labor Standards Act & Sections 3141 to 3148 Davis-Bacon Act; or has not received a final determination for a monetary sanction from the Department of Administration or Transportation for failure to meet group business, disadvantaged business enterprise or veteran-owned goals, due to lack of good faith effort;

2. is currently not suspended or debarred by the federal government or the State of Minnesota or any of its departments, commissions, agencies or political subdivisions; and