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Long Painting Company
21414 68th Ave. S.
Kent, WA 98032
BID
Reservoir 19 Exterior Coating Replacement
C/O Robert Endsley, EIT
Bid Opening: Monday, April 05, 2021
1:00pm PST
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SECTION 00300
BID FORMS
ACKNOWLEDGEMENT OF BID AND ADDENDA
BID TO:CITY OF BREMERTON,PUBLIC WORKS AND UTILITIES-ENGINEERING DIVISION
F
I. The undersigned Bidder proposes and agrees,if this Bid is accepted,to enter into an Agreement
with the OWNER in the form included in the Contract Documents to perform the WORK as
specified or indicated in said Contract Documents entitled"RESERVOIR 19—EXTERIOR
COATING REPLACEMENT."
2. Bidder accepts all of the terms and conditions of the Contract Documents,including without
limitation those in the Notice Inviting Bids and Instruction to Bidders,dealing with the
disposition of Bid Security.
3. This Bid will remain open for the period stated in the"Notice Inviting Bids"unless otherwise
required by law. Bidder will enter into an Agreement within the time and in the manner required
in the"Notice Inviting Bids"and the"Instructions to Bidders." and will furnish the Insurance
Certificates,Payment Bond,and Performance Bond required by the Contract Documents.
4. Bidder has examined copies of all the Contract Documents including the following addenda
(receipt of all of which is hereby acknowledged).Failure to acknowledge addenda shall render
the bid non-responsive and shall be cause for its rejection.
Addenda Number: Date:
1 March 30, 2021
5. Bidder has familiarized itself with the nature and extent of the Contract Documents,WORK, site,
locality where the WORK is to be performed,the legal requirements(federal,state and local
laws,ordinances,rules,and regulations),and the conditions affecting cost,progress or
performance of the WORK and has made such independent investigations as Bidder deems
necessary.
To all the foregoing,and including all Bid Forms contained in this Bid, said Bidder further agrees to
complete the WORK required under the Contract Documents within the Contract Time stipulated in said
Contract Documents,and to accept in full payment,therefore,the Contract Price based on the Total Bid
Price(s)named in the aforementioned Bid Fomis.
Dated: 04/05/2021 Bidder: Long Painting Company
(Company Name) 7
' � I
John Fisher ' �
By: Title: Presid ht
(.igna ,re)
RESERVOIR 19 EXTERIOR COATING REPLACEMENT BID FORMS
APRIL 2021 00300-1
SS: BID CERTIFICATE
(if Corporation)
STATE OF Washington )
COUNTY OF King )
I HEREBY CERTIFY that a meeting of the Board of Directors of the Long Painting Company
a corporation existing under the laws of the State of Washington ,held on
December 31 ,2021,the following resolution was duly passed and adopted:
"RESOLVED,that John Fisher ,as
President of the Corporation, be and is hereby authorized to
execute the Bid dated 04/05 ,2021,to the City of Bremerton
by this corporation and that his/her execution thereof,attested by the Secretary of the Corporation,and
with the Corporate Seal affixed,shall be the official act and deed of this Corporation."
I further certify that said resolution is now in full force and effect.
IN WITNESS WHEREOF,I have hereunto set my hand and affixed the official seal of the
corporation this s-74 ,day of .AA''.'/ 2021.
°9111
Secretary 3 6[,,
(SEAL)
RESERVOIR 19 EXTERIOR COATING REPLACEMENT BID FORMS
APRIL 2021 00300-2
BID CERTIFICATE
(if Partnership)
STATE OF )
) SS:
COUNTY OF )
I HEREBY CERTIFY that a meeting of the Partners of the
a partnership existing under the laws of the State of ,held on
,2021,the following resolution was duly passed and adopted:
"RESOLVED,that ,as
of the Partnership,be and is hereby authorized to
execute the Bid dated ,2021,to the City of Bremerton by this partnership and that
his/her execution thereof,attested by the
shall be the official act and deed of this Partnership."
I further certify that said resolution is now in full force and effect.
IN WITNESS WHEREOF,I have hereunto set my hand this ,day
of ,2021.
Partner
(SEAL)
RESERVOIR 19 EXTERIOR COATING REPLACEMENT BID FORMS
APRIL 2021 00300-3
BID CERTIFICATE
(if Joint Venture)
STATE OF )
) SS:
COUNTY OF
I HEREBY CERTIFY that a meeting of the Principals of the
a_joint venture existing under the laws of the State of held on
,2021,the following resolution was duly passed and adopted:
"RESOLVED,that ,as
of the Joint Venture,
be and is hereby authorized to execute the Bid dated , 2021,
to the City of Bremerton by this joint venture and that his/her execution thereof,attested by the
shall be the official act and deed of this Joint Venture."
I further certify that said resolution is now in full force and effect.
IN WITNESS WHEREOF,I have hereunto set my hand this , day
of , 2021.
Managing Partner
(SEAL)
RESERVOIR 19 EXTERIOR COATING REPLACEMENT BID FORMS
APRIL 2021 00300-4
BID CERTIFICATE
(if Limited Liability Company)
STATE OF )
) SS:
COUNTY OF )
I HEREBY CERTIFY that a meeting of the Members of the
a limited liability company existing under the laws of the State of ,held on
,2021,the following resolution was duly passed and adopted:
4•
"RESOLVED,that and
as members of the Limited Liability Company,be and are hereby authorized to execute the Agreement
dated 2021
to the City of Bremerton by this limited liability company and that their execution thereof shall be the
official act and deed of this Limited Liability Company."
I further certify that said resolution is now in full force and effect.
IN WITNESS WHEREOF,I have hereunto set my hand this ,day
of ,2021.
A Limited Liability Company
By:
Member
By:
Member
(SEAL)
RESERVOIR 19 EXTERIOR COATING REPLACEMENT BID FORMS
APRIL 2021
00300-5
BID SCHEDULE
Following is the Bid Schedule for construction of the RESERVOIR 19-- EXTERIOR COATING
REPLACEMENT in accordance with the Contract Documents. The Bid Schedule must be completed
by the Bidder by filling in each blank. The cost item shall be in dollars and cents,using numerals only.
Failure to do so will render the bid non-responsive and will cause its rejection.
NOTE ON SALES TAX: Washington State Department of Revenue Rule 170 applies to this project.Bids
will be evaluated on the basis of the TOTAL BID AMOUNT.
BID OPENING DATE: April 5,2021
Long Painting Company
NAMEOF CON 1RACTOR:
BID COST
ITEM ITEM DESCRIPTION IN DOLLARS & CENTS
NO.
1 EXTERIOR COATING REPLACEMENT $ 279,983.00
2 FORCE ACCOUNT $30,000.00
SUBTOTAL 309,983.00
$ 27,898.47
SALES TAX ON SUBTOTAL @ 9.0%
TOTAL BID PRICE (SUBTOTAL PLUS SALES TAX) $ 337,881.47
RESERVOIR 19 EXTERIOR COATING REPLACEMENT BID FORMS
APRIL 2021 00300-6
BID BOND
KNOW ALL MEN BY THESE PRESENTS,
That Long Painting Company as Principal,and
Travelers Casualty and Surety Company of America as Surety,are
held and firmly bound unto City of Bremerton hereinafter called "OWNER," in the sum of
Five Percent(5%)of Bid Amount dollars,
(not less than fire percent(5%)of the total amount of'the Bid)
for the payment of which sum, well and truly to be made, we bind ourselves,our heirs, executors,
administrators, successors, and assigns,jointly and severally, firmly by these presents.
WHEREAS,said Principal has submitted a Bid to said OWNER to perform the WORK required under
the bidding schedule(s) of the OWNER's Contract Documents entitled RESERVOIR 19—
EXTERIOR COATING REPLACEMENT.
if the Principal is awarded the Bid and,within 14 calendar days after receipt of the Contract Document
forms from the OWNER, fails to provide the OWNER with the duly executed Agreement; the duly
executed Certificates of Insurance, the duly executed Performance Bond and the duly executed Payment
Bond, all as specified in the Contract Documents,then the Surety shall,without condition and within 30
calendar days from written demand from the OWNER, pay to the OWNER in U.S. funds, by certified or
cashier's check, the full amount of this Bid Bond. This Bond shall be irrevocable for 90 days after the bid
opening,as defined in the Contract Documents.
The Surety stipulates and agrees that the obligation of said Surety shall in no way be impaired or affected
by an extension of the time within which the OWNER may accept such bid and Surety further waives
notice of any such extension. In the event suit is brought upon this bond by said OWNER and OWNER
prevails,said Principal and Surety shall pay all costs incurred by said OWNER in such suit,including
reasonable attorney's fees and costs to be fixed by the court.
5th
SiGNED AND SEALED, this"day of April 2021
Travelers Casualty and Surety
Long Painting Company (SEAL) Company of America (SEAL)
(Principal) (Surety)
By: By; akesta. -er)
iatu•-) (Signature) Alyssab.Lopez,
Attorney-in-Fact
(SEAL AND NOTARIAL ACKNOWLEDGMENT OF SURETY)
Travelers Casualty and Surety Company of America
1501 Fourth Ave., Suite 1000,
Address of Surety to which all notices shall be sent: Seattle, WA 98101
Travelers Casualty and Surety Company of America
1501 Fourth Ave., Suite 1000,
Address for Service of Process(must be a physical address): Seattle,WA 98101
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RESERVOIR 19 EXTERIOR COATING REPLACEMENT 131)FORMS
APRIL 2021 0030U-7
Travelers Casualty and Surety Company of America
.41 . Travelers Casualty and Surety Company
TRAVELERS,- St. Paul Fire and Marine Insurance Company
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS: That Travelers Casualty and Surety Company of America, Travelers Casualty and Surety Company, and St.
Paul Fire and Marine Insurance Company are corporations duly organized under the laws of the State of Connecticut (herein collectively called the
"Companies"),and that the Companies do hereby make,constitute and appoint Alyssa J Lopez of TACOMA
Washington , their true and lawful Attorney-in-Fact to sign, execute, seal and acknowledge any and all bonds, recognizances,
conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the
fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any
actions or proceedings allowed by law.
IN WITNESS WHEREOF,the Companies have caused this instrument to be signed, and their corporate seals to be hereto affixed,this 17th day of January,
2019.
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State of Connecticut
By:
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City of Hartford ss. Robert L.Rane enior Vice President
On this the 17th day of January, 2019, before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President
of Travelers Casualty and Surety Company of America,Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company, and
that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of said
Companies by himself as a duly authorized officer.
.�'p a Nj.C�r.,
IN WITNESS WHEREOF,I hereunto set my hand and official seal. rr, r 4��r�
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My Commission expires the 30th day of June,2021 . �a
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}� Anna P.Nowik,Notary Public
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This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Travelers Casualty and
Surety Company of America,Travelers Casualty and Surety Company, and St. Paul Fire and Marine Insurance Company,which resolutions are now in full
force and effect, reading as follows:
RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any
Second Vice President, the Treasurer, any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and
Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign
with the Company's name and seal with the Company's seal bonds, recognizances,contracts of indemnity,and other writings obligatory in the nature of a
bond,recognizance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such appointee and revoke
the power given him or her;and it is
FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice
President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such
delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is
FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional
undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any
Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any
Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if
required)by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one
or more Company officers pursuant to a written delegation of authority;and it is
I FURTHER RESOLVED,that the signature of each of the following officers: President,any Executive Vice President, any Senior Vice President,any Vice
President,any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of
Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of
executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing
such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile
signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached.
I, Kevin E. Hughes, the undersigned, Assistant Secretary of Travelers Casualty and Surety Company of America, Travelers Casualty and Surety
Company, and St. Paul Fire and Marine Insurance Company, do hereby certify that the above and foregoing is a true and correct copy of the Power of
I Attorney executed by said Companies,which remains in full force and effect.
i Dated this 5th day of April , 2021 .
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G Kevin E.Hughes,Assistant Secretary
To verify the authenticity of this Power of Attorney,p/ease call us at 1-800-421-3880.
Please refer to the above-named Attorney-in-Fact and the details of the bond to which this Power of Attorney is attached.
i
LIST OF SUBCONTRACTORS
The Bidder shall provide the following information for each Subcontractor who will perform work or
labor or render service to the CONTRACTOR in or about the construction of the work or improvement in
an amount in excess of ten(10) percent of the CONTRACTOR's total bid."Rendering service' includes a
subcontractor that specially fabricates and installs a portion of the work or improvement. The Bidder
agrees to submit the list of Subcontractors as part of the Bid or within 24 hours of the Bid. The
CONTRACTOR shall list only one Subcontractor for each portion of the WORK as is defined by the
CONTRACTOR in its bid. If no Subcontractor is listed, the bidder acknowledges that it does not intend to
use any subcontractor whose work on the CONTRACT will exceed ten(10)percent of the bid price.
Failure to comply with this requirement may render the Bid non-responsive and may cause its rejection.
Attach additional sheets if required.
SUBCONTRACTOR#1
Company Name:
Subcontractor License#:
Work to be Performed:
Address:
Phone Number:
Bid Amount and%of Total Bid:
SUBCONTRACTOR#2
Company Name:
Subcontractor License#:
Work to be Performed:
Address:
Phone Number:
Bid Amount and%of Total Bid:
SUBCONTRACTOR#3
Company Name:
Subcontractor License#:
Work to be Performed:
Address:
Phone Number:
Bid Amount and%of Total Bid:
SUBCONTRACTOR#4
Company Name:
Subcontractor License#:
Work to be Performed:
Address:
Phone Number:
Bid Amount and%of Total Bid:
RESERVOIR 19 EXTERIOR COATING REPLACEMENT BID FORMS
APRIL 2021
00300-8
INFORMATION REQUIRED OF BIDDER
The Bidder shall furnish the following information.Additional sheets shall be attached as required.
Failure to complete these items may cause the Bid to be non-responsive and may cause its rejection. In
any event,no award will be made until all of the Bitirle�' : rich vcrcrl its ilia
OWNER.
Contractor Name:
Long Painting Company
Primary Classification: 238320
Address: 21414 68th Ave S, Kent,WA 98032
Telephone: 253-234-8050
Fax Number: 253-234-0034
E-mail Address: Johnf@longpainting.com
Name and contact information for proposed Project Manager:
Charles Pham/charlesp@longpainting.com/253-234-8050
•
Employment Security Department Number: 328817-007
Washington Industrial Insurance Number: 706, 150-00-0
Washington State Unified Business Identification(UBI)Number: 578-090-687
Washington State Excise Tax Registration Number: c578 090-687
Washington State Contractor's Registration Number and Expiration Date: LONGP"`230MA/jULY
City of Bremerton Business License Number: 11421
*If not available, must be obtained prior to issuance of Notice to Proceed
Name,address,and telephone number of Surety Company and Agent who will provide the required bonds
this Contract:
Travelers Casualty&Surety Company of America
Agent: Propel Insurance Company;Alyssa Lopez; 925 4th Avenue, Suite 3200
Seattle, WA 98104; 206-695-6625; alyssa.lopez@propelinsurance.com
RESERVOIR 19 EXTERIOR COATINGREPLACENIENI BID FORMS
APRIL 2021 00300—9
Long Painting Company .
Project Referrences&General Information
Reservoir 19 Exterior Coating Replacement
Job Description&Location Description Contract Owner/GC Owner Representative Engineer Comp Date
City of Walla Walla,WA Frank Nicholson
Pressure wash and recoat exterior of two tanks 183'Dia x 15 North 3rd Avenue
Mill Creek Water Tanks $317,000 Project Manager Unknown 2019
Walla Walla,WA 38'Tall.7MG each.700 Tnemec. Walla Walla,WA 99362 509-527 4537
Owner.City of Snoqualmie
Snoqualmie Water Reservoir Abrasive blast and recoat 3 tanks;30'Dia x 28.5'Tall,15' Kyle Engle
Snoqualmie,WA Dia x 24'Tall and 47'Dia x 32'Tall. $293,250 GC:CBI Services, Inc Project Manager Unknown 2018
5500 S 1st Ave 425-249-5703
Everett,WA 98203
Abrasive blast,Lead Paint removal and recoat,interior and Seattle Public Utilities Shaunie Vail
Beverly Park Tank exterior of tank.Interior coating-Tnemec 94 H20,N140 $3,250,500 700 5th Ave,Suite 4900 Project Manager City Engineer 2020
Seattle,WA Pota Pox.Exterior 94 H2O Zinc,Series 1029,Series 700
HydroFlon Seattle,WA 98124 206-255-6713
Abrasive blast and repaint tank inteiror,abrasive blast and Spanaway Water Company Tim Wells
Spanaway Water Tank 2 repaint tank exterior(removal of lead paint)and perform John Knowles&
Spanaway,WA tank modifications.Tank Size:46'dia x 127'dia.Includes $991.800 18413 B Street E Assistant Manager Associates,Inc. 2016
epoxy coatings. Spanaway,WA 98387 253-875-5231
Silver Lake Water&Sewer Rick Gilmore
SLWSD Reservoir 2 Interior&exterior painting. Interior:Macropoxy 646 Dist
Snohomish,WA Potable Coating;Exterior.Moisture Cure. $1,700,000 15205 41st Ave SE City Engineer City Engineer 2014
Bothell,WA 98012 425-337-3647
Surface preparation and coating of two exisiting 100'
diameter 35'3"tall potable water tanks for the City of
Redmond. Interior work consisted of sandblasting existing
Redmond Tanks 4&5 coating and cleaning the steel to an SSPC SP-10,applying 3 City of Redmond Mike Caccavano
243
Redmond,OR coats of Devoe BarRust 233H and disinfecting the entire $717,500 Redmond,NE Antler Ave City Engineer Unknown 2013
tanks. Exterior work consisted of washing the tank with Red OR 97756 541-504-2011
DevPrep 88 and applying 1 coat of BarRust 231 and 1 coat
of Devthane 379.
List of Major Equipment Contracts in hand,gross amount and percent complete:
Owned: 152/$58,299,000/50.8%complete
1,600 CFM Compressor
1,600 CFM Air Dryer
12,000-20.000 CFM Dust Collector 53 years in business as Long Paintingi Company
8 ton blast pot
Hurrican vacuum
Rented:
6,000-8,000 Lb Forklift
PROJECT REFERENCES& GENERAL INFORMATION
To be considered for award,the CONTRACTOR shall have completed at least three(3)projects of
similar type,complexity,and comparable value to that WORK described in Notice Inviting Bids.
ATTACH TO THIS BID,or provide within 24 hours of the Bid Opening,a list of three(3)projects
minimum,completed by the CONTRACTOR,that are similar to the RESERVOIR 19—EXTERIOR
COATING REPLACEMENT in nature,value,and complexity of work.The projects must have been
completed under the bidder's name as the mime(general)cunt ractoi within the last ten(10)ycals. The
list shall include the following information as a minimum:
* Names, address,and telephone number of Owner.
' Name of project.
SEE ATTACHED
* Location of project.
• Brief description of the work involved.
is
Contract amount.
6 Date of completion of contract.
O Name, address,and telephone number of architect or engineer.
• Name of owner's project engineer.
• List of major equipment.
• Years in business under current name.
6 Contracts now in hand, gross amount, and percent complete.
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RESERVOIR 19 EXTERIOR COATING REPLACEMENT BID FORMS
APRIL 2021 00300-10
NON-COLLUSION AFFIDAVIT
STATE OF )
) SS:
COUNTY OF )
John Fisher , being first duly sworn,deposes and says that he or she
is of the party making the foregoing bid that the bid is not made in the interest of,or on behalf of, any
undisclosed person,partnership,company, association,organization,or corporation; that the bid is
genuine and not collusive or sham;that the bidder has not directly or indirectly induced or solicited any
other bidder to put in a false or sham bid,and has not directly or indirectly colluded,conspired,connived,
or agreed with any bidder or anyone else to put in a sham bid,or that anyone shall refrain from bidding;
that the bidder has not in any manner,directly or indirectly, sought by agreement,communication,or
conference with anyone to fix the bid price of the bidder or any other bidder,or to fix any overhead,
profit,or cost element of the bid price,or of that of any other bidder,or to secure any advantage against
the public body awarding the contract of anyone interested in the proposed contract;that all statements
contained in the bid are true; and further,that the bidder has not,directly or indirectly,submitted his or
her bid price or any breakdown thereof,or the contents thereof,or divulged information or data relative
thereto,or paid,and will not pay,any fee to any corporation,partnership, company association,
organization,bid depository,or to any member or agent thereof to effectuate a collusive or sham bid.
1
Signed-
.,
Subscribed and sworn to before me this ,_ day of
i.1."i)r . ` , 2021
,7- ev ,
Notary Public in and for the
County of •\. C
State of L/j.Vjg L,.,,v „ y
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RESERVOIR 19 EXTERIOR COATING REPLACEMENT BID FORMS
APRIL 2021 003(10-11
CERTIFICATION
C TION BY PROPOSED CONTRACTOR REGARDING EQUAL EMPLOYMENT
In accordance with Chapter 56, Laws of 1975 1st Extraordinary Session,Certification regarding Equal
Opportunity is required of bidders or prospective contractors and their proposed subcontractors prior to
the award of contracts or subcontracts.
Long Painting Company
Name of Prime Contractor
Address 21414 68th Ave S, Kent,WA 98032
Internal Revenue Service Employer Identification No. 91-0856060
a. Contractor has participated in a previous contract Yes X No
or subcontract subject to the Equal Opportunity Clause.
b. Compliance reports were required to be filed in Yes X No
connection with such contract/subcontract.
c. Contractor has filed all compliance reports required by Yes X No
Executive Orders 10925, 11114, 11246, or by regulations
of the Equal Opportunity Commission issued pursuant to
Title VII of the Civil Rights Act of 1964.
a. If answer to item 'c'is "no",please explain in detail in the space below.
CERTIFICATION: I, the undersigned,certify that the information above is true and complete to the best
of my knowledge and belief.
Long Painting Company
Company Name
John Fisher,President
Name and Ti e of Si (P ase e or print clearly)
1111 04/05/2021
Date
RESERVOIR 19 EXTERIOR COATING REPLACEMENT BID FORMS
APRIL 2021 00300-12
CERTIFICATION OF NON-SEGREGATED FACILITIES
(Applicable to federally assisted construction contracts and related subcontracts exceeding$10,000 which
are not exempt from the Equal Opportunity clause.)
The federally assisted construction contractor certifies that he/she does not maintain or provide for his/her
employees any segregated facilities at any of his/her establishments,and that he/she does not permit
his/her employees to perform their services at any location,under his/her control, where segregated
facilities are maintained. The federally assisted construction contractor certified,further that he/she will
not maintain or provide for his/her employees any segregated facilities at any of his/her establishments,
and that he/she will not permit his/her employees to perform their services at any location,under his/her
control, where segregated facilities are maintained. The federally assisted construction contractor agrees
that a breach of this certification is a violation of the Equal Opportunity clause in this contract.
As used in this certification,the term "segregated facilities" means any waiting rooms,work area,rest
rooms and wash rooms,restaurants and other eating areas,time clocks, locker rooms and other storage or
dressing areas,parking lots,drinking fountains, recreation or entertainment areas, transportation,and
housing facilities provided for employees which are segregated by explicit directive or area, in fact,
segregated on the basis of race,creed,color, or national origin, because of habit,local custom,or
otherwise. The federally assisted construction contractor agrees that(except where he/she has obtained
identical certifications from proposed contractors for specific time periods) he/she will obtain identical
certifications from proposed subcontractors prior to the award of subcontracts exceeding$10,000 which
are not exempt from the provisions of the Equal Opportunity clause,and that he/she will retain such,
certification in this file.
CERTIFICATION: I, the undersigned,certify that the information above is true and complete to the
best of my knowledge and belief.
Long Painting Company
Company Name
John Fisher, President
Name and Tit( of Signer(P1;ht type or print clearly)
04/05/2021
Sign tur Date
RESERVOIR 19 EXTERIOR COATING REPLACEMENT BID FORMS
APRIL 2021 00300-13
CERTIFICATION OF FEDERAL NON-DEBARMENT AND SUSPENSION
INSTRUCTIONS TO BIDDERS: THIS FORM SHALL BE EXECUTED BY THE CONTRACTOR
AND SUBMITTED WITH THE BID.
THE CONTRACTOR SHALL MAKE COPIES AND DISTRIBUTE THIS FORM TO ALL
SUBCONTRACTORS. SUBCONTRACTORS MUST SUBMIT THIS FORM TO THE CITY PRIOR
is TO PERFORMING ANY WORK ON THE PROJECT.
As a prospective contractor for the City of Bremerton and as a requirement of your submittal,you are
required to provide debarment/suspension certification indicating that you are in compliance with the
below Federal Executive Order.
Debarment: Federal Executive Order(E.O.) 12549 "Debarment and Suspension" requires that all
contractors receiving individual awards or using federal funds,and all sub-recipients certify that
the organization and its principals are not debarred,suspended,proposed for debarment,declared
ineligible,or voluntarily excluded by any Federal department or agency from doing business with
the Federal Government or from receiving Federally-assisted contracts.
Your signature certifies that neither you nor your principal is presently debarred, suspended,proposed for
debarment,declared ineligible,or voluntarily excluded from participation in this transaction by any
federal department or agency. If,at any time during the term of the contract,such condition occurs the
Contractor will notify the City without delay.
CERTIFICATION: I,the undersigned,certify that the information above is true and complete to the
best of my knowledge and belief.
Long Painting Company
Company Name
John Fisher,President
Name and Ti a of Signer(P ase a or print clearly)
04/05/2021
Sig at Date
RESERVOIR 19 EXTERIOR COATING REPLACEMENT BID FORMS
APRIL 2021
00300-14
CERTIFICATION OF COMPLIANCE WITH WAGE PAVEMENT STATUTES
The undersigned bidder hereby certifies that,within the three (3)year period immediately preceding the
bid solicitation date for this I'toject.that the bidder is not a''OJillfn!' violator.a,;desired in ltC'V
49.48.082,of any provision of chapters 49.46,49.48,or 49.52 RCW, as determined by a final and binding
citation and notice of assessment issued by the Department of Labor and Industries or through a civil
judgment entered by a court of limited or general jurisdiction.
l certify under penalty oIperjnry under the law,(lithe State of hingion drat the I egoin,>_ is true and
:onect."
Signature: 3 Date:
04/05/2021
Print DC/and Title. Location or Place executed: (City,State)
John Fisher, President Kent, WA
Check One:
Individual I�-1 Partnership Ft Joint Venture 1:lCorporation K1
State of Incorporation,or if not a corporation,State where business entity was formed:
Washington
If a co-partnership, give firm name under which business is transacted:
Note: If a corporation,proposal must be executed in the corporate name by the president or vice-
president(or any other corporate officer accompanied by evidence of'authority to sign).If a co-
partnership,proposal must be executed by a partner.
END OF BID FORMS
RESERVOIR 19 EXTERIOR COATING REPLACEMENT BID FORMS
APRIL 2021 00300-15