Aug 14 2019 09:53am P002 2019-08-14 09:48 3044858030 304 558 3970 2/11 :gz'g??h??mgwa 33 3E 333k State of West Virginia PM am? 201:3? Request for Quotation Chodo-tnn.WV25805-0130 1n - Consulting Proc Fuldor: 613700 Ono CONSULTING SERVICE-SECONDARY ROAD MAINT. (69200001) PM: Central Contracl- Fixed Amt Data lulu-d Clolol 3 Sollultluon No Version 2019-0801 2019-00-1 6 CRFO 0803 DOT2000000013 1 3 13:30: 00 ??-Irrz- 3.3.33.3I..--.I 1? 4 I 4333343 333 '3 If.? 3333333 3333-33333? 3331733333333 nut! "3.3333333 BLT ?1le BID CLERK DEPARTMENT or ADMINISTRATION PURCHASING DIVISION 2079 WASHINGTON ST CHARLESTON WV 26306 us I-vI-vI-f rnnmou?quI??I 333 . ?33.3. .3.. I334.. [rim-I. V?n?nr ?drug and Toluphono NunIh-r: TB Pb Box 20 WV 25142- (304) 5'88 032:4 Il? I . I..- . .. .. . . .- .. I In .I . Hwy-I. . . FOR INFORMATION CONTACT THE BUYER (3 Hustaad (304) 558-2402 cIyataI.g.huataad wv.aov we 8/13/19 I Plan: 1 FORM ID Hug 142019 09:54am P003 2019-08-14 09:48 3044858030 304 558 3970 3/11 '?am .- . H. I v?nfp?-u-u-?THE STATE OF WEST VIRGINIA PURCHASING DIVISION FOR THE AGENCY, WEST VIRGINIA DIVISION OF HIGHWAYS. IS SDLICITING BIDS TO ESTABLISH AN OPEN-END CONTRACT FOR CONSULTING SERVICES TO ASSIST WITH COORDINATION AND OVERSIGHT OF THE SECONDARY ROAD MAINTENANCE INITIATIVE PER THE ATTACHED DOCUMENTS. QUESTIONS REGARDING THE SOLICITATION MUST BE SUBMITTED IN WRITING TO PRIOR TO THE QUESTION PERIOD DEADLINE CONTAINED IN THE INSTRUCTIONS TO VENDORS SUBMITTING BIDS. DIVISION OF HIGHWAYS DIVISION OF HIGHWAYS FINANCE 8 ADMINSTATION EXECUTIVE DIVISION 1900 KANAWHA BLVD E. BLDG 5 RM A220 1800 KANAWHA BLVD E. BLDG 6 CHARLESTON CHARLESTON vw 253050430 US US Llno Comm Ln Due Qty quo Unll PrIcu Tow Prluo CONSULTING SERVICES [Comm Coda Manufanluror Spud?uqtlon Modal. II [72141003 Ext-nun! nunrlp?on CONSULTING SERVICES - SECONDARY ROAD MAINTENANCE SEE ATTACHED EXHIBIT A PRICING PAGE Hm ?1101 W9, 1 VENDOR QUESTION DEADLINE 2019-08-Page 2 Hug it 2019 09:54am 2019-08-14 09:49 3044858030 304 558 3970 4/11 REQUEST FOR QUOTATION CRFQ DOT2000000013 Consulting Services- Secondary Roads Maintenance Initiative (692C001) l0. VENDOR DEFAULT: 10.1. The following shall be considered a vendor default under this Contract. 10.1.1.Failune to perform Contract Services in accordance with the requirements contained herein. 10.1.2.Failure to comply with other speci?cations and requirements contained herein. 10.1.3.Failure to comply with any laws, rules, and ordinances applicable to the Contract Services provided under this Contract. . 10.1.4.Fai1ure to remedy de?cient performance upon request. 10.2. The following remedies shall be available to Agency upon default 10.2.1. Immediate cancellation of the Contract. 10.2.2. Immediate cancellation of one or more release orders issued under this Contract. 10.2.3. Any other remedies available in law or equity. ll. MISCELLANEOUS: 11.! Contract Manager: During its performance of this Contract, Vendor must designate and maintain a primary contract manager responsible for overseeing Vendor's responsibilities under this Contract. The Contract manager must be available during normal business hours to address any customer service or other issues related to this Contract. Vendor should list its Contract manager and his or her contact information below. Contract Manager: Jame . Telephone Number: 0 Fax Number: Email Address: sink?. Cam Revlsod 12/12/2017 EXHIBIT A PRICING PAGE CRFQ DOT-2000000013 Consultant Se_n?ices for the Governor's Secondary Road Maintenance Initiative Unit Cost I Pa . Elma-den Cost (Unit Cost "if; ?fe Description I Dayer - ?mm? pun" Waves Quality) 1 Days Consuliant Services - Secondary Road Maintenance Initiative ?52,100 150 I 92,050, OD Daily rate must include have! charges HQ) 0 50: 00 69:60 0162 955 705 09208597702 1?898 900d ?9791605103 3W Rug 142019 09:54am 2019-08-14 09:49 3044858030 304 558 3970 ADDENDUM ACKNOWLEDGEMENT FORM SOLICITATION NO.: csFo 0072000000013 Instructions: Please acknowledge receipt of all addenda issued with this solicitation by completing this addendum acknowledgment fotm. Check the box next to each addendum received and sign below. Failure to acknowledge addenda may result in bid disquali?cation. Acknowledgment: I hereby acknowledge receipt of the following addenda and have made the necessary revisions to my proposal, plans andlor speci?cation, etc. ddendum Numbers Received: (Check the box next to each addendum received) Addendum No. I Addendum No. 6 Addendum No. 2 Addendum No. 7 Addendum No. 3 Addendum No. 8 Addendum No. 4 [j Addendum No. 9 Addendum No. 5 Addendum No. 10 I understand that failure to con?rm the receipt of addenda may be cause for rejection of this bid. I further understand that any verbal representation made or assumed to be made during any oral discussion held between Vendor's representatives and any state personnel is not binding. Only the information issued in writing and added to the speci?cations by an of?cial addendum is binding. T5 1212; LLC. Company ?at-ind store I ?lls/Fr Date NOTE: This addendum acknowledgement should be submitted with the bid to expedite document processing. *No ?meuoum ADDEUDA- RECEIVED: Revised 06/05/2019 Hug 142019 09:54am 2019-08-14 09:49 3044858030 304 558 3970 7/11 A6553 CERTIFICATE or LIABILITY INSURANCE TRIO CERTIFICATE ID IDOUID A: A OF ONLY AND NO mama UPON THE HOLDER. TI-IID CERTIFICATE NOT OR AMINO. EXTEND OR ALTER THE OMMOE BY THE BELOW. THIS OERTIFIOATE Ol' INDURANOO OOED NOT CONSTITUTE A CONTRACT BETWEEN THE INDURERIOI. AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE HOLDER. IMPORTANT: II 1m IIoIdor II ADDITIONAL INDURED, the mull In" ADDITIONAL INDURED pmlolonu or In andonad. II DOBROOATION l8 WAIVED, In th- bun- and o! pulley, poll-slu- my nquln In ?down: A alumni on ml- cnn?lm don not conhr II In ammun- hold-r In ?on a! ondonomlnl ?own Chuck Naming? MM Chuck Noll-mar. Agent, OPCU. 304-295-0575 [m muluckno?nlngemom 2301 mm Cam: Ava an- Mm A: State Plan Flu and mum Dummy 25143 INIUREO m. Tu RR BoonIn .I?ll?l'l Parka-burn. vw 2010441400 ., mum"- coszuIcsa CERTIFICATE nun-en: ammo" NUMBER: THIS IS TO CERTIFY THAT THE POLICIEU OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOIGATED. NOMHITANOINO ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH TO WHICH TNIB CERTIFICATE MAY BE IBSUED OR MAY PERTNN. THE INOURMICH AFFORDED BY THE POLICIES DESCRIBED HEREIN IS TO ALL THE TERMS. EXOLUOIONO AND CONDITIONS OF nucI-I POLICIES. LIMITs GROWN MAY HAVE BEEN REDUCED BY PAIO CLAIM. TE mum-Immo- I HIP couInquIumwn-Iuw mommneuc: . 1.000.000 lawman! occu- I a IIEIJ Ell-M mop-In] I OT-BJ 5664-0 autumn: Momma . azmaodnmnuun ?manna: I 2.000.000 Dunc mmI-mwm I Imu?lum I Amuum mwmeIIP-p-w I a can LIO puma? @0315occun IEHEURRINOI I H- mum" 3 Imp I Ingmm . 1 I i Ea? Alumnu'unw . em. I I Luann-mm II. a mama-mum um I Oi ILNATIONI I WWI 1M. Immi- IIWA. mu I loan II liquid] Inaumd BIOIO OI W. 1900 KNOW BLVD E. BLDG B. 28300 Contract ?Man: 0! WV Oopanmanl oI CERTIFICATE HOLDER GA NCELLATION WOULD OF Am BI GWILLID ?ml HWTION OATI NOTIOI HILL Ill I WITH THE POI-I07 81m uI WV 1WD Rum BLVD E. BLDG 5 Oharlauon. WV 25305 ORPORATION. ACORD (201 am) The AOORO mm and logo nu unlit-M mun of AO Twill! MAO-IMO HUI II 2019 09:54am PUUH 2019-08-14 09:49 3044858030 304 558 3970 8/11 A 7 mm CERTIFICATE or LIABILITY INSURANCE "gm THIS CERTIFICATE ID ISSUED A8 AFTER OF INFORMATION ONLY MID COHFEIIC N0 UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATWELY OR AMEND. EXTEND OR ALTER THE COVERAGE AFFOHOHO BY THE POLICIES BELOW. THIS CERTIFICATE OF DOES NOT CONSTITUTE A CONTRACT BETWEEN THE MITHORIZED REPRESENTATIVE OR AND THE CERTIFICATE HOLDER. IMPORTANT: ll ?mum holder I: ADDITIONAL INSURED. Illa um! um ADDITIONAL INDURED or no endomd. ll OUHHOOATIOM ll WAIVBD. cubical to In. Dunn and con?uent 0! pulley. ?lulu pollolu may ?gum ln ondorumnnl. A autumnal on Inn ?alum- am not cont-r In th- unman- hollm In llou cl tutu "mun Chuck Null-I Stamina Chuck Momma-I. Mum. cpcu. cw. enrc macs-?7: 28001 Grand Camel An mm, 25?05 . a sun Faun Mulual Mamba Immune: Company 25118 ml] James Halon. Jr. II I 540 aanlc Dr IIW mm mm was I @311!an REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF LISTED BELOW HAW BEIN MUEO TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTIMTHITAHDIHO ANY TERM OR CONDITION OF MW CONTRACT OR OTHER DOCUMENT WITH TO THIS CERTIFICATE MAY IE OH MY PERTAIH. THE INCUWCE AFFOHDED IV THE POUCIEB DESCRIBED HEREIN IS SUIJICT TO ALL THE TERMS. EIGLUBIOHB AND CONDITIONS 0' POLICIES. LIMITS SHOW MAY HAVE BEEN REDUCED BY PAID CLAIMS. Tm OE In lam um: OIHIML I 3 mm mm - m1." - gamma-GENI- Tl UNIT I FIR: Elm 8 new 5E8: Lac awn-wumrm mun; ADMIOIILI I . MN AUTO m! [hr-nun I 1.000 M, sum mt In- mm: women 129 Inna-529439 0212mm common ocean I ?m0 cwuam m" . swLanm[Imam . I DE I LOCIMHIIWHICLII IICMD AM Mill um II- Inm- up? "gum? Inmd: Blue WV. IDOO BLVD E, BLDG 5. cumuon. WV 28308 nonmetal ?mulling amia- lo In. Blah olIIw CQEIIFICAIE CANCELLATION CHOULO ANY OF ABOVE OIOCIBID IE CANCELLED EXPIRATION DATE THEREOF. NOTICE WILL IE DIWV ACCOI - WITH THI MOWOIONO. 1800 Kan-um BLVD E. BLOG 25305 . . - - - - PORATION. All mmod. :5 mamas] The mm. and logo are mum-ml In rim of neu: 20 19-08-14 09:49 AchD" I CERTIFICATE OF LIA 3044858030 304 558 3970 Rue 142019 09:54am P009 9/11 DATE IMMIDDIWWI BILITY INSURANCE 0311312019 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEOATIVELY AMEND REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. THIS CERTIFICATE I8 IEBUED A8 A MATTER OF INFORMATION ONLY AND . EXTEN BELOW. THIB CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A ONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS OR ALTER COVERAGE AFFORDED BY THE POLICIES ONTRACT BETWEEN THE ISSUINC INSURERID), AUTHORIZED IMPORTANT: II II In ADDITIONAL INSURED. the II SUEROOATION I3 WAIVED. ID torml and of I thIo do" not quor I'Inhto to the ccnl?cato In "on of ouch ondo poIIcwInI mun: have ADDITIONAL INSURED or be endonod. IIO pulley. comm pollclu may Tequlro an andomomont. A statement on DENE HAYNES THIS IS TO CERTIFY THAT THE POLICIES 0F INBURAN INDICATED. NOTWITHSTANDING ANY REQUIREMENT. EXCLUSIONS AND EUCH POLICIES. LIMITS SHOWN MAY PRODUCER State-Farm GENE A. HAYNES INSURANCE AGENCY. INC mm Mama-7561 . MJMME 3909 EMERSON AVE gonahayn?-bwc?O?t?IBIHFM-mm PARKERSBURG. WV 26104 men?mm .. .. .. HEEL .. A. AGENT mama sum Faun MquaI Automobile Inauranca Company 25178 INOURID maumu a: THOMAS DADOETT maumn c. 1837 WHITE OAK RUN RD "?ung n; I WALKER, WV 20180 maunu? I. I I COVE-RACES CERTIFICATE NUMBER: REVISION NUMBER: ca LISTED BELOW HAVE BEEN ISSUED To THE INSURED NAMED AOOVE FOR THE POLICY PERIOD TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE Issuer: OR MAY PERTAIN. THE AFFORDED BY THE POLICIES DESCRIBED HAVE DEEN REDUCED BY END CLAIMS. OCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, FOLICV I I ma I?m war II UNIT- COMMERCIAL DIINEIIAL LIADILITY I EACH OCCURRENCE I 3 I CLAIMS-MADE I OCCUR mm I l_ . .. MED EXP {Any one p?lon} insomumv INJURY AGGREGATE LIMIT PER: I I GENERAL AGGREGATE 7 5387' we I I mowers-comma ADD 5 I OTHER: . I I momom man-m I 136 . oanmoIa 12I07I2019 4W . ANY AUTO I I BODILY INJURY IPor pmun) II 1.000300 OWNED SCHEDULED A AUTOS ONLY IXI gums}: I . ?on? INJURY 1000000 HIRED M50 OPERTY I 3 1 000 Dog ONLY ONLY I .. . . I UMBRELLA . occun I EACH OCCURRENCE I 5 . CLAIMS-MADE I I AGGREGATE I I OED I RETENIIDHI - woman: FH- AND LIAIILITV I . 2R: IANY cu we ELISA MA OFFICERIMEMDDII ENDLUOED-I [3 NM . Imnumry In I I - EA II ?mum umur DE 592 mg? m: gm?m I E.L. DISEASE - POLICY LIMIT I OI- I IVEHICLII m. AamIon-I non-duh. may mama II mm In nqulndl 2018 KIA SORENTO. VIN TO BE USED BY THOMAS BADOETT. FOR WV STATE DEPARTMENT OF HIGHWAYS. CERTIFICATE HOLDER CANCELLATION DHDULD ANY OF THE ABOVE DEBCRIDED POLICIES BE CANCELLED BEFORE THE DATE THEREOF. NOTICE WILL BE DELIVERED STATE OF VW ACCORDANCE WITH THE POLICY PROVISIONS. 1900 KANAWHA BLVD EAST BUILDING 5 CHARLESTON. WV 26305 I 19? if] 2:21. ACORD 25 (2016103) v? Ina-.2015 ACORD CORPORATION. AII Ham reserved. The ACCORD name and logo era Tool-tarot! mark: of ACORD 132n49.12 03-18-2018 iiug 102010 00155am P010 2019-08-14 09:50 3044858030 304 558 3970 10/11 STATE OF WEST VIRGINIA Purchasing DIvieion PURCHASING AFFIDAVIT CONETRUGTION CONTRACTS: Under W. Va. Code the contracting publlo entity ahell not award a construction oontraot to any bidder that Ia known to be In default on any monetary obligation owed to the etete or a political of the etate. Including. but not limited to. ohllpatlona related to payroll tattoo. property tam. eaten and tattoo. fire aervloe or other tlnea or teen. ALL CONTRACTS: Under W. Va. Code ?5A~3~10e. no contract or renewal of any contract may be awarded by the etate or any of Ila political to any vendor or prospective vendor when the vendor or proa-peollva vendor or a related party to the vendor or proepeotlve vendor to a debtor and: (1) the debt owed Ie an amount greater than one thouaand dollara in the aggregate: or (2) the debtor to in employer default. EXCEFTION: The prohibition Ilated above doae not apply where a vendor hoe oontoetad any tax percent to chapter eleven of the W. Va. Code. workere' oompenaatlon premium. permit tea or environmental fee or and the matter he not become ?nal or where the vendor hoe entered Into a payment plan or aare-rn-nt end the vendor la not In dot-alt of any of the provlelona ateueh plan or agreement. DEPINITIONI: ?Debt? marine any premium. penalty. tine. tax or other amount of money outed to the etate or any of tie political of a judgment. tine. permit violation. lloenaa defaulted workerl? oompanaetlon premium. penalty or other entree-mam preaently delinquent or due and required to be paid to the little or any of Ila political Including any Internet or additional penettlee accrued thereon. ?Employer default" meane having an balenoe or liability to the old fund or to the unineured employara' fund or being In policy default, aa de?ned In W. Va. Code 9 23-2o-2. failure to maintain mandatory wattleII' oompeneatlon coverage. or failure to fully meat It obligation: no a workare? oompereellon eell-Ineured employer. An employer Ia not In employer default If It hae entered Into a repayment agreement with the lnauranoe Commiealoner and romaine In oomplienoe with the obligation: under the agreement ?Related perty' mean! a party. whether an individual. corporation. pamarehlp. annotation. limited liability company or any other form or bualneea or other entity whomever. related to any vendor by blood. marriage. ownerehlp or contract through whloh the party tree a relationship of ownarahlp or other interaet vvl?t the vendor an out the party will naturally or by effect receive or mntrol a portion of the benefit. pro?t or other oonelderatlon from perionnanoe of a vendor oontraot with the party an amount that mean: or evoeed ?ve percent of the total contract amount. AFFIRMATION: By eluding thle form. the vendor's authorized alpner and acknowledge: under penalty of law for falee marina (W. Va. Code set-so) that: if) for conetruotlon contact. the vendor to not In default on any monetary obligation ovved to the atone or a political aubdlvialon of the etate. and (2) for all other contract. that neither vendor nor any related party owe a debt as defined above and that neither vendor nor any related party are In employer default ea defined above. unloae the debt or employer default to permitted under the exception above. WITNESS THE FOLLOWING SIINATURE: Vendor'e Name: T5 8' RH. LLCI Authorized Signature: r/bth/g/L/ ?d?l Date: g/Hf/f?? suite of Writ I l/(v it tit-L County of . to-vvlt: Taken, euheorlhed, and awom to before me thla whey of 1?00; Uti i . 20B. My Commlaelon explree 2 . 20.22;; AFFIX SEAL HERE Film. nerd-m (milked emanate) lug 112019 09:55am P011 2019-08-14 09:50 3044858030 304 558 3970 11/11 West Virginia Ethics Commission Disclosure of Interested Parties to Contracts (Required by w. Va. Code 30-1-2) Name of Contracting Business Entity: T83 F1111 Address: Box 20 PAWS Z?rl?i?Z. Name ol'Authorized Agent: Jme: E. 85131412.. Address: 51/6 Qanic?rus amoeba y. Centract Number: oofgwomws Contract yRmo) 1'73. L0 Governmental agency awarding contract: MDOT Check here it this is Supplemental Disclosure List the Names of interested Parties to the contract which are known or reasonably anticipated by the contracting business entity for each category below (attach additional pages if necessary): 1. Subcontractors or other entities performing work or service under the Contract ill/Check here it none. otherwise list names below. 2. person or entity who owns 26% or more of contracting entity (not applicable to publicly traded entitles} Check here if none. otherwise list names below. 3. Any person or entity that facilitated. or negotiated the terms of. the applicable contract (excluding legal services related to the negotiation or of the applicable contract) HChacit here if none. otherwise list entitylindividuai names below. Signature/:1; iPWg/{/ Date Signed: E?fj Notary veri?cation State {:11 11 41111161 .County .the authorized agent of the contracting business entity listed above. being duly sworn. acknowledge that the Disclosure herein is being made under oath and under the penalty of perjury. ,3 i . - Taken. sworn to and subscribed before me this 1? day of ?1:111! Ll 1 . 101(?1. Air/1 1 11-1 1?1.ng 1 Notary Publlc's Signature Date Received by State Agency: twin Elf?" Date submitted to Ethics Commission: Governmental agenw submitting Disclosure: . "mil" .eora . Hug 1420190915301 P001 2019-08-14 09:48 3044858030 304 558 3970 1/11 30% ?6170 ?11111 401/ DOT Cons-011111101 Sam/11,48 From/Y. 11R LLC Aug 01 2010 00:50am P001 2019-08-14 09:52 3044858030 304 558 3970 1/12 300558 ?rm 4w DOT 2000000003 0000qu Emmi RR, 2019-08-14 09:52 3044858030 304 558 3970 Aug 10 0010 00:50am P002 2/12 Fumhulng 2010 Slrul East Poul Of?ce Box 00130 WV 25305-0130 State of West VlrgInIa Request for Quatatlon 10 - Proc Foldet: B13700 PM TWO: Central Contract FIxad Amt 0'35 DUIBFIPIIDHJ CONSULTING SERVICE-SECONDARY ROAD MAINT. (09206001) DnIo Illuud CIOIGI No leon 2019?00-01 2019-08-15 CRFQ 0003 DOT2000000013 1 13:30:00 "0-7111: 0110 0100-011 050.100.. ..- ..--.. aw CLERK DEPARTMENT or ADMINISTRATION PURCHASING DIVISION 2010 WASHINGTON ST CHARLESTON us nI-?w-?v rpm: m: -unuu_ 3-.- -1v ,"31 .?1fu'W0'my}? 4..L In}; 11' 04.0.; it" 71-1-1 11.? 00.2.; 7.: .. .. mum Vendor Nam. Adams and Talaphono Number(304)588maw .. - - - . .0- .u .. ..-. Man Ln FOR INFORMATION CONTACT THE BUYER Cwatal Hualead (304) 558-2402 FEIN a 9?11 Bb?otng?t Ho Iormu nd In Paul 1 DATE FORM IO Hug 14 2019 10:05am P001 2019-08-14 10:04 304 485 6786 304 558 3970 1 @6170 B\o\ new DOT 2000000013 ?mum? From1TP>+ (12? LLC 003 10 2010 10:05am P002 2019-08-14 10:04 304 485 6786 304 558 3970 2 a; State of West Virgir?lia . Post Of?ce Bi: 50130 Request for QuotatIon 1o - Consuiting Pros Folder: 313705 . . 00!: CONSULTING SERVICE-SECONDARY ROAD MAINT. (69200001) PM: W96: Central Contract - Fixed Amt Date Issued Solicitation closes Solicitation No ?"5000 201008.01 201903?15 CRFCI 0003 DOT2000000013 1 13:30:00 0m CLERK DEPARTMENT OF ADMINISTRATION PURCHASING DIVISION 2019 WASHINGTON ST CHARLESTON wv 25305 05 VondOr Name. mssand Telephone Hmh-er: I TB ARK. PO Box 20 WV 2604-2. (304) 58840920 FOR INFORMATION CONTACT THE BUYER Hustead (304) 558-2402 cwstal.g.hustead@wv.gov Signature gm FEIN 8?11? 8 bbeg 1+ I 1? DATE 8/131]? All offers 50 Ho all conditio co?n'lalned' In this solicitation Page 1 FORM 02142019 10:05am P003 2019-08-14 10:04 304 485 6786 304 558 3970 THE STATE OF WEST VIRGINIA PURCHASING DIVISION FOR THE AGENCY. VIRGINIA DIVISION OF HIGHWAYS. IS BIDS TO ESTABLISH AN OPEN-END CONTRACT OR CONSULTING SERVICES TO ASSIST WITH COORDINATION AND OVERSIGHT OF THE SECONDARYROAD MAINTENANCE INITIATIVE PER THE ATTACHED DOCUMENTS. QUESTIONS REGARDING THE SOLICITATION MUST BE SUBMITTED IN WRITING TO PRIOR TO THE QUESTION PERIOD DEADLINE CONTAINED-IN THE INSTRUCTIONS TO VENDORS SUBMITTING BIOS. DIVISION OF HIGHWAYS DIVISION OF HIGHWAYS FINANCE ADM INSTATION EXECUTIVE DIVISION 1900 KANAWHABLVD E. BLDG 5 RM A220 1900 KANAWHA BLVD E. BLDG 5 CHARLESTON - WV25305-0430 . CHARLESTON WV 25305-0430 US US Ling Cumin Ln tics: Qty Unit issue Unit Price Tom] Price 1 CONSULTING SERVICES Comm Coda Manufacturer Specification Modal 72141003 Extended Description CONSULTING SERVICES - SECONDARY ROAD MAINTENANCE SEE ATTACHED EXHIBITA PRICING PAGE LIE 5mm MIA 1 VENDOR QUESTION DEADLINE 201903415 Page 2 Hug 142019 10:05am 2019-08-14 10:04 304 485 6786 304 558 3970 4 REQUEST FOR QUOTATION CRFQ DOT2000000013 Consulting Services? Secondary Roads Maintenance Initiative (692C001) wF 10. VENDOR DEFAULT: "v 10.1. The following shall be considered a vendor default under this Contract 10.1.1.Failure to perform Contract Services in accordance with the requirements contained herein. 10.1.2.Failure to comply with other speci?cations and requirements contained herein. 10-1.3. Failure to comply with any laws, rules, and ordinances applicable to the Contract Services provided under this Contract. 10.1.4. Failure to remedy de?cient performance upon request. 10.2. The following remedies shall be available to Agency upon default. 10.2.1. Immediate cancellation of the Contract. 10.2.2. Immediate cancellation of one or more release orders issued under this Contract. 10.2.3. Any other remedies available in law or equity. 11. MISCELLANEOUS: 11.1 Contract Manager: During its performance of this Contact, Vendor must designate and maintain a primary contract manager responsible for overseeing Vendor responsibilities under this Contract. The Contract manager must be available during normal business hours to address any customer service or other issues related to this Contract. VendOr should list its Contract manager and his or her contact information below. Contract Manager: James E. Telephone Number: 0+ 15 ?Fax Number: Email Adams: jig?JV: ?d @jalxoo. com Revised 12/12/2017 EXHIBIT A -- PRICING PAGE CRFQ Consultant Services for the Governor's Secondary Road Malnte nance lnItIatIve Unit Cost 1 Per Extended Cost (Unit Cost Item Ilmt of Estimated - Number Measure 5:131:32; ?af?rm 1 Days Consultant Servlces - Secondary Road Maintenance Initia?ve 4% [51700 150 #1991050. 00 Daily rate must Include travel charges Hal) 0 50: 00 02.62 855 ?702 9919 59*? 702 13388 5d ??901? EUR 3% 900d Hug 2019 10:06am P005 2019-03-14 10:05 304 485 6786 304 553 3970 6 ADDENDUM ACKNOWLEDGEMENT FORM - SOLICITATION N0.: car-"o Instructions: Please acknowledge receipt of all addenda issued with this solicitation by completing this addendum aclmowledgment form- Check the box next to each addendum received and sign below. Failure to aclmowledge addenda may result in bid disquali?cation. Aclmowled'gnent: I hereby. acknowledge receipt of the following addenda and have made the necessary revisions to my proposal, plans and/or speci?cation. etc. *?ddendum Numbers Received: (Check the box next to each addendum received) Addendum No. Addendum No. 6 Addendum No. 2 [j Addendum No. 7 [j Addendum No. 3 [j Addendum No. 8 UAddendumNo.4 [:IAddendum No. 9 Addendum No. 5 Addendum No. 10 I understandtbat ?ilure to con?rm the receipt of addenda may be cause for rejection of this bid. I further understand that any verbal repres-tation made or assumed tobe made dining any oral discussion held between Vendor?s representatives and any state personnel is not binding. Only the information issued in writing and added to the speci?cations by an official addendum is binding. T5 LLC, Company oxized ture 9123/1? Date NOTE: This addendum acknowledgement should be submitted with the bid to expedite document processing. *No @95qu RECEIVED. Revised 06/05/2019 Aug 14 2019 10:05am 2019-08-14 10:05 304 485 6786 304 558 3970 7 DESIGNATED CONTACT: Vendor appoints the individual identi?ed in this Section as the Contract Administrator and. the initial point of contact for matters relating to this Contract James NEW '(Name,TitE) r1155 32.5724;ng MEMIQL. (PrintedName and Title) 20-13?. 20/, Dru/own; WV zelez - - (Add: s) (3015 5:88-06 24, (Phone Number) I (Fax Number) @thheo- com. (email address) ?7 CERTIFICATION AND SIGNATURE: By signing below, or submitting documentation through I certify that Ihave reviewed this Solicitation in its entirety; that Iunderstand the requirements, terms and conditions, and other information contained herein; that this bid, offer or pmposal co ?tetee an offer to the State that cannot be unilaterally withdrawn; that the product or service proposed meets the mandatory requirements contained in the Solicitation for that product or service, toilets otherwise stated herein; that the Vendor accepts the terms and conditions contained in the solicitation, unless otherwise stated herein; that I am submitting this bid, o?er 0r proposal for review and eonsideratioa; that I am authorized by the vendor to execute and submit this bid, offer, or preposa], or any documents related thereto on vendor?s behalf; that I am authorized to bind the vendor in a contractual relationship; and that to the best of my knowledge, the vendor has properly registered with any State agency that may require registration. IS an LIL (Company) . {?zmnze uthon'zed Signaling) (RepresentatiVe Name, Title) .J?m?s Ei RETENIJL tH?maEK (Printed Name and Title of Authorized Representative) 9 {1311? (Date) 585-0826 (Phone Number) (Fax Number) Revised 06/05/2019 Hug 1d 2019 10:05am P008 2019-08-14 10:05 304 485 6786 304 558 3970 8 Acono' CERTIFICATE OF LIABILITY INSURANCE ontoarzms THIS CERTIFICATE l3 ISSUED A3 A MATTER OF ONLY AND CONFERS N0 UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT CR NEGATIVELY AMEND. EXTEND OR ALTER COVERAGE AFFORDED BY THE POLICIES BELOW. THIS OF INSURANCE DOES NOT A CONTRACT BETWEEN THE ISSUING AUTHORIZED REPRESENTATIVE 0R PRODUCER. AND THE HOLDER. IMPORTANT: II the ?ammo holder Is an INSURED. the po?cyIIesI must have INSURED or be endowed; II Is WANED. molded In the terms and oI Illa policy. mlu pouchthis cot??m do? not under dam: Iutha certified: holdo?n Ilou olsuch ?Communal. mm . ChudI Mofhinger 5mm Chuck :1 304-295-4575 - 23m Ava mmemm WV 231? ma: Farm FIte'and Casualty Company 2514:! mm Mm540 Scenic me: I COVERAGES CERTIFICATE Imus-I: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE FOUCY PERIOD INDIMTED. WANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE IMY BE OR MAY PERTAIN. THE INSURANCE AFFORDEO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. meal 080mm MEN mum- mm WIS comm. BEHEIIALW 559, 0mm 3 1.000.000 IW MED EXP [My mom} 8- 97?8.! 8554-0 0810012019 0010012020 ?mm?mwmm, gamma-ism; um muss pm: GENERAL AGGREGATE 2.000.000 PCUCVDECY LOG am 3 magnum mum-Ian" 3 Am mm) BODILY 1W (?rm-I omen AUTOS mm. $5 BODILY INNRY (9::me 3 man momma WW: 5 was mm was ONLY mm occua momentum Incl-sauna CLAIMS-MADE AGGREGATE can I RETENTION: mamas catamaran ?a momma-v . I quiz I [38 ?If WRIETWAWTWE EL momma-wan mouse? OF OVERATIDPB haul! EL. DISEASE - POLICY Hi? I baseman a: um mm) Add?lmal Inland State MW. 1900 Karim BLVD E. ELDG 5. Charleston. W25305 Contract consulting services to Iha Slab onv Dapammnt of Highways CERTIFICATE HOLDER . CANCELLATION SHOULD ANY OF THE ABOVE DE8CRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE . NOTICE WILL BE DELIVERED ACCOR mm? POLICY PROVISIONS, 19m mama awn Am :1 Charleston. I . -. Stale of wv . 1900401 GRATION. All rights reserved. ACORD 25 (2010103) The name and logo are registered one IWKIIE 003 10 2019 1010130 P000 2019-08-14 10:05 304 485 6786 304 558 3970 9 - ?Tammi-rm CERTIFICATE OF LIABILITY INSURANCE Wm, nus CERTIFICATE Is IssuED as A MATTER OF INFORMATION ONLY AND commas NO mam won me CERTIFICATE HOLDER. Wis CERTIFICATE DOES NOT AFFIRMATWELY OR NEGATIVELY AMIID. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE GOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS). AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER. IMPORTANT: the ammo holder In an ADDITIONAL INSURED. the poucy?os) must Ium ADDITIONAL IHSURED or be endorsed. If SUBROGATIOH IS WAIVED. subject la the Dam and conditions of the policy. curtain pandas may mum an uncommon. A summon! on Ihls day: not com "gun to the hoIdor In lieu ohm-1 onetime]. meow: Chunk Miarm Chuck Nulungef. Agent. CPcu. cw, my mama zoom Grand semi Ava fag-?: . - . State Farm Mutual Automobile Insurance Company 26118 mum mama: James Eaten. Jr. me 5?5 SMIO Or mo, Pa?tershulg. "mums: Wk COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOWANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSU- OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POI-IOIES DESCRIBED HEREIN IS SUBJECT TO .ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOW MAY HAVE BEEN REDUCED BY PAID CLAIMS. mm I'm um: comtcaumumuw acumen: - _l r] Pm. Gamma?! "0??ij cm nmaEE?mm . uun' I a 9 03m 1 manmuwwomm r. 1,000,000 W?Tosmv 125 Baum-458 mm 120 9 WWE 3 1.000.090 mu? Owl" WW 5 mum mm AGGREGATE . am-ammw a - mosses-WE 4 uncommon (loom km Addl?llonal hunted: Stall: DIWV. 1900 Kama BLVD BLOG 5. 013mm VIN 25305 .- mlradad cumming In lho Slate CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE AOOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL OE DWEO WITH THE POLICY PROVISIONS. I x! 1983.155 A 1 PORATION. All rights named. ACORD 25 The ACORD name and Iago of A60 Slate of 1900 Kanawha BLVD E. BLOG 5 Ghanaian, vw 25305 1 IMHO 112M112 ?48.1310 HUI 142019 2019-00-14 10:06 am 304 405 6786 304 550 3970 10 DATE A I AI CORD CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS). AUTHORIZED REPRESENTATIVE OR PRODUCER. AND CERTIFICATE HOLDER. IMPORTANT: II tho certl?cato holder Is an: ADDITIONAL INSURED, tho policyIloa) must have ADDITIONAL INSURED provlslons or be endorsed. If SUBROGATION IS WAIVED. subject to the terms and of the policy. cenaln pollclos may require an endorsement. A Statement on thla conl?cato does not confer rlghu to tho holder In "on of such ondorsomontls]. PRODUCER 323g?? GENE HAYNES i StateFarm A. HAYNES INSURANCE AGENCY. INC . 30H857561 Siam 2.044033% 3909 EMERSON AVE ?ats: gene.haynes.wastatefamnom PARKERSBURG. WV 26104 INSUREEISIAFFOROING COVERAGE NAIC GENE A. HAYNES, AGENT mum. Farm Mutual Automobile Insurance Company 25178 INSURED - INSURER a: THOMAS BADGEIT ?sum 1837 WHITE OAK RUN RD mum WALKER. vw 26160 ?sum E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITI-ISTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED DR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DOUSUDR POLICY EFF POLICY EXP TYPE OF INSURANCE Inga I POLICY NUMBER ?swam; commencuu. EACH OCCURRENCE CLAIMS-MADE OCCUR 35531; E: Mama: 5 MED EJLP {An} ono person; 5 PERSONAL ADV INJURY - AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE I 5 POLICY 3287' we OTHER: I I 5 AUTOMOBILE maum I 130 0834-F07-48 0010mm 1210712019 ?Igua'??fg?s'm? I 1.000.000 ANYAUTO I BODILY INJURY a 1.000.000 OWNED SCHEDULED A AUTOS ONLY Am. BODILY INJURY (Macadam) 1,000,000 HIRED NON-OWNED PROPERTY DAMAGE 1 000 000 Auras ONLY ONLY mumm? . I OCCUR EACH OCCURRENCE 5 I CLAIMS-MADE AGGREGATE sea I I RETENTION COM PENSATION PER OTH- AND I ANY mormarowmnmememcuma E.L EACH ACCIDENT OF: MEN :anquIom In NHI EL DISEASE - EA EMPLOYEE OPERATIONS below E.L. LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES IACORO 101. Ram? Senadulo. may In mama Ir move apnea II mums; 2013 KIA SORENTO, VIN TO BE USED BY THOMAS BADGETT. FOR VW STATE DEPARTMENT OF HIGHWAYS. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. STATE OF WV 1900 KANAWHA BLVD EAST AUTHOR - RECENTA .1 BUILDING 5 CHARLESTON, WV 25305 . I I: I 00193342015 ACORD CORPORATION. All I?Ighta resarved. ACORD 26 (2016103) The ACORD name and logo are roglstored marks of ACORD 1001456 132849.12 0318-20? lug 112019 10:01am P011 2019-08-14 10:06 304 485 6786 304 558 3970 11/12 STATE OF WEST VIRGINIA Purchasing Division PURCHASING AFFIDAVIT CONSTRUCTION CONTRACTS: Under W. Va. Code 5 5-22-16). the contracting public entity shall not award a construction?contract to any bidder that to known to be in default on any monetary obligation owed to the state or a political subdivision of the state. including. but not limited to. obligations related to payroll taxes. property taxes. sales and use taxes. tire service fees. or other ?nes or fees. ALLICONTRACTS: Under W. Va. Code no contract or renewal of any contract may be awarded by the state or any of its political subdivisions to any vendor or prospective vendor when the vendor or prospective vendor or a related party to the vendor or prospective vendor is a debtor and: (1) the debt owed is an amount greater than one thousand dollars in the aggregate: or (2) the debtor is in employer default. EXCEPTION: The prohibition listed above does not apply where a vendor has contested any tax administered pursuant to chapter eleven of the W. Va. Code. workers' compensation premium. permit fee or environmental fee or assessment and the matter has not become final orwhere the vendor has entered Into a payment plan or agreement and the vendor ls not in deiauh or any or the provisions ofsuch plan or agreement. DEFINITIONS: "Debt? means any assessment. premium. penalty. tine, tax or other amount of money owed to the state or any of its political because of a ludgrnent. tine. permit violation. license assessment. defaulted worlrers' compensation premium. penalty or other assessment presently delinquent or due and required to be paid to the state or any of its political subdivisions. including any Interest or additional penalties accrued thereon. ?Employer default" means having an outstanding balance or liability to the old fund orto the uninsured empioyers? fund or being In policy default. as de?ned in w. Va. Code 23.2w. tenure to maintain mandatory workers? compensation coverage. crialiure to fully meet its obligations as a workers' compensation self-hsured employer. An employer Is not in employer default if It has entered into a repayment agreement with the insurance Commissioner and remains to compliance with the obligations under the repayment agreement "Releted party' means a party. whether an individual. corporation, partnership. association. limited liability company or any other form or business sswdatlon or other entity whatsoever. related to any vendor by blood. montage. omership or contract through Which the party has a relationship of ovoiership orcther interest with the vendor so that the party will actually or by eilect receive or control a portion of the bene?t pro?t or other consideration from performance of a vendor die party receiving an amount that meets or wooed live percent or the total contract amount AFFIRMATION: By signing this form, the vendor's authorized signer affirms and acknowledges under penalty of. law for false swearing (W. Va. Code 561-54) that: (1) for construction contracts. the vendor is not in default on any monetary obligation owed to the state or a political subdivision of the state. and (2) for all other ccnhacb. that neither vendor nor any related party owe a debt as defined above and that neither vendor nor any related party are in employer default as defined above. unless the debt or employer default is permitted under the exception above. WITNESS THE FOLLOWING SIGNATURE: Vendor?s Name: TB RK . Authorized Signature: Womr Date: 3161/]? seteor WW3) mot Countyof .to-mit: Taken. subscribed. and sworn to before me this 1511?s., of Mg URI . 20331 My Commission expires MCKXII 251 . . 2012?. Pursha?ng arse-m (Mud mascara) AFFIX SEAL HERE iug 142019 10:07am P012 2019-08-14 10:06 304 485 6786 304 558 3970 12/12 West Virginia Ethics Commission Disclosure of Interested Parties to Contracts (Required by W. Va. Code 60-1-2) Narne of Contracting Business Entity: Address: PO Box 20 DAVE WLLE, NV 26:142. Name of Authorized Agent: .Jmes E. Refer: Address: 545 ?mncli?us, Roaming, Contract Number: DOT-Z 60000001.?) Contract Description: (Mgumg Sign; g- getaway Kano: Governmental agency awarding contract: El Check here if this is 3 Supplemental Disclosure Listthe Names of lnterected Parties to the contract which are known or reasonably anticipated by the contracting business entity for each category below (attach additional pages if necessary): 1. Subcontractors or other entities performing work or service under the Contract MCheck here if none. otherwise list entity?ndividual names below. 2. an) person or entity who owns 25% or more of contracting entity (not applicable to publicly traded entities) Check here if none. otherwise list entityrindividual names below. 3. Any person or entity that facilitated. or negotiated the terms of. the applicable contract (excluding legal services related to the negotiation or drafting of the applicable contract) EfCheck here it none. otherwise list entitylindividual names below. Signature: Date Signed: 9 Notarye le/cation Stateof VlWimm .Ccuntyof WUrllAr I. (imtft i. BOTCW i the authorized agent ofthe contracting business entity listed above being duly sworn. aolrnowledge that the Disclosure herein ls being made under oath and under the penalty of perjury Taken. sworn to and subscribed before me this \Lk? day of WAG 2010i. Ohm/W. {Mk Notary Publlc'a Sig nature To be com Sate A Date Received by State Agency: Date submitted to Ethics Commission: Governmental agency submitting Disclosure: . 2018 Hug 15 2019 10:13am P001 Aug 1519 10:073 ROTEN FAX 3044200379 p.1 C, 75 ERR, LL WV waugsw? i/Torx?fao? 555447 70 ?26* 50%me 5 mm 03303 19017000000015 1 Antanaum 1 15> Fan, Rchr/v'f? 49% L. mauve mm (mm. EID ?2t:wm5u/ 99(sz ?w577 P?a? EWEKSHBET Hus 15 2019 10:13am P002 Aug 15191010731 ROTEN FAX 3044200379 p.2 ADDENDUM ACKNOWLEDGEMENT FORM SOLICITATION 007200900001 3 Instructions: Please acknowledge receipt of all addenda issued with this solicitation by completing this addendum acknowledgment form. Check the box next to each addendum received and sign below. Failure to acknowledge addenda may result in bid disquali?cation. Acknowledgment: I hereby acknowledge receipt of the following addenda and have made the necessary revisions to my proposal, plans and/or speci?cation, etc. Addendum Numbers Received: (Check the box next to each addendum received) Addendum No. Addendum No. 6 Addendum No. 2 Addendum No. 7 Addendum No. 3 Addendum N0. 8 Addendum No. 4 Addendum No. 9 Addendum No. 5 Addendum No. 10 Iundersumd that failure to con?rm the receipt of addenda may be cause for rejection of this bid. I further understand that any verbal representation made or assumed to be made during any oral discussion held between Vendor?s representatives and any state personnel is not binding. Only the information issued in writing and added to the speci?cations by an of?cial addendum is binding. TBMR. Author-i2 Jgnature {3/15 no Date NOTE: This addendum acknowledgement should be submitted with the bid to expedite document processing. Revised 51312012 Receivedz3044200379 Hug 15 2019 03:290m P001 Aug 1519 03:23p ROTEN FAX 3044200379 p.1 $120,724 TE ask/21a, Lu: Jprmas 0 1/ @qu 5?59 5970 007 5" a, Army CRFQ c5803 chizoaow (5 1 Eat Z. ATTAWZD *5 77% [50/2 ?7 .2. wag/mafia Rewrf?i? m? ADD?Qidpqm . ,v 7 WFD: 0009.. 'PAcm?-?ra?; La Yam] J4 W2 :25 ?2mm? 1 RAGE @ng Receivedi3044200379 Hug 15 2019 03:29pm P002 Aug 1519 03:23p ROTEN FAX 3044200379 p2 ADDENDUM ACKNOWLEDGEMENT FORM Instructions: Please acknowledge receipt of all addenda issued with this solicitation by completing this addendum acknowledgment form. Check the box next to each addendum received and sign below. Failure to acknowledge addenda may result in bid disquali?cation. Acknowledgment: I hereby acknowledge receipt of the following addenda and have made the necessary revisions to my proposal, plans and/or speci?cation, etc. Addendum NImeei-s Received: (Check the box next to each addendum received) I Addendum No. 1 Addendum No. 6 Addendum No. 2 I Addendum No. 7 Addendum No. 3 Addendum No. 8 Addendum No. 4 .Addendum No. 9 Addendum No. 5 Addendum No. 10 I understand that failure to con?rm the receipt of addenda may be cause for rejection of this bid. I further understand that any verbal representation made or assumed to be made during any oral discussion held between Vendor?s repreSentatives and any state personnel Is not binding. Only the information iSSued in writing and added to the speci?cations by an of?cial addendum 15 binding. Midi-11L; . Company Authorized 3? store 29/15? Date NOTE: This addendum acknowledgement should be submitted with the bid to expedite document processing. Revised 6/812012