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- State Form 96 "Contractor's Bid for Public Work" - Indiana
State Form 96 "Contractor's Bid for Public Work" - Indiana
What Is State Form 96?
This is a legal form that was released by the Indiana Department of Workforce Development - a government authority operating within Indiana. As of today, no separate filing guidelines for the form are provided by the issuing department.
Form Details:
- Released on February 1, 2013;
- The latest edition provided by the Indiana Department of Workforce Development;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of State Form 96 by clicking the link below or browse more documents and templates provided by the Indiana Department of Workforce Development.
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6Reset Form
CONTRACTOR'S BID FOR PUBLIC WORK - FORM 96
State Form 52414 (R2 / 2-13) / Form 96 (Revised 2013)
Prescribed by State Board of Accounts
PART I
(To be completed for all bids. Please type or print)
Date (month, day, year):__________________________
1. Governmental Unit (Owner):___________________________________________________________
2. County :___________________________________________________________________________
3. Bidder (Firm):_______________________________________________________________________
Address:___________________________________________________________________________
City/State/ZIPcode:__________________________________________________________________
4. Telephone Number:__________________________________________________________________
5. Agent of Bidder (if applicable):__________________________________________________________
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete
the public works project of _____________________________________________________________________
(Governmental Unit) in accordance with plans and specifications prepared by _____________________________
_________________________________________________ and dated _____________________ for the sum of
____________________________________________________ $_____________________________________
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the
notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the
notice. Any addendums attached will be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as
that shown in the original contract if accepted by the governmental unit. If the bid is to be awarded on a unit
basis, the itemization of the units shall be shown on a separate attachment.
The contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee,
or applicant for employment, to be employed in the performance of this contract, with respect to any matter
directly or indirectly related to employment because of race, religion, color, sex, national origin or ancestry.
Breach of this covenant may be regarded as a material breach of the contract.
CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS
(If applicable)
I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory
obligation to use steel products made in the United States (I.C. 5-16-8-2).
I hereby certify that I and all
subcontractors employed by me for this project will use U.S. steel products on this project if awarded.
I
understand that violations hereunder may result in forfeiture of contractual payments.
Reset Form
CONTRACTOR'S BID FOR PUBLIC WORK - FORM 96
State Form 52414 (R2 / 2-13) / Form 96 (Revised 2013)
Prescribed by State Board of Accounts
PART I
(To be completed for all bids. Please type or print)
Date (month, day, year):__________________________
1. Governmental Unit (Owner):___________________________________________________________
2. County :___________________________________________________________________________
3. Bidder (Firm):_______________________________________________________________________
Address:___________________________________________________________________________
City/State/ZIPcode:__________________________________________________________________
4. Telephone Number:__________________________________________________________________
5. Agent of Bidder (if applicable):__________________________________________________________
Pursuant to notices given, the undersigned offers to furnish labor and/or material necessary to complete
the public works project of _____________________________________________________________________
(Governmental Unit) in accordance with plans and specifications prepared by _____________________________
_________________________________________________ and dated _____________________ for the sum of
____________________________________________________ $_____________________________________
The undersigned further agrees to furnish a bond or certified check with this bid for an amount specified in the
notice of the letting. If alternative bids apply, the undersigned submits a proposal for each in accordance with the
notice. Any addendums attached will be specifically referenced at the applicable page.
If additional units of material included in the contract are needed, the cost of units must be the same as
that shown in the original contract if accepted by the governmental unit. If the bid is to be awarded on a unit
basis, the itemization of the units shall be shown on a separate attachment.
The contractor and his subcontractors, if any, shall not discriminate against or intimidate any employee,
or applicant for employment, to be employed in the performance of this contract, with respect to any matter
directly or indirectly related to employment because of race, religion, color, sex, national origin or ancestry.
Breach of this covenant may be regarded as a material breach of the contract.
CERTIFICATION OF USE OF UNITED STATES STEEL PRODUCTS
(If applicable)
I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory
obligation to use steel products made in the United States (I.C. 5-16-8-2).
I hereby certify that I and all
subcontractors employed by me for this project will use U.S. steel products on this project if awarded.
I
understand that violations hereunder may result in forfeiture of contractual payments.
ACCEPTANCE
The above bid is accepted this _____________ day of _________________, ________, subject to the
following conditions: _______________________________________________________________________
________________________________________________________________________________________
Contracting Authority Members:
______________________________________
_______________________________________
______________________________________
_______________________________________
______________________________________
_______________________________________
PART II
(For projects of $1 0,000 or more – IC 36-1-12-4)
Governmental Unit: ___________________________________________________________
Bidder (Firm)
___________________________________________________________
Date (month, day, year): _______________________________________________________
These statements to be submitted under oath by each bidder with and as a part of his bid.
Attach additional pages for each section as needed.
SECTION I EXPERIENCE QUESTIONNAIRE
1.
What public works projects has your organization completed for the period of one (1) year prior to the
date of the current bid?
Completion
Contract Amount
Class of Work
Date
Name and Address of Owner
2.
What public works projects are now in process of construction by your organization?
Expected
Contract Amount
Class of Work
Completion
Name and Address of Owner
Date
3.
Have you ever failed to complete any work awarded to you? _______________ If so, where and why?
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
4.
List references from private firms for which you have performed work.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE
1.
Explain your plan or layout for performing proposed work. (Examples could include a narrative of when
you could begin work, complete the project, number of workers, etc. and any other information which you
believe would enable the governmental unit to consider your bid.)
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
2.
Please list the names and addresses of all subcontractors (i.e. persons or firms outside your own firm
who have performed part of the work) that you have used on public works projects during the past five (5)
years along with a brief description of the work done by each subcontractor.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
3.
If you intend to sublet any portion of the work, state the name and address of each subcontractor,
equipment to be used by the subcontractor, and whether you will require a bond. However, if you are
unable to currently provide a listing, please understand a listing must be provided prior to contract
approval. Until the completion of the proposed project, you are under a continuing obligation to
immediately notify the governmental unit in the event that you subsequently determine that you will use a
subcontractor on the proposed project.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
4.
What equipment do you have available to use for the proposed project? Any equipment to be used by
subcontractors may also be required to be listed by the governmental unit.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
5.
Have you entered into contracts or received offers for all materials which substantiate the prices used in
preparing your proposal? If not, please explain the rationale used which would corroborate the prices
listed.
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
SECTION III CONTRACTOR’S FINANCIAL STATEMENT
Attachment of bidder’s financial statement is mandatory.
Any bid submitted without said financial
statement as required by statute shall thereby be rendered invalid. The financial statement provided hereunder to
the governing body awarding the contract must be specific enough in detail so that said governing body can make
a proper determination of the bidder’s capability for completing the project if awarded.
SECTION IV CONTRACTOR'S NON – COLLUSION AFFIDAVIT
The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other
member, representative, or agent of the firm, company, corporation or partnership represented by him, entered
into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such
letting nor to prevent any person from bidding nor to include anyone to refrain from bidding, and that this bid is
made without reference to any other bid and without any agreement, understanding or combination with any other
person in reference to such bidding.
He further says that no person or persons, firms, or corporation has, have or will receive directly or
indirectly, any rebate, fee, gift, commission or thing of value on account of such sale.
SECTION V OATH AND AFFIRMATION
I HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS AND INFORMATION
CONTAINED IN THE FOREGOING BID FOR PUBLIC WORKS ARE TRUE AND CORRECT.
Dated at ____________________ this ______________ day of __________________, _______
__________________________________________________________
(Name of Organization)
By________________________________________________________
__________________________________________________________
(Title of Person Signing)
ACKNOWLEDGEMENT
STATE OF ______________________)
) ss
COUNTY OF_____________________)
Before me, a Notary Public, personally appeared the above-named _________________________________ and
swore that the statements contained in the foregoing document are true and correct.
Subscribed and sworn to before me this ____________ day of ___________________, ________.
____________________________________________
Notary Public
My Commission Expires:_____________________
County of Residence:________________________
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