Pameacha Pond Repair-Public Works Department

CITY OF MIDDLETOWN
PURCHASING DEPARTMENT
CONTRACTOR'S CHECK LIST
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BID #2026-021
PAMEACHA POND DAM REPAIR
PUBLIC WORKS DEPARTMENT
Middletown, CT
The following forms are required for submittal for the above referenced bid and shall be submitted with
the bid proposal pages by the time and date specified. This check list is provided for the bidder's use and
shall not be required for submittal. The following forms shall be submitted in duplicate.
FORM DESCRIPTION
Bidder please enclose the following forms with your bid:
1. LOCAL BIDDER AFFIDAVIT (Middletown based businesses only)
2. BID BOND (5%)
3. CERTIFICATE OF SURETY
4. BID PROPOSAL PAGES
5. NON-COLLUSIVE STATEMENT
(Notarized Original)
6. STATEMENT OF BIDDERS EEO COMPLIANCE
______ 7. OSHA COMPLIANCE FORMS
______ 8. STATEMENT OF CONTRACTORS QUALIFICATIONS
(Notarized Original)
9. WAGE CERTIFICATION FORM (State)
10. WORKER'S COMPENSATION ACT CONFORMANCE FORM
11. PROPOSAL TO BE SUBMITTED IN DUPLICATE (ORIGINAL & ONE COPY)
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CITY OF MIDDLETOWN
PURCHASING DEPARTMENT
AFFIDAVIT OF LOCAL VENDOR
(applies to Middletown, CT based businesses only)
I, being duly sworn,
Vendor name
make affidavit and say that I own and operate
Business name and address
which is the bona fide principal place of business for
.
Business name
Evidence of ownership and principal place of business is attached to this affidavit and may include:
(Check the one which applies.)
1. Copy of canceled check for payment of personal property taxes on the business to be utilized in
performance of the Bid.
2. Copy of long term lease of the real estate from which the principal place of business is operated.
Vendor Name
STATE OF CONNECTICUT:
ss. Middletown, CT
COUNTY OF MIDDLESEX:
Personally appeared, ,
vendor name
owner of , signer and sealer
business name
of the foregoing instrument and acknowledged the truth of the foregoing, before me.
Notary Public:
My Commission Expires:
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BID BOND
KNOW ALL MEN BY THESE PRESENTS, that we the undersigned
as Principal, and
as Surety are held and firmly bound unto the City of Middletown hereinafter called the
"Owner", in the penal sum of $ Dollars ($ _) lawful money of the
United States, 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.
THE CONDITION OF THIS OBLIGATION IS SUCH that whereas the Principal has submitted the Accompanying Bid,
dated___ for BID #2026-021 PAMEACHA POND DAM REPAIRS - PUBLIC WORKS DEPARTMENT
- Middletown, CT
NOW THEREFORE, if the Principal shall not withdraw said Bid within the period specified therein after the opening
of the same or within any extended time period agreed to by the Principal, Surety and Owner, or if no period be
specified, within ninety (90) days, after the said opening, and shall within the period specified therefore, or if no
period be specified, within ten (10) days after the prescribed forms are presented to him for signature, enter into
a written Contract with the Owner in accordance with the Bid as accepted, and give bond with good and sufficient
performance and proper fulfillment of such Contract; then the above obligation shall be null and void and of no
effect, otherwise to remain in full force or virtue.
Failure to comply with the aforementioned condition shall result in the forfeiture of this Bid Bond.
IN WITNESS WHEREOF, the above-bounded parties have executed this instrument under their several seals this
day of , 2026, the name and corporate seal of each by its undersigned representative pursuant
to authority of its governing body.
No extension of time or other modification of this Bid Bond shall be valid unless agreed to in writing by the
parties of this Bond.
ANY CHANGES, MODIFICATIONS, AMENDMENTS AND / OR ALTERATIONS TO THIS ORIGINAL BOND FORM SHALL
BE HIGHLIGHTED AND THE CITY SHALL BE ADVISED OF SAME AND CONSENT TO SAME PRIOR TO ITS ACCEPTANCE
OF THE BOND AS SO CHANGED, MODIFIED, AMENDED, AND / OR ALTERED.
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(Seal)

Individual Principal
_____________________________________
Business Address
____________________________
Attest: _______________ By:__________________________
Corporate Principal
____________________
____________________________
Business Address
By__________________________
Affix Corporate Seal
Attest:
____________________________
Corporate Surety
____________________________
Business Address
By
Affix Corporate Seal
Countersigned by ________________________________________
*Attorney-in-fact, State of___________________________________
*Power-of-Attorney for person signing for Surety Company must be attached to bond.
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CERTIFICATE OF SURETY
The undersigned hereby certifies that it is a surety, duly authorized to do
business in the State of Connecticut and hereby agrees and guarantees to furnish to
the labor and material payment bond and/or the performance bond required by the Contract
Documents, as defined in BID #2026-021 PAMEACHA POND DAM REPAIRS - PUBLIC WORKS DEPARTMENT -
Middletown, CT if________________________ 's bid is accepted by the City of Middletown.
IN WITNESS WHEREOF, the undersigned has set its hand and seal this day of ,
2026.
Signed, Sealed and Delivered in
the Presence of:
SURETY COMPANY OF DULY
AUTHORIZED AGENT
____________________________ __________________________________
Its _, Duly Authorized
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BID #2026-021
PAMEACHA POND DAM REPAIRS
PUBLIC WORKS DEPARTMENT
Middletown, CT
Issue Date: 09/8/2026 Reply Date: FRIDAY, OCTOBER 9, 2026 by 11:00 AM
To: Supervisor of Purchase
City of Middletown
Municipal Building, Room 112
245 DeKoven Drive
Middletown, CT 06457
We, the undersigned, have examined the Contract Documents, which include the plans and specifications as prepared by
City of Middletown, dated August, 2026. Included in the bid documents are the Invitation to Bidders, Specifications,
General Conditions and related Contract Documents and propose and agree to Contract with the City of Middletown
(herein called the Owner) in the form of a Contract, to provide all necessary labor, machinery, tools, apparatus, equipment
and other means of construction and to see the work and furnish all materials called for/or shown on the drawings,
specifications and other documents in the manner prescribed and according to the requirements of the Owner, within the
time set for the in the Contract Documents at the bid prices incorporated herein. Should there be a discrepancy in the
language within the Contract Documents, the more stringent shall apply.
THE BID MUST BE SIGNED BY THE BIDDER TO BE ACCEPTED
COMPANY NAME SIGNATURE AND TITLE
The bid is made with the understanding that it cannot be withdrawn for a period of ninety (90) days after the
date set for opening of the bids.
Bid Bond or Check is attached to this bid in the amount of:
($ )
Written figures
Bid Security from:
(Insert Bonding Company/Bank name and address on the line provided.)
BIDDER acknowledges receipt of the following ADDENDA:
No 1 Date:
No. 2 Date:
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Bid Proposal Pages (Continued)
PAMEACHA POND DAM REPAIRS
Item# QTY UNIT OF ITEM DESCRIPTION
MEASURE
1 1 Lump Pricing shall be inclusive the following:
Sum
Furnish all labor, materials, equipment, tools, submittals, and incidentals necessary
to perform structural, hydraulic, and seepage control repairs at the Pameacha Pond
Dam (CT Dam ID #8313) in accordance with the Contract Documents, City of
Middletown and State of Connecticut standards, and the project plan entitled
"PAMEACHA DAM SHEETING REPAIR PLAN".
Clearing, grubbing, erosion controls, care of water, concrete cap removal,
excavation, and backfill. Structural operations encompass installing ~115 LF of steel
sheet piling driven or socketed into bedrock with mechanical anchors, vacuum-
excavating sediments, and grouting the void between the sheet wall and existing
masonry wall, and concrete spillway crest.
($ )
Written Figures
IN SUBMITTING THIS BID, THE BIDDER ACKNOWLEDGES THAT:
Upon receipt of written notice of acceptance of this bid by the owner, the bidder shall execute the contract attached
to these documents within ten (10) calendar days and deliver the bonds as required in these documents. The bid
security submitted with this bid will become the property of the owner in the event the contract and bonds are not
executed within the time herein set forth as liquidated damages for the delay and additional expense to the owner
caused thereby.
This bid is submitted in full compliance with the conditions outlined in the contract documents. The bidder has fully
responded to and completely filled in all required spaces in the bid documents, including the non-collusive form, and
obtained the necessary notary public signatures, where required.
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Bid Proposal Pages (Continued)
PLEASE NOTE: All of the information below is REQUIRED. Please do not leave any information blank.
_________ ______ __ ________
Corporation Name (if applicable) Company Name
Mailing Address: Payment Address (If different from mailing addr.):
__________________________________________ ___________________________________________
Address Address
__________________________________________ ___________________________________________
__________________________________________ ___________________________________________
City, State and Zip City, State and Zip
FEIN NUMBER: _______ -- __________________________
Type of Organization: ____ Individual / Sole Proprietor
(Please Check One)
____ Limited Liability Company
____ Corporation
Contact Information
Contact Name: __________________________________ Title: ___________________________________
Additional Contact: ______________________________ Title: ___________________________________
Phone Number: _________________________________ Fax: ___________________________________
Email Address: ______________________________________________________________________
Website: ____________________________________________________________________________
SIGN HERE: I hereby certify that the above information is correct.
__________________________________________ ________________________________ ____________
Print or Type Name & Title Signature Date
WITH EACH PROPOSAL, THE BIDDER SHALL SUBMIT A SIGNED NON-COLLUSIVE STATEMENT ON THE FORM ENCLOSED HERE-
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CITY OF MIDDLETOWN CONNECTICUT
NON-COLLUSIVE BID STATEMENT
All bidders are required to sign a Non-Collusive Statement with all public bids as follows:
l. The bid has been arrived at by the bidder, independently and has been submitted without collusion with, and
without any agreement, understanding, or planned common course of action with any other bidder of materials,
supplies, equipment, or services described in the Invitation to Bid, designed to limit independent bidding or
competition; and
2. The contents of the bid have not been communicated by the bidder or its employees or agents to any person not
an employee or agent of the bidder or its surety on any bond furnished with the bid, and will not be communicated
to any person prior to the official opening of the bid.
Date
Signed
Company
Address
City, State, Zip
Telephone Number
9

STATEMENT OF BIDDERS EEO COMPLIANCE
IT IS HEREBY CERTIFIED THAT:
NAME OF BIDDER:
BUSINESS ADDRESS:
____________________________________________________
We the undersigned agree to comply with all applicable laws and regulations regarding equal employment opportunities as
stated in Chapter 26, Contracts, Article I - Equal Opportunity Employment incorporated here within and any applicable Executive
Orders.
Signature
Title
Subscribed and sworn to before me this
day of , 2026.
(Title)
My commission expires , 2026.
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