Adams/Santa Cruz Waterline Project
| Location: | Arizona |
|---|---|
| Posted: | Oct 9, 2025 |
| Due: | Dec 10, 2025 |
| Agency: | Town of Wickenburg |
| Type of Government: | State & Local |
| Category: |
|
| Solicitation No: | Bid 25-04 |
| Publication URL: | To access bid details, please log in. |
| Bid Number: |
Bid 25-04
|
| Bid Title: |
Adams/Santa Cruz Waterline Project
|
| Category: | Construction - Infrastructure |
| Status: | Open |
|
Attachment Preview
Last updated: 7/3/24
CDBG Forms and Federal Requirements
Form 1, The Bidder’s Information Form: Required to be submitted with each bid.
All other forms in this section: To be completed by the apparent low bidder and submitted by
the deadline indicated on the form. If there is no deadline on the form, it should be submitted
within 5 days of notification of bid results.
Form Title
1 BIDDERS INFORMATION FEDERALLY FUNDED PROJECT FORM (required with the bid)*
FORMS 2 - 10 are required by the apparent low bidder prior to the start of
construction.
2 CERTIFICATION ON FEDERALLY FUNDED CONTRACTS PUBLIC LAW 100-690,
SECTION 5152 DRUG-FREE WORKPLACE ACT OF 1988**
3 EQUAL EMPLOYMENT OPPORTUNITY CERTIFICATION**
4 AFFIRMATIVE ACTION PLAN STATEMENT**
5 BIDDER'S ASSURANCE OF COMPLIANCE WITH TITLE 49 PART 23 RELATING TO
MINORITY BUSINESS ENTERPRISE PARICIPATION**
6 MINORITY AND WOMEN BUSINESS ENTERPRISE – JOB REPORT*
7 CERTIFICATION OF UNDERSTANDING AND AUTHORIZATION LABOR STANDARDS AND
DAVIS BACON *
8 AUTHORIZATION FOR DEDUCTIONS: REQUEST FOR CERTIFICATION OF APPLICABLE
FRINGE BENEFIT PAYMENTS FOR DAVIS BACON PAYROLLS**
9 IMMIGRATION LAW AND REGULATIONS CERTIFICATION**
10 LCP TRACKER REGISTRATION FORM *
Send to Maricopa County at least 1 week before the start of construction.
11 SECTION 3 POLICIES AND PROCEDURES FOR SUBRECIPIENTS, CONTRACTORS, AND
SUBCONTRACTORS OF HOME and CDBG PROGRAM FUNDS
ADDITIONAL FEDERAL REQUIREMENTS
HUD 4010 FEDERAL LABOR STANDARDS PROVISIONS
WAGE DETERMINATION - TO BE INCLUDED IN EVERY CONTRACT AND SUBCONTRACT
* To be turned in prior to the issuance of the final Notice to Proceed
** To be turned in prior to any construction activities
Human Services
234 N. Central Ave., Suite 3000
Phoenix, Arizona 85004
E: HCD@maricopa.gov
BIDDERS INFORMATION FORM
FEDERALLY FUNDED PROJECT
Form 1-1
To be completed by each contractor and subcontractor working on the project and submitted to the Owner’s representative at
the time of bid submittal. Following award, the prime contractor will supply the forms to the lower tier contractors as a part of
the pre Notice to Proceed paperwork.
Project Name:
City/Town Name:
Contractor/Company Name:
Phone:
Street # and Street Name or
P.O. Box:
City:
State:
Zip:
Federal ID number
or Social Security number:
Type of License:
License number:
Unique Entity ID (SAM.gov):
All Bidders must be registered in SAM.gov (System for Award Management) prior to award. All subs
must be registered in SAM.gov prior to the issuance of the Notice to Proceed.
Owner Name:
Date:
Signature
Human Services
234 N. Central Ave., Suite 3000
Phoenix, Arizona 85004
E: HCD@maricopa.gov
CERTIFICATION ON FEDERALLY FUNDED CONTRACTS
PUBLIC LAW 100-690, SECTION 5152
DRUG-FREE WORKPLACE ACT OF 1988
Form 2-1
To be completed by each contractor and subcontractor working on the project and submitted to the Owner’s
representative at least 5 days prior to the beginning of any construction activities.
The OWNER has adopted a policy and certified to all Federal Agencies that have granted federal
funds to the OWNER that OWNER will provide a drug-free workplace for our employees and
that Contractors providing property or services to OWNER with a value of $25,000 or more
under a federally funded contract must also provide a drug-free workplace for their employees.
DRUG-FREE WORKPLACE REQUIREMENTS FOR CONTRACTORS ON FEDERALLY FUNDED
CONTRACTS
(A) DRUG-FREE WORKPLACE REQUIREMENT.
(1) REQUIREMENT FOR PERSONS OTHER THAN INDIVIDUALS. -- No person, other
than an individual, shall be considered a responsible source, under the meaning of such
term as defined in the section 4(8) of the Office of Federal Procurement Policy Act [41
U.S.C. 403(8)], for the purposes of being awarded a contract for the procurement of any
property or services of a value of $25,000 or more from any Federal agency unless such
person has certified to the contracting agency that it will provide a drug-free workplace
by -
(a) publishing a statement notifying employees that the unlawful
manufacture, distribution, dispensation, possession, or use of a controlled
substance is prohibited in the persons workplace and specifying the actions that
will be taken against employees for violations of such prohibition;
(b) establishing a drug-free awareness program to inform employees about
(i) the dangers of drug abuse in the workplace;
(ii) the person's policy of maintaining a drug-free workplace;
(iii) any available drug counseling, rehabilitation, and employee
assistance programs; and
(iv) the penalties that may be imposed upon employees for drug
abuse violation;
Human Services
234 N. Central Ave., Suite 3000
Phoenix, Arizona 85004
E: HCD@maricopa.gov
Form 2-2
(c) making it a requirement that each employee to be engaged in the
performance of such contract be given a copy of the statement required by
subparagraph (A);
(d) notifying employees in the statement required by subparagraph (A), that
as a condition of employment on such contract, the employee will-
(i) abide by the terms of the statement; and notify the employer of
any criminal drug statute conviction for a violation occurring in the
workplace no later than five (5) days after such conviction;
(e) notifying the contracting agency within ten (10) days after receiving
notice under subparagraph (D)(ii) from an employee or otherwise receiving
actual notice of such conviction;
(f) imposing a sanction on, or requiring the satisfactory participation in a
drug abuse assistance or rehabilitation program by, any employee who is so
convicted, as required by section 5154; and
(g) making a good faith effort to continue to maintain a drug-free workplace
through implementation of subparagraphs (A), (B), (C), (D), (E), and (F).
(2) REQUIREMENT FOR INDIVIDUALS. No Federal agency shall enter into a contract
with an individual unless such contract includes a certification by the individual that the
individual will not engage in the unlawful manufacture, distribution, dispensation,
possession, or use of a controlled substance in the performance of the contract.
(B) SUSPENSION, TERMINATION, OR DEBARMENT OF THE CONTRACTOR.
(1) GROUNDS FOR SUSPENSION, TERMINATION, OR DEBARMENT. -- Each federally
-funded contract shall be subject to suspension of payments under the contract or
termination of the contract, or both, and the contractor thereunder or the individual
who entered the contract, as applicable, shall be subject to suspension or debarment in
accordance with the requirements of this section if the head of the contracting agency
determines that -
(a) the contractor or individual has made a false certification under
subsection (a);
Human Services
234 N. Central Ave., Suite 3000
Phoenix, Arizona 85004
E: HCD@maricopa.gov
Form 2-3
(b) the contractor violates such certification by failing to carry out the
requirements of subparagraph (A), (B), (C), (D), (E), or (F) of subsection (a)(1); or
(c) such a number of employees of such contractor have been convicted of
violations occurring in the workplace as to indicate that the contractor has failed
to make a good faith effort to provide a drug-free workplace as required by
subsection (a).
(2) CONDUCT OF SUSPENSION, TERMINATION, AND DEBARMENT PROCEEDINGS. -
(a) If a contracting officer determines, in writing, that cause for suspension
of payments, termination, or suspension or debarment exists, an appropriate
action shall be initiated by a contracting officer of the agency, to be conducted
by the agency concerned in accordance with the Federal Acquisition Regulation
and applicable agency procedures.
(b) The Federal Acquisition Regulation shall be revised to include rules for
conducting suspension and debarment proceedings under this subsection,
including rules providing notice, opportunity to respond in writing or in person,
and such other procedures as may be necessary to provide a full and fair
proceeding to a contractor or individual in such proceeding.
(3) EFFECT OF DEBARMENT. -- Upon issuance of any final decision under this
subsection requiring debarment of a contractor or individual, such contractor or
individual shall be ineligible for award of any contract by any Federal agency, and for
participation in any future procurement by any Federal agency, for a period specified in
the decision, not to exceed (5) years.
Human Services
234 N. Central Ave., Suite 3000
Phoenix, Arizona 85004
E: HCD@maricopa.gov
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