2026 HMA Overlay Program

(ii:;)\ Dllnols llepartroent Local Public Agency
W of Transportation Formal Contract Proposal
COVER SHEET
L__ - - -* ..
Proposal Submitted By:
Contractor's Name
I
I I
Contractor's Address City State Zio Code
II
II
11
STATE OF ILLINOIS
FL""'"oca=l '-Pu=b=li=c-'--A""'ge=n.;.ac"""y ___________________ _,'"'"C-'-o_u.n.. .t.v ..__ _____~ ,-S_ect_i_on_N_um_be_r_ ___
l._c_ity_o_f_M_t._V_e_rn_o_n- ------------~IIJefferson I126-00147-00-RS
Route(s) (Street/Road Name) Type of Funds
IL-v_an_*o_us_ __________________ ___,IIL-M_F_T _______ _.
0 181 D
Proposal Only Proposal and Plans Proposal only, plans are separate
Submitted/Approved
For Local Public Agency:
For a County and Road Dlsb'ict Project For a Municipal Project
I Submitted/Approved Submitted/Approved/Passed
degrees""'
Hlghwal( Commissioner Slgnalure &
Submitted/Approved
Department of Transportation
Released for bid based on limited review
Note: All proposal documents, Including Proposal Guaranty Checks or Proposal Bid Bonds, should be stapled together to prevent loss
when bids are processed.
Completed 07/08/26 Page 1 of6 BLR 12200 (Rev. 01/19/23)

,...L_oca_l_P_u_bl_lc_A_g_e_ n_ ..c ..v. .__ _____~ County _s_e_ct_io_n_N_u_m_b_e_r ____ Route s StreeVRoad Name
~lc_ity_o_fM _t._V_e_rn_o_n_ ____ _.l!,..;;;Je=ff=e=rs_o_n_ ___- -,1126-00147-00-RS IL..v_a_rio_u_s_ _______ ____.
NOTICE TO BIDDERS
Sealed proposals for the project described below will be received at the office of Mt. Vernon City Hall -Clerks Office,
Name of Office
Au!/, 4 ,.lo.2'3
_1_10_o_s_t_re_e_t._M_t._V_e_rn_o_n_,I _L_6_2_8_64_-___________ until 10:00 AM on
Address Time Wale 1
Sealed proposals will be opened and read publicly at the office of Mt. Vernon City Hall
------------e-N:-a_m_e_of::-:O=m=-ce----------
1100 Main Street, Mt. Vernon, IL 62864 at 10:00 AM
---------------A.,,..d.,..,d,....re_ss_______________ Time
DESCRIPTION OF WORK
Location Pro ect Len th
Various Streets within the City of Mt. Vernon 16,381ft (3.1 mi}
Prooosed lmorovement
2" HMA Surface Course, HMA SC IL-9.5 C N70 on existing HMA Surfaces
1. Plans and ro osal forms will be available In the office of
City of Mt. Vernon Public Works Department
1201 Casey Ave., Mt. Vernon, IL 62864
Attn: Stephen Talle , Ph: 618) 242-6853, email: stephen.talle mtvemon.com
2. ~ Prequalification
If checked, the 2 apparent as read low bidders must file within 24 hours after the letting an "Affidavit of Availability" (Fonn BC 57) In
triplicate, showing all uncompleted contracts awarded to them and all low bids pending award for Federal, State, County, Municipal
and private work. One original shall be filed with the Awarding Authority and two originals with the IDOT District Office.
3. The Awarding Authority reserves the right to waive technicalities and to reject any or all proposals as provided in BLRS Special
Provision for Bidding Requirements and Conditions for Contract Proposals.
4. The following BLR Forms shall be returned by the bidder to the Awarding Authority:
a. Local Public Agency Formal Contract Proposal (BLR 12200)
b. Schedule of Prices (BLR 12201)
c. Proposal Bid Bond (BLR 12230) (if applicable)
d. Apprenticeship or Training Program Certification (SLR 12325) (do not use for project with Federal funds.)
e. Affidavit of Illinois Business Office (BLR 12326) (do not use for project with Federal funds)
5. The quantities appearing in the bid schedule are approximate and are prepared for the comparison of bids. Payment to the Contractor
will be made only for the actual quantities of work performed and accepted or materials furnished according to the contract. The
scheduled quantities of work to be done and materials to be furnished may be increased, decreased or omitted as hereinafter
provided.
6. Submission of a bid shall be conclusive assurance and warranty the bidder has examined the plans and understands all requirements
for the performance of work. The bidder will be responsible for all errors in the proposal resulting from failure or neglect to conduct an
In depth examination. The Awarding Authority will, in no case, be responsible for any costs, expenses, losses or changes In
anticipated profits resulting from such failure or neglect of the bidder.
7. The bidder shall take no advantage of any error or omission In the proposal and advertised contract.
8. If a special envelope is supplied by the Awarding Authority, each proposal should be submitted In that envelope furnished by the
Awarding Agency and the blank spaces on the envelope shall be filled in correctly to clearly Indicate its contents. When an envelope
other than the special one furnished by the Awarding Authority Is used, it shall be marked to clearly Indicate its contents. When sent
by mall, the sealed proposal shall be addressed to the Awarding Authority at the address and in care of the official In whose office the
bids are to be received. All proposals shall be filed prior to the time and at the place specified In the Notice to Bidders. Proposals
received after the time specified will be returned to the bidder unopened.
9. Permission will be given to a bidder to withdraw a proposal If the bidder makes the request in writing or in person before the time for
opening proposals.
Completed 07/16/26 Page2 of6 BLR 12200 (Rev. 01/19/23)

"'L,,,o:,,ca,elc,P_,u,_,b,,,li,cc!...A,,,ge,e,,nc,e;yL_ ______II County Section Number Route s Street/Road Name
!city of Mt. Vernon c=J=eff=e=r~s_o_n----~I/r '2~6=-0'-'-0'-'-1'--'4-=7-=-0=--c0'-'---R-S--.,, ""'v"'a=ri"'o"'us'---"'-=""--"=-'-"'=L--~
I
PROPOSAL
1. Proposal of_ _________________- =-=c-c.--.--a-c--------------------
Contractor's Name
Contractor's Address
2. The plans for the proposed work are those prepared byCity of Mt. Vernon Public Works Department
and approved by the Department of Transportation on ____________________________
3. The specifications referred to herein are those prepared by the Department of Transportation and designated as "Standard
Specifications for Road and Bridge Construction" and the " Supplemental Specifications and Recurring Special Provisions" thereto,
adopted and in effect on the date of invitation for bids.
4. The undersigned agrees to accept, as part of the contract, the applicable Special Provisions indicated on the "Check Sheet for
Recurring Special Provisions" contained in this proposal.
5. The undersigned agrees to complete the work within _____ working days or by _1_0_/3_0_/_2_6_ ___ unless additional time
is granted in accordance with the specifications.
6. The successful bidder at the time of execution of the contract will be required to deposit a contract bond for the full amount of
the award. When'a contract bond is not required, the proposal guaranty check will be held in lieu thereof. If this proposal is accepted
and the undersigned fails to execute a contract and contract bond as required, ii is hereby agreed that the Bid Bond of check shall be
forfeited to the Awarding Authority.
7. Each pay item should have a unit price and a total price. lfno total price is shown or if there is a discrepancy between the products of
the unit price multiplied by the quantity, the unit price shall govern. If a unit price is omitted, the total price will be divided by the
quantity in order to establish a unit price. A bid may be declared unacceptable if neither a unit price nor a total price is shown.
8. The undersigned submits herewith the schedule of prices on BLR 12201 covering the work to be performed under this contract.
9. The undersigned further agrees that if awarded the contract for the sections contained in the combinations on BLR 12201, the work
shall be in accordance with the requirements of each individual proposal for the multiple bid specified in the Schedule for Multiple Bids
below.
10. A proposal guaranty in the proper amount, as specified in BLRS Special Provision for Bidding Requirements and Conditions for
Contract Proposals, will be required. Bid Bonds will be allowed as a proposal guaranty. Accompanying this proposal is either
a bid bond, if allowed, on Department form BLR 12230 or a proposal guaranty check, complying with the specifications, made payable
to: City of Mt. Vernon Treasurer of :M..:..:,t_.: c_Vc..e.::.:rcn..:..o:c.n:..:_ _ ___________
The amount of the check is ___________________________
Attach Cashier's Check or Certified Check Here
In the event that one proposal guaranty check is intended to cover two or more bid proposals, the amount must be equal to the
sum of the proposal guaranties which would be required for each individual bid proposal. If the proposal guaranty check is
placed in another bid proposal, state below where it may be found.
The proposal guaranty check will be found in the bid proposal for: Section Number 26-0014 7-00-RS
Completed07l08/26 Page 3 of6 BLR 12200 (Rev. 01119/23)

,_,L,,,o.,,ca,,,l'-'P_,u,.,b,,,li-"c'-A"'g"'e'-'nc""y'------~r"C"'o"'u'-'nt,.,y_ _____~ .-s_e_c-=tio'--n~N-=u'-'-m=b--=ec.r ___~ Routes Street/Road Name
Llc_it_y_o_f_M_Vt_e.__r n_o_n_ _____ ,/ LIJ_e_ff_er_s_o_n _____ _.ll26-00147-00-RS / LV_a_ri_o_u_s ________ _,
.CONTRACTOR CERTIFICATIONS
The certifications hereinafter made by the bidder are each a material representation of fact upon which reliance is placed should the
Department enter into the contract with the bidder.
1. Debt Delinquency. The bidder or contractor or subcontractor, respectively, certifies that it is not delinquent in the payment of any tax
administered by the Department of Revenue unless the individual or other entity is contesting, in accordance with the procedure
established by the appropriate Revenue Act, its liability for the tax or the amount of the tax. Making a false statement voids the
contract and allows the Department to recover all amounts paid to the individual or entity under the contract in a civil action.
2. Bid-Rigging or Bid Rotating. The bidder or contractor or subcontractor, respectively, certifies that it is not barred from contracting
with the Department by reason of a violation of either 720 ILCS 5/33E-3 or 720 ILCS 5/33E-4.
A violation of section 33E-3 would be represented by a conviction of the crime of bid-rigging which, in addition to Class 3 felony
sentencing, provides that any person convicted of this offense, or any similar offense of any state or the United States which contains
the same elements as this offense shall be barred for 5 years from the date of conviction from contracting with any unit of State or
local government. No corporation shall be barred from contracting with any unit of State or local government as a result of a conviction
under this Section of any employee or agent of such corporation if the employee so convicted is no longer employed by the
corporation: (1) it has been finally adjudicated not guilty or (2) if it demonstrates to the governmental entity with which it seeks to
contract that entity finds that the commission of the offense was neither authorized, requested, commanded, nor performed by a
director, officer or a high managerial agent on behalf of the corporation.
A violation of Section 33E-4 would be represented by a conviction of the crime of bid-rotating which, in addition to Class 2 felony
sentencing, provides that any person convicted of this offense or any similar offense of any state or the United States which contains
the same elements as this offense shall be permanently barred from contracting with any unit of State of Local government. No
corporation shall be barred from contracting with any unit of State or Local government as a result of a conviction under this Section of
any employee or agent of such corporation if the employee so convicted is no longer employed by the corporation and: (1) it has been
finally adjudicated not guilty or (2) if it demonstrates to the governmental entity with which it seeks to contract and that entity finds that
the commission of the offense was neither authorized, requested, commanded, nor performed by a director, officer or a high
managerial agent on behalf of the corporation.
3. Bribery. The bidder or contractor or subcontractor, respectively, certifies that, it has not been convicted of bribery or attempting to
bribe an officer or employee of the State of Illinois or any unit of local government, nor has the firm made an admission of guilt of such
conduct which is a matter or record, nor has an official, agent, or employee of the firm committed bribery or attempted bribery on
behalf of the firm and pursuant to the direction or authorization of a responsible official of the firm.
4. Interim Suspension or Suspension. The bidder or contractor or subcontractor, respectively, certifies that it is not currently, under a
suspension as defined in Subpart I of Title 44 Subtitle A Chapter Ill Part 6 of the Illinois Administrative code. Furthermore, if
suspended prior to completion of this work, the contract or contracts executed for the completion of this work may be canceled.
Completed0?/08/26 Page 4 of6 BLR 12200 (Rev. 01/19123)

rL=o_c_al~P~u=b=li_c~A~g~e=n~cY~--------, County Section Number Route s Street/Road Name
/c_it_y_o_f_M_t_. _V_e_rn_o_n_ _____ ,//r J~eff=e=r~s_o_n-----,/ r/2-6--0-0-1-47---0-0--R-S--,, Various
' ~-------~ '-------------'
SIGNIA TURES
(If an individual) Bidder Signature & Date
Business Address
rC=it~Y---------------, State Zip _Code
---~''~.___/ ____.
.___/
Firm Name
(If a partnership)
I
Signature & Date
Title
Business Address
Cit State Zip Code
~-~-~O,.___I- ~
Insert the Names and Addresses of all Partners
(If a corporation) Corporate Name
I
Signature & Date
Title
Business Address
,C,ity= =-------,1~1Stat e Zip- Cod-e ~
~~
Insert Names of Officers President
Completed0?/08/26 Page 5 of6 BLR 12200 (Rev. 01/19/23)

Secretary
Attest:
Treasurer
Secretary
Completed0?/08/26 Page 6 of6 BLR 12200 (Rev. 01/19/23)

Q
W lllfnois Deparbnent
Schedule of Prices
of "lfansportatton
Contractor's Name
Contractor's Address City ___S.ItaDte ..._ z~ != C _od_e __.
...___ _ _ _ __ __..__I._ _ _
,..Loca="""P'. ...u...b ...= lic_ _A ...._g=e,.._ngy,...__ _________________ __,,.:::c=o=un=ty.__, _____ ,,,.::S~ecti::;;;;*=on:.:..;N:...:.;u=m=ber=--------.
._[c_ity_of_M_t_. _V_er_n_o_n _________. ..,..... _____ _.I .J.J _e_ffi_ers_o_n ___ _,ll2s-00147-00-RS
Route(s) (Street/Road Name)
~arious .
Schedule for Multiple Bids
I Combination Letter Section Included in Combinations ~ Total
Schedule for Single Bid
(For complete information covering these items, see plans and specifications.)
I Item Number Items Unit Quantity Unit Price Total
40604052 HMA SC IL-9.5 C N70 TON 4715
40600290 BIT MATLS TACK COAT POUNDS 18,866
.
40600982 HMA SURF REM BUTT JT EACH 21
60266600 WATER VALVE ADJUST EACH 19
60255500 MANHOLE FRAME ADJUST EACH 18
70102632 TRAFFIC CONTROL LSUM 1
X4401198 HMA REM VAR DEPTH SY 41,505
Bidder's Total Proposal
1. Each pay Item should have a unit price and a total price.
2. If no total price is shown or if there is a discrepancy between the product of the unlt price multiplied by the quantity, the unit price
shaU govern.
3. If a unit price is omitted, the total price wlll be divided by the quantity In order to establish a unit price.
4. A bid may be declared unacceptable if neither a unit price or total price Is shown.
Printed 07/16126 Page 1 of1 BtR 12201 (Rev. 05/07/21)

~
W IIHnois Department
Local Public Agency
of Transportation
Proposal Bid Bond
rL"'o""ca,,,l_,_P_,u,_,b"'li"-c'---A"'g"'e"'nc"'y'------------------------~.-'C'-'o"'u"'n~ty'---------~rS'-'e'-'c"'ti""on"-'-'N"'u"'m,_,b'-"e"-r_ __~
Llc_it"----y _of_M_t_.V _e_rn_o_n ________________ __JIL..IJe_ff_e_rs_o_n _____, ILl2_6_-0_0_14.:....7_-0_0.:....-_R_ S '-----_
_J
WE, _______________________________ as PRINCIPAL, and
---,,----------------------,--------------------as SURETY, are held jointly,
severally and firmly bound unto the above Local Public Agency (hereafter referred to as "LPA'') in the penal sum of 5% of the total bid
price, or for the amount specified in the proposal documents in effect on the date of invitation for bids, whichever is the lesser sum. We
bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly pay to the LPA this sum under the conditions of this
instrument.
WHEREAS THE CONDITION OF THE FOREGOING OBLIGATION IS SUCH that, the said PRINCIPAL is submitting a written
proposal to the LPA acting through its awarding authority for the construction of the work designated as the above section.
THEREFORE if the proposal is accepted and a contract awarded to the PRINCIPAL by the LPA for the above designated section
and the PRINCIPAL shall within fifteen (15) days after award enter into a formal contract, furnish surety guaranteeing the faithful
performance of the work, and furnish evidence of the required insurance coverage, all as provided in the "Standard Specifications for Road
and Bridge Construction" and applicable Supplemental Specifications, then this obligation shall become void; otherwise it shall remain in
full force and effect.
IN THE EVENT the LPA determines the PRINCIPAL has failed to enter into a formal contract in compliance with any
requirements set forth in the preceding paragraph, then the LPA acting through its awarding authority shall immediately be entitled to
recover the full penal sum set out above, together with all court costs, all attorney fees, and any other expense of recovery.
IN TESTIMONY WHEREOF, the said PRINCIPAL and the said SURETY have caused this instrument to be signed by their
respective officers this -----.-c=----of_~=-=--
Day Month and Year
Principal
Company Name Company Name
._I ___________ __,! ,
Si:nature & Date Si:nature & Date
By:I . By: I __
i.,1-.,t~e--------------------~ '"'l""n"'e--------------------~
(If Principal is a joint venture of two or more contractors, the company names, and authorized signatures of each contractor must be
affixed.)
Surety
Name of Surety
Signature of Attornev-in-Fact Sionature & Date
By:
STATEOF IL
COUNTY OF
I _____________________ , a Notary Public in and for said county do hereby certify that
(Insert names of individuals signing on behalf of PRINCIPAL & SURETY)
who are each personally known to me to be the same persons whose names are subscribed to the foregoing instrument on behalf of
PRINCIPAL and SURETY, appeared before me this day in person and acknowledged respectively, that they signed and delivered said
instruments as their free and voluntary act for the uses and purposes therein set forth.
--x===-==---
Given under my hand. and notarial seal this~-----~ day of __
Day Month and Year
(SEAL, if required by the LPA)
Date commission expires
---------
Completed 07/16/26 Page 1 of2 BLR 12230 (Rev. 01/19/23)

FL=oc~a=l~P~u=b~lic~A=g=en~c~Y--------------------~rC~o~u~n~ty_ ______ rS_e_c_tio_n_N_u_m_b_e_r ___- ,
7
~
.__lc_it_y_o_f_M_t._V_e_r_no__n ________________ ,I_IJe_ff_e_r_so_n_ ___~ l_i2_6_-0_0_1_47_-_o_o_-R_S_ _
=================ELECTRONIC BID BOND=================:
D
Electronic bid bond is allowed (box must be checked by LPA if electronic bid bond is allowed)
The Principal may submit an electronic bid bond, in lieu of completing the above section of the Proposal Bid Bond Form. By providing an
electronic bid bond ID code and signing below, the Principal is ensuring the identified electronic bid bond has been executed and the
Principal and Surety are firmly bound unto the LPA under the conditions of the bid bond as shown above. (If PRINCIPAL is a joint venture
of two or more contractors, an electronic bid bond ID code, company/Bidder name title and date must be affixed for each contractor in the
venture.)
Electronic Bid Bond ID Code Company/Bidder Name
I I I I I I
*I
I
Signature & Date
Title
Completed 07/16/26 Page 2 of2 BLR 12230 (Rev. 01/19/23)

~
W llllnois Department Affidavit of Availability
of Transportation
For the Letting of
Bureau of Construction Instructions: Complete this form by either typing or using black ink. "Authorization to Bid" will
2300 South Dirksen Parkway/Room 322 not be issued unless both sides of this form are completed in detail. Use additional forms
Springfield, IL 62764 as needed to list all work.
I
Part I. Work Under Contract
List below all work you have under contract as either a plime contractor or a subcontractor. It is required to include all pending low bids not
yet awarded or rejected. In a joint venture, list only that portion of the work which is the responsibility of your company. The uncompleted
dollar value is to be based upon the most recent enginee~s or owners estimate, and must include work subcontracted to others. If no work
is contracted, show NONE.
Awards Accumulated
1 2 3 4 Pending Totals
Contract Number
- '
Contract With
Estimated Completion Date
Total Contract Price
Uncompleted Dollar Value if Firm
is the Prime Contractor
Uncompleted Dollar Value if Firm
is the Subcontractor
Total Value of All Work
!Part II. Awards Pending and Uncompleted Work to be done with your own forces.
List below the uncompleted dollar value of work for each contract and awards pending to be completed with your own forces. All work
subcontracted to others will be listed on the reverse of this form. In a joint venture, list only that portion of the work to be done by your
company If no work is contracted show NONE
'
Earthwork
Portland Cement Concrete Paving
HMA Plant Mix
HMAPaving
Clean & Seal Cracks/Joints
Aggregate Bases, Surfaces
Highway, R.R., Waterway Struc.
Drainage
Electrical
Cover and Seal Coats
Concrete Construction
Landscaping
Fencing
Guardrail
Painting
Signing
Cold Milling, Planning, Rotomilling
Demolition
Pavement Markings (Paint)
other Construction (List)
Totals
..
.
D1sclosure ofth1s mformat1on 1s REQUIRED to accomplish the statutory purpose as outlined m the " lllrno1s Procurement Code. " Failure to comply will result
in non~issuance of an "Authorization To Bid." This form has been approved by the State Forms Management Center.
Printed 07/08/26 Page1 of10 BC 57 (Rev. 02/16/21)