East Dirt Road Shaping Susq Co

STATEMENT OF WORK FOR EAST SUSQUEHANNA COUNTY DIRT ROAD SHAPING, AND DUST PALLIATIVE

General Provisions

General Information

Estimated Quantities

Shaping and Dust Palliative Information

Mandatory Site Visit

Contractor Qualification Requirements

Equipment Demonstration and Calibration

Pre-Season Meeting

Contractor's Representative

Personnel Requirements

Work Status/Jobsite Reporting

General Equipment Requirements

Project Requirements

Work Zone Traffic Control Requirements (WZTC)

Invoice and Billing Instructions

Liquidated Damages

Shaping and Palliative Map

Spill Response Plan

PennDOT's Strategic Environmental Manager Program (SEMP) Requirements

Scope of Work

End Result Specifications

Road Shaping

General Information

Material

Payment

Dust Palliative

General Information

Material

Payment

ATTACHMENTS

Attachment 1 - Contractor Information Form

Attachment 2 - List of Vehicles and Equipment

Attachment 3 - List of Dirt Roads

Attachment 4 - Accessing PennDOT iPad Applications for Business Partner

Attachment 5 - Confirmation of Service Form, OS-501

Attachment 6 - BOP 2201 Worker Protection & Investment Cert.

Attachment 7 - Domestic Workforce Certification Form

Attachment 8 - Trade Secret Form

Attachment 9 - Green Plan Policy

Attachment 10 - Summary of Bid Items

General Provisions

General Information

The Pennsylvania Department of Transportation, hereinafter referred to as PennDOT, requires dirt road shaping, and dust palliative services, within the guidelines described in Chapter 6.3 of PennDOT's Maintenance Manual (Publication 23) and this Statement of Work. PennDOT Publication 23 is available on PennDOT's website at the "Forms, Publications, & Maps" page. The Purchase Order awarded from this solicitation will be valid from the starting validity date through June 30th 2027. The services provided shall be consistent with the standard operating procedures and applicable Federal, State, and local laws, rules, and regulations for the protection of public health and the environment. This includes following OSHA safety requirements, and any other agencies, involved in the application of dust palliative.

The contractor shall not shape dirt roads during a rain event.

The contractor shall not apply dust palliative in the following circumstances:

Directly to a water source.

During, or one day after a rain event.

PUBLIC BID OPENING: Public Bid Opening will be held virtually via Microsoft Teams on 08/11/2026 at 12:00PM, (EST). Please contract locobb@pa.gov for meeting invitation.

Questions & Answers: All questions pertaining to Solicitation # 6100066287 must be made prior to 08/04/2026 at 12:00 PM (EST). All questions answers will be posted to the Solicitation in eMarketplace for public viewing.

The Commonwealth reserves the right, upon notice to the Contractor, to extend any single term of the Contract for up to three (3) months upon the same terms and conditions.

Estimated Quantities

All quantities are estimated, and PennDOT reserves the right to increase, or decrease, these quantities based upon need. See Attachment 8, Summary of Bid Items: Dirt Road Shaping and Dust Palliative and Attachment 9, List of Dirt Roads.

Shaping and Dust Palliative Information

Unless indicated otherwise within this Statement of Work, the contractor shall furnish all equipment, personnel, and materials, for dirt road shaping and dust palliative. Maintain the equipment in good condition for the duration of the contract.

The contractor should be capable of supplying a minimum forty hours of production work per crew each week. The contractor shall be permitted to work extended workdays as long as it is in the best interest of PennDOT, and permission is granted in writing by the Assistant Highway Maintenance Manager (AHMM), or designee. In the event of programming needs, weather conditions, or major equipment failure, that affects the timing of the dirt road shaping and dust palliative, the contractor, at PennDOT's discretion, shall be required to work in excess of the normal forty-hour work week. This shall require an extended workday, and up to a six-day work week. This additional work shall be paid at the normal contract unit prices. Premium rates will not be paid by PennDOT. When directed by the AHMM, spraying shaping and dust palliative shall be scheduled, weather permitting, on any weekday Monday through Friday. No work is to be performed on holidays.

MANDATORY SITE VISIT

Mandatory site visits must be performed between September 14, 2026 and September 18, 2026. Department ACMM must accompany vendor. Contact Dan Colachino at 272-281-3033 to schedule a mandatory site visit.

Contractor Qualification Requirements

The Contractor shall provide proof of having been actively in the business in highway construction/maintenance for the past two (2) years. The Contractor shall provide this proof with the electronic bid.

The Contractor shall also submit with their bid, the name of a contractor representative, the contractor representative's 24 houraday cell phone number with the electronic bid.

Subcontracting of this work will only be permitted in regard to the spraying of dust palliative. The contractor is responsible for payment and the work of the subcontractor. In performing its obligations under the Contract, the Contractor will act as an independent contractor and not as an employee or agent of the Commonwealth. The Contractor will be responsible for all services in this Contract whether or not the Contractor provides them directly. Further, the Contractor is the sole point of contact regarding all contractual matters, including payment of any and all charges resulting from the Contract.

Equipment Demonstration and Calibration

Equipment Demonstration -

Bidders are required to prepare Attachment 3, List of Vehicles and Equipment and submit this document with the electronic bid.

After the bid opening and prior to award, the apparent low bidder shall demonstrate to the County Equipment Manager (CEM) 2 that the equipment proposed for use in meeting the requirements of the contract is of sufficient capacity and quantity, and that all such equipment is in good working order. Additionally, the apparent low bidder must demonstrate that the personnel employed for the purpose of providing the services required by the contract are sufficiently trained to operate the Contractor's proposed equipment fleet. The demonstration will also include equipment and personnel needed for compliance with traffic safety requirements as defined in the current version of PennDOT Publication (Pub) 213. Within 10 calendar days of the bid opening, the CEM 2 will notify the apparent low bidder regarding the time and location of the demonstration. This meeting is considered incidental to the contract and no additional payment will be made. PennDOT will provide the contractor written communication regarding the outcome of the equipment demonstration.

If the apparent low bidder fails to demonstrate the acceptability of its equipment and/or personnel, the apparent low bidder will be deemed nonresponsive and not responsible and its bid will be rejected. The contract will then be awarded to the next lowest responsive and responsible bidder that successfully demonstrates the acceptability of its equipment and personnel. At the discretion of the CEM 2, the apparent low bidder may be provided with up to five (5) additional calendar days after an initial, unsuccessful demonstration of equipment and personnel acceptability to prepare for and satisfactorily complete a second demonstration.

If changes to equipment and/or personnel are made after the award, the Contractor must successfully demonstrate the acceptability of the equipment and/or personnel as specified above.

For subsequent years under contract, the Equipment Demonstration and Calibration will take place during the first week of February (weather permitting).

At the time of demonstration, the Contractor must submit all vehicle insurance, registration and any other required inspections of certifications for the equipment. See "General Equipment Requirements" below for more information.

Contractor shall present required spare parts and tools for each piece of equipment. See Attachment 3, List of Spare Parts and Tools Required for Each Spray Truck.

Equipment Calibration - After issuance of the Purchase Order, the Contractor will be required to perform any necessary equipment calibration testing.

The initial calibration will take place within 10 working days of notification by PennDOT; the time and location will be determined by the CEM 2.

The CEM 2 will record results of the calibration.

If the initial calibration is unacceptable, the Contractor will be sent notice requesting a second calibration.

Upon receipt, the Contractor has five (5) business days to request a second calibration date.

1. Upon a successful calibration, a PreSeason Meeting with the Contractor will be scheduled (see PreSeason Meeting below)

2. If recalibration is unsuccessful, PennDOT will review available options, which may include rejection of the apparent low bidder's bid and moving to the second lowest responsible bidder submitting a responsive bid.

All spray equipment shall be calibrated at the beginning of the season and at discretion of the CEM 2. All calibrations shall be done in the presence of the CEM 2.

During the calibration test(s) the applicators must demonstrate the ability to operate, calibrate, and perform field maintenance on all equipment associated with the spraying complement without assistance. An applicator's failure to properly set up and calibrate their equipment during the demonstration will result in their removal from all application work on a spray unit until they can demonstrate to the CEM 2 their ability has increased to an adequate level.

Pre-Season Meeting

Following a successful Equipment Demonstration and Calibration, the Contractor will be required to attend a PreSeason meeting with the Assistant Highway Maintenance Managers (AHMM)s at a site within Susquehanna County. This meeting will be approximately one (1) hour in length. This meeting is considered incidental to the contract and no additional payment will be made.

For subsequent years under contract, the PreSeason Meeting will take place during the first week of March (weather permitting).

Contractor's Representative

The vendor shall designate one Contractor Representative as PennDOT's main person to contact regarding all contract issues (See Attachment 1). The Contractor Representative shall have 24hour, seven (7) day per week contact availability throughout the duration of the contract. Should an issue such as insufficient work zone, or other safety related issues arise, the PennDOT Representative will address it with a crew Foreperson. The Contractor Representative shall have a cellular telephone. Should the Contractor have a need to change the Contractor Representative during the validity period of the Purchase Order, the Contractor is to immediately contact the AHMM during business hours with the new Contractor Representative's name and telephone number.

Personnel Requirements

The Contractor shall supply all necessary licensed, and certified, operators to accomplish the work explained within this Statement of Work.

PennDOT reserves the right to have any crew member removed from the project at any time at its discretion.

In addition to the Contractor Representative, each complement working shall have a designated working Foreperson. The Contractor shall provide the Foreperson a cellular phone, and the number shall be given to the AHMM prior to the start of any work. The Foreperson shall be responsible for the following items:

Scheduling of dirt road shaping, and dust palliative, within the County as coordinated with the AHMM and County Management.

2. Familiarization with the roads to be shaped, and sprayed with dust palliative, within Susquehanna County. It is imperative that each crew Foreperson be familiar with the geographical area to maintain smooth and efficient operations.

3. Scheduling of meetings with the AHMM and County Management Representative prior to working in Susquehanna County, resolving the sequence of roads to be shaped, and sprayed, and the respective traffic controls and protection equipment and devices required in accordance with Section 901 of PUB 408 and PUB 213.

4. Complete understanding of the procedure for reporting of work progress by the use of Electronic Form M609, Roadside Activity Report. Electronic Form M609's will be filled out completely. See Attachment 5, Accessing PennDOT iPad Applications for Business Partners.

5. Contact the AHMM, or representative, by 12:00 PM Friday to list the roads that are planned to be worked on for the upcoming week. Contact the AHMM by email, or phone, before 7:15 AM each day to list the roads that are worked on during that day.

6. Possessing knowledge and ability sufficient to maintain and field adjust the equipment in order to sustain a continuous and productive operation.

Work Status/Jobsite Reporting

Each crew complement foreperson may be asked to report work status (working/not working) to the AHMM by telephone each day.

Unless otherwise directed by the AHMM, the start and end of the work shift to be billed shall begin no earlier than sunrise and work shall end no later than sunset, and only when sufficient daylight and/or weather conditions are available to safely complete work activities.

Operations may be performed Monday through Friday. The AHMM, or County Management Representative, may authorize work on Saturday and Sunday, as necessary. No work shall be scheduled to occur on the following holidays unless written permission to do so is provided by PennDOT:

1. New Year's Day

2. Dr. Martin Luther King Jr. Day

3. President's Day

4. Memorial Day

5. Juneteenth

6. Independence Day

7. Labor Day

8. Columbus Day

9. Veteran's Day

10. Thanksgiving Day

11. Day after Thanksgiving Day

12. Christmas Day

General Equipment Requirements

All equipment shall be in sound mechanical condition and in good working order, with a uniformly painted, neat and clean appearance. All equipment is to be washed and cleaned at the request of the AHMM.

Overnight storage of equipment will be the responsibility of the Contractor.

All vehicles shall display the Contractor's business name, City, State, U.S. DOT numbers.

No payment will be made for time spent on field repairs requiring more than one hour of down time.

Project Requirements

Any PennDOT property, or private property, damaged by the Contractor due to the operation(s) will be replaced and/or repaired at no additional cost to PennDOT.

Work Zone Traffic Control Requirements (WZTC)

Conduct Maintenance and Protection of Traffic in accordance with current version of Publication 213. Provide all traffic control setups, truck mounted attenuators, shadow vehicles, signage, warning lights, flags, and flashing lights necessary to assure maximum safety to the public and minimize interference with the normal flow of traffic. Road closures must be coordinated with the AHMM, or their designee, prior to 7:00 AM each day.

The contractor shall exercise all precautions to minimize interference with the normal flow of traffic.

Invoice and Billing Instructions

The Contractor shall complete a Roadside Activity Report (Electronic Form M609) at the completion of each day's work. The schedule for submission of the M609 will be established during the preservice meeting.

A completed Confirmation of Services Form (Form OS501) shall be submitted by the Contractor to the AHMM, for review and verification, on a weekly basis. The AHMM will notify the Contractor if corrections are needed. Each Form OS501 shall be itemized, including sufficient detail, and coordinate with the line items on the Purchase Order. Untimely or incomplete submissions of Form OS501 and required supporting documentation (including M609s) may delay processing of a "proper invoice" as required by the Payment section of the Terms and Conditions. See Attachment 5, Instructions for Completing Confirmation of Service Form, OS501 and Attachment 6, Confirmation of Service Form, OS501.

Invoices shall be submitted by the Contractor on a regular basis. For further instructions regarding invoicing see the Billing Requirements section of the Terms and Conditions.

PennDOT reserves the right, throughout the life of the contract, to make changes to Forms M609 and/or OS501, including their instructions, content, and all other requirements.

Liquidated Damages

Liquidated Damages will be assessed in accordance with the Terms and Conditions.

Additionally, liquidated damages will be assessed for any requested complement (equipment and/or personnel) that is not produced within five (5) days of written notice by the AHMM. Written notification will include email, fax or mailed delivery.

Liquidated Damage for NonCompliance:

If for any reason the contractor fails to comply with the requirements of this contract, the following items shall be applied:

Failure to comply with the deadline in this statement of work (All roads shaped and sprayed by June 15th of the contract Fiscal Year. The contract will commence on the validity date of the fully executed PO and conclude on June 30th of the following year, aligning with the Fiscal Year.) will result in $500 dollars in liquidated damages being assessed per working day until all work is complete.

Liquidated damages will be deducted from the next invoice received after notice of violation.

All letters pertaining to noncompliance of the requirements of this contract shall be entered into the Contractor NonCompliance files and could affect the award of a future bid.

PennDOT reserves the right to sample any road shaping, or dust palliative, materials.

If, for any reason, the contractor fails to comply with the requirements of the contract, Pub 408 shall prevail.

In the event that any materials furnished by the contractor are found to be defective, unsuitable, or otherwise unacceptable, the materials shall be removed by the contractor and replaced with acceptable materials at the cost and expense of the contractor.

Worker Protection and Investment:

Executive Order 2021-06, Worker Protection and Investment: Pursuant to Executive 2021-06, Worker Protection and Investment (October 21,2021), the Commonwealth is responsible for ensuring that every Pennsylvania worker has a safe and healthy work environment, and the protections afforded them through labor laws. To that end, contractors and grantees of the Commonwealth must certify that they are in compliance with all applicable Pennsylvania state labor and workforce safety laws. Such certification shall be made through the Worker Protection and Investment Certification Form (BOP-2201) and submitted with the bid, proposal, or quote.

Shaping and Palliative Map

Spill Response Plan

A hard copy of the Contractor's Spill Response Plan shall be submitted to the AHMM.

The Spill Response Plan shall summarize the following procedures at a minimum:

1. Background and Applicable Regulations;

2. Incident Reporting Chain of Command;

3. Spill Preparedness Checklist;

4. Spill Response/Control Method; and

5. Spill Response Procedures

The Contractor is responsible for all cleanup activity and cost resulting from any contamination caused by the accidental or intentional spilling, leakage, or dumping of fuel, oil, or any other contaminant from Contractorsupplied equipment.

PennDOT will not pay for any materials spilled by the Contractor.

PennDOT's Strategic Environmental Manager Program (SEMP) Requirements

Before the start of any work, the Contractor must comply with PennDOT's STRATEGIC ENVIRONMENTAL MANAGEMENT PROGRAM (SEMP) REQUIREMENTS.

The requirements of this program can be found in PennDOT's PUB 712A (1115) Green Plan Policy Statement (Attachment 7).

The Contractor is required to submit a Contractor Roster to the AHMM prior to starting

work.

Scope of Work

The contractor proposes to furnish and deliver all materials and to do and perform all work on the following project as set forth below.

If designated as the successful bidder, the contractor will begin work on the date specified in the notice to proceed, or as otherwise provided in the special requirements, and will complete all work within the established time frames.

Description of Work:

Reshape approx. 28 miles of unpaved roads in the spring and then approx. 10 miles of reshaping in the fall. This includes all actions such as scarifying, grading, shaping, and compacting to restore cross section, or eliminate corrugations and potholes. The amount of reshaping in the fall we be based on need and at the direction of the AHMM of the area.

It is important to maintain proper roadway cross-section and adequate ditch line for proper drainage. The grader blade should be set to pull suitable material from the ditch line, toward the center of the roadway.

Environmental concerns such as wetlands, erosion control, and waterway pollution are to be addressed in the disposal of excavated materials, refer to Publication 23.

Waste materials shall not be placed in wetlands or waterways. Waste materials must be stabilized. rolling is acceptable stabilization.

The Work Zone Traffic Control set up shall be placed in accordance with current Publication 213. This assembly is typically a mobile operation.

Arrangements for the disposal of waste material should be made in advance of the operation. Under no circumstances shall material be disposed in a wetland, water way or flood plain or be disposed on private property in such a manner that the material could be graded into any of these areas.

The grader operator is to set the grader blade to the proper angle and pitch to achieve the

desired crown. It is important to maintain proper roadway cross-section and adequate ditch line for proper drainage.

Shaping: The grader should make the first pass along the ditch line, bringing suitable material toward the center of the roadway. Distribute the loose material over the width of the roadway, maintaining the desired width and a crown of 3 to 4 inches. The grader should cut the entire width of the roadway in areas of ruts and potholes. High spots and ruts can be leveled during this process.

Surface Preparation: Pull a rake along the roadway, working from center of the road

toward the shoulder, so that oversize stones and lumps of sod are worked to the side of the roadway. In certain circumstances utilize a stone box to contain the placement of 2A Modified material.

Handwork: Crew members remove stones and sod from the roadway. All excess material around drainage facilities shall be removed to allow water to enter the facilities.

Compaction: The entire width of the roadway, disturbed by grading, shall be compacted with a roller prior to completion of the day's activities.

Embankments: The excavation of embankment slopes in conjunction with ditch cleaning will require that a minimum the vertical face of the embankment be seeded and mulched. Excavated material is to be properly disposed in a non-wetland area and is not to be broadcast onto the slopes of ditches or drainage channels.

Erosion Controls: Straw bales, silt fence or rock filters are required at the point of discharge until the ditch line revegetates and the area becomes stabilized. Rock filters may be installed as a more permanent control measure at outlet ditches.

Equipment required: Grader; roller; tractor/rake; haul truck; stone box

Material required: 2A, estimated 4,000 ton

Once roads are reshaped, they should receive an application of dust palliatives.

All dirt roads shall be spot treated with dust palliative. Spot treating involves the spreading of a dust palliative for approximately several hundred feet in front of residences, schools, churches, markets, factories, road intersections, railroad crossings, and bridges. Other areas of dirt roads will be required to be treated with dust palliative when there are a number of complaints, or a safety hazard exists. This should be completed once enough mileage is completed to utilize a full tanker of Dust Palliative. Dust Palliative may be required during fall shaping as well at the direction of the AHMM.

Equipment required: Distributor

Material required: Bitum, Emulsified Dust Palliative, estimated 20,000 gallons

This bid solicitation has been reserved for Small Business Contracting. Only those Bidders certified as DGS Small Businesses through the Small Business Contracting Program may submit a bid for these services.

PUBLIC BID OPENING: Public Bid Opening will be held virtually via Microsoft Teams on 272-281-3033 at 10:00AM (EST). Please contact Lori Cobb for meeting invitation.

Questions & Answers: All questions pertaining to Solicitation # 127585 must be made prior to XXXXX at 10:00AM (EST). All questions and answers will be posted to the Solicitation in eMarketplace for public viewing.

The Purchase Order awarded from this solicitation will be valid for 1 year with no renewals.

The Commonwealth reserves the right, upon notice to the Contractor, to extend any single term of the contract for up to three (3) months upon the same terms and conditions.

Attachment 1 - Contractor Information Form

This page is to be completed and returned with bid.

1. Contractor Name:________________________

2. Name of Contractor's Representative:________________________

3. Contractor Representative's 24 houra day Cell Phone Number:__________________

Attachment 2 - List of Vehicles and Equipment

(List Only the Vehicles and Equipment that will be used for this Contract, including Work Zone Traffic Control Vehicles and Equipment)

Vehicles and equipment utilized for maintenance contract work must meet the requirements as described in the contract specifications and the laws and regulations of Pennsylvania. The Contractor hereby verifies that all vehicles and equipment in the above table as submitted with the bid is adequate and necessary for the contract maintenance work and all listed vehicles and equipment will be available at the initial demonstration. All vehicles and equipment in the above table shall be inspected and approved by PennDOT during the demonstration(s). Where a contractor intends to rent vehicles and equipment, the identification number or license number on the table above may be provided at the time of the initial demonstration; however, all remaining information for the rented vehicles and equipment must be provided in the table above with the bid. The Contractor agrees to maintain and, as applicable, update this list of all vehicles and equipment after start of work for the duration of the contract.

Name of Company: ______________________________________ Date:__________

Attachment 3 - List of Dirt Roads

Attachment 4 - Accessing PennDOT iPad Applications for Business Partners

PennDOT Mobile applications (apps) are available to approved 3rd parties to allow business partners to benefit from the efficiencies they provide. The distribution method for these apps is through the Apple Volume Purchase Program (VPP) store. To access these apps, 3rd party business partners must first perform the following steps.

Ensure your iPad devices meet minimum hardware requirements

PennDOT apps are designed to support iPad Air with a minimum of 16GB of storage and newer running iOS 10.1 or newer. The apps have been tested with iPad Air, iPad Air 2 or iPad Pro as well, but for ideal experience, iPad Air 2 or newer is recommended. When procuring new iPad, wifi/cellular connection are both required to fully utilize our mobile applications. In addition, iPads must have a minimum of 4 GB of free disk space to allow for installing of apps and associated data.

Ensure your end users have access to CWOPA

PennDOT Apps are configured using Commonwealth of Pennsylvania (CWOPA) credentials for authentication. The Department requires that each end user have their own unique CWOPA credential. Therefore, any end user who will need access to the M-609 app must have their own valid CWOPA credentials. To obtain CWOPA credentials, the 3rd Party Business owner must contact their Department District personnel and request to complete an OA HRSC-11 External Assignment form. Upon completion of that process, the Department District personnel will contact you. It is the 3rd Party Business owner's responsibility to distribute the corresponding CWOPA credential to each personnel who will access the PennDOT Mobile Apps.

Furthermore, the Department requires that each end user create and update their own password. The 3rd Party Business owner is responsible to provide directions to change the temporary password prior to accessing the app. Information on that process will be provided by the District personnel.

Enroll in the Apple VPP

All custom Business to Business (B2B) apps will be made available to business partners through the Apple VPP store. This requires creating a Business Apple ID at deploy.apple.com. To register, you will need to provide a business phone number and email address, Dun & Bradstreet number, valid business address and a tax registration number, if applicable.

Notify PennDOT of your Apple ID and Requested Apps

For security purposes, PennDOT iPad apps are provided only to "approved" business partners through the VPP store. This access is controlled by your Business Apple ID. Once you have registered, provide your business's Apple ID with the request to gain access to the M-609 app by contacting the PennDOT IT Service Desk at 717-783- 8330 or toll free 1-855-783-8330. Once your account has been approved and the apps made available, you will be contacted by the Department.

Attachment 4

Download PennDOT Apps

After receiving notification from the Department, the requested app will be downloadable through the Apple VPP store. A guide has been created to assist you in that process, Apple B2B Download Guide. You will need to indicate the quantity of the app you need and a corresponding number of unique, redeemable codes will be generated.

Distribute PennDOT Apps to your Users

After downloading the redeemable codes, you need to use a distribution method. You can either, (A) upload the redeemable codes into your own Mobile Device Management (MDM) software to distribute them or, (B) distribute the redeemable codes to your end users directly, via email or some other method. Regardless of which method used, as mentioned before, the installation of the app will require the end user to have a valid personal Apple ID. For more details on enrolling in Apple VPP or Downloading and Distributing apps from the VPP Store, please refer to the Apple VPP Business Guide.

Instructions for Completing Confirmation of Service Form (OS-501)

Instructions

Complete the OS-501 form in accordance with the instructions below. Once the form is complete, the Contractor must apply

their signature and date. Then the Contractor must forward the signed/dated form to the appropriate PennDOT

representative for approval. This may be done electronically via email.

The Contractor should not submit an invoice for payment until a fully executed OS-501 is received back from the appropriate

PennDOT representative.

Date Service Rendered: Provide the date of service (i.e., weekly, monthly, delivery date, date range, etc.)

SAP Vendor Number: This is the vendor's six digit vendor number (i.e. 412345) as it appears on the fully executed

Purchase Order.

Contractor Name: Enter name exactly as it appears on the fully executed Purchase Order.

Contractor Address: Fill in complete address, street, city, state, zip code, as it appears on the fully executed Purchase

Order.

Phone: Area code and phone number exactly as it appears on the fully executed Purchase Order

PURCHASE ORDER # the ten digit number in the upper right corner on the fully executed Purchase Order

PO item#: Enter the PO line item number(s) in this column. Many PO's contain numerous line items. Create a separate

entry to account for each item that was delivered.

Material / Service Description: Enter the exact description from the PO line item "Material/Service Description" column

on the fully executed Purchase Order.

Quantity: Enter the quantity delivered for the time period.

U.O.M: This is the unit of measure for the service/product rendered, i.e. hours, number, etc.

Delivery Date: Date for service/product commitment to be fulfilled.

Net Price: Cost per individual unit

Total: Number of units X cost per individual unit.

Attachment 5 - Confirmation of Service Form (OS-501)

Attachment 9 - Green Plan Policy

Attachment 10 - Summary of Bids Items