RES 2020-1188 - PO to Hughes Mulch Products for christmas tree grinding services City Clerk Office Use Only:
��� _J I Publication Date(if a plicable):
RESOLUTION NO.2P2D //
Agenda Date:
Department: PUb',� /1LVVkS
Submitter: C1a PIC'h
CITY OF OMAHA
LEGISLATIVE CHAMBER
Omaha, Nebraska
RESOLVED BY THE CITY COUNCIL OF THE CITY OF OMAHA:
WHEREAS, the Environmental Quality Control Division of the Public Works Department is in
need of Christmas tree grinding services; and,
WHEREAS, bids were received on November 30, 2020, for Christmas tree grinding services,
to be utilized by the Environmental Quality Control Division; and,
WHEREAS, Hughes Mulch Products, LLC submitted the lowest and best bid to Douglas
County Purchasing for the attached bid named Grinding Christmas Trees 2020-2021 which by this
reference, is made a part hereof; and,
WHEREAS, the cost of this purchase, totaling $24,950.00, will be paid from the General Fund
11111, Solid Waste - Collect & Disposal Organization 116321, year 2020 funding.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF OMAHA:
THAT, as recommended by the Mayor, the Purchasing Agent be authorized to issue a
Purchase Order to Hughes Mulch Products, LLC,for Christmas tree grinding services, to be utilized
by the Environmental Quality Control Division, in the amount of $24,950.00.
BE IT FURTHER RESOLVED:
THAT,the Finance Department is authorized to pay the cost of this purchase from the General
Fund 11111, Solid Waste - Collect & Disposal Organization 116321, year 2020 funding.
2769grp APPROVED AS TO FORM
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1-Xpali CITY ATTORNEY DATE
Adopted: DEL 2 2 ZO2O 1 -1)
Attest:
City
Clerkk e n
Approved: A4. _
Mayor
TMH
Douglas County Purchasing Department REQUEST FOR QUOTATION
1819 Farnam Street Room 902 ON CITY OF OMAHA
Omaha, NE 68183-0902
(402)444-7155 Grinding Christmas Trees 2020-2021
NOT AN ORDER
Publish date: Quote must be received and date stamped no later than: DEPARTMENT
Monday,November 16,2020 11:00 a.m. CT on Monday, November 30, 2020 PUBLIC WORKS
Please use this form to quote price,terms,and
} I i delivery on the items described below. Vendor
COMPANY NAME: v1-C7'3 (4' �. '\ 1 2 ,, ,- must provide all requested information and sign
form to receive consideration. Quote should be
mailed,faxed or emailed to the Douglas County
Purchasing Department.
ADDRESS: 0�J 'K `.4 )1)(. WE QUOTE YOU AS BELOW
EMAIL: '51ac.�f (� hU
-'' �C'j �t2-CEOr,t J
f i PHONE#: l 'Oa- 11i )9 De
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CITY/ STATE: AA ft � .:� t�l I---� FAX#:
Submitted by(print): j`7'G`sy' u 5 jvc?'1
ZIP CODE: („ ), c SIGNATURE: 7� J
OFFICIAL TITLE: DATE�,� DATE i 133 3? 1,0
TERMS F.O.B. DATE SHIPMENT CAN BE MADE SHIPMENT VIA
Delivered
QUANTITY DESCRIPTION UNIT PRICE AMOUNT
Provide all labor, materials, and equipment to grind or chip
Christmas trees to be used as mulch per the attached
5 sites specifications.
TOTAL LUMP SUM BID: 01i
Questions regarding this quote must be emailed to bidquestions@douglascounty-ne.gov and must be
received by 11:00 a.m. CT on: Monday, November 23, 2020
Vendor must include the quote title in the subject line. Answers to questions will be posted via addendum
no later than: Tuesday, November 24, 2020
Quote should be sent to Douglas County Purchasing using one of the following methods:
MAIL TO: Douglas County Purchasing, 1819 Farnam St Rm 902, Omaha, NE 68183-0902
EMAIL TO: quotes@douglascounty-ne.gov (Quote title must be in the subject line of the email.)
FAX TO: (402)444-5423
DOUGLAS COUNTY
REQUEST FOR QUOTATION
ON: CITY OF OMAHA- Grinding Christmas Trees 2020-2021
NOT AN ORDER Page 2
DESCRIPTION
Lump Sum Bid -All Five (5) Sites Inclusive $ I 0
Pleale put this amount on Page 1
Indicate the Trash Disposal option that will be used:
Plan A: A minimum of one (1)20-yard roll-off container
Plan B: Servicing of the trash barrels as needed
Plan C: Commercial dumpsters placed at four (4) of the five (5) sites and serviced as needed
Indicate the Quantity Reporting option that will be used:
A Plan A: The total weight of the tree mulch
Plan B: Estimations of the number of trees collected by site
Indicate the destination of the mulch:
Plan A: Mulch delivered to Oma-Gro
Plan B: Mulch will be used for beneficial use in the following way and at the following location:
Person'sName: (kct JI `-'e- )C" j
Contact /"�
I
Contact Person's Phone Number (Business Hours): 9 0 L- j (1) 3
Contact Person's Phone Number (Weekends): q DQ _ 3 ``' L I cf C 3
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1
SIGN ALL COPIES Firm f�l►r
By S-te,c‘ a'4✓jj(—j
Title
CONTINUATION SHEET
DOUGLAS COUNTY
REQUEST FOR QUOTATION
ON: CITY OF OMAHA-Grinding Christmas Trees 2020-2021
NOT AN ORDER • Page 3
BID CLAUSES-TERMS AND CONDITIONS
Conflict of Interest: Pursuant to all state and local rules,CONTRACTOR assures the City of Omaha(CITY)that no elected Official or
any officer or CITY employee shall have a financial interest,direct or indirect, in any CITY agreement. In the performance of this
agreement, CONTRACTOR will avoid all conflicts of interests or appearances of conflict of interest. CONTRACTOR will report any
conflict of interest immediately to the CITY. CONTRACTOR did not and will not provide any money or other benefit of any kind to any
CITY employee in the procuring of,facilitation of,and execution of or during the duration of this Agreement.
Communication with Staff: From the date this bid is issued until a contract is awarded, communication regarding this solicitation
between potential vendors and individuals employed by the City of Omaha is prohibited. Only written communication via email to
bidquestions@douglascounty-ne.gov is permitted. Once an award is made the vendor will be permitted to speak with person(s)
participating in contract negotiations. Violation of these conditions may be considered sufficient cause to reject a vendor's bid
and/or selection irrespective of any other condition. The following exceptions to these restrictions are permitted: (1)Contacts
made pursuant to any pre-existing contracts or obligations; (2)County staff and/or vendor staff present at a Pre-Proposal Conference,
if scheduled,when recognized by the County as staff facilitating the meeting for the purpose of addressing questions;and(3)
Presentations, key personnel interviews,clarification sessions or discussions to finalize a contract, as requested by Douglas County.
Unavailability of Funding: Due to possible future reductions including but not limited the City of Omaha(CITY), State and/or Federal F
appropriations,the CITY cannot guarantee the continued availability of funding for this Agreement, notwithstanding the consideration R
stated in this Agreement. In the event funds to finance this Agreement become unavailable either in full or in part due to such
reduction in appropriations,the CITY may terminate the Agreement or reduce the consideration upon notice in writing to Contractor.
The notice shall be delivered by certified mail, return receipt requested, or in person with proof of delivery. The CITY shall be the final
authority as to the availability of funds. The effective date of such Agreement termination or reduction in consideration shall be
specified in the notice as the date of service of the notice or the actual effective date of the CITY,State and/or Federal funding
reduction,whichever is later. Provided,that reduction shall not apply to payments made for services satisfactorily completed prior to
the effective date. In the event of a reduction of consideration, Contractor may cancel this Agreement as of the effective date of the
proposed reduction upon the provision of advance written notice to CITY.
Assignment and Delegation: This Agreement is exclusive to the Parties and rights may not be assigned nor duties delegated by
either Party except on prior written consent of the other. Any attempted assignment or delegation without such approval shall be void
and shall constitute a material breach of contract. Any and all additional fees,charges, costs or expenses,which result from an
approved assignment or delegation,shall be paid by the assigning/delegating Party.
Termination: The City of Omaha may terminate the awarded contract at any time if the vendor fails to carry out the terms or fails to
make substantial progress toward the fulfillment of the contract obligations. In such event,the City shall provide the vendor with thirty
(30)days written notice of conditions which endanger contract performance. If after such notice the vendor fails to remedy these
conditions,the City may send a certified letter to the vendor for immediate cancellation of the contract. In such event,the City would
receive a pro-rated portion of the value of the performance bond depending on the value of the remaining portion of the contract. The
City will give the vendor sixty(60)days'notice of termination of contract if appropriations cease.The City of Omaha may also terminate
the agreement for any reason upon 30 days notice.
Payment Terms: Net 30 payment terms shall apply to all invoices billed to the City of Omaha. Payment of invoice amount will occur
within 30 days following receipt of invoice or receipt of goods/services,whichever is later.
Drug Free Policy: CONTRACTOR assures the City of Omaha that CONTRACTOR has established and maintains a drug free
workplace policy.
SIGN ALL COPIES Firm t� L�< 1112bBy
Title PR".3. .(of/1-'
CONTINUATION SHEET
DOUGLAS COUNTY
REQUEST FOR QUOTATION
ON: CITY OF OMAHA-Grinding Christmas Trees 2020-2021
NOT AN ORDER Page 4
BID CLAUSES -TERMS AND CONDITIONS
FEDERAL DEBARMENT OR SUSPENSION
Has bidder or its principals been debarred or suspended from Federal contracts?
YES )\ NO (failure to provide a response may be cause for rejection of bid)
Bidder certifies by submission of this bid that neither it nor its principals are presently debarred or suspended from participation in
Federal contracts. If during the term of the agreement the awarded bidder or any person engaged in performing this agreement
becomes debarred or suspended such Party shall notify the City of Omaha immediately.
Form CC-1: All bidders awarded a City contract in the amount of$10,000 or more must comply with the Contract Compliance
Ordinance by having a current Contract Compliance Report(Form CC-1)on file with the Human Rights&Relations Department. This
report shall be in effect for 24 months from the date received by the Human Rights&Relations Department. Any questions regarding
the Contract Compliance Ordinance should be directed to the Human Rights&Relations Department at(402)444-5055. Bidders are
encouraged to use the following weblink to determine if they have a current Form CC-1 on file(search by company name):
https:llhumanrights.cityofomaha.org/cc-1-search.
Equal Employment Opportunity: In accordance with the Nebraska Fair Employment Practice Act,Neb.Rev. Stat.§48-1122,the
Contractor agrees that neither it nor any of its subcontractors shall discriminate against any employee,or applicant for employment to
be employed in the performance of this Agreement,with respect to hire,tenure,terms,conditions,or privileges of employment
because of the race, color,religion, sex,disability,or national origin of the employee or applicant.
Non-Discrimination: Both Parties agree that in accordance with 42 USCS 12101 et seq.,the Nebraska Fair Employment Practice
Act-Neb.Rev.Stat.§48-1122,and Omaha Municipal code 13-89,they will not discriminate against any employee or applicant for
employment,to be employed in the performance of this Agreement,with respect to hire,tenure,terms,conditions,or privileges of
employment because of the age, race,color,religion,sex,disability,or national origin of the employee or applicant. None of the
Parties shall,in the performance of this Agreement,discriminate or permit discrimination in violation of federal or state laws or local
ordinances.
E-Verify: New Employee Work Eligibility Status(Neb.Rev.Stat.§4-108-114)
The Contractor is required and hereby agrees to use a federal immigration verification system to determine the work eligibility status
of new employees physically performing services within the state of Nebraska. A federal immigration verification system means the
electronic verification of the work authorization program authorized by the Illegal Immigration Reform and Immigrant Responsibility
Act of 1996,8 U.S.C. 1324a,known as the E-Verify Program,or an equivalent federal program designated by the United States
Department of Homeland Security or other federal agency authorized to verify the work eligibility status of a newly hired employee. If
the Contractor is an individual or sole proprietorship,the following applies:
1. The Contractor must complete the United States Citizenship Attestation Form,available on the Department of Administrative
Services website at www_das.state.ne.us
2. If the Contractor indicates on such attestation form that he or she is a qualified alien,the Contractor agrees to provide the US
Citizenship and Immigration Services documentation required to verify the Contractor's lawful presence in the United States
using the Systematic Alien Verification for Entitlements(SAVE)Program.
3. The Contractor understands and agrees that lawful presence in the United States is required and the Contractor may be
disqualified or the contract terminated if such lawful presence cannot be verified as required by Neb. Rev.Stat.§4-108.
t '
JLJtSIGN ALL COPIES Firm --)1
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By 7<.z Yi
Title ,1 r r I
CONTINUATION SHEET
DOUGLAS COUNTY
REQUEST FOR QUOTATION
ON: CITY OF OMAHA-Grinding Christmas Trees 2020-2021
NOT AN ORDER Page 5
BID CLAUSES -TERMS AND CONDITIONS
INSURANCE: Each bidder must provide a Certificate of Insurance with their bid documents which details their current levels
of coverage.
FOLLOWING AWARD OF CONTRACT: For City projects where the scope of work will be less than$200,000.00,it is required that
the awarded contractor provide a Certificate of Insurance meeting or exceeding the following levels of insurance:(1)adequate
workers'compensation (statutory);(2)commercial general liability in an amount not less than $250,000 for any person for any number
of claims arising out of a single occurrence and not less than$500,000 for all claims arising out of a single occurrence;and(3)
property damage insurance in an amount not less than$500,000;and naming CITY OF OMAHA as an additional insured,except for
Workers'Compensation policies/certificates,for the term of the agreement. Certificates of Insurance are required before service
begins.
FOLLOWING AWARD OF CONTRACT: For City projects where the scope of work will exceed$200,000.00,it is required that the
awarded contractor provide a Certificate of Insurance meeting or exceeding the following levels of insurance: (1)adequate workers'
compensation (statutory); (2)commercial general liability in an amount not less than$1,000,000 for any person for any number of
claims arising out of a single occurrence and not less than$5,000,000 for all claims arising out of a single occurrence;and(3)
property damage insurance in an amount not less than$500,000;and naming CITY OF OMAHA as an additional insured, except for
Workers'Compensation policies/certificates,for the term of the agreement. Certificates of Insurance are required before service
begins.
Liquidated damages shall be assessed at a rate of 1%of the total purchase order amount per calendar day that satisfactory
performance is not fully complete. Satisfactory performance shall occur on or before the date agreed to at the time of the bid or
purchase award between the City and the awarded bidder. Satisfactory performance shall also be deemed to include product or
purchase compliance with all specifications set forth in the bid award. The amount of liquidated damages shall be deducted from any
monies due the awarded bidder by the City. If applicable,when the monies due to the awarded bidder are not sufficient to satisfy the
City's liquidated damages,the awarded bidder shall submit payment to the City the amount to satisfy any outstanding liquidated
damages owed within 10 days of the date of non-performance.
The City may,at its sole discretion,allow"excusable delays"when assessing if liquidated damages are applicable. An excusable
delay is defined as a delay that causes disruption to the installation schedule but which is beyond the awarded bidder's control.
Excusable delay may include delays caused by weather,strikes,or natural disasters. Any determination of excusable delay by the
City shall be limited in time and scope and shall not be a guarantee or promise of future determinations of excusable delay by the
City.
INDEPENDENT VENDOR: Both parties understand and agree that(vendor)is an independent vendor under the provisions of this
Agreement and not employed by or otherwise affiliated with Douglas County(COUNTY)or the City of Omaha(CITY). Employees of
vendor(if any)are not employees of COUNTY/CITY. Each Party shall pay all wages,salaries and other amounts due its employees
and shall be responsible for all reports,obligations, and payments pertaining to social security taxation, income tax withholding,
workers'compensation,unemployment compensation,group insurance coverage, collective bargaining agreements or any other such
similar matters. Both parties understand and agree that vendor is solely responsible for acquiring and maintaining,for the term of this
Agreement,adequate general and special liability insurance, including but not limited to workers'compensation insurance,sufficient
to protect vendor's ability to complete performance under this Agreement. Neither Party shall have any authority to bind the other by
or with any contract or agreement,nor to impose any liability upon the other.All acts and contracts of each shall be in its own name
and not in the name of the other.
SIGN ALL COPIES Firm !L, A.c a 11
By '�--i ) , 1 -a
Title
CONTINUATION SHEET
DOUGLAS COUNTY
REQUEST FOR QUOTATION
ON: CITY OF OMAHA-Grinding Christmas Trees 2020-2021
NOT AN ORDER Page 6
BID CLAUSES-TERMS AND CONDITIONS
EXTRAORDINARY EVENTS: In the event of a pandemic,natural disaster,terroristic attack,or closure of a facility due to
construction,remodeling or sale or any other extraordinary event which results in one,some or all of the listed facilities in this
Agreement being closed for two weeks or more,the City may discontinue services upon immediate notice.
Solid Waste Disposal: Pursuant to an Interlocal agreement between the City of Omaha(Res. 124)and Douglas County(Res.85)
dated January 31,2012,all solid waste collected and/or processed pursuant to City or County contracts is required to be taken to the
Douglas County Pheasant Point Landfill.This includes trash,rubbish,construction,and other solid waste.This is a requirement that
will not be waived. C&D, hazardous waste, untreated medical waste,asbestos and recycled materials are exempt from this directive.
Quantities are estimated. Depending on bid pricing and budget,the City may purchase more or less than the quantities listed.
No SEB Reserve:This bid does not have an SEB reserve. Please see the SEB utilization and disclosure forms included with this
bid. These documents must be completed and returned with bid submission. If your company is qualified Tier 1 /Tier 2 ESB/SB,
then please disclose this on the disclosure form. If your company is not qualified,then please put"N/A"on the disclosure form.
•
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SIGN ALL COPIES Firm l /
By IcL �(( IY" q /
/i'tp>'
Title �32N; r i ✓
CONTINUATION SHEET
Responsible Contractor Compliance Form
RC-1
.
1. Regulation: qr.)
A.Article IV,Division I of Chapter 10 of the Omaha Municipal Code thereon require:
1.That all contractors who submit a bid to City of Omaha shall designate a representative who on
behalf of the Contractor,shall fill out completely a Responsible Contractor Compliance Form
(RC-I). An incomplete or unsigned RC-1 form will make your bid null and void.
2. Filing this Report(please initial in the boxes below):
Contractor agrees that Contractor will not knowingly employ or hire an employee not lawfully
uauthorized to perform employment in the United States and that the Contractor and all sub-
contractors shall use E-Verify to determine work eligibility.
Contractor agrees that Contractor will not knowingly violate Nebraska's Misclassification of
Employee law(Neb.Rev. Stat. Section 48-2901 et seq.).
Contractor agrees that Contractor will not knowingly violate Nebraska's Fair Labor Standards
Law(Neb.Rev.Stat.Section 73-104 et seq.).
X Contractor has not been convicted of any tax violations(local,State and Federal)within the last
three years from the date this bid is submitted.
Contractor has not,upon final determination by the Occupational Safety and Health
x Administration,been convicted of a criminal,repeat,or willful violation of the Occupational
Safety and Health Act(OSHA)or been convicted of 3 (three)separate"serious"OSHA violations
within the past three(3)years.
xContractor agrees to make a good faith effort to ensure all subcontractors employed on this project
comply with the provisions of the Responsible Contractor Compliance Form RC-I.
f p r G/
Signature Dat
By signing,I verify on behalf of the Contractor that the information above is true and correct. Filing false
information carries a penalty of up to a S500 fine or six months in jail. In addition,the contractor and sub-
contractors can be subject to immediate disqualification and prohibited from any future City of Omaha
contract for a period of 10 years.
EMPLOYEE CLASSIFICATION ACT:
Each contractor who performs construction or delivery service pursuant to this contract shall
submit with their bid submission an affidavit attesting that (1) each individual performing
services for such contractor is properly classified under the Nebraska Employee Classification
Act, 2010 LB 563 ("the Act"); (2) such contractor has completed a Federal I-9 Immigration form
and has such form on file for each employee performing services; (3) such contractor has
complied with Neb. Rev. Stat. Section 4-114 (Federal Immigration Verification System--E-
Verify); (4) such contractor has no reasonable basis to believe that any individual performing
services for such contractor is an undocumented worker; and (5) as of the time of the contract,
such contractor is not barred from contracting with the state or any political subdivision pursuant
to the Act. The contractor shall follow the provisions of the Act. A violation of the Act by a
contractor is grounds for rescission of the contract by City of Omaha/Douglas County.
CONTRACTOR shall follow the provisions of the Employee Classification Act (Act). A
violation of the Act will be a material breach and, in addition to any other remedies, be grounds
for immediate contract rescission. If CONTRACTOR is performing construction or providing
delivery service, CONTRACTOR shall submit an affidavit that complies with the
Act. CONTRACTOR will also ensure that all subcontractors performing services for Contractor
will also complete affidavits that comply with the Act. Contractor may submit the affidavit(s)
with their bid submission. In all circumstances, Contractor shall provide the affidavits
before work or services are undertaken pursuant to this Agreement.
Following award, if CONTRACTOR changes or adds additional subcontractors,
CONTRACTOR shall ensure that the subcontractor provides an Employee Classification Act
affidavit to Douglas County Purchasing Department before that subcontractor begins work or
services.
All Employee Classification Act affidavits shall be sent to: Douglas County Purchasing Agent,
1819 Farnam Street,Room 902, Omaha NE 68183.
FAIR LABOR STANDARDS:
CONTRACTOR agrees to maintain FAIR LABOR STANDARDS as defined in Neb. Rev Stat §
73-104. CONTRACTOR has filed with Douglas County (City/County Purchasing) a statement
that it is complying with and will continue to comply with, fair labor standards as provided in
Neb. Rev. Stat. § 73-102 & 73-104. In addition, CONTRACTOR assures County that it will
continue to comply with statutory fair labor standards throughout its performance under this
contract.
1
AFFIDAVIT FOR EMPLOYEE CLASSIFICATION ACT & FAIR LABOR
STANDARDS
I -1-. <y cam'-) 1 .. , being first duly sworn under oath, state and
/
depose as follows:
1. I am competent to testify to, and have personal knowledge of,the matters stated in
this affidavit.
2. I am I(a contractor) or (the authorized agent of the contractor) for
N,.� 1 c g t 3lC 6L PR-1{ jCompany, (hereinafter "Contractor"). I attest to the
)
following: (a) each individual performing services for Contractor is properly classified under
the Nebraska Employee Classification Act, ("the Act"), (b) Contractor has completed a federal I-
9 immigration faun and has such form on file for each employee performing services, (c)
Contractor has complied with Neb. Rev. Stat. §4-114 (use of federal immigration verification
system), (d) Contractor has no reasonable basis to believe that any individual performing
services for Contractor is an undocumented worker, (e) as of the time of the contract, Contractor
is not barred from contracting with the state or any political subdivision pursuant to the Act, and
(f) Contractor is complying with and will continue to comply with, fair labor standards as
provided in Neb.Rev.Stat. §§73-102 & 73-104, as applicable and as amended hereinafter.
Contractor will also ensure that all subcontractors execute affidavits in compliance with the Act.
FURTHER AFFIANT SAYETH NAUGHT.
Affiant ontractor)
SUBSCRIBED AND SWORN TO before me this [.L� day of�J`'`-�'�u20 .
GENERAL NOTARY-State of Nebraska
ROCHELLE EiOLTE t
4.4
` My Comm.Exp.May 5,2021 'C \91-e .1.p.bk, .
Notary Public
City Of Omaha Small & Emerging Small Business Program
Participation Disclosure Form
THIS FORM MUST BE SUBMITTED WITH THE BID
NOTICE: This form must be submitted by the General Contractor/Lead Consultant at the time of bid/agreement submission,designating all companies utilized to complete the scopes
of work designated as reserved for Program Participants on the Participation Utilization Form attached to the project documentation. The General Contractor/Lead Consultant may
utilize SEB Program Participants for additional scopes of work not specified on the Participation Utilization Form,but they may not be substituted for scopes specifically identified by
the City on the Participation Utilization Form. Should the below listed SEB Program Participant be determined to be unable to perform successfully or is not performing satisfactorily,
the General Contractor/Lead Consultant shall obtain written approval from the Public Works Director or a designee before dismissal/substitution of the Participant. By submitting this
form,the General Contractor/Lead Consultant is certifying that it has afforded any/all applicable program participants the opportunity to submit bids/proposals on this project.
Identified Full Name of Projected start/ Percentage of total
Scope Participant completion date Agreed Price contract
TOTAL:
CERTIFICATION:
The undersigned certifies that he/she has read,understands,and agrees to be bound by small and/or emerging small business participation utilization requirements,and the other terms
and conditions of the Invitation for Bids/Request for Proposals. The undersigned further certifies that he/she is legally authorized to make the statements and representations as to the
Participation Utilization requirements and that said statements and representations are true and correct to the best of his/her knowledge and belief. The undersigned will enter into
formal agreement(s)with the Participating Companies listed in the above disclosure at the price(s)set forth in this disclosure,conditioned upon execution of a contract/agreement by
the undersigned company with the City of Omaha. The undersigned agrees that if any of the representations made regarding utilization of small and/or emerging small business by the
General Contractor/Lead Consultant,knowing them to be false,or if there is a failure by the undersigned company to implement the stated agreements,intentions,objectives,goals,
and comments set forth herein without prior approval of the Public Works Director or designee, such action shall constitute a material breach of the contract, entitling the City of
Omaha to reject the bid/proposal or to terminate the Contract/Agreement for default. The right to so terminate shall be in addition to,and not in lieu of,any other rights or remedies
the City of Omaha may have for other defaults under the Contract/Agreement,under City of Omaha's Contract Compliance Ordinance or otherwise.
Signed this Q! f l t�vri c"c in the year �J� 1) r
Signature: �� ' G Title:.., 9 3�2 �.clecA
Printed Name: 5�e2 s �✓
Firm or Corporate Name: /��, � S )0,14 I P j />�—e-1--1
Address: 3;,,/1 1'C�1 .— (.4) 44, A!1;� �7 6 J 3 L/ Telephone No.: >'L); — %9/- 7%e i)