Get documents about "Estimated Date of Completion format xx
Document Sample
PART "C"
REVISED 7/11
CONNECTICUT DEPARTMENT OF TRANSPORTATION
BID PROPOSAL REQUEST FORM
(AFFIDAVIT)
IMPORTANT INSTRUCTIONS:
1. THIS AFFIDAVIT MUST BE SUBMITTED TO THE CONTRACTS SECTION OF THE DEPARTMENT OF TRANSPORTATION AS A REQUEST FOR
PROJECT SPECIFIC OFFICIAL BID PROPOSAL DOCUMENTS.
2. THIS FORM WILL ALSO BE REQUIRED AS A PRE-AWARD SUBMITTAL FOR THE APPARENT LOW BIDDER AFTER THE BID OPENING AS
REQUESTED BY THE CONTRACTS MANAGER.
3. THIS AFFIDAVIT MUST CONTAIN ORIGINAL SIGNATURES AND BE PROPERLY NOTARIZED.
4. THE CONTRACTS UNIT WILL ALLOW FOR ELECTRONIC SUBMISSION OF THIS FORM AS A "REQUEST FOR OFFICIAL BID PROPOSAL" ONLY.
PLEASE EMAIL (a single PDF file) THE COMPLETED FORM INCLUDING THIS SIGNATURE PAGE AND THE LIST OF OUTSTANDING WORK, SIGNED,
SEALED AND DATED, TO DOTCONTRACTS@CT.GOV. PLEASE INDICATE THE FOLLOWING IN THE SUBJECT MATTER OF YOUR EMAIL: "BID
PROPOSAL REQUEST - PROJECT # XXXX-XXXX"
5. ORIGINAL SIGNATURES WILL STILL BE REQUIRED OF THE APPARENT LOW BIDDER WHEN SUBMITTING THIS FORM PRIOR TO AWARD OF A
CONTRACT.
DATE COMPLETED:
NAME OF COMPANY OR CORPORATION:
BID OPENING DATE:
STATE PROJECT NUMBER(S):
TOWN(S) / PROJECT DESCRIPTION:
List all outstanding private and public work both bonded and not bonded as of this date. This must include all work in state, out of state, and in any jurisdiction
both in progress and not started. Make certain that you state the total value of all work under your contract whether as a prime or a subcontractor, including
work that you may engage a subcontractor to perform.
I do hereby certify and affirm that the information set forth in this document, which includes the attached list of ALL outstanding work and any other relevant
information that may be attached, which are hereby made part of this document, are true and accurate to the best of my knowledge.
________________________________________________________________
Signature and Title of Authorized Individual
Sworn to and subscribed before me by ________________________________________________________
Who is personally known to me, this _______________ day of _______________________, ____________year
________________________________________
Notary Public/Justice of the Peace My Commission expires _________________________
FAILURE TO REPORT ALL OUTSTANDING WORK MAY RESULT IN A NONRESPONSIVE BID. THIS FORM IS NOT TO BE ALTERED.
Current Amount of
Contract Awarded to you Amount of Work Amount of Work
OR Pending Award Completed on the Job Remaining by Applicant
Totals automatically carried forward from 2nd tab
$0.00 $0.00 $0.00
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List all outstanding private and public work both bonded and not bonded as of this date. This must include all work in state, out of state and in any
jurisdiction both in progress and not started. Make certain that you state the total value of ALL work under your contract, whether as a prime or a
subcontractor, including work that you may engage a subcontractor to perform.
ENTER INFORMATION IN THE GREEN SHADED AREAS ONLY
Far right column and "Total" row at bottom will calculate automatically. Round to the nearest dollar. Contact the Contracts Unit if you need more
space in the document.
ENTER CONTRACTOR LEGAL NAME:
Estimated Current Amount
Prime Date of of Contract
(P) or Completion Awarded to you Amount of Work Amount of Work
Project Number, Name, Town and State Sub (format OR Pending Completed on the Remaining by
Located (S) Project Description xx/xx/xx) Award Job Applicant
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
TOTAL $0 $0 $0
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