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AGREEMENT FOR PROFESSIONAL SERVICES
This Agreement For Professional Services (this "Agreement") is entered into on
September 26, 2017 (the "Effective Date"), by and between the City of South Bend, acting by
and through its Board of Public Works (the "City"), and ZimmcimanNolk Associates, Inc., a
New Jersey corporation with its address at P.O. Box 4907, Clinton, New Jersey 08809 (the
"Provider") (each a "Party" and collectively the "Parties").
For and in consideration of the mutual covenants and promises contained herein, the
Parties agree as follows:
1. Services. The Provider will provide to the City the professional services (the
"Services") set forth in the Provider's proposal attached hereto as Exhibit A (the "Scope of
Work"). In the event of any conflict between the terms of this Agreement and the terms of the
Scope of Work, the terms of this Agreement will prevail. The Provider will execute its
obligations under this Agreement in accordance with the prevailing professional standard of care
for projects of similar design and complexity.
2. Compensation. In exchange for the Provider's satisfactory performance of the
Services, and subject to the terms and conditions of this Agreement, the City will pay the
Provider a total sum not to exceed Forty -Five Thousand Dollars ($45,000.00) (the "Contract
Amount"). The City will pay the Contract Amount in installments upon invoicing by the
Provider as described in the Scope of Work (each a "Contract Installment"). The City will not be
required to pay any Contract Installment if the City is not satisfied with the Provider's
performance under this Agreement or any default or breach of this Agreement by the Provider
exists, as the City may determine in its sole discretion. The sum of all Contract Installments will
not exceed the Contract Amount.
3. Expenses. Upon invoicing, supported by adequate documentation of the
Provider's data, travel, and lodging expenses incurred in connection with rendering the Services
(as described in the Scope of Work), the City will reimburse the Provider for its expenses in an
amount not to exceed Three Thousand Dollars ($3,000.00) (the "Pre -Approved Expense Cap").
The City will reimburse the Provider for expenses in excess of the Pre -Approved Expense Cap,
upon invoicing and adequate documentation, only if the Provider first obtained the Contract
Administrator's written approval before incurring such expenses.
4. Term; Termination. Unless earlier terminated in accordance with its terms, this
Agreement will commence on the Effective Date and end upon the Provider's satisfaction of all
its obligations hereunder and the City's final payment therefor. Notwithstanding the foregoing,
effective immediately upon delivery of a written termination notice to the Provider, the City may
terminate this Agreement, in whole or in part, for any reason, if the City determines that such
termination is in the best interest of the City. In addition, in accordance with Ind. Code 6-1.1-18,
payments are subject to appropriation by the City. If the City makes a written determination that
funds are not appropriated or are otherwise unavailable to support the continuation of this
Agreement, it shall be cancelled. A determination by the City that funds are not appropriated or
are otherwise unavailable to support the continuation of performance shall be final and
1
conclusive. The City will not be required to pay any Contract Installment or be otherwise liable
for any cost associated with the Provider's performance of any Services. after the effective date
of termination.
5. Remedies for Breach of Contract. Failure to complete the Services in accordance
with this Agreement will be considered a material breach. In the event of such breach, the City
may suspend all payments to the Provider and may pursue any and all remedies available at law
or in equity. The Provider shall repay to the City any portion of the Contract Amount expended
for matters not within the scope of the Services.
b. Point of Contact. The Contract Administrator identified in Section 11 below will
serve as the City's principal point of contact for purposes of this Agreement.
7. Relationship. The Provider shall at all times be an independent contractor for the
performance of the Services rather than an employee of the City, and no act or omission to act by
the Provider shall in any way bind or obligate the City. This Agreement is strictly for the benefit
of the Parties and not for any third -party or person. This Agreement was negotiated by the
Parties at arm's length and each of the parties hereto has reviewed the Agreement after the
opportunity to consult with independent legal counsel. Neither party shall maintain that the
language in the Agreement shall be construed against any signatory hereto. The City and the
Provider hereby renounce the existence of any form of agency relationship, joint venture, or
partnership between the Provider and the City and agree that nothing contained herein or in any
document executed in connection herewith shall be construed as creating any such relationship
between the City and the Provider.
8. Indemnification of City. The Provider hereby agrees to defend, indemnify, and
hold harmless the City, its officials, employees, and agents from any and all claims of any nature
which arise from the Provider's negligence, reckless, or willful misconduct in performing under
this Agreement and from all costs and attorney fees in connection therewith, excepting for claims
arising out of the negligence of the City, its officials, directors, employees, and agents. The
obligations of the Provider under this Section shall survive the termination of this Agreement.
9, Work Product; Ownership. The Provider will submit its work product to the City
in accordance with the terms of the Scope of Work. Any and all work product submitted by the
Provider to the City as part of the Provider's performance of the Services will become the
exclusive property of the City, and the City will have the right to use and reproduce copies of the
Provider's work product as the City determines in its sole discretion without compensation to the
Provider except the compensation expressly provided for in this Agreement. Notwithstanding
the foregoing sentence, the Provider's target market descriptions will remain the property of the
Provider, and the Provider hereby grants the City permission to use and distribute the same
without limitation and without cost to the City.
10. Limitation of Liability. Notwithstanding anything to the contrary and the fullest
extent permitted by law, the City agrees that the total liability of the Provider in connection with
this Agreement, whether in contract, tort, negligence, breach or otherwise, shall not exceed the
Contract Amount. In addition, the Provider will not be liable for indirect, incidental, special,
O]
punitive, or consequential damages.
11. Notices. Any notice required or permitted to be delivered hereunder shall be
deemed to be delivered, whether or not actually received, when deposited in the United States
Postal Service, postage prepaid, registered or certified mail, return receipt requested, addressed
to the City or the Provider, as the case may be, at the address set forth below.
Provider:
Zimmetman/Volk Associates, Inc
P.O. Box 4907
Clinton, NJ 08869
Attn: Laurie Volk
City
Department of Community Investment
City of South Bend
227 W. Jefferson Boulevard, Suite 1400 S.
South Bend, IN 46601
Pamela C. Meyer (the "Contract Administrator")
12. Equal Opportunity. The Provider shall comply with federal, state, and local law
in its hiring and employment practices and policies for any activity covered by this Agreement.
13. Entire Agreement; Amendment; Applicable Law. This Agreement sets forth the
entire agreement and understanding between the parties as to the subject matter hereof, and
merges and supersedes all prior discussions, agreements, and understanding of any and every
nature between them. This Agreement may be amended only by separate writing, signed by
authorized representatives of both the Provider and the City. This Agreement will be construed
and interpreted according to the laws of the State of Indiana.
14. Assi ent. The Provider shall not assign or subcontract the whole or any part of
this Agreement or its obligations hereunder without the prior written consent of the City.
15. Non -Collusion. The undersigned attests, subject to the penalties of perjury, that
he is the Provider and that he has not entered into or offered to enter into any combination,
collusion, or agreement to receive or pay, and that he has not received or paid, any sum of money
or other consideration for the execution of this Agreement other than that which appears upon
the face hereof. The Provider agrees that he will execute and submit to the City and any other
appropriate bodies, an affidavit in the form attached hereto as Exhibit B.
16. Drug -Free Warp place. The Provider hereby agrees to make a good faith effort to
provide and maintain a drug -free workplace. The Provider will give written notice to the City
within ten (10) days after receiving actual notice that the Provider or an employee of the Provider
within the State of Indiana has been convicted of a criminal drug violation occurring in the
workplace.
17. E-Verify. The Provider hereby certifies that it does not and will not knowingly
employ or contract with an unauthorized alien, nor retain any employee or contract with a person
that the Provider subsequently learns is an unauthorized alien. The Provider agrees that he/she/it
shall enroll in and verify the work eligibility status of all of the Provider's newly hired
employees through the E-Verify program as defined by Ind. Code 22-5-1.7-3.
91
IN WITNESS WHEREOF, the Parties .hereto have caused this Agreement For
Professional Services to be effective as of the Effective Date stated above.
CITY OF SOUTH BEND
BOARD OF PUBLIC WORK
Gary Gilot, President
Therese Dorau, NXember
Suzanna Frit erg, Member
Elizabeth Maradik, Member
Jame/ Mueller, Member
ATTEST:
Lin a Martin, Cler
ZIMMERMANNOLK ASSOCIATES, INC.,
a New Jersey corporation
IC
Laurie Volk,
1500.0000001
52772986.003
EXHIBIT A
Scope of Work
[See attached.]
EXHIBIT B
Contractor's Affidavit
[See attached.]
EXHIBIT A
Scope of Work
[See attached.]
LINIMERMANNOLK ASSOCIATES, INC.
R 0, Box 4907
i1 Clinton, New Jersey 08809
908 735-6336
'/ infb0)ZNTA.cc - w%w.ZVA.cc
GS Research & Strategic Analysis
SCOPE OF SERVICES AND FEE ESTIMATE
For
An Analysis of Residential Market Potential
In the
City of South Bend
St. Joseph County, Indiana
August 9, 2017 {revised}
SCOPE OF SERVICES AND IEEE ESTIMATE
An Analysis of Residential Market Potential
City of South Bend, St. Joseph County, Indiana
August 9, 2017 (revisedl
INTRODUCTION___
Page 2
This document outlines the scope of work designed to establish the depth and breadth of the
potential market for new housing units, added through new construction and/or the adaptive re -use
of existing non-residential structures, within the City of South Bend, St. Joseph County, Indiana
and within several target areas within the city (see Map and Legend following this page).
For this analysis, Zimmerman/Volk Associates, Inc. will research and evaluate market activity and
geo-demographic data relating to the St. Joseph County, the City of South Bend and the target
neighborhoods. The determination of the market potential for new and existing dwelling units in
the city and the study area neighborhoods will be based on the housing preferences and economic
capabilities of target households, the existing conditions and characteristics of the study area
neighborhoods within the city, as well as the development objectives of the client. The scope of
services will determine:
• Geographic areas for analysis: the study areas (the City of South Bend and selected
neighborhoods); the draw areas (where the potential renters and buyers of new and
existing housing units in the City of South Bend are likely to move from); and the
South Bend market area (the housing market context; relevant existing rental and
for -sale housing units that represent alternatives to new housing in the city).
• Target markets. Who currently lives in the draw areas and what they are like, and
who would be likely to move within or to South Bend and to the study area
neighborhoods.
• Market potential. How many are likely to move within or to South Bend and to the
study area neighborhoods if appropriate housing units were to be made available
(depth and breadth of the market).
• Optimum residential mix. What the housing preferences are in aggregate (rental or
ownership, multi -family or single-family, by income) of the target markets for new
housing in South Bend and the study area neighborhoods.
• Absorption forecasts. How many, and what type of new dwelling units can be leased
or sold within the city in general and the study area neighborhoods in specific over
the next five years.
ZI AMERMANNOLK ASSOCIATES, INC.
SCOPE OF SERVICES AND FEE ESTIMATE
An Analysis of Residential Market Potential
City of South Bend, St. Joseph County, Indiana
August 9, 2017 (revised]
SCOPE OF SERVICES
This analysis will be conducted in four phases, outlined as follows.
PHASE ONE: PROJECT INITIATION
TASK 1.1------DATA COLLECTION
The client will provide any previous relevant studies and base maps, if any, for the city as a
whole and for the individual neighborhoods in advance of the area visit.
TASK 1.2—CLIENT MEETING
Page 5
A Zimmerman/Volk Associates principal will meet with appropriate City personnel and/or
stakeholders during the area visit to review the objectives of the study and the methodology
to be employed in the analysis. A key goal of the meeting will be to ensure that
Zimmerman/Volk Associates possesses all pertinent data relative to the city as a whole, as
well as to determine, in conjunction with the client, how many neighborhood study areas are
to be analyzed. Thirteen neighborhoods have been identified; however, given the small size
of some of the neighborhoods, the potential to combine neighborhoods with common
characteristics into larger study areas will be discussed.
TASK 1.3—STUDYAREA EVALUATION
Zimmerman/Volk Associates will evaluate the characteristics, constraints and opportunities
of the city and the individual neighborhoods. Residential market activity within areas
germane to South Bend will be evaluated during this visit.
TASK 1.4—INTERVIEWS
Representatives of neighborhood organizations, real estate professionals (brokers, sales agents,
leasing managers, developers, builders, bankers, City personnel, residents) and other
stakeholders familiar with the nuances of the South Bend market area will be interviewed for
their opinions on city-wide and individual neighborhood market challenges and
opportunities.
ZIMMERMANNOLK ASSOCIATES, INC.
SCOPE OF SERVICES AND FEE ESTIMATE
An Analysis of Residential Market Potential Page 6
City of South Bend, St. Joseph County, Indiana
August 9, 2017 {revisedl
PHASE TWO: MARKET ANALYSIS
TASK 2.1—MARKET POTENTIAL: TARGET MARKET ANALYSIS
To achieve the study objectives and establish the framework for analysis, Zimmerman/Volk
Associates will employ its proprietary target market methodology. In contrast to conventional
supply/demand analysis —which is based on supply-side dynamics and baseline demographic
projections —target market analysis establishes the optimum market position for new housing
based on the housing and lifestyle preferences and financial capabilities of households in the
draw areas.
Task 2.1.1—Draw Area Delineation
Zimmerman/Volk Associates will identify the appropriate draw areas for housing
within St. Joseph County and the City of South Bend, based on historical settlement
patterns, migration trends, and other market dynamics.
Task 2.1.2—Determination of Market Potential
Zimmerman/Volk Associates will determine the depth and breadth of the potential
market for the City of South Bend --including rehabilitation/renovation or adaptive
re -use of existing structures as well as new construction —through target market
analysis of households in the draw areas, as follows:
• Current (2017) household classification by market group within the draw
areas.
• Qualification and filtering of the draw area households by relevant criteria
including, among others, housing and neighborhood preferences and
household mobility rates.
• Identification of those households within the draw areas with the potential to
move within or to the City of South Bend each year over the next five years.
The potential market will be correlated by household group (empty-nesters/retirees,
traditional and non-traditional families, younger singles/couples); by tenure (rental and
ownership); by income (below 30 percent AMI, between 30 and 60 percent AMI, between
60 and 80 percent AMI, between 80 and 100 percent AMI, and above 100 percent AMI, or
other income categories to meet specific client objectives); and by housing type (e.g.--
multi -family for -rent and for -sale {lofts/apartments}, single-family attached
{rowhouses/townhouses/live-world; single-family detached).
Task 2.1.3—The Current Context
Analysis of the current context, including existing conditions as well as information, as
available, on relevant newly -created for -sale developments and relevant recently -
developed rental properties.
Zimmerman/Volk Associates will evaluate the current residential context city-wide in
relation to target market housing preferences.
ZIMMERMANNOI.K ASSOCIATES, INC.
SCOPE OF SERVICES AND FEE ESTIMATE
An Analysis of Residential Market Potential
City of South Bend, St. Joseph County, Indiana
August 9, 2017 {revisedl
PHASE THREE: CONCLUSIONS AND RECOMMENDATIONS
TASK 3.1—DETERMINATION OF OPTIMUM RESIDENTIAL MIX BY HOUSING TYPE AND
AFFORDABILITY
Target market housing preferences and financial capabilities will be correlated and
analyzed in order to determine the optimum city-wide mix of housing types. Market
recommendations will include:
• Housing types appropriate for new development within the city and the
individual neighborhoods, based on target household preferences and
financial capabilities; and
• Annual market capture, over five years (absorption forecasts).
PHASE FOUR: PUBLICATION AND PRESENTATION OF FINDINGS
TASK 4.1—PUBLICATION
The complete study, including text and all appendices, will be provided in print -compatible
Adobe Portable Document File (.pdo format for unlimited reproduction of the study.
TASK 4.2—PRESENTATION OF FINDINGS
A principal of Zimmerman/Volk Associates will present the findings of the analysis, using
PowerPoint, at meetings to take place on a specified date after completion of the study. In
addition to City representatives/stakeholders, this presentation can be made to a variety of
stakeholders, including neighborhood organizations, bankers, the local press, real estate
professionals, and other interested parties.
PROPOSED SCHEDULE
A general timeline for this market analysis would be as follows:
Month One (October) Review of existing planning/research materials
Client meeting
Area evaluation
Month Two (November) Analysis of the current context
Target market analysis
Month Three (December) Determination of optimum residential mix
Delivery of draft study
Month Four (January) Delivery of final study and presentation of findings
Page 7
ZIMMERMANNOLK AssOCIATES, INC.
SCOPE OF SERVICES AND FEE ESTIMATE
An Analysis of Residential Market Potential
City of South Bend, St. Joseph County, Indiana
August 9, 2017 {revisedl
PROFESSIONAL FEE/EXPENSES
Page 8
Depending on how many neighborhood study areas are to be analyzed, the professional fee for the
above -described scope of services will likely range between $30,000 and $45,000. The professional
fee will thus be agreed upon at the first client .meeting. Reimbursable expenses for the analysis have
been estimated based on two visits to South Bend —the first visit will include a Zimmerman/Volk
Associates' principal and an associate; the second visit, for the presentation, will be by a
Zimmerman/Volk Associates' principal only.
Reimbursable expenses are charged as follows, with estimates based on current fares and recent
comparable assignments:
• Census, demographic, and consumer data,
At cost
Estimated at $250
• Air transportation (air fare, airport transit),
At cost, three round -trips—
Estimated at $1,500
• Auto rental and/or mileage, tolls, gasoline, and parking,
At cost, two trips—
Estimated at $400
• Lodging and meals,
At cost, two persons trip one; one person trip two—
Estimated at $850
Total estimated expenses------
$3,000
BILLING, PAYMENT AND TERMINATION
The total professional fee will be invoiced as follows:
$15,000 upon acceptance of this proposal,
$10,000 upon delivery of the draft study.
Fee balance upon delivery of the complete study and presentation of findings, plus travel
expenses associated with the presentation.
Expenses of the first trip will be included in the second invoice.
Additional meeting and/or charrette fees and expenses would be invoiced as incurred. No expenses
above $3,000.00 will be incurred without prior approval by the City.
All payments are within 30 days of the billing date. Payments received after 30 days may be assessed
a one -and -a -half percent (1.5%) per month late payment charge at the discretion of
Zimmerman/Volk Associates.
This proposal can be terminated by either parry with written notice. In the event the contract is
terminated by the client, Zimmerman/Volk Associates will cease all work upon receipt of written
notice. The amount due Zimmerman/Volk Associates shall be calculated according to the actual
work completed as a percentage of the total project.
ZIMMERMANNOLK AssoCIA` ES, INC.
SCOPE OF SERVICES AND FEE ESTIMATE
An Analysis of Residential Market Potential
City of South Bend, St. Joseph County, Indiana
August 9, 2017 lrevisedl
ACCEPTANCE
Page 9
This proposal will become effective with the appropriate signatures below. One signed copy should
be returned to Zimmerman/Volk Associates.
Upon acceptance with authorized signatures below, this document constitutes the entire contract
between the client and Zimmerman/Volk Associates. Any modification to this proposal must be
made in writing, signed by both parties, and attached to this document.
The authorized signatures below show acceptance of the terms and obligations of this proposal by
Zimmerman/Volk Associates, Inc., and the client.
Laurie Volk
For ZIMMERMANIVOLKASSOCIATES, INC.
August 9, 2017 {revised}
The methodology, schedule, client obligations, fees, and
payment method outlined above, as well as any signed
attachments, are accepted for the client with the following
signature(s) of responsible and authorized individual(s):
For the client:
Title
Date
ZIMMERNIANNOLK ASSOCIATES, INC.
EXHIBIT B
Contractor's Affidavit
[See attached.]
When the prospective Contractor is unable to certify to any of the statements below, it shall attach an explanation to this Affidavit.
CONTRACTOR'S NON -COLLUSION AND NON -DEBARMENT AFFIDAVIT,
CERTIFICATION REGARDING INVESTMENT WITH IRAN, EMPLOYMENT ELIGIBILITY
VERIFICATION, NON-DISCRIMINATION COMMITMENT AND CERTIFICATION OF USE
OF UNITED STATES STEEL PRODUCTS OR FOUNDRY PRODUCTS
(Must be completed for all quotes and bids. Please type or print)
STATE OF }
} SS:
COUNTY }
The undersigned Contractor, being duly sworn upon his/her/its oath, affirms under the penalties of perjury that:
1. Contractor has not, nor has any other member, representative, or agent of the firm,
company, corporation or partnership represented by him, entered into any combination, collusion
or agreement with any person relative to the price to be bid by anyone at such letting nor to
prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid
is made without reference to any other bid and without any agreement, understanding or
combination with any other person in reference to such bidding. Contractor further says that no
person or persons, firms, or corporation has, have or will receive directly or indirectly, any
rebate, fee, gift, commission or thing of value on account of such sale; and
2. Contractor certifies by submission of this proposal that neither contractor nor any of its
principals are presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from participation in this transaction by any Federal department or agency;
and
3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in
investment activities in Iran.
a. For put -poses of this Certification, "Iran" means the government of Iran and any agency or
instrumentality of Iran, or as otherwise defined at Ind. Code § 5-22-16.5-5, as amended from
time -to -time.
b. As provided by Ind. Code § 5-22-16.5-8, as amended from tirne-to-time, a Contractor is
engaged in investment activities in Iran if either:
i. Contractor, its successor or its affiliate, provides goods or services of twenty million
dollars ($20,000,000) or more in value in the energy sector of Iran; or
ii. Contractor, its successor or its affiliate, is a financial institution that extends twenty
million dollars ($20,000,000) or more in credit to another person for forty-five (45)
days or more, if that person will (i) use the credit to provides goods and services in
F-Non-Collusion Non -Debarment Affidavit Non Iran Form 2012
the energy sector in Iran; and (ii) at the time the financial institution extends credit, is
a person identified on list published by the Indiana Department of Administration.
4. Contractor does not knowingly employ or contract with an unauthorized alien, nor retain
any employee or contract with a person that the Contractor subsequently learns is an
unauthorized alien. Contractor agrees that he/she/it shall enroll in and verify the work eligibility
status of all of Contractor's newly hired employees through the E-Verify Program as defined by
I.C. 22-5-1.7-3. Contractor's documentation of enrollment and participation in the E-Verify
Program is included and attached as part of this bid/quote; and
5. Contractor shall require his/her/its subcontractors performing work under this public
contract to certify that the subcontractors do not knowingly employ or contract with an
unauthorized alien, nor retain any employee or contract with a person that the subcontractor
subsequently learns is an unauthorized alien, and that the subcontractor has enrolled in and is
participating in the E-Verify Program. The Contractor agrees to maintain this certification
throughout the term of the contract with the City of South Bend, and understands that the City
may terminate the contract for default if the Contractor fails to cure a breach of this provision no
later than thirty (30) days after being notified by the City.
6. Persons, partnerships, corporations, associations, or joint venturers awarded a contract by
the City of South Bend through its agencies, boards, or commissions shall not discriminate
against any employee or applicant for employment in the performance of a City contract with
respect to hire, tenure, terms, conditions, or privileges of employment, or any matter directly or
indirectly related to employment because of race, sex, religion, color, national origin, ancestry,
age, or disability that does not affect that person's ability to perform the work.
In awarding contracts for the purchase of work, labor, services, supplies, equipment, materials,
or any combination of the foregoing including, but not limited to, public works contracts
awarded under public bidding laws or other contracts in which public bids are not required by
law, the City, its agencies, boards, or commissions may consider the Contractor's good faith
efforts to obtain participation by those Contractors certified by the State of Indiana as a Minority
Business ("MBE") or as a Women's Business Enterprise ("WBE") as a factor in determining
the lowest, responsible, responsive bidder.
In no event shall persons or entities seeking the award of a City contract be required to award a
subcontract to an MBEIWBE; however, it may not unlawfully discriminate against said
WBE/MBE. A finding of a discriminatory practice by the City's MBE/WBE Utilization Board
shall prohibit that person or entity from being awarded a City contract for a period of one (1)
year from the date of such determination, and such determination may also be grounds for
terminating the contact for which the discriminatory practice or noncompliance pertains.
7. The undersigned contractor agrees that the following nondiscrimination commitment
shall be made a part of any contract which it may henceforth enter into with the City of South
Bend, Indiana or any of its agencies, boards or commissions.
F-Non-Collusion Non -Debarment Affidavit Non Iran Fonn 2012
Contractor agrees not to discriminate against or intimidate any employee or applicant for
employment in the performance of this contract with privileges of employment, or any matter
directly or indirectly related to employment, because of race, religion, color, sex handicap,
national origin or ancestry. Breach of this provision may be regarded as material breach of
contract.
I, the undersigned bidder or agent as contractor on a public works project, understand my
statutory obligations to the use of steel products or foundry products made in the United States
(I.C. 5-16-8-1). 1 hereby certify that I and all subcontractors employed by me for this project will
use steel products or foundry products on this project if awarded. 1 understand that violations
hereunder may result in forfeiture of contractual payments.
I hereby affirm under the penalties of perjury that the facts and infonnation contained in the foregoing bid for
public works are true and correct.
Dated this day of , 20_
Subscribed and sworn to before me this
My Commission Expires
County of Residence
F-Non-Collusion Non -Debarment Affidavit Non [ran Form 2012
Contractor/Bidder (Firm)
Signature of Contractor/Bidder or Its Agent
Printed Name and Title
day of , 20�
N6tary Public
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