HomeMy WebLinkAboutGM BedknifeandReelGrinders2024 GM Grinders
Village of Oak Brook
Golf Maintenance Facilities
Bedknife Grinder & Reel Grinder
Bid Package
January 2024
Table of Contents
Section
A. Notice to Bidders
B. Bid
C. Instructions to Bidders
D. Specifications
E. Special Conditions
F. Statement of Bidder’s Qualifications
G. References
H. Bid Certification
I. Contract
Section A Notice to Bidders
Posted on the Village Website January 17, 2024
The Village of Oak Brook will receive bids for:
Golf Maintenance Facilities Bedknife Grinder & Reel Grinder
Sealed bids will be received by Rania Serences, Purchasing and Budgeting Coordinator,
Village of Oak Brook, 1200 Oak Brook Road, Oak Brook, IL 60523 until 11:00 A.M.,
Wednesday, January 31, 2024, prevailing time, and publicly opened in the Samuel E.
Dean Board Room at that time.
A complete bid package, of which this notice is a part, is on file for inspection and may be
downloaded from the Village’s website www.oak-brook.org, or picked up at the Butler
Government Center, 1200 Oak Brook Road, Oak Brook, Illinois 60523, between the hours
of 8:00 A.M. and 4:30 P.M. Monday through Friday. There is no charge for the package.
No bid shall be withdrawn after opening of bids without the consent of the Village of Oak
Brook for a period of ninety (90) days after the scheduled time of opening bids.
The Village of Oak Brook reserves the right to reject any or all bids and to waive any
informalities in bidding and to accept the bid deemed most advantageous to it.
The Village also reserves the right to split the award based on categories or individual
items contained in the bid.
Netasha Scarpiniti
Village Clerk
Page 1
Section B Bid
Golf Maintenance Facilities Bedknife Grinder & Reel Grinder
1. COST OF WORK:
The undersigned, acting for and on behalf of contractor and having familiarized
himself with conditions affecting the cost of the work and its performance and
having carefully examined and fully understood the entire bid package, hereby
affirms, and agrees to enter into a contract with the Village of Oak Brook, Oak
Brook, IL.
To provide all supervision, labor, material, equipment, and all other expense items
to completely perform the work covered by the specifications in this Bid Package,
including completely assembling all items in an operable condition and delivering
said items to the Village of Oak Brook.
Page 2
Lump Sum Bids
(Please see Section D for Specifications)
1 – Foley Company 673 Automatic Bedknife Grinder:
$
In words
1 – Foley Company 653 Accu-Master Spin & Relief Reel Grinder:
$
In words
Trade-in of 1 – 1999 Neary Bedknife Grinder:
$
In words
Trade-in of 1 – 1999 Neary Reel Grinder:
$
In words
Total Lump Sum Bid after trade-ins:
$
In words
Delivery is required within 90 calendar days after placement of order. Bidders that
are unable to meet the 90-day requirement should indicate on their bid their
proposed delivery schedule.
Page 3
2. COSTS:
The undersigned contractor hereby affirms and states the prices quoted herein
constitute the total cost to the Village for all work involved in the respective items
and that this cost also includes all insurance, royalties, transportation charges, use
of all tools and equipment, superintendence, overhead expense, all profits and all
other work, services and conditions necessarily involved in the work to be done and
materials to be furnished in accordance with the requirements of the contract
documents considered severally and collectively. All bids shall be held valid for a
period of ninety (90) days after the bid due date.
3. TIME OF COMPLETION:
The items ordered under this contract will be completed and delivered within 90
calendar days after placement of order, or a date mutually agreed upon between
the Village and the selected vendor, but no later than December 31, 2024.
4. INSTRUCTIONS TO BIDDERS:
The undersigned vendor/contractor shall comply with all Sections of this Bid
Package which are incorporated herein by reference.
Firm Name:
Address:
City, State, ZIP:
Signature:
Name Printed:
Title:
Telephone: Date:
If a Corporation:
ATTEST:
____________________________
Secretary
Page 1
Section C Instructions to Bidders
1. RECEIPT OF BID: Wednesday, the 31st day of January; 11:00 A.M.
2. BASIS OF BID: Sealed bids will be received until the above noted time and date.
3. BID DESCRIPTION: Golf Maintenance Facilities Bedknife Grinder & Reel Grinder
4. PREPARATION AND SUBMISSION OF BIDS:
A. The bid must be delivered to the office of Rania Serences, Purchasing and
Budgeting Coordinator, Village of Oak Brook, 1200 Oak Brook Road, Oak
Brook, IL 60523 on or before Wednesday, at 11:00 A.M., prevailing time,
January 31,2024, at which time it will be publicly opened and read in the S. E.
Dean Board Room of the Village Hall. Bids received after this time will not be
considered and will be returned unopened.
B. Each bid shall be submitted on the exact form furnished. All blank spaces for
bid prices, unit costs and alternates must be filled in--in ink--in both words and
figures if indicated. In case of any discrepancy in the amount bid, the prices
expressed in written words shall govern.
C. Each bidder must complete, execute and submit with its bid a certification that
contractor is not barred from public contracting due to bid-rigging or bid rotating
convictions on the form included with the bidding documents.
D. Each bidder must submit a complete bid package, including the
following items:
1. Bid.
2. References
3. Statement of Bidder's Qualifications.
4. Bid Certification.
5. Contract (Signed).
6. Sexual Harassment Certificate (filled out and signed).
7. Contractor’s Certifications (filled out and signed).
E. The bid shall be submitted in an opaque sealed envelope on or before the time
stated and shall bear the name of the individual, firm, or corporation submitting
the Bid and the Bid Name “Golf Maintenance Facilities Bedknife Grinder &
Reel Grinder”.
F. Bidders may attach separate sheets to the bid for the purpose of explanation,
exception, alternate bid and to cover unit prices, if needed.
Page 2
G. Bidders may withdraw their bid either personally or by written request at any
time before the hour set for the bid opening and may resubmit it. No bid may
be withdrawn or modified after the bid opening except where the award of
contract has been delayed for a period of more than ninety (90) days.
H. In submitting this bid, the bidder further declares that the only person or party
interested in the proposal as principals are those named herein; and that the
bid is made without collusion with any other person, firm, or corporation.
I. The bidder further declares that he has carefully examined this entire Bid
Package, and he has familiarized himself with all of the local conditions
affecting the contract and the detailed requirements of this work and
understands that in making the bid he waives all rights to plead a
misunderstanding regarding same.
J. The bidder further understands and agrees that if his bid is accepted, he is to
furnish and provide all necessary machinery, tools, apparatus, and other
means to do all of the work and to furnish all of the materials specified in the
contract, except such materials as are to be furnished by the owner (Village),
in the manner and at the time therein prescribed, and in accordance with the
requirements therein set forth.
K. The bidder further agrees that if the Village decides to extend or shorten the
work, or otherwise alter it by extras or deductions, including elimination of one
or more of the items, as provided in the specifications, he will perform the work
as altered, increased, or decreased.
L. The bidder further agrees that the Village representative may at any time
during the progress of the work covered by this Contract, order other work or
materials incidental thereto and that all such work and materials as do not
appear in the bid or contract as a specific item covered by a lump sum price,
and which are not included under the bid price for other items in the Contract,
shall be performed as extra work.
M. The bidder shall submit a fully executed Contract and Contractor’s Certification
for the supply of the Golf Cars as a part of his bid.
N. The bidder further agrees to complete all work not later than the Time of
Completion stated in his Bid after receipt of the Notice to Proceed, unless
otherwise provided, and to execute the work in such a manner and with
sufficient materials, equipment and labor as will insure its completion within the
time limit specified within the bid, it being understood and agreed that the
completion within the time limit is an essential part of the contract.
Page 3
O. By submitting a bid, the bidder understands and agrees that, if his bid is
accepted, and he fails to enter into a contract forthwith, he shall be liable to the
Village for any damages the Village may thereby suffer.
5. SUBSTITUTIONS:
A. Certain materials and equipment are specified by a manufacturer or trade
name to establish standards of quality and performance and not for the
purpose of limiting competition. Bidders are invited to submit bids not only on
named items but also on items which they propose for substitution of named
items. Products of other manufacturers may be substituted, if, in the opinion of
the Village, they are equal to those specified in quality, performance, design
and suitability for intended use. Where two or more items are specified, the
selection among those specified is the bidder's option, or he may submit his
bid on all such items.
B. Bids shall be based on materials included in the specifications. Substitutions
for the purpose of evaluating bids will be considered only if proposed
substitutions are set forth in the sealed bid and will only be accepted prior to
the award of the contract. The offer of substitutions shall be an integral part of
the bid, appearing immediately after all requested bids and before the
signature of the bidder.
C. Substitutions of materials other than those specified will not be considered in
the base bid price. However, other substitutions may be listed in the specified
place in the Bid Form, with the indication of the change in the base bid price for
the total cost.
D. In addition to the requirements heretofore mentioned, in order for substitutions
to qualify for consideration, the following shall accompany each bid:
1. Each proposed substitution shall be itemized showing manufacturer name,
catalog number, quantity, unit cost and total cost. The bidder shall prepare
the necessary forms to list his substitutions in the manner outlined.
2. Each bid offering substitutions shall be accompanied by descriptive
literature, catalog data, complete technical specifications, and reports
of all pertinent tests concerning the bidder’s proposed substitutions
6. CONDITIONS:
A. The Village is exempt from Federal excise tax and the Illinois Retailer's
Occupation Tax. This bid cannot include any amounts of money for these
taxes.
Page 4
B. To be valid, the bids shall be itemized so that selection for purchase may be
made, there being included in the price of each u4nit the cost of delivery (FOB
Destination).
C. The Village shall reserve the right to add or to deduct from the base bid and/or
alternate bid any item at the prices indicated in itemization of the bid.
D. All bids shall be good for ninety (90) days from the date of the bid opening.
7. BASIS OF AWARD:
The Village of Oak Brook reserves the right to reject any or all bids and to waive any
informality or technical error and to accept any bid deemed most favorable to the
interests of the Village of Oak Brook. In addition to price, the Village will consider:
A. Ability, capacity, and skill to fulfill the contract as specified.
B. Ability to supply the commodities, provide the services or complete the
construction promptly, or within the time specified, without delay or
interference.
C. Character, integrity, reputation, judgment, experience, and efficiency.
D. Quality of performance on previous contracts.
E. Previous and existing compliance with laws and ordinances relating to the
contract.
F. Sufficiency of financial resources.
G. Quality, availability and adaptability of the commodities, services, or
construction, in relation to the Village's requirements.
H. Ability to provide future maintenance and service under the contract.
I. Number and scope of conditions attached to the bid/proposal.
J. Record of payments for taxes, licenses, or other monies due the Village.
8. GUARANTEE:
The Contractor will also forward copies of all applicable manufacturer's warranties
for all equipment/commodities supplied by the Contractor as a part of the Contract.
Page 5
9. PAYMENT:
The Village of Oak Brook authorizes the payment of invoices on the second and
fourth Tuesday of the month. For consideration on one of these dates, payment
request must be received no later than fourteen (14) days prior to the second or
fourth Tuesday of the month.
10. INDEMNIFICATION:
The Contractor shall protect, indemnify, save, defend and hold forever harmless the
Village and/or its officers, officials, employees, volunteers and agents from and
against all liabilities, obligations, claims, damages, penalties, causes of action, costs
and expenses, including without limitation court costs, insurance deductibles and
attorney's fees and expenses, which the Village and/or its officers, officials,
employees, volunteers and agents may incur, suffer or sustain, or for which the
Village and/or its officers, officials, employees, volunteers and agents may become
obligated by reason for any accident, injury to or death of persons or loss of or
damage to property, or civil and/or constitutional infringement of rights (specifically
including violations of the Federal Civil Right Statutes), arising indirectly or directly in
connection with or under, or as a result of, this or any Agreement by virtue of any act
or omission of any of the Contractor's officers, employees, subcontractors, and/or
agents, provided that the Contractor shall not be liable for claims, obligations,
damages, penalties, causes of action, costs and expenses arising solely by any act
or omission of the Village's officers, officials, employees, volunteers and/or agents.
The contractor shall hold the Village harmless for any and all claims for labor,
material, apparatus, equipment, fixtures, or machinery furnished to the contractor for
the purpose of performing the work under the contract; and the payment of all direct
and indirect damages to any person, firm, company, or corporation suffered or
sustained on account of the performance of such work during the time the contract is
in force.
11. SAFETY:
The contractor and any subcontractors shall comply with all the provisions of the
Federal Occupational Safety and Health Act of 1970 (84 Stat. 1590), as amended.
12. NON-DISCRIMINATING:
The Vendor, its employees, and subcontractors, agrees not to commit unlawful
discrimination and agrees to comply with applicable provisions of the Illinois Human
Rights Act, the U.S. Civil Rights Act and Section 504 of the Federal Rehabilitation
Act, and rules applicable to each.
Page 6
13. EQUAL OPPORTUNITY:
The contractor will not discriminate against any employee or applicant for
employment because of race, color, religion, sex, ancestry, national origin, place of
birth, age, or handicap unrelated to bona fide occupational qualifications.
14. EXECUTION OF DOCUMENTS
The Contractor, in signing his Bid on the whole or on any portion of the work, shall
conform to the following requirements:
Bids signed by an individual other than the individual represented in the Bid
documents shall have attached thereto a power of attorney evidencing authority to
sign the Bid in the name of the person for whom it is signed.
Bids which are signed for a partnership shall be signed by all of the partners or by
an attorney-in-fact. If signed by an attorney-in-fact, there shall be attached to the
Bid a power of attorney evidencing authority to sign the bid, executed by the
partners.
Bids which are signed for a corporation, shall have the correct corporate name
thereof and the signature of the President or other authorized officer of the
corporation manually written below the corporate name.
If such Bid is manually signed by an official other than the President of the
Corporation, a certified copy of a resolution of the board of directors evidencing the
authority of such official to sign the Bid should be attached to it. Such Bid shall also
bear the attesting signature of the Secretary of the corporation and the impression
of the corporate seal.
The Contract shall be deemed as have been awarded when formal notice of award
shall have been duly served upon the intended awardee.
15. ASSIGNMENT
Neither the VILLAGE nor the Contractor shall assign or transfer any rights or
obligations under this Agreement without the prior written consent of the other
party, which consent shall not be unreasonably withheld.
16. GOVERNING LAW
This Agreement shall be governed by the laws of the State of Illinois as to
interpretation, performance, and enforcement. The forum for resolving any
disputes concerning the parties’ respective performance or failure to perform
under this Agreement shall be the Circuit Court for the Eighteenth Judicial Circuit,
DuPage County, Illinois.
Page 7
17. INDEPENDENT CONTRACTOR:
There is no employee/employer relationship between the Contractor and the
Village. Contractor is an independent contractor and not the Village’s employee
for all purposes, including, but not limited to, the application of the Fair Labors
Standards Act minimum wage and overtime payments, Federal Insurance
Contribution Act, the Social Security Act, the Federal Unemployment Tax Act, the
Worker’s Compensation Act (820 ILCS 305/1, et seq.). The VILLAGE will not (i)
provide any form of insurance coverage, including but not limited to health,
worker’s compensation, professional liability insurance, or other employee
benefits, or (ii) deduct any taxes or related items from the monies paid to
Contractor. The performance of the services described herein shall not be
construed as creating any joint employment relationship between the Contractor
and the Village, and the Village is not and will not be liable for any obligations
incurred by the Contractor, including but not limited to unpaid minimum wages
and/or overtime premiums, nor does there exist an agency relationship or
partnership between the Village and the Contractor.
Page 8
Section D Specifications
Foley Company 673 Automatic Bedknife Grinder
• Electro Magnetic Mounting System
• Angle Set-up
• Integrated and Adjustable Flood Coolant
• Quick Retractable Setup Gauge
• Powered, Fixed Stop Grind Angle
• Integrated Diamond Dresser
• Height Adjustable Grinding Head
• Variable Speed Belt Drive Traverse System
• Automatic Mode – with Powered Infeed Control
• Supplemental Power Supply
• Bellows Kit
• Optional Equipment:
Borazon Wheel
Flood Coolant Additive
Foley Company 653
• Spin Grind Capable
• Auto Indexing Hands Free Relief Grinding
• Robust Grinding Head and Relief Assembly
• Electronically Control Torque for Relief
• Quick Reel Placement – ACCU – Reel Selector
• ACCU-Positioning Gauge
• Cylinder Height Stop
• Cone/Taper Removal – Easy Alignment of Reel to Grinder
• Variable Speed Spin Drive Motor
• Variable Speed Belt Drive Traverse System
• Three Drive Adapters (male – 8, 9 and 11 tooth spline)
• Front Safety Door with Safety Interlock
• Front Roller Clamp
• Quick Change Grinding Wheel
• ACCU-Touch 3 with Standard and Custom Programs (End of Cycle Indicator
Light)
• Noise and Dust Abatement
• Dust Collection – Vacuum System
• Overhead Boom
Page 1
Section E General Conditions
1. F.O.B.:
All goods are to be shipped prepaid, F.O.B. Destination.
Shipments sent C.O.D. without Village's written consent will not be accepted and will, at
Vendor's risk and expense, be returned to Vendor. Unauthorized shipments are subject to
rejection and return at Vendor's expense.
2. Material Safety Data Sheets (MSDS):
Vendor shall furnish MSDS sheets for their products, in compliance with the Illinois Toxic
Substance Disclosure to Employee Act and the "Right-To-Know" law.
3. Liens, Claims, and Encumbrances:
Vendor warrants and represents that all the goods and materials ordered herein are free
and clear of all liens, claims, or encumbrances of any kind.
4. Inspections:
The Village reserves the right to visit and inspect the premises and operation of the
Vendor.
5. Contract Terms/Cancellation and Damages:
Any Contract entered into by the Village and Bidder may be terminated by the Village upon
thirty (30) days written notice.
If such Contract is terminated by the Village because of the Vendor's breach, the Village
shall have the right to purchase items covered by the Contract elsewhere and to charge
the Vendor for any additional cost incurred.
Notwithstanding the above, the Vendor shall not be relieved of any liability to the Village
for damages sustained by the Village by virtue of any breach of such Contract by the
Vendor, and the Village may withhold any payments to the Vendor until such time as the
amount of such damages due the Village from the Vendor shall be determined.
Page 1
Section F Statement of Bidder’s Qualifications
All questions must be answered, and the data given must be clear and comprehensive.
This statement must be notarized. If necessary, questions may be answered on separate
attached sheets. The Bidder may submit any additional information he or she desires.
1. Name of Bidder:
2. Permanent main office address:
3. When organized:
4. If a corporation, where incorporated:
5. How many years have you been engaged in the contracting business under your
present firm or trade name:
6. Contracts on hand: (Schedule these, showing amount of each contract and the
appropriate anticipated dates of completion)
7. General character of work performed by your company:
8. Have you ever defaulted on a contract:
9. List, on an attached sheet, the more important projects recently completed by your
company, stating the approximate cost for each, and the month and year
completed. Include a contact person and phone # for each.
10. List your major equipment available for this contract:
11. Experience in work similar in importance to this project:
12. Background and experience of the principal members of your organization,
including the officers.
13. Credit available:
Page 2
14. Bank reference:
15. Will you, upon request, fill out a detailed financial statement and furnish any other
information that may be required by the Village of Oak Brook:
16. The undersigned hereby authorizes and requests any person, firm, or corporation
to furnish any information requested by the Village of Oak Brook in verification of
the recitals comprising this Statement of Bidder's Qualifications.
DATED at _____________, Illinois this ____ day of _________________, 2024.
By:
Title
STATE OF ILLINOIS )
) SS.
COUNTY OF )
___________________________ being duly sworn deposes and says that he is the
___________ of ____________________________ and that the answers to the foregoing
questions and all statements therein contained are true and correct.
SUBSCRIBED and sworn to before me this _____ day of _____________________,
2024.
Notary Public
Page 1
Section G References
Bidder shall supply the following information listing at least five customers for which the
bidder has supplied a similar type of commodities, service, or construction.
1. Company Name:
Address:
Phone #:
Contact:
2. Company Name:
Address:
Phone #:
Contact:
3. Company Name:
Address:
Phone #:
Contact:
4. Company Name:
Address:
Phone #:
Contact:
5. Company Name:
Address:
Phone #:
Contact:
Page 2
Section H Bid Certification
The undersigned, being first duly sworn an oath, deposes and states that he has the
authority to make this certification on behalf of the bidder for the construction, product,
commodity, or service briefly described as follows:
“Golf Maintenance Facilities Bedknife Grinder & Reel Grinder”
(A) The undersigned certifies that, pursuant to Chapter 720, Section 5/33E of the
Illinois Compiled Statutes, 1993, the bidder is not barred from bidding on this
contract as a result of a conviction for the violation of State of Illinois laws
prohibiting bid-rigging or bid-rotating.
(B) The undersigned states under oath that, pursuant to Chapter 65, Section 5/11-42.1-
1 of the Illinois Compiled Statutes, 1993, the bidder is not delinquent in the payment
of any tax administered by the Illinois Department of Revenue.
(C) The undersigned certifies that, pursuant to Chapter 775, Section 5/2-105. of the
Illinois Compiled Statutes, 1993, the bidder has a written sexual harassment policy
in place including the following information:
1. An acknowledgment of the illegality of sexual harassment.
2. The definition of sexual harassment under State law.
3. A description of sexual harassment, utilizing examples.
4. The contractor’s internal complaint process including penalties.
5. The legal recourse, investigative and complaint process available
through the Illinois Department of Human Rights and the Human
Rights Commission.
6. Directions on how to contact the Department or the Commission.
Page 3
This business firm is: (check one)
_____ Corporation _____ Partnership _____ Individual
Firm Name:
Address:
City, State, ZIP:
Signature:
Name Printed:
Title:
Telephone: __________________________Date:
ATTEST:
___________________________
-SEAL-
SUBSCRIBED AND SWORN TO
before me this ______ day
of _____________, 2024
_____________________________
Notary Public
Page 1
Section I Contract
(To Be Filled, Signed, and Submitted as a part of Bid Package)
Golf Maintenance Facilities Bedknife Grinder & Reel Grinder
1. THIS AGREEMENT, made and concluded this _____ day of ________, 2024,
between the Village of Oak Brook, a municipal corporation, acting by and through
its President and Board of Trustees, known as VILLAGE, and ________________
his executors, administrators, successors, or assigns, known as CONTRACTOR.
2. WITNESSETH: That for and in consideration of the payments and agreements
mentioned in the Bid hereto attached, to be made and performed by the VILLAGE,
and according to the terms expressed in the Bond (if applicable) referring to these
presents, the CONTRACTOR agrees, at their own proper cost and expense, to do
all work, furnish all materials and all labor necessary to complete the work in
accordance with the plans and specifications hereinafter described, and in full
compliance with all of the terms of this Contract.
3. And it is also understood and agreed that the entire Bid Package hereto attached,
approved by the VILLAGE this _____ day of ________, 2024 are all essential
documents of this contract and are a part hereof.
4. IN WITNESS WHEREOF, the said parties have executed these presents on the
above-mentioned date.
ATTEST: VILLAGE OF OAK BROOK
____________________________ By____________________________
Nethasha Scarpiniti Greg Summers
Village Clerk Village Manager
ATTEST:
_____________________________
Corporate Name
___________________________ By______________________________
Secretary Contractor
Page 2
Partners doing Business under (If a Co-Partnership)
the firm name of _____________________________
_____________________________
_____________________________
________________________________
Party of the Second Part (If an Individual)
_____________________________
Party of the Second Part
Page 3
SEXUAL HARASSMENT CERTIFICATE
(To Be Filled, Signed, and Submitted as a part of Bid Package)
hereinafter referred to as “Contractor”
having submitted a bid/proposal for to the Village of
Oak Brook, DuPage/Cook Counties, Illinois, hereby certifies that said Contractor has a
written sexual harassment policy in place in full compliance with 775 ILCS 5/2-105(A)(4)
including the following information:
1. An acknowledgment of the illegality of sexual harassment.
2. The definition of sexual harassment under State law.
3. A description of sexual harassment, utilizing examples.
4. The contractor’s internal complaint process including penalties.
5. The legal recourse, investigative and complaint process available through the Illinois
Department of Human Rights and the Human Rights Commission.
6. Directions on how to contact the Department or the Commission.
7. An acknowledgment of protection of a complaint against retaliation as provided in
Section 6-101 of the Human Rights Act.
Each contractor must provide a copy of such written policy to the Illinois Department of
Human Rights upon request.
By:
Authorized Agent of Contractor
Subscribed and sworn to
before me this _____ day
of ____________, 2024
___________________________________
Notary Public
Page 4
CONTRACTOR'S CERTIFICATIONS
(To Be Filled, Signed, and Submitted as a part of Bid Package)
(CONTRACT EXECUTION)
______________________, having executed a contract for ____________________with
the VILLAGE, hereby certifies that said contractor is not barred from executing said
contract as a result of a violation of either Section 5/33E-3 or 5/33E-4 of Chapter 720 of
the Illinois Compiled Statutes.
(DRUG-FREE WORKPLACE)
Contractor deposes, states, and certifies it will provide a drug free workplace by complying
with Section 3 of the Illinois Drug Free Workplace Act, being 30 ILCS 580/3.
Attest/Witness: Contractor
By: _____________________ By: ____________________________
Name of Contractor’s Executing
Officer
Title: _____________________ Title: ___________________________
Title of Contractor’s Executing
Officer
Subscribed and Sworn to
before me this ______ day
of ______________, 2024
___________________________ My Commission Expires: __________
Notary Public
-SEAL-