2026-2027 Infrastructure 27-00000-04-GM

Local Public Agency an
Formal Contract Proposal

Proposal Submitted By:
Contractor's Name

Contractor's Address

State

city Zip Code

STATE OF ILLINOIS
Local Public Agency

County. Section Number

CITY OF BELLEVILLE

[st clair J27-00000-04-6M

Type of Funds.

Route(s) (Street/Road Name)
Various locations in the city

INFRASTRUCTURE - MFT/TIF

(21 Proposal Only [XJ Proposal and Plans [[] Proposal only, plans are separate

Submitted/Approved
For Loca! Public Agency}

For a County and Road District Project

For a Municipal Project

County Engineer/Superintendent of Highways Date

Submitted/Approved Submitted/Approved/Passed
Highway Commissioner Signature Date Signature Date
(ee
'4 2
A JA DAS
Official Title
Submitted/Approved Mayor

Deparimont of Transportation

id Released for bid based on limited review
Regional Engineer Signature Date

Coe Vite iPr 08 at

Note: All proposal documents, including Proposal Guaranty Checks or Proposal Bid Bonds, should be stapled together to prevent loss

when bids are processed.

Printed 03/29/26

Page 1 of 6 BLR 12200 (Rev. 01/21/21)

Local Public Agency. County Section Number Route(s) (Street/Road Name)
[erty OF BELLEVILLE St. Clair [27-00000-04-GM Various locations in the city

Sealed proposals for the project described below will be received at the office of City Clerk

Namie of Office
101 South Illinois Street, Belleville, Hinois 62220 untit 10:00 a.m. on May 11, 2026.

'Address Time Dale
Sealed proposals will be opened and read publicly at the office of City Clerk

Name of Office
101 South Illinois Street, Belleville, Illinois 62220 at 10:00 a.m. on May 11, 2026.
Address 'Time Date
DESCRIPTION OF WORK

Location Project Length

|\Various locations in the city I

Proposed Improvement
Provide Labor, Equipment and Materials to make repairs to Belleville's Infrastructure at established prices subject}
ito terms and conditions contained in this proposal.

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4. Plans and proposal forms will be available in the office of
City Engineer
2300 West Main Street, Bldg. M- Suite M116, Belleville, Illinois 62226 and Belleville.net

2. &] Prequalification

if checked, the 2 apparent as read low bidders must file within 24 hours after the letting an "Affidavit of Avaitability" (Form BC 57) in
triplicate, showing all uncompleted contracts awarded to them and all low bids pending award for Federal, State, County, Municipal
and private work, One original shalt be filed with the Awarding Authority and two originals with the {DOT District Office.

3. The Awarding Authority reserves the right to waive technicalities and to reject any or all proposals as provided in BLRS Special
Provision for Bidding Requirements and Conditions for Contract Proposals.

4, The following BLR Forms shail be returned by the bidder to the Awarding Authority:
a. Local Public Agency Formal Contract Proposal (BLR 12200)
b, Schedule of Prices (BLR 12201)
. Proposal Bid Bond (BLR 12230) (if applicable)
d. Apprenticeship or Training Program Certification (BLR 12325) (do not use for project with Federal funds.)
e. Affidavit of Illinois Business Office (BLR 12326) (do not use for project with Federal funds)

5, The quantities appearing in the bid schedule are approximate and are prepared for the comparison of bids. Payment to the Contractor
will be made only for the actual quantities of work performed and accepted or materials furnished according to the contract. The
scheduled quantities of work to be done and materials to be furnished may be increased, decreased or omitted as hereinafter
provided,

6. Submission of a bid shall be conclusive assurance and warranty the bidder has examined the plans and understands all requirements
for the performance of work. The bidder will be responsible for all errors in the proposal resulting from failure or neglect to conduct an
in depth examination. The Awarding Authority will, in no case, be responsible for any costs, expenses, losses or changes in
anticipated profits resulting from such failure or neglect of the bidder.

7. The bidder shall take no advantage of any error or omission in the proposal and advertised contract.

8. Ifa special envelope is supplied by the Awarding Authority, each proposal should be submitted in that envelope furnished by the
Awarding Agency and the blank spaces on the envelope shall be filled in correctly to clearly indicate its contents. When an envelope
other than the special one furnished by the Awarding Authority is used, it shall be marked to clearly indicate its contents. When sent
by mail, the sealed proposal shall be addressed to the Awarding Authority at the address and in care of the official in whose office the
bids are to be received. All proposals shail be filed prior to the time and at the place specified in the Notice to Bidders. Proposals
received after the time specified will be returned to the bidder unopened.

9. Permission will be given to a bidder to withdraw a proposal if the bidder makes the request in writing or in person before the time for
'opening proposals.

Printed 09/29/26 Page 20f6 BLR 12200 (Rev. 04/21/21)

Local Public Agency _ County Section Number Route(s) (Street/Road Name)

lerry OF BELLEVILLE St. Clair \27-00000-04-GM [Various locations in the city
BETES, z BOOS Se 3 saa
age FES) re

1. Proposal of,

'Contractor's Name

Contractor's Address

2. The plans for the proposed work are those prepared by__The City of Belleville :
and approved by the Department of Transportation on

3. The specifications referred to herein are those prepared by the Department of Transportation and designated as "Standard
Specifications for Road and Bridge Construction" and the " Supplemental Specifications and Recurring Special Provisions" thereto,
adopted and in effect an the date of invitation for bids.

4, The undersigned agrees to accept, as part of the contract, the applicable Special Provisions indicated on the "Check Sheet for
Recurring Special Provisions" contained in this proposal.

8. The undersigned agrees to complete the work within working days or by 04/30/27 unless additional time
is granted in accordance with the specifications.

6. The successful bidder at the time of execution of the contract will be required to deposit a contract bond for the full amount of

the award, When a contract band is not required, the proposal guaranty check will be held in lieu thereof. If this proposal is accepted '
and the undersigned fails to execute a contract and contract bond as required, it is hereby agreed that the Bid Bond of check shail be :
forfeited to the Awarding Authority. I

7. Each pay item should have a unit price and a total price. If no total price is shown or if there is a discrepancy between the products of :
the unit price multiplied by the quantity, the unit price shall govern. if a unit price is omitted, the total price will be divided by the i
quantity in order to establish a unit price. A bid may be declared unacceptable if neither a unit price nor a total price is shown.

8. The undersigned submits herewith the schedule of prices on BLR 12201 covering the work to be performed under this contract.

9. The undersigned further agrees that if awarded the contract for the sections contained in the combinations on BLR 12201, the work
shall be in accordance with the requirements of each individual proposal for the multiple bid specified in the Schedule for Multiple Bids i
below.

10. A proposal guaranty in the proper amount, as specified in BLRS Special Provision for Bidding Requirements and Conditions for

Contract Proposals, will be required. Bid Bonds will be allowed as a proposal guaranty. Accompanying this proposal is either
@ bid bond, if allowed, on Department form BLR 12230 or a proposal guaranty check, complying with the specifications, made payable
to: City Treasurerof_ Belleville

The amount of the check is ).

Attach Cashier's Check or Certifled Check Here

In the event that one proposal guaranty check is intended to cover two or more bid proposals, the amount must be equal to the 1
sum of the propasal guaranties which would be required for each individual bid proposal. If the proposal guaranty check is
placed in another bid proposal, state below where it may be found.

The proposal guaranty check will be found in the bid proposal for: Section Number 27-00000-04-GM .

Printed 03/29/26 Page 3 of 6 BLR 12200 (Rev. 01/24/21)

Local Public Agency County Section Number Route(s) (StreetiRoad Name).
[erry OF BELLEVILLE St. Clair 127-00000-04-GM Various locations in the city

ES

The certifications hereinafter made by the bidder are each a material representation of fact upon which reliance is placed should the i
Department enter into the contract with the bidder.

4. Debt Delinquency. The bidder or contractor or subcontractor, respectively, certifies that it is not delinquent in the payment of any tax !
administered by the Department of Revenue unless the individual or other entity is contesting, in accordance with the procedure '
established by the appropriate Revenue Act, its liability for the tax or the amount of the tax. Making a false statement voids the
contract and allows the Department to recover all amounts paid to the individual or entity under the contract in a civil action.

2. Bid-Rigging or Bid Rotating. The bidder or contractor or subcontractor, respectively, certifies that it is not barred from contracting
with the Department by reason of a violation of either 720 LCS 6/33E-3 or 720 ILCS 5/33E-4.

A violation of section 33E-3 would be represented by a conviction of the crime of bid-rigging which, in addition to Class 3 felony
sentencing, provides that any person convicted of this offense, or any similar offense of any state or the United States which contains
the same elements as this offense shall be barred for 5 years from the date of conviction from contracting with any unit of State or
local government. No corporation shall be barred from contracting with any unit of State or focal government as a result of a conviction
under this Section of any employee or agent of such corporation if the employee so convicted is no longer employed by the
corporation: (1) it has been finally adjudicated not guilty or (2) if it demonstrates to the governmental entity with which it seeks to
contract that entity finds that the commission of the offense was neither authorized, requested, commanded, nor performed by a
director, officer or a high managerial agent on behalf of the corporation.

A violation of Section 33E-4 would be represented by a conviction of the crime of bid-rotating which, in addition to Class 2 felony :
sentencing, provides that any person convicted of this offense or any similar offense of any state or the United States which contains t
the same elements as this offense shall be permanently barred from contracting with any unit of State of Local government. No :
corporation shall be barred from contracting with any unit of State or Local government as a result of a conviction under this Section of

any employee or agent of such corporation if the employee so convicted is no longer employed by the corporation and: (1) it has been

finally adjudicated not guilty or (2) if it demonstrates to the governmental entity with which it seeks to contract and that entity finds that

the commission of the offanse was neither authorized, requested, commanded, nor performed by a director, officer or a high

managerial agent on behalf of the corporation,

3. Bribery. The bidder or contractor or subcontractor, respectively, certifies that, it has not been convicted of bribery or attempting to '|
bribe an officer or employee of the State of Iitinols or any unit of local government, nor has the firm made an admission of guilt of such i
conduct which is a matter or record, nor has an official, agent, or employee of the firm committed bribery or attempted bribery on
behalf of the firm and pursuant to the direction or authorization of a responsible official of the firm.

4, Interlm Suspension or Suspension. The bidder or contractor or subcontractor, respectively, certifies that it is not currently under a
suspension as defined in Subpart | of Title 44 Subtitie A Chapter Il! Part 6 of the Illinois Administrative code. Furthermore, if
suspended prior to completion of this work, the contract or contracts executed for the completion of this work may be canceled.

Printed 03/23/26 Page 4 of 6 BLR 12200 (Rev. 01/21/21)

Local Public Agency County, Section Number Route(s) (Street/Road Name)
CITY OF BELLEVILLE St. Clair 127-00000-04-GM \Various locations in the city
SIGNATURES
(If an individual) Signature of Bidder Date
Business Address.
City State__ Zip Code
(Ifa partnership) Firm Name
Signature l
Title
Business Address
City State Zip Code
Insert the Names and Addresses of all Partners
{Ifa corporation) Corporate Name
Signature Date
Title
Business Address,
City State __ Zip Code
Insert Names of Officers President
Printed 03/29/26 Page 5 of6 BLR 12200 (Rev. 01/21/21)

Secretary

Attest:

Treasurer

Secretary

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Printed 03/23/26 Page 6 of 6 BLR 12200 (Rev. 01/21/21)

linois Department Local Public Agency

of Transportation Proposal Bid Bond
Local Public Agency Count Section Number,
CITY OF BELLEVILLE [st clair [27-00000-04-GM
WE, as PRINCIPAL, and

as SURETY, are held jointly,
severally and firmly bound unto the above Local Public Agency (hereafter referred to as "LPA") in the penal sum of 5% of the total bid
price, or for the amount specified in the proposal documents in effect on the date of invitation for bids, whichever is the lesser sum. We
bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly pay to the LPA this sum under the conditions of this
instrument.

WHEREAS THE CONDITION OF THE FOREGOING OBLIGATION IS SUCH that, the seid PRINCIPAL is submitting a written
proposal to the LPA acting through its awarding authority for the construction of the work designated as the above section.

THEREFORE if the proposal is accepted and a contract awarded to the PRINCIPAL by the LPA for the above designated section
and the PRINCIPAL shall within fifteen (15) days after award enter into a formal contract, fumish surety guaranteeing the faithful
performance of the work, and furnish evidence of the required insurance coverage, all as provided in the "Standard Specifications for Road
and Bridge Construction" and applicable Supplemental Specifications, then this obligation shall become void; otherwise it shall remain in
full force and effect.

IN THE EVENT the LPA determines the PRINCIPAL has failed to enter into a format contract in compliance with any
requirements set forth in the preceding paragraph, then the LPA acting through its awarding authority shall immediately be entitled to
recover the full penal sum set out above, together with all court costs, ail attorney fees, and any other expense of recovery.

IN TESTIMONY WHEREOF, the said PRINCIPAL and the sald SURETY have caused this instrument to be signed by their

respective officers this of
---Day_-s Montrand Year
Principal
Company Name. 7 Company Name.
Signature Date Signature Date
Sia - sia
By: By:
Title Title

(If Principat is a joint venture of two or more contractors, the company names, and authorized signatures of each contractor must be
affixed.)

Surety
Name of Surety Signature of Attomey-in-Fact, Date
ay |
STATE OF IL
COUNTY OF

' , a Notary Public in and for said county do hereby certify that

-Tsert names of Individuals signing on behalf of PRINCIPAL & SURETY)
who are each personally known to me to be the same persons whose names are subscribed to the foregoing instrument on behalf of
PRINCIPAL and SURETY, appeared before me this day in person and acknowledged respectively, that they signed and delivered said
instruments as their free and voluntary act for the uses and purposes therein set forth.

Given under my hand and notarial seat this day of
Day Month and Year

Notary Public Signature

(SEAL)

Date commission expires

Printed 03/29/26 Page 1 of 2 BLR 12230 (Rev. 01/21/21)

Local Public Ageno: County Section Number :
CITY OF BELLEVILLE [st Clair '27-00000-04-GM :
ELECTRONIC BID BOND:

C1 Electronic bid bond Is allowed (box must be checked by LPA if electronic bid bond is allowed)

The Principal may submit an electronic bid bond, in lieu of completing the above section of the Proposal Bid Bond Form. By providing an
electronic bid bond ID code and signing below, the Principal is ensuring the identified electronic bid bond has been executed and the
Principat and Surety are firmly bound unto the LPA under the conditions of the bid bond as shown above. (\f PRINCIPAL is a joint venture
of two or more contractors, an electronic bid bond ID code, company/Bidder name title and date must be affixed for each contractor in the
venture.)

Electronic Bid Bond ID Code Company/Bidder Name.

i

Signature Date.

Title i

Printed 03/23/28 Page 2 of 2 BLR 12230 (Rev, 01/21/21)

Apprenticeship and
Training Program Certification

Local Public Agency County. Street Name/Road Name Section Number,
[CITY OF BELLEVILLE [st ctair [city STREETS |[z7-00000-04-6m _|

All contractors are required to complete the following certification
(J For this contract proposal or for all bidding groups in this deliver and install proposal.

For the following deliver and install bidding groups in this material proposal,

IHinois Department of Transportation policy, adopted in accordance with the provisions of the Illinois Highway Code, requires this contract
to be awarded to the lowest responsive and responsible bidder. The award decision is subject to approval by the Department. in addition
to all other responsibility factors, this contract or deliver and install proposal requires all bidders and all bidder's subcontractors to disclose
participation in apprenticeship or training programs that are (1) approved by and registered with the United States Department of Labor's
Bureau of Apprenticeship and Training, and (2) applicable to the work of the above indicated proposais or groups. Therefore, all bidders
are required to complete the following certification:

4. Except as provided in paragraph 4 below, the undersigned bidder certifies that it is a participant, either as an individual or as part of a
group program, in an approved apprenticeship or training program applicable to each type of work or craft that the bidder will perform with
its own employees.

2. The undersigned bidder further certifies, for work to be performed by subcontract, that each of its subcontractors either (A) is, at the
time of such bid, participating in an approved, applicable apprenticeship or training program; or (B) will, prior to commencement of
performance of work pursuant to this contract, establish participation in an approved apprenticeship or training program applicable to the
work of the subcontract.

3, The undersigned bidder, by inclusion in the list in the space below, certifies the official name of each program sponsor holding the
Certificate of Registration for all of the types of work or crafts in which the bidder is a participant and that will be performed with the bidder's
employees. Types of work or craft that will be subcontracted shall be included and listed as subcontract work. The list shall also Indicate
any type of work or craft job category for which there is no applicable apprenticeship or training program available.

4, Except for any work identified above, if any bidder or subcontractor shall perform all or pact of the work of the contract or deliver and
install proposal solely by individual owners, partners or members and not by employees to whom the payment of prevailing rates of wages
would be required, check the following box, and identify the owner/operator workforces and positions of ownership.

'The requirements of this certification and disclosure are a material part of the contract, and the contractor shall require this certification
provision to be included in all approved subcontracts. The bidder is responsible for making a complete report and shall make certain that
each type of work or craft job category that will be utilized on the project Is accounted for and listed. The Department at any time before or
afterward may require the production of a copy of each applicable Certificate of Registration issued by the United States Department of
Labor evidencing such participation by the contractor and any or all of its subcontractors. In order to fulfill the participation requirement, it
shall not be necessary that any applicable program sponsor be currently taking or that it will take applications for apprenticeship, training or
employment during the performance of the work of this contract or deliver and install proposal.

Bidder 'Signature Date
Title |
Address City State__ Zip Code.

Printed 03/2/26 Page 1 of 1 BLR 12325 (Rev. 01/21/21)

llinois Department

Affidavit of Illinois Business Office

of Transportation

Local Public Agency County Street Name/Road Name Section Number
[erty OF BELLEVILLE St. Clair CITY STREETS |[z7-00000-04-6m
I, of ' '

Name of Affiant City of Affiant State of Affant
being first duly sworn upon oath, state as follows:
1. That | am the of

'Officer or Position Bidder

2, That | have personal knowledge of the facts herein stated,

3. That, if selected under the proposal described above,

, Will maintain a business office in the

State of Illinois, which will be located in
County

Bidder

County, Illinois.

4. That this business office will serve as the primary place of employment for any persons employed in the construction contemplated by

this proposal.

5. That this Affidavit is given as a requirement of state law as provided in Section 30-22(8) of the Illinois Procurement Code,

Signature Date

Print Name of Affiant

Notary Public
State of IL
County
Signed (or subscribed or attested) before me on by
Cate)
, authorized agent(s) of
iamals of person/s)
Bidder
Signature of Notary Public
(SEAL) My commission expires

Printed 03/23/26 Page 1 of 1 BLR 12326 (Rev. 01/21/21)

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