R2013-113 ACCEPTING THE BID AND AUTHORIZING A CONTRACT

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' Illinois Department Affidavit of Availability of Transportation For the Letting of 10/31/2013 Bureau of Construction (Letting date) ' 2300 South Dirksen Parkway/Room 322 Instructions: Complete this form by either typin or using black ink. Springfield,Illinois 62764 "Authorization to Bid"will not be issued unless bath sides of this form are completed in detail Use additional forms as neetled to list all work. ' Part I. Work Under Contract List below all work you have under contract as either a prime contractor or a subcontractor It is required to include all pending low bids not yet awarded or rejected. In a joint venture,list only that portion of the work which is the responsibility of your company. The uncompleted dollar value is to be based upon the most recent engineer's or owners estimate,and must include work subcontracted to others. If no work is contracted,show NONE. ' 1 2 3 4 Award3 Pending County and Section Number 622608 DE074 622761-CONT72E11 622568CONT46249 72932 ' Contract With Collins&Herman IVP SANGAMO [DOT Estimated Completion Date 12113 09113 10/14 6/14 Accumulated Total Contract Price 76,614.00 240,004.00 81,585.00 28,838.00 Totals ' Uncompleted Doar Value if Firm IS the 25,774.00 269,629.00 ncomp e e Oar a Ue I Irm IS e Subcontractor 60,394.001 42,063.001 81,585.001 1,625,442.00 ' Total Value of All Work 1,895,071.00 Part 11. Awards Pending and Uncompleted Work to be done with your own forces. List below the uncompleted dollar value of work for each contract and awards pending to be completed with your own forces. All work Accumulated ' Subcontracted to others will be listed on the reverse of this form. In a joint venture,list only that portion of the work to be done by your Totals company. If no work is contracted,show NONE. Earthwork 0.00 ' Portland Cement Concrete Paving 0.00 HMA Plant Mix 0.00 HMA Paving 0.00 ' Clean&Seal Cracks/Joints 0.00 Aggregate Bases&Surfaces 0.00 ' Highway,R.R.and Waterway Structures 0.00 Drainage 0.00 Electrical 60,394.00 42,063.00 81,585.00 25,774.00 1,895,071.00 ' Cover and Seal Coats 0.00 Concrete Construction 0.00 Landscaping 0.00 ' Fencing 0.00 Guardrail 0.00 ' Painting 0.00 Signing 0.00 Cold Milling,Planning&Rotomilling 0.00 ' Demolition 0.00 Pavement Markings(Paint) 0.00 Other Construction(List) 0.00 0.00 0.00 ' Totals 60,394.00 42,063.00 81,585.00 25,774.00 0.00 1,895,071.00 Disclosure of this information is REQUIRED to accomplish the statutory purpose as outlined in the"Illinois Procurement Code". Failure to comply will result in non-issuance of an"Authorization To Bid." This form has been approved by the State Forms Management Center. ' Printed 10/17/2013 Page 4 of 10 BC 57(06/09/08)