Common use of Owner Default Clause in Contracts

Owner Default. Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract or to perform and complete or comply with the other terms thereof. § 77-1323 Every person, partnership, limited liability company, association, or corporation furnishing labor or material in the repair, alteration, improvement, erection, or construction of any public improvement shall furnish a certified statement to be attached to the contract that all equipment to be used on the project, except that acquired since the assessment date, has been assessed for taxation for the current year, giving the county where assessed. Pursuant to Neb. Rev. Stat. § 77-1323, I, , do hereby certify that all equipment to be used on Bid No. 23-056, except that equipment acquired since the assessment date, has been assessed for taxation for the current year, in County, Nebraska. DATED this day of , 2023. By: Title: STATE OF NEBRASKA ) COUNTY OF ) On , 2023, before me, the undersigned Notary Public duly commissioned for and qualified in said County, personally came , to me known to be the identical person, whose name is affixed to the foregoing instrument and acknowledged the execution thereof to be his voluntary act and deed. Witness my hand and notarial seal the day and year last above written. For the purposes of complying with THE NEBRASKA EMPLOYEE CLASSIFICATION ACT, Nebraska Revised Statutes 48-2901 to 48-2912 and City of Lincoln Executive Order 083319, I, , herein below known as the Contractor, state under oath and swear as follows: 1. Each individual performing services for the Contractor is properly classified under the Employee Classification Act. 2. The Contractor has completed a federal I-9 immigration form and has such form on file for each employee performing services. 3. The Contractor has complied with Neb Rev Stat 4-114. 4. The Contractor has no reasonable basis to believe that any individual performing services for the Contractor is an undocumented worker. 5. The Contractor is not barred from contracting with the state or any political subdivision pursuant to NRS 48-2912 of this Act. 6. As the Contractor I understand that pursuant to the Employee Classification Act a violation of the Act by a contractor is grounds for rescission of the contract by the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission. I understand that pursuant to the Act any contractor who knowingly provides a false affidavit may be subject to criminal penalties and upon a second or subsequent violation shall be barred from contracting with the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission for a period of three years after the date of discovery of the falsehood. I hereby affirm and swear that the statements and information provided on this affidavit are true, complete and accurate. The undersigned person does hereby agree and represent that he or she is legally capable to sign this affidavit and to lawfully bind the Contractor to this affidavit. PRINT NAME: ____________________________________ (First, Middle, Last) SIGNATURE: ____________________________________ TITLE: ____________________________________ State of Nebraska ) ) ss. County of ) This affidavit was signed and sworn to before me, the undersigned Notary Public, on this ____ day of , 20__. _____________________ Notary Public

Owner Default. Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract or to perform and complete or comply with the other terms thereof. § 77-1323 Every person, partnership, limited liability company, association, or corporation furnishing labor or material in the repair, alteration, improvement, erection, or construction of any public improvement shall furnish a certified statement to be attached to the contract that all equipment to be used on the project, except that acquired since the assessment date, has been assessed for taxation for the current year, giving the county where assessed. Pursuant to Neb. Rev. Stat. § 77-1323, I, , do hereby certify that all equipment to be used on Bid No. 2319-056, 022 except that equipment acquired since the assessment date, has been assessed for taxation for the current year, in County, Nebraska. DATED this day of , 2023. By: Title: STATE OF NEBRASKA ) COUNTY OF ) On , 2023, before me, the undersigned Notary Public duly commissioned for and qualified in said County, personally came , to me known to be the identical person, whose name is affixed to the foregoing instrument and acknowledged the execution thereof to be his voluntary act and deed. Witness my hand and notarial seal the day and year last above written. For the purposes of complying with THE NEBRASKA EMPLOYEE CLASSIFICATION ACT, Nebraska Revised Statutes 48-2901 to 48-2912 and City of Lincoln Executive Order 083319, I, , herein below known as the Contractor, state under oath and swear as follows: 1. Each individual performing services for the Contractor is properly classified under the Employee Classification Act. 2. The Contractor has completed a federal I-9 immigration form and has such form on file for each employee performing services. 3. The Contractor has complied with Neb Rev Stat 4-114. 4. The Contractor has no reasonable basis to believe that any individual performing services for the Contractor is an undocumented worker. 5. The Contractor is not barred from contracting with the state or any political subdivision pursuant to NRS 48-2912 of this Act. 6. As the Contractor I understand that pursuant to the Employee Classification Act a violation of the Act by a contractor is grounds for rescission of the contract by the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission. I understand that pursuant to the Act any contractor who knowingly provides a false affidavit may be subject to criminal penalties and upon a second or subsequent violation shall be barred from contracting with the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission for a period of three years after the date of discovery of the falsehood. I hereby affirm and swear that the statements and information provided on this affidavit are true, complete and accurate. The undersigned person does hereby agree and represent that he or she is legally capable to sign this affidavit and to lawfully bind the Contractor to this affidavit. PRINT NAME: ____________________________________ (First, Middle, Last) SIGNATURE: ____________________________________ TITLE: ____________________________________ State of Nebraska ) ) ss. County of ) This affidavit was signed and sworn to before me, the undersigned Notary Public, on this ____ day of , 20__. _____________________ Notary Public.

Owner Default. Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract or to perform and complete or comply with the other terms thereof. § 77-1323 Every person, partnership, limited liability company, association, or corporation furnishing labor or material in the repair, alteration, improvement, erection, or construction of any public improvement shall furnish a certified statement to be attached to the contract that all equipment to be used on the project, except that acquired since the assessment date, has been assessed for taxation for the current year, giving the county where assessed. Pursuant to Neb. Rev. Stat. § 77-1323, I, , do hereby certify that all equipment to be used on Bid No. 23-056055, except that equipment acquired since the assessment date, has been assessed for taxation for the current year, in County, Nebraska. DATED this day of , 2023. By: Title: STATE OF NEBRASKA ) COUNTY OF ) On , 2023, before me, the undersigned Notary Public duly commissioned for and qualified in said County, personally came , to me known to be the identical person, whose name is affixed to the foregoing instrument and acknowledged the execution thereof to be his voluntary act and deed. Witness my hand and notarial seal the day and year last above written. For the purposes of complying with THE NEBRASKA EMPLOYEE CLASSIFICATION ACTNumber: 23-055 Title: Electrical and Large-Scale Electrical Services - Unit Price Type: Notice to Bidders Issue Date: 2/2/2023 Deadline: 2/17/2023 02:00 PM (CT) Notes: Contact: Xxxxxx Xxxxxxx, Nebraska Revised Statutes 48-2901 to 48-2912 and City of Lincoln Executive Order 083319, I, , herein below known as the Contractor, state under oath and swear as follows: 1Asst. Each individual performing services for the Contractor is properly classified under the Employee Classification Act. 2Purchasing Agent Address: Purchasing Suite 200 Purchasing 000 X. 0xx Xx. The Contractor has completed a federal I-9 immigration form and has such form on file for each employee performing services. 3. The Contractor has complied with Neb Rev Stat 4-114. 4. The Contractor has no reasonable basis to believe that any individual performing services for the Contractor is an undocumented worker. 5. The Contractor is not barred from contracting with the state or any political subdivision pursuant to NRS 48-2912 of this Act. 6. As the Contractor I understand that pursuant to the Employee Classification Act a violation of the Act by a contractor is grounds for rescission of the contract by the City of Lincoln, Lancaster County, and XxxxxxxNE 68508 Phone: (000) 000-Xxxxxxxxx County Public Building Commission0000 Email: xxxxxxxx@xxxxxxx.xx.xxx Address: 0000 Xxxxxxxxxx Xx. I understand that pursuant to the Act any contractor who knowingly provides a false affidavit may be subject to criminal penalties and upon a second or subsequent violation shall be barred from contracting with the City of Lincoln, Lancaster CountyNE 68527 Phone: (000) 000-0000 Fax: (000) 000-0000 Web Address: xxx.xxxxxxxxxxxxxx.xxx By submitting your response, you certify that you are authorized to represent and Xxxxxxx-Xxxxxxxxx County Public Building Commission for a period of three years after the date of discovery of the falsehoodbind your company. I hereby affirm and swear that the statements and information provided on this affidavit are true, complete and accurateAttestation Form Affidavit Ins. The undersigned person does hereby agree and represent that he or she is legally capable to sign this affidavit and to lawfully bind the Contractor to this affidavitIns. PRINT NAME: ____________________________________ (First, Middle, Last) SIGNATURE: ____________________________________ TITLE: ____________________________________ State of Nebraska ) ) ssIns. County of ) This affidavit was signed and sworn to before me, the undersigned Notary Public, on this ____ day of , 20__Ins. _____________________ Notary PublicIns. Ins. Ins. Recommendation Letter Reference Letter_DW.pdf Recommendation Letter

Owner Default. Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract or to perform and complete or comply with the other terms thereof. § 77-1323 Every person, partnership, limited liability company, association, or corporation furnishing labor or material in the repair, alteration, improvement, erection, or construction of any public improvement shall furnish a certified statement to be attached to the contract that all equipment to be used on the project, except that acquired since the assessment date, has been assessed for taxation for the current year, giving the county where assessed. Pursuant to Neb. Rev. Stat. § 77-1323, I, , do hereby certify that all equipment to be used on Bid No. 2322-056263, except that equipment acquired since the assessment date, has been assessed for taxation for the current year, in County, Nebraska. DATED this day of , 2023. By: Title: STATE OF NEBRASKA ) COUNTY OF ) On , 2023, before me, the undersigned Notary Public duly commissioned for and qualified in said County, personally came , to me known to be the identical person, whose name is affixed to the foregoing instrument and acknowledged the execution thereof to be his voluntary act and deed. Witness my hand and notarial seal the day and year last above written. For the purposes of complying with THE NEBRASKA EMPLOYEE CLASSIFICATION ACT, Nebraska Revised Statutes 48-2901 to 48-2912 and City of Lincoln Executive Order 083319, I, , herein below known as the Contractor, state under oath and swear as follows: 1. Each individual performing services for the Contractor is properly classified under the Employee Classification Act. 2. The Contractor has completed a federal I-9 immigration form and has such form on file for each employee performing services. 3. The Contractor has complied with Neb Rev Stat 4-114. 4. The Contractor has no reasonable basis to believe that any individual performing services for the Contractor is an undocumented worker. 5. The Contractor is not barred from contracting with the state or any political subdivision pursuant to NRS 48-2912 of this Act. 6. As the Contractor I understand that pursuant to the Employee Classification Act a violation of the Act by a contractor is grounds for rescission of the contract by the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission. I understand that pursuant to the Act any contractor who knowingly provides a false affidavit may be subject to criminal penalties and upon a second or subsequent violation shall be barred from contracting with the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission for a period of three years after the date of discovery of the falsehood. I hereby affirm and swear that the statements and information provided on this affidavit are true, complete and accurate. The undersigned person does hereby agree and represent that he or she is legally capable to sign this affidavit and to lawfully bind the Contractor to this affidavit. PRINT NAME: ____________________________________ (First, Middle, Last) SIGNATURE: ____________________________________ TITLE: ____________________________________ State of Nebraska ) ) ss. County of ) This affidavit was signed and sworn to before me, the undersigned Notary Public, on this ____ day of , 20__. _____________________ Notary PublicPublic Number: 22-263 Title: Roofing Services - Unit Price Type: Notice to Bidders Issue Date: 11/21/2022 Deadline: 12/14/2022 12:00 PM (CT) Notes: Unit Price Contracts are established to provide quick access to prequalified Contractors who perform smaller construction jobs and other services which fall into a category that allows for a set labor and material cost with markup. Contact: Xxxxxx Xxxxxxx, Assistant Purchasing Agent Address: Purchasing\City & County 000 X. 0xx Xx. Lincoln, NE 68508 Phone: 0 (000) 000-0000 Email: xxxxxxxx@xxxxxxx.xx.xxx Contact: Xxxxx XxXxxxxxxx Address: 0000 X.X. 44th St Lincoln, NE 68524 Phone: (000) 000-0000 Fax: (000) 000-0000 Email: xxxxxx@xxxxxxxxxxxx.xx By submitting your response, you certify that you are authorized to represent and bind your company. I acknowledge reading, understanding and agree to the Instructions to Bidders. Yes (Yes)

Owner Default. Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract or to perform and complete or comply with the other terms thereof. § 77-1323 Every person, partnership, limited liability company, association, or corporation furnishing labor or material in the repair, alteration, improvement, erection, or construction of any public improvement shall furnish a certified statement to be attached to the contract that all equipment to be used on the project, except that acquired since the assessment date, has been assessed for taxation for the current year, giving the county where assessed. Pursuant to Neb. Rev. Stat. § 77-1323, I, , do hereby certify that all equipment to be used on Bid No. 23-056031, except that equipment acquired since the assessment date, has been assessed for taxation for the current year, in County, Nebraska. DATED this day of , 20232024. By: Title: STATE OF NEBRASKA ) COUNTY OF ) On , 20232024, before me, the undersigned Notary Public duly commissioned for and qualified in said County, personally came , to me known to be the identical person, whose name is affixed to the foregoing instrument and acknowledged the execution thereof to be his voluntary act and deed. Witness my hand and notarial seal the day and year last above written. For the purposes of complying with THE NEBRASKA EMPLOYEE CLASSIFICATION ACT, Nebraska Revised Statutes 48-2901 to 48-2912 and City of Lincoln Executive Order 083319, I, , herein below known as the Contractor, state under oath and swear as follows: 1. Each individual performing services for the Contractor is properly classified under the Employee Classification Act. 2. The Contractor has completed a federal I-9 immigration form and has such form on file for each employee performing services. 3. The Contractor has complied with Neb Rev Stat 4-114. 4. The Contractor has no reasonable basis to believe that any individual performing services for the Contractor is an undocumented worker. 5. The Contractor is not barred from contracting with the state or any political subdivision pursuant to NRS 48-2912 of this Act. 6. As the Contractor I understand that pursuant to the Employee Classification Act a violation of the Act by a contractor is grounds for rescission of the contract by the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission. I understand that pursuant to the Act any contractor who knowingly provides a false affidavit may be subject to criminal penalties and upon a second or subsequent violation shall be barred from contracting with the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission for a period of three years after the date of discovery of the falsehood. I hereby affirm and swear that the statements and information provided on this affidavit are true, complete and accurate. The undersigned person does hereby agree and represent that he or she is legally capable to sign this affidavit and to lawfully bind the Contractor to this affidavit. PRINT NAME: ____________________________________ (First, Middle, Last) SIGNATURE: ____________________________________ TITLE: ____________________________________ State of Nebraska ) ) ss. County of ) This affidavit was signed and sworn to before me, the undersigned Notary Public, on this ____ day of , 20__. _____________________ Notary Public20 .

Owner Default. Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract or to perform and complete or comply with the other terms thereof. § 77-1323 Every person, partnership, limited liability company, association, or corporation furnishing labor or material in the repair, alteration, improvement, erection, or construction of any public improvement shall furnish a certified statement to be attached to the contract that all equipment to be used on the project, except that acquired since the assessment date, has been assessed for taxation for the current year, giving the county where assessed. Pursuant to Neb. Rev. Stat. § 77-1323, I, , do hereby certify that all equipment to be used on Bid No. 23-056046, except that equipment acquired since the assessment date, has been assessed for taxation for the current year, in County, Nebraska. DATED this day of , 2023. By: Title: STATE OF NEBRASKA ) COUNTY OF ) On , 2023, before me, the undersigned Notary Public duly commissioned for and qualified in said County, personally came , to me known to be the identical person, whose name is affixed to the foregoing instrument and acknowledged the execution thereof to be his voluntary act and deed. Witness my hand and notarial seal the day and year last above written. For the purposes of complying with THE NEBRASKA EMPLOYEE CLASSIFICATION ACT, Nebraska Revised Statutes 48-2901 to 48-2912 and City of Lincoln Executive Order 083319, I, , herein below known as the Contractor, state under oath and swear as follows: 1. Each individual performing services for the Contractor is properly classified under the Employee Classification Act. 2. The Contractor has completed a federal I-9 immigration form and has such form on file for each employee performing services. 3. The Contractor has complied with Neb Rev Stat 4-114. 4. The Contractor has no reasonable basis to believe that any individual performing services for the Contractor is an undocumented worker. 5. The Contractor is not barred from contracting with the state or any political subdivision pursuant to NRS 48-2912 of this Act. 6. As the Contractor I understand that pursuant to the Employee Classification Act a violation of the Act by a contractor is grounds for rescission of the contract by the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission. I understand that pursuant to the Act any contractor who knowingly provides a false affidavit may be subject to criminal penalties and upon a second or subsequent violation shall be barred from contracting with the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission for a period of three years after the date of discovery of the falsehood. I hereby affirm and swear that the statements and information provided on this affidavit are true, complete and accurate. The undersigned person does hereby agree and represent that he or she is legally capable to sign this affidavit and to lawfully bind the Contractor to this affidavit. PRINT NAME: ____________________________________ (First, Middle, Last) SIGNATURE: ____________________________________ TITLE: ____________________________________ State of Nebraska ) ) ss. County of ) This affidavit was signed and sworn to before me, the undersigned Notary Public, on this ____ day of , 20__20 . _____________________ Notary PublicNumber: 23-046 Title: Unit Price - Concrete/Pavement Services Type: Notice to Bidders Issue Date: 1/26/2023 Deadline: 2/9/2023 02:00 PM (CT) Notes: Contact: Xxxxxx Xxxxxx, Asst. Purchasing Agent Address: Purchasing Suite 200 Purchasing 000 X. 0xx Xx. Lincoln, NE 68508 Phone: (000) 000-0000 Fax: (000) 000-0000 Email: xxxxxxx@xxxxxxx.xx.xxx Contact: Xxx Xxxxxx Address: PO BOX 22812 0000 X0xx Xx Xxx 0 Lincoln, NE 68542 Phone: (000) 000-0000 Fax: (000) 000-0000 Email: xxx@xxxxxxxxxxxxxxxxxxxxxxx.xxx Web Address: xxx.xxxxxxxxxxxxxxxxxxxxxxx.xxx By submitting your response, you certify that you are authorized to represent and bind your company. I acknowledge reading and understanding the Instructions to Bidders. Yes (Yes)

Owner Default. Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract or to perform and complete or comply with the other terms thereof. Vasa 21‐003 dw 14 | P a g e § 77-1323 Every person, partnership, limited liability company, association, or corporation furnishing labor or material in the repair, alteration, improvement, erection, or construction of any public improvement shall furnish a certified statement to be attached to the contract that all equipment to be used on the project, except that acquired since the assessment date, has been assessed for taxation for the current year, giving the county where assessed. Pursuant to Neb. Rev. Stat. § 77-1323, I, , do hereby certify that all equipment to be used on Bid No. 2321-056003, except that equipment acquired since the assessment date, has been assessed for taxation for the current year, in County, Nebraska. DATED this day of , 20232021. By: Title: STATE OF NEBRASKA ) COUNTY OF ) On , 20232021, before me, the undersigned Notary Public duly commissioned for and qualified in said County, personally came , to me known to be the identical person, whose name is affixed to the foregoing instrument and acknowledged the execution thereof to be his voluntary act and deed. Witness my hand and notarial seal the day and year last above written. For Notary Public Vasa 21‐003 dw Attachment 1 Fill in the purposes following Tables in the areas as shown. If an item does not apply, please do not make an entry in that column. Number of complying with THE NEBRASKA EMPLOYEE CLASSIFICATION ACT, Nebraska Revised Statutes 48-2901 Days to 48-2912 Complete Total Rental Equipment Costs 10% Total Materials Cost 10% Total Shipping/Freight Cost Mobilization - Equipment and City of Lincoln Executive Order 083319, I, , herein below known as the Contractor, state under oath and swear as follows:Labor $400.00 LS 1. Each individual performing services for the Contractor is properly classified under the Employee Classification Act.Type "A" Sawing - Portland Cement Concrete Pavement $5.00 LF 2. The Contractor has completed a federal I-9 immigration form and has such form on file for each employee performing services.Type "B" Sawing - Portland Cement Concrete Pavement $5.00 LF 3. The Contractor has complied with Neb Rev Stat 4-114.Type "C" Sawing - Portland Cement Concrete Pavement $6.00 LF 4. The Contractor has no reasonable basis to believe that any individual performing services for the Contractor is an undocumented worker. Miscellaneous Asphalt and Concrete Removal $90.00 CY 5. The Contractor is not barred from contracting with the state or any political subdivision pursuant to NRS 48-2912 of this Act. Concrete Sidewalk, 4" Thick $5.00 SF 6. As Concrete Sidewalk, 7" Thick $7.25 SF 7. Concrete Sidewalk, 8" Thick $8.25 SF 8. Concrete Sidewalk, 9" Thick $9.25 SF 9. Concrete Sidewalk, 10" Thick $10.25 SF 10. Concrete Bikeway, 5" Thick $5.25 SF 11. Concrete Driveway, 5" Thick $5.50 SF 12. Concrete Driveway, 6" Thick $6.50 SF 13. Concrete Driveway, 8" Thick $8.50 SF 14. Detectable Warning Panel $12.00 SF 15. Remove Concrete Sidwalk, 4" Thick $2.25 SF 16. Remove Concrete Bikeway, 5" Thick $2.50 SF 17. Remove Concrete Driveway, 6" Thick $2.75 SF 18. Remove Concrete Driveway, 8" Thick $3.25 SF 19. Sub-Grade Preparation $10.00 SY 20. 5" Concrete Base (L-5500) $115.00 SY 21. 6" Concrete Base (L-5500) $115.50 SY 22. 7" Concrete Base (L-5500) $116.00 SY 23. 8" Concrete Base (L-5500) $119.00 SY 24. Tie Bars $5.00 EA 25. Surface Milling No Bid SY 26. 6" Concrete Pavement (L-5500) $116.00 SY 27. 7" Concrete Pavement (L-5500) $116.00 SY 28. 8" Concrete Pavement (L-5500) $117.00 SY 29. 9" Concrete Pavement (L-5500) $118.00 SY 30. 10" Concrete Pavement (L-5500) $119.00 SY 31. 24" Curb and Gutter $25.00 LF 32. Adjust Manhole to Grade $225.00 EA 33. Adjust Water Valve Box to Grade $225.00 EA 34. Remove & Reset Storm Inlet Top $500.00 LS 35. Reconstruct Storm Drain Inlet $1,500.00 EA 36. Install & Remove Curb Inlet Filters $300.00 EA 37. Parking Space Finish (Minor grading & preparing the Contractor I understand that pursuant to the Employee Classification Act a violation area between sidewalk & curb for either seed / sod $15.00 SY 38. Modular Block Retaining Wall (Based on total area of the Act by a contractor is grounds for rescission of the contract by the City of Lincoln, Lancaster County, retaining wall installed) $65.00 SF 39. Dowel Bars $5.00 EA 40. Crack Sealing $5.00 LF 41. Seeding $0.50 SF 42. Sodding $1.25 SF 1. Type "A" Sawing - Asphaltic Concrete Pavement $5.00 LF 2. Type "D" Sawing - Asphaltic Concrete Pavement $6.00 LF 3. Miscellaneous Asphalt and Xxxxxxx-Xxxxxxxxx County Public Building Commission. I understand that pursuant to the Act any contractor who knowingly provides a false affidavit may be subject to criminal penalties and upon a second or subsequent violation shall be barred from contracting with the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission for a period of three years after the date of discovery of the falsehood. I hereby affirm and swear that the statements and information provided on this affidavit are true, complete and accurate. The undersigned person does hereby agree and represent that he or she is legally capable to sign this affidavit and to lawfully bind the Contractor to this affidavit. PRINT NAME: ____________________________________ (First, Middle, Last) SIGNATURE: ____________________________________ TITLE: ____________________________________ State of Nebraska ) ) ss. County of ) This affidavit was signed and sworn to before me, the undersigned Notary Public, on this ____ day of , 20__. _____________________ Notary PublicConcrete Removal $90.00 CY

Owner Default. Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract or to perform and complete or comply with the other terms thereof. § 77-1323 Every person, partnership, limited liability company, association, or corporation furnishing labor or material in the repair, alteration, improvement, erection, or construction of any public improvement shall furnish a certified statement to be attached to the contract that all equipment to be used on the project, except that acquired since the assessment date, has been assessed for taxation for the current year, giving the county where assessed. Pursuant to Neb. Rev. Stat. § 77-1323, I, , do hereby certify that all equipment to be used on Bid No. 2322-056263, except that equipment acquired since the assessment date, has been assessed for taxation for the current year, in County, Nebraska. DATED this day of , 2023. By: Title: STATE OF NEBRASKA ) COUNTY OF ) On , 2023, before me, the undersigned Notary Public duly commissioned for and qualified in said County, personally came , to me known to be the identical person, whose name is affixed to the foregoing instrument and acknowledged the execution thereof to be his voluntary act and deed. Witness my hand and notarial seal the day and year last above written. For the purposes of complying with THE NEBRASKA EMPLOYEE CLASSIFICATION ACT, Nebraska Revised Statutes 48-2901 to 48-2912 and City of Lincoln Executive Order 083319, I, , herein below known as the Contractor, state under oath and swear as follows: 1. Each individual performing services for the Contractor is properly classified under the Employee Classification Act. 2. The Contractor has completed a federal I-9 immigration form and has such form on file for each employee performing services. 3. The Contractor has complied with Neb Rev Stat 4-114. 4. The Contractor has no reasonable basis to believe that any individual performing services for the Contractor is an undocumented worker. 5. The Contractor is not barred from contracting with the state or any political subdivision pursuant to NRS 48-2912 of this Act. 6. As the Contractor I understand that pursuant to the Employee Classification Act a violation of the Act by a contractor is grounds for rescission of the contract by the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission. I understand that pursuant to the Act any contractor who knowingly provides a false affidavit may be subject to criminal penalties and upon a second or subsequent violation shall be barred from contracting with the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission for a period of three years after the date of discovery of the falsehood. I hereby affirm and swear that the statements and information provided on this affidavit are true, complete and accurate. The undersigned person does hereby agree and represent that he or she is legally capable to sign this affidavit and to lawfully bind the Contractor to this affidavit. PRINT NAME: ____________________________________ (First, Middle, Last) SIGNATURE: ____________________________________ TITLE: ____________________________________ State of Nebraska ) ) ss. County of ) This affidavit was signed and sworn to before me, the undersigned Notary Public, on this ____ day of , 20__. _____________________ Notary PublicPublic Number: 22-263 Title: Roofing Services - Unit Price Type: Notice to Bidders Issue Date: 11/21/2022 Deadline: 12/14/2022 12:00 PM (CT) Notes: Unit Price Contracts are established to provide quick access to prequalified Contractors who perform smaller construction jobs and other services which fall into a category that allows for a set labor and material cost with markup. Contact: Xxxxxx Xxxxxxx, Assistant Purchasing Agent Address: Purchasing\City & County 000 X. 0xx Xx. Lincoln, NE 68508 Phone: 0 (000) 000-0000 Email: xxxxxxxx@xxxxxxx.xx.xxx Contact: Xxxxxx Xxxxxxxx Address: 000 Xxx Xxxx Xx. STE 1 Lincoln, NE 68522 Phone: (000) 000-0000 Fax: (000) 000-0000 Email: xxxxxx@xxxxxxxxxxxxxxxxxx.xxx Web Address: xxx.xxxxxxxxxxxxxxxxxx.xxx By submitting your response, you certify that you are authorized to represent and bind your company. I acknowledge reading, understanding and agree to the Instructions to Bidders. Yes (Yes)

Owner Default. Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract or to perform and complete or comply with the other terms thereof. § 77-1323 Every person, partnership, limited liability company, association, or corporation furnishing labor or material in the repair, alteration, improvement, erection, or construction of any public improvement shall furnish a certified statement to be attached to the contract that all equipment to be used on the project, except that acquired since the assessment date, has been assessed for taxation for the current year, giving the county where assessed. Pursuant to Neb. Rev. Stat. § 77-1323, I, , do hereby certify that all equipment to be used on Bid No. 23-056055, except that equipment acquired since the assessment date, has been assessed for taxation for the current year, in County, Nebraska. DATED this day of , 2023. By: Title: STATE OF NEBRASKA ) COUNTY OF ) On , 2023, before me, the undersigned Notary Public duly commissioned for and qualified in said County, personally came , to me known to be the identical person, whose name is affixed to the foregoing instrument and acknowledged the execution thereof to be his voluntary act and deed. Witness my hand and notarial seal the day and year last above written. For the purposes of complying with THE NEBRASKA EMPLOYEE CLASSIFICATION ACTNumber: 23-055 Title: Electrical and Large-Scale Electrical Services - Unit Price Type: Notice to Bidders Issue Date: 2/2/2023 Deadline: 2/17/2023 02:00 PM (CT) Notes: Contact: Xxxxxx Xxxxxxx, Nebraska Revised Statutes 48-2901 to 48-2912 and City of Lincoln Executive Order 083319, I, , herein below known as the Contractor, state under oath and swear as follows: 1Asst. Each individual performing services for the Contractor is properly classified under the Employee Classification Act. 2Purchasing Agent Address: Purchasing Suite 200 Purchasing 000 X. 0xx Xx. The Contractor has completed a federal I-9 immigration form and has such form on file for each employee performing services. 3. The Contractor has complied with Neb Rev Stat 4-114. 4. The Contractor has no reasonable basis to believe that any individual performing services for the Contractor is an undocumented worker. 5. The Contractor is not barred from contracting with the state or any political subdivision pursuant to NRS 48-2912 of this Act. 6. As the Contractor I understand that pursuant to the Employee Classification Act a violation of the Act by a contractor is grounds for rescission of the contract by the City of Lincoln, Lancaster County, and XxxxxxxNE 68508 Phone: (000) 000-Xxxxxxxxx County Public Building Commission0000 Email: xxxxxxxx@xxxxxxx.xx.xxx Contact: Xxxxxxx Xxxxx Address: 0000 X. 00xx Xx. I understand that pursuant to the Act any contractor who knowingly provides a false affidavit may be subject to criminal penalties and upon a second or subsequent violation shall be barred from contracting with the City of Lincoln, Lancaster CountyNE 68507 Phone: (000) 000-0000 Fax: (000) 000-0000 Email: xxxxxx@xxxxxxxxxxxxxxxxxxxx.xxx Web Address: xxx.xxxxxxxxxxxxxxxxxxxx.xxx By submitting your response, you certify that you are authorized to represent and Xxxxxxx-Xxxxxxxxx County Public Building Commission for a period of three years after bind your company. CECM - Labor Rates 2023 I acknowledge reading and understanding the date of discovery of the falsehoodInstructions to Bidders. I hereby affirm and swear that the statements and information provided on this affidavit are true, complete and accurate. The undersigned person does hereby agree and represent that he or she is legally capable to sign this affidavit and to lawfully bind the Contractor to this affidavit. PRINT NAME: ____________________________________ Yes (First, Middle, Last) SIGNATURE: ____________________________________ TITLE: ____________________________________ State of Nebraska ) ) ss. County of ) This affidavit was signed and sworn to before me, the undersigned Notary Public, on this ____ day of , 20__. _____________________ Notary PublicYes)

Owner Default. Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract or to perform and complete or comply with the other terms thereof. § 77-1323 Every person, partnership, limited liability company, association, or corporation furnishing labor or material in the repair, alteration, improvement, erection, or construction of any public improvement shall furnish a certified statement to be attached to the contract that all equipment to be used on the project, except that acquired since the assessment date, has been assessed for taxation for the current year, giving the county where assessed. Pursuant to Neb. Rev. Stat. § 77-1323, I, , do hereby certify that all equipment to be used on Bid No. 23-056, except that equipment acquired since the assessment date, has been assessed for taxation for the current year, in County, Nebraska. DATED this day of , 2023. By: Title: STATE OF NEBRASKA ) COUNTY OF ) On , 2023, before me, the undersigned Notary Public duly commissioned for and qualified in said County, personally came , to me known to be the identical person, whose name is affixed to the foregoing instrument and acknowledged the execution thereof to be his voluntary act and deed. Witness my hand and notarial seal the day and year last above written. For the purposes of complying with THE NEBRASKA EMPLOYEE CLASSIFICATION ACT, Nebraska Revised Statutes 48-2901 to 48-2912 and City of Lincoln Executive Order 083319, I, , herein below known as the Contractor, state under oath and swear as follows: 1. Each individual performing services for the Contractor is properly classified under the Employee Classification Act. 2. The Contractor has completed a federal I-9 immigration form and has such form on file for each employee performing services. 3. The Contractor has complied with Neb Rev Stat 4-114. 4. The Contractor has no reasonable basis to believe that any individual performing services for the Contractor is an undocumented worker. 5. The Contractor is not barred from contracting with the state or any political subdivision pursuant to NRS 48-2912 of this Act. 6. As the Contractor I understand that pursuant to the Employee Classification Act a violation of the Act by a contractor is grounds for rescission of the contract by the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission. I understand that pursuant to the Act any contractor who knowingly provides a false affidavit may be subject to criminal penalties and upon a second or subsequent violation shall be barred from contracting with the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission for a period of three years after the date of discovery of the falsehood. I hereby affirm and swear that the statements and information provided on this affidavit are true, complete and accurate. The undersigned person does hereby agree and represent that he or she is legally capable to sign this affidavit and to lawfully bind the Contractor to this affidavit. PRINT NAME: ____________________________________ (First, Middle, Last) SIGNATURE: ____________________________________ TITLE: ____________________________________ State of Nebraska ) ) ss. County of ) This affidavit was signed and sworn to before me, the undersigned Notary Public, on this ____ day of , 20__. _____________________ Notary PublicPublic Number: 23-056 Addendum 1 Title: Plumbing - Unit Price Type: Notice to Bidders Issue Date: 2/6/2023 Deadline: 2/17/2023 02:00 PM (CT) Notes: Contact: Xxxxxx Xxxxxx Address: Purchasing\City & County 000 X. 0xx Xx. Email: xxxxxxx@xxxxxxx.xx.xxx Contact: Xxx Xxxxxx Address: 0000 X 000xx Xxxxxx. Email: xxxxxxx@xxxxxxxxxxxxxxx.xxx Web Address: xxx.xxxxxxxxxxxxxx.xxx By submitting your response, you certify that you are authorized to represent and bind your company. Proposal Letter References Attestation Form Plumbing unit price. quick question, line 6, 7, and 8 where it says manufacturer, what do you want in that line? For supplies we don't use the same company every time, same with rental places. A) We are asking a set percentage here. This will be a markup rate of these items and/or services regardless of where they are purchased and what is purchased. All other terms, conditions, and requirements of the request remain the same as originally indicated in the document or as modified on previous addenda. Xxxxxx Xxxxxx Asst. Purchasing Agent Yes (Yes)

Owner Default. Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract or to perform and complete or comply with the other terms thereof. § 77-1323 Every person, partnership, limited liability company, association, or corporation furnishing labor or material in the repair, alteration, improvement, erection, or construction of any public improvement shall furnish a certified statement to be attached to the contract that all equipment to be used on the project, except that acquired since the assessment date, has been assessed for taxation for the current year, giving the county where assessed. Pursuant to Neb. Rev. Stat. § 77-1323, I, , do hereby certify that all equipment to be used on Bid No. 23-056023, except that equipment acquired since the assessment date, has been assessed for taxation for the current year, in County, Nebraska. DATED this day of , 2023. By: Title: STATE OF NEBRASKA ) COUNTY OF ) On , 2023, before me, the undersigned Notary Public duly commissioned for and qualified in said County, personally came , to me known to be the identical person, whose name is affixed to the foregoing instrument and acknowledged the execution thereof to be his voluntary act and deed. Witness my hand and notarial seal the day and year last above written. For the purposes of complying with THE NEBRASKA EMPLOYEE CLASSIFICATION ACTNumber: 23-023 Title: Unit Price - Demolition Services Type: Notice to Bidders Issue Date: 1/13/2023 Deadline: 1/27/2023 02:00 PM (CT) Notes: Contact: Xxxxxx X. Xxxxxx Asst Purchasing Agent Address: Purchasing Suite 200 Purchasing 000 X. 0xx Xx. Lincoln, Nebraska Revised Statutes 48NE 68508 Phone: (000) 000-2901 0000 Fax: (000) 000-0000 Email: Xxxxxxxxxx@xxxxxxx.xx.xxx Contact: Xxxxx Xxxx Address: 00000 X 000xx. Ct. Bennet, NE 68516 Phone: (000) 000-0000 Fax: (000) 000-0000 Email: xxxxx@xxxxxxxxxxxxxxxx.xxx By submitting your response, you certify that you are authorized to 48-2912 represent and City of Lincoln Executive Order 083319, I, , herein below known as the Contractor, state under oath and swear as follows: 1bind your company. Each individual performing services for the Contractor is properly classified under the Employee Classification Act. 2. The Contractor has completed a federal I-9 immigration form and has such form on file for each employee performing services. 3. The Contractor has complied with Neb Rev Stat 4-114. 4. The Contractor has no reasonable basis to believe that any individual performing services for the Contractor is an undocumented worker. 5. The Contractor is not barred from contracting with the state or any political subdivision pursuant to NRS 48-2912 of this Act. 6. As the Contractor I understand that pursuant to the Employee Classification Act a violation Affidavit I acknowledge reading and understanding the Instructions to Bidders. Yes (Yes) Yes (Yes) Insurance Certificate and required endorsements are required at time of contract execution by awarded vendor. Vendor agrees to provide insurance coverage and comply with each provision listed in the Insurance Requirements form, including the submission of the Act by a contractor is grounds for rescission Certificate of XXXXX and the contract by the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commissionapplicable endorsements. I understand that pursuant to acknowledge reading and understanding the Act any contractor who knowingly provides a false affidavit may be subject to criminal penalties and upon a second or subsequent violation shall be barred from contracting with the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission for a period of three years after the date of discovery of the falsehoodspecifications. I hereby affirm and swear that the statements and information provided on this affidavit are true, complete and accurate. The undersigned person does hereby agree and represent that he or she is legally capable to sign this affidavit and to lawfully bind the Contractor to this affidavit. PRINT NAME: ____________________________________ Yes (First, Middle, Last) SIGNATURE: ____________________________________ TITLE: ____________________________________ State of Nebraska ) ) ss. County of ) This affidavit was signed and sworn to before me, the undersigned Notary Public, on this ____ day of , 20__. _____________________ Notary PublicYes)

Owner Default. Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract or to perform and complete or comply with the other terms thereof. § 77-1323 Every person, partnership, limited liability company, association, or corporation furnishing labor or material in the repair, alteration, improvement, erection, or construction of any public improvement shall furnish a certified statement to be attached to the contract that all equipment to be used on the project, except that acquired since the assessment date, has been assessed for taxation for the current year, giving the county where assessed. Pursuant to Neb. Rev. Stat. § 77-1323, I, , do hereby certify that all equipment to be used on Bid No. 23-056025, except that equipment acquired since the assessment date, has been assessed for taxation for the current year, in County, Nebraska. DATED this day of , 2023. By: Title: STATE OF NEBRASKA ) COUNTY OF ) On , 2023, before me, the undersigned Notary Public duly commissioned for and qualified in said County, personally came , to me known to be the identical person, whose name is affixed to the foregoing instrument and acknowledged the execution thereof to be his voluntary act and deed. Witness my hand and notarial seal the day and year last above written. For the purposes of complying with THE NEBRASKA EMPLOYEE CLASSIFICATION ACT, Nebraska Revised Statutes 48-2901 to 48-2912 and City of Lincoln Executive Order 083319, I, , herein below known as the Contractor, state under oath and swear as follows: 1. Each individual performing services for the Contractor is properly classified under the Employee Classification Act. 2. The Contractor has completed a federal I-9 immigration form and has such form on file for each employee performing services. 3. The Contractor has complied with Neb Rev Stat 4-114. 4. The Contractor has no reasonable basis to believe that any individual performing services for the Contractor is an undocumented worker. 5. The Contractor is not barred from contracting with the state or any political subdivision pursuant to NRS 48-2912 of this Act. 6. As the Contractor I understand that pursuant to the Employee Classification Act a violation of the Act by a contractor is grounds for rescission of the contract by the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission. I understand that pursuant to the Act any contractor who knowingly provides a false affidavit may be subject to criminal penalties and upon a second or subsequent violation shall be barred from contracting with the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission for a period of three years after the date of discovery of the falsehood. I hereby affirm and swear that the statements and information provided on this affidavit are true, complete and accurate. The undersigned person does hereby agree and represent that he or she is legally capable to sign this affidavit and to lawfully bind the Contractor to this affidavit. PRINT NAME: ____________________________________ (First, Middle, Last) SIGNATURE: ____________________________________ TITLE: ____________________________________ State of Nebraska ) ) ss. County of ) This affidavit was signed and sworn to before me, the undersigned Notary Public, on this ____ day of , 20__. _____________________ Notary PublicPublic Number: 23-025 Title: Unit Price - HVAC Services Type: Notice to Bidders Issue Date: 1/13/2023 Deadline: 1/27/2023 02:00 PM (CT) Notes: Contact: Xxxxxx X. Xxxxxx Asst Purchasing Agent Address: Purchasing Suite 200 Purchasing 000 X. 0xx Xx. Lincoln, NE 68508 Phone: (000) 000-0000 Fax: (000) 000-0000 Email: Xxxxxxxxxx@xxxxxxx.xx.xxx Contact: Xxx Xxxxxx Address: 0000 X 000xx Xxxxxx. Email: xxxxxxx@xxxxxxxxxxxxxxx.xxx Web Address: xxx.xxxxxxxxxxxxxx.xxx By submitting your response, you certify that you are authorized to represent and bind your company. Signed Attestation Form Proposal for 23-025 (Unit Price - HVAC Services) I acknowledge reading and understanding the Instructions to Bidders. Yes (Yes) Yes (Yes) Insurance Certificate and required endorsements are required at time of contract execution by awarded vendor. Vendor agrees to provide insurance coverage and comply with each provision listed in the Insurance Requirements form, including the submission of the Certificate of XXXXX and the applicable endorsements. I acknowledge reading and understanding the specifications. Yes (Yes)

Owner Default. Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract or to perform and complete or comply with the other terms thereof. § 77-1323 Every person, partnership, limited liability company, association, or corporation furnishing labor or material in the repair, alteration, improvement, erection, or construction of any public improvement shall furnish a certified statement to be attached to the contract that all equipment to be used on the project, except that acquired since the assessment date, has been assessed for taxation for the current year, giving the county where assessed. Pursuant to Neb. Rev. Stat. § 77-1323, I, , do hereby certify that all equipment to be used on Bid No. 23-056, except that equipment acquired since the assessment date, has been assessed for taxation for the current year, in County, Nebraska. DATED this day of , 2023. By: Title: STATE OF NEBRASKA ) COUNTY OF ) On , 2023, before me, the undersigned Notary Public duly commissioned for and qualified in said County, personally came , to me known to be the identical person, whose name is affixed to the foregoing instrument and acknowledged the execution thereof to be his voluntary act and deed. Witness my hand and notarial seal the day and year last above written. For the purposes of complying with THE NEBRASKA EMPLOYEE CLASSIFICATION ACTNumber: 23-024 Title: Unit Price - General Construction Services Type: Notice to Bidders Issue Date: 1/13/2023 Deadline: 1/27/2023 02:00 PM (CT) Notes: Contact: Xxxxxx X. Xxxxxx Asst Purchasing Agent Address: Purchasing Suite 200 Purchasing 000 X. 0xx Xx. Lincoln, Nebraska Revised Statutes 48NE 68508 Phone: (000) 000-2901 0000 Fax: (000) 000-0000 Email: Xxxxxxxxxx@xxxxxxx.xx.xxx Contact: Xxxxx Xxxx Address: 00000 X 000xx. Ct. Bennet, NE 68516 Phone: (000) 000-0000 Fax: (000) 000-0000 Email: xxxxx@xxxxxxxxxxxxxxxx.xxx By submitting your response, you certify that you are authorized to 48-2912 represent and City of Lincoln Executive Order 083319, I, , herein below known as the Contractor, state under oath and swear as follows: 1bind your company. Each individual performing services for the Contractor is properly classified under the Employee Classification Act. 2. The Contractor has completed a federal I-9 immigration form and has such form on file for each employee performing services. 3. The Contractor has complied with Neb Rev Stat 4-114. 4. The Contractor has no reasonable basis to believe that any individual performing services for the Contractor is an undocumented worker. 5. The Contractor is not barred from contracting with the state or any political subdivision pursuant to NRS 48-2912 of this Act. 6. As the Contractor I understand that pursuant to the Employee Classification Act a violation Affidavit I acknowledge reading and understanding the Instructions to Bidders. Yes (Yes) Yes (Yes) Insurance Certificate and required endorsements are required at time of contract execution by awarded vendor. Vendor agrees to provide insurance coverage and comply with each provision listed in the Insurance Requirements form, including the submission of the Act by a contractor is grounds for rescission Certificate of XXXXX and the contract by the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commissionapplicable endorsements. I understand that pursuant to acknowledge reading and understanding the Act any contractor who knowingly provides a false affidavit may be subject to criminal penalties and upon a second or subsequent violation shall be barred from contracting with the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission for a period of three years after the date of discovery of the falsehoodspecifications. I hereby affirm and swear that the statements and information provided on this affidavit are true, complete and accurate. The undersigned person does hereby agree and represent that he or she is legally capable to sign this affidavit and to lawfully bind the Contractor to this affidavit. PRINT NAME: ____________________________________ Yes (First, Middle, Last) SIGNATURE: ____________________________________ TITLE: ____________________________________ State of Nebraska ) ) ss. County of ) This affidavit was signed and sworn to before me, the undersigned Notary Public, on this ____ day of , 20__. _____________________ Notary PublicYes)

Owner Default. Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract or to perform and complete or comply with the other terms thereof. § 77-1323 Every person, partnership, limited liability company, association, or corporation furnishing labor or material in the repair, alteration, improvement, erection, or construction of any public improvement shall furnish a certified statement to be attached to the contract that all equipment to be used on the project, except that acquired since the assessment date, has been assessed for taxation for the current year, giving the county where assessed. Pursuant to Neb. Rev. Stat. § 77-1323, I, , do hereby certify that all equipment to be used on Bid No. 2322-056263, except that equipment acquired since the assessment date, has been assessed for taxation for the current year, in County, Nebraska. DATED this day of , 2023. By: Title: STATE OF NEBRASKA ) COUNTY OF ) On , 2023, before me, the undersigned Notary Public duly commissioned for and qualified in said County, personally came , to me known to be the identical person, whose name is affixed to the foregoing instrument and acknowledged the execution thereof to be his voluntary act and deed. Witness my hand and notarial seal the day and year last above written. For the purposes of complying with THE NEBRASKA EMPLOYEE CLASSIFICATION ACT, Nebraska Revised Statutes 48-2901 to 48-2912 and City of Lincoln Executive Order 083319, I, , herein below known as the Contractor, state under oath and swear as follows: 1. Each individual performing services for the Contractor is properly classified under the Employee Classification Act. 2. The Contractor has completed a federal I-9 immigration form and has such form on file for each employee performing services. 3. The Contractor has complied with Neb Rev Stat 4-114. 4. The Contractor has no reasonable basis to believe that any individual performing services for the Contractor is an undocumented worker. 5. The Contractor is not barred from contracting with the state or any political subdivision pursuant to NRS 48-2912 of this Act. 6. As the Contractor I understand that pursuant to the Employee Classification Act a violation of the Act by a contractor is grounds for rescission of the contract by the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission. I understand that pursuant to the Act any contractor who knowingly provides a false affidavit may be subject to criminal penalties and upon a second or subsequent violation shall be barred from contracting with the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission for a period of three years after the date of discovery of the falsehood. I hereby affirm and swear that the statements and information provided on this affidavit are true, complete and accurate. The undersigned person does hereby agree and represent that he or she is legally capable to sign this affidavit and to lawfully bind the Contractor to this affidavit. PRINT NAME: ____________________________________ (First, Middle, Last) SIGNATURE: ____________________________________ TITLE: ____________________________________ State of Nebraska ) ) ss. County of ) This affidavit was signed and sworn to before me, the undersigned Notary Public, on this ____ day of , 20__. _____________________ Notary PublicPublic Number: 22-263 Title: Roofing Services - Unit Price Type: Notice to Bidders Issue Date: 11/21/2022 Deadline: 12/14/2022 12:00 PM (CT) Notes: Unit Price Contracts are established to provide quick access to prequalified Contractors who perform smaller construction jobs and other services which fall into a category that allows for a set labor and material cost with markup. Contact: Xxxxxx Xxxxxxx, Assistant Purchasing Agent Address: Purchasing\City & County 000 X. 0xx Xx. Lincoln, NE 68508 Phone: 0 (000) 000-0000 Email: xxxxxxxx@xxxxxxx.xx.xxx Contact: Xxxxxx Xxxxxxx Address: 0000 Xxxx xx Lincoln, NE 68502 Phone: (000) 000-0000 Fax: (000) 000-0000 Email: xxxxxx@xxxxxxxxxxxxxx.xxx By submitting your response, you certify that you are authorized to represent and bind your company. I acknowledge reading, understanding and agree to the Instructions to Bidders. Yes (Yes)

Owner Default. Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract or to perform and complete or comply with the other terms thereof. § 77-1323 Every person, partnership, limited liability company, association, or corporation furnishing labor or material in the repair, alteration, improvement, erection, or construction of any public improvement shall furnish a certified statement to be attached to the contract that all equipment to be used on the project, except that acquired since the assessment date, has been assessed for taxation for the current year, giving the county where assessed. Pursuant to Neb. Rev. Stat. § 77-1323, I, , do hereby certify that all equipment to be used on Bid No. 23-056025, except that equipment acquired since the assessment date, has been assessed for taxation for the current year, in County, Nebraska. DATED this day of , 2023. By: Title: STATE OF NEBRASKA ) COUNTY OF ) On , 2023, before me, the undersigned Notary Public duly commissioned for and qualified in said County, personally came , to me known to be the identical person, whose name is affixed to the foregoing instrument and acknowledged the execution thereof to be his voluntary act and deed. Witness my hand and notarial seal the day and year last above written. For the purposes of complying with THE NEBRASKA EMPLOYEE CLASSIFICATION ACT, Nebraska Revised Statutes 48-2901 to 48-2912 and City of Lincoln Executive Order 083319, I, , herein below known as the Contractor, state under oath and swear as follows: 1. Each individual performing services for the Contractor is properly classified under the Employee Classification Act. 2. The Contractor has completed a federal I-9 immigration form and has such form on file for each employee performing services. 3. The Contractor has complied with Neb Rev Stat 4-114. 4. The Contractor has no reasonable basis to believe that any individual performing services for the Contractor is an undocumented worker. 5. The Contractor is not barred from contracting with the state or any political subdivision pursuant to NRS 48-2912 of this Act. 6. As the Contractor I understand that pursuant to the Employee Classification Act a violation of the Act by a contractor is grounds for rescission of the contract by the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission. I understand that pursuant to the Act any contractor who knowingly provides a false affidavit may be subject to criminal penalties and upon a second or subsequent violation shall be barred from contracting with the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission for a period of three years after the date of discovery of the falsehood. I hereby affirm and swear that the statements and information provided on this affidavit are true, complete and accurate. The undersigned person does hereby agree and represent that he or she is legally capable to sign this affidavit and to lawfully bind the Contractor to this affidavit. PRINT NAME: ____________________________________ (First, Middle, Last) SIGNATURE: ____________________________________ TITLE: ____________________________________ State of Nebraska ) ) ss. County of ) This affidavit was signed and sworn to before me, the undersigned Notary Public, on this ____ day of , 20__. _____________________ Notary PublicPublic Number: 23-025 Title: Unit Price - HVAC Services Type: Notice to Bidders Issue Date: 1/13/2023 Deadline: 1/27/2023 02:00 PM (CT) Notes: Contact: Xxxxxx X. Xxxxxx Asst Purchasing Agent Address: Purchasing Suite 200 Purchasing 000 X. 0xx Xx. Lincoln, NE 68508 Phone: (000) 000-0000 Fax: (000) 000-0000 Email: Xxxxxxxxxx@xxxxxxx.xx.xxx Contact: Xxxxx Xxxxxx Address: 0000 X 000xx Xx Xxxxx, XX 00000 Phone: (000) 000-0000 Fax: (000) 000-0000 Email: xxxxx.xxxxxx@xxx.xxx Web Address: xxx.xxxxxxxxxxxxxxx.xxx By submitting your response, you certify that you are authorized to represent and bind your company. Please contact Xxxx Xxxxxxxxxxxxx-Xxxxx Xxxxxx is no longer at JCI branch. Xxxx is point of contact for city I acknowledge reading and understanding the Instructions to Bidders. Yes (Yes) Yes (Yes) Insurance Certificate and required endorsements are required at time of contract execution by awarded vendor. Vendor agrees to provide insurance coverage and comply with each provision listed in the Insurance Requirements form, including the submission of the Certificate of ACORD and the applicable endorsements. I acknowledge reading and understanding the specifications. Yes (Yes)

Owner Default. Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract or to perform and complete or comply with the other terms thereof. § 77-1323 Every person, partnership, limited liability company, association, or corporation furnishing labor or material in the repair, alteration, improvement, erection, or construction of any public improvement shall furnish a certified statement to be attached to the contract that all equipment to be used on the project, except that acquired since the assessment date, has been assessed for taxation for the current year, giving the county where assessed. Pursuant to Neb. Rev. Stat. § 77-1323, I, , do hereby certify that all equipment to be used on Bid No. 23-056031, except that equipment acquired since the assessment date, has been assessed for taxation for the current year, in County, Nebraska. DATED this day of , 2023. By: Title: STATE OF NEBRASKA ) COUNTY OF ) On , 2023, before me, the undersigned Notary Public duly commissioned for and qualified in said County, personally came , to me known to be the identical person, whose name is affixed to the foregoing instrument and acknowledged the execution thereof to be his voluntary act and deed. Witness my hand and notarial seal the day and year last above written. For the purposes of complying with THE NEBRASKA EMPLOYEE CLASSIFICATION ACTNumber: 23-031 Title: Unit Price - Excavating, Nebraska Revised Statutes 48Grading and Dozing Services Type: Notice to Bidders Issue Date: 1/18/2023 Deadline: 2/1/2023 02:00 PM (CT) Contact: Xxxxxx Xxxxxx, Asst. Purchasing Agent Address: Suite 200 Purchasing 000 X. 0xx Xx. Email: xxxxxxx@xxxxxxx.xx.xxx Contact: Xxxxx Xxxx Address: 00000 X 000xx. Ct. Bennet, NE 68516 Phone: (000) 000-2901 0000 Fax: (000) 000-0000 Email: xxxxx@xxxxxxxxxxxxxxxx.xxx By submitting your response, you certify that you are authorized to 48-2912 represent and City of Lincoln Executive Order 083319, I, , herein below known as the Contractor, state under oath and swear as follows: 1bind your company. Each individual performing services for the Contractor is properly classified under the Employee Classification Act. 2. The Contractor has completed a federal I-9 immigration form and has such form on file for each employee performing services. 3. The Contractor has complied with Neb Rev Stat 4-114. 4. The Contractor has no reasonable basis to believe that any individual performing services for the Contractor is an undocumented worker. 5. The Contractor is not barred from contracting with the state or any political subdivision pursuant to NRS 48-2912 of this Act. 6. As the Contractor I understand that pursuant to the Employee Classification Act a violation Affidavit I acknowledge reading and understanding the Instructions to Bidders. Yes (Yes) Yes (Yes) Insurance Certificate and required endorsements are required at time of contract execution by awarded vendor. Vendor agrees to provide insurance coverage and comply with each provision listed in the Insurance Requirements form, including the submission of the Act by a contractor is grounds for rescission Certificate of ACORD and the contract by the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commissionapplicable endorsements. I understand that pursuant to acknowledge reading and understanding the Act any contractor who knowingly provides a false affidavit may be subject to criminal penalties and upon a second or subsequent violation shall be barred from contracting with the City of Lincoln, Lancaster County, and Xxxxxxx-Xxxxxxxxx County Public Building Commission for a period of three years after the date of discovery of the falsehoodspecifications. I hereby affirm and swear that the statements and information provided on this affidavit are true, complete and accurate. The undersigned person does hereby agree and represent that he or she is legally capable to sign this affidavit and to lawfully bind the Contractor to this affidavit. PRINT NAME: ____________________________________ Yes (First, Middle, Last) SIGNATURE: ____________________________________ TITLE: ____________________________________ State of Nebraska ) ) ss. County of ) This affidavit was signed and sworn to before me, the undersigned Notary Public, on this ____ day of , 20__. _____________________ Notary PublicYes)