The Hickman County Finance Office will be accepting bids for a "Epoxy Floor Coating." This bid
will be system wide for all schools. This bid will be from June 1, 2026 - May 31, 2027.
All bidders must attach:
A conflict-of-interest disclosure form can be obtained at
https://ww.hickmank12.org/requestforproposal.
Iran Divestment Act Certification
Non-Boycott of Israel Certification
Background Acknowledgement Form
TN business license
A 1-million-dollar liability insurance certificate
Workers compensation insurance
Per TCA 49-5-406, all bidders' employees working on school properties must comply with all
local, state, and federal laws.
Sealed bids must be mailed or hand-delivered to the Hickman County Finance Office, 114 North
Central Avenue, Suite 203, Centerville, TN 37033, and clearly marked on the outside of the
envelope "Epoxy Floor Coating."
Bids will be opened on May 13, 2026, at 11:00 a.m. in the Finance Office.
The Hickman County Board of Education reserves the right to accept or reject any and all bids or
parts of the bids and to waive any informalities that would prevent the acceptance of a better
bid.
Complete the bid on B (specs) and submit your bid on those forms.
Specifications can be found at https://ww.hickmank12.org/requestforproposal. Or by calling
391-729-3391 Ext 3.
Present Penny Rochille
2 Bids Ree'd
Must weems
Garage Floor Coating of Nashville LLC
BJB Construction Company Inc.
BA
APR 22 2026
ACORD®
DATE (MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE
4/27/2026
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
CONTACT
PRODUCER
NAME:
David Michael Wiatr
PHONE
BNA Insurance Group LLC
(A/C, No, Ext):
(615) 431-1262
(A/C, FAX No): (615) 468-4712
E-MAIL
9045 Carothers Pkwy
ADDRESS:
frontdesk@bnainsurancegroup.com
Ste 301
INSURER(S) AFFORDING COVERAGE
-NAIC #
Franklin
TN 37067
INSURER A: WILSON MUT INS CO
19950
INSURED
INSURER B : HANOVER AMER INS CO
36064
GARAGE FLOOR COATING OF NASHVILLE LLC
INSURER C :
2913 CHERRYBARK CT
INSURER D:
INSURER E:
HERMITAGE
TN 37076
INSURER F:
COVERAGES
CERTIFICATE NUMBER:
REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
ADDLISUBR
POLICY EFF
POLICY EXP
LTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
(MM/DD/YYYY)
(MM/DD/YYYY)
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
1,000,000
DAMAGE TO RENTED
CLAIMS-MADE
OCCUR
PREMISES (Ea occurrence)
$
100,000
MED EXP (Any one person)
$
5,000
A
5000274758
07/18/2025
07/18/2026
PERSONAL & ADV INJURY
$
1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$
2,000,000
PRO-
POLICY
JECT
LOC
PRODUCTS - COMP/OP AGG
$
2,000,000
$
OTHER:
COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY
$
(Ea accident)
1,000,000
ANY AUTO
BODILY INJURY (Per person)
$
OWNED
SCHEDULED
A
AUTOS ONLY
5000274758
07/18/2025
07/18/2026
BODILY INJURY (Per accident)
$
AUTOS
HIRED
NON-OWNED
PROPERTY DAMAGE
$
AUTOS ONLY
AUTOS ONLY
(Per accident)
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
EXCESS LIAB
CLAIMS-MADE
AGGREGATE
$
DED
RETENTION $
$
WORKERS COMPENSATION
PER
OTH-
STATUTE
ER
AND EMPLOYERS' LIABILITY
Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
EL EACH ACCIDENT
$
1,000,000
B
OFFICER/MEMBER EXCLUDED?
N
N/A
WZ5H689899
07/18/2025
07/18/2026
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE
$
1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Hickman County Schools
ACCORDANCE WITH THE POLICY PROVISIONS.
Hickman County Finance Office
AUTHORIZED REPRESENTATIVE
114 North Central Avenue, Suite 203
David Michael Wish
Centerville TN 37033
© 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03)
The ACORD name and logo are registered marks of ACORD
The
Hanover
Insurance Group-
WORKERS COMPENSATION AND EMPLOYER'S LIABILITY INSURANCE POLICY
31
EXTENSION OF INFORMATION PAGE
RENEWAL OF W25-H689899-03
CARRIER CODE NO. 30937
Policy Number
Policy Period
Coverage is Provided in the
Agency Code
From
To
WZ5-H689899-04
07/18/2025
07/18/2026
THE HANOVER AMERICAN INSURANCE COMPANY
1802610
ITEM 1. Named Insured and Address
Agent
Telephone: 615-431-1262
GARAGE FLOOR COATING OF NASHVI
BNA INSURANCE GROUP, LLC
2913 CHERRYBARK CT
9045 CAROTHERS PKWY #301
HERMITAGE, TN 37076
FRANKLIN, TN 37067
Federal ID No.
POLICY
**ADDITIONAL LOCATIONS **
SCHEDULE
PAGE 2
PAGE 1
LOCATION
ADDRESS
NUMBER
001
2913 CHERRYBARK CT
HERMITAGE, TN
37076
Form 331-0226 (9-03)
WC000001B
Date Issued: 05/14/2025
ORIGINAL/INSURED
Payment Type: ELECTRONIC EXCHANGE
WCDEC1
NASHVILLE AND DAVIDSON COUNTY BUSINESS
Davidson County Clerk's Office
TAX LICENSE
700 Second Avenue South, Suite 101
P.O. Box 196333
BUSINESS NUMBER
214695
Nashville, Tennessee 37219-6333
RECEIPT NUMBER
1054019
615-862-6254
GOVERNMEN
THIS LICENSE EXPIRES
05/15/2027
OWNER(S)/OFFICER(S)
PHRUCE DAVIES
*
KURT MILLER
AO
COLLETTO
BUSINESS LOCATION ADDRESS
GARAGE FLOOR COATING OF NASHVILLE
2913 CHERRYBARK CT
GARAGE FLOOR COATING OF NASHVILLITYLE ESEVIALE
3241 THOROUGHBRED DR
HERMITAGE, TN 37076
DAVIDSON
HERMITAGE, TN 37076
AND
MUST DISPLAY IN A CONSPICUOUS PLACE
Contact Metro Codes to verify this location is properly
zoned.
BUSINESS NUMBER
214695
RECEIPT NUMBER
1054019
CLASSIFICATION
3
TAX PERIOD
FROM
01/01/2025
TO
12/31/2025
THIS LICENSE EXPIRES 05/15/2027
ISSUE DATE
04/17/2026
Brenda Wynn
BRENDA WYNN, COUNTY CLERK
A ROBERSON
DEPUTY CLERK
NASHVILLE AND DAVIDSON COUNTY BUSINESS
Davidson County Clerk's Office
TAX LICENSE
700 Second Avenue South, Suite 101
P.O. Box 196333
BUSINESS NUMBER
214695
Nashville, Tennessee 37219-6333
RECEIPT NUMBER
0902519
615-862-6254
SECURITY
THIS LICENSE EXPIRES
05/15/2026
OWNER(S)/OFFICER(S)
BRUCE DAVIES
KURT MILLER
BUSINESS LOCATION ADDRESS
GARAGE FLOOR COATING OF NASHVILLE, LLC
GARAGE FLOOR COATING OF NASHVILLE
2913 CHERRYBARK CT
SERVICE
3241 THOROUGHBRED DR
HERMITAGE, TN 37076
DAVIDSON
HERMITAGE, TN 37076
AND
MUST DISPLAY IN A CONSPICUOUS PLACE
Contact Metro Codes to verify this location is properly
zoned.
BUSINESS NUMBER
214695
CITY
COUNTY
RECEIPT NUMBER
0902519
TOTAL GROSS SALES
CLASSIFICATION
3
LESS DEDUCTIONS
BUSINESS TAX DUE
TAX PERIOD
(LESS CREDITS)
FROM
STARTED
MINIMUM TAX
TO
07/24/2019
PENALTY
INTEREST
NEW LICENSE FEE
15.00
THIS LICENSE EXPIRES 05/15/2026
TOTAL TAX DUE
15.00
ISSUE DATE
09/18/2025
ORIGINAL ISSUE DATE
07/24/2019
ORIGINAL ISSUE USER
RMEYER
COMBINED TOTAL
15.00
Brenda Wynn
BRENDA WYNN, COUNTY CLERK
TL DANDRIDGE
DEPUTY CLERK
STANDARD BUSINESS TAX LICENSE
TOTAL DUE
$15.00
USER
RMEYER
CHECK
$30.00
STATION
WK208
CHECK NO.
103
DRAWER
267
CHANGE
$15.00
SITE
1
WORK DATE
07/24/2019
Specifications Part B
Epoxy Floor Coating
Scope:
Prep floors so there is no debris before application.
Apply 2 coats of two-component high solids, moisture-mitigating,
industrial epoxy floor coating.
The epoxy coating should be low odor and zero VOC.
Add full-chip media of customer's choosing from the supplier's
selection.
Apply 2 coats of a two-component polyaspartic-polyurea clear coat
providing a high gloss finish to a 5.0 mils dry film thickness per coat.
All labor and materials to complete this work shall be included in the
bid.
BID
All bid amounts should be quoted per square foot.
1. Bid per square foot of less than 1,000 square foot.
$5.75
2. Bid per square foot of 1,000 - 3,000 square feet.
$5.25
3. Bid per square foot greater than 3,000 square feet.
$5.00
Submitted By:
Name of Organization
Garage Floor Coating of Nashville, LLC
Submitted by (Name)
Bruce Davies
Title
Managing Member
Address
2913 Cherrybark Ct.
Hermitage, TN 37076
Telephone
(615) 878-4320
Background Check Acknowledgement Form
Contractor is required to meet al TCA 49-5-406, local, state, and federal laws
regarding "workers on school properties." The Hickman County Board of
Education further requires that no prior felons, drug offenders, or sexual
registered offenders work on any school properties.
Contractors will be required to wear contractor provided identification when
on school premises. The contractor may be asked to provide proof of
background check.
Signature: Burce Dawir
Print: BRUCE DAVIES
Title: Managing Member
Date: April 27, 2026
Hickman County Government
Conflict of Interest Disclosure Form
The County Financial Management System of 1981 contains the most stringent conflict of
interest provisions. TCA $5-21-121 provides:
(a) The director, purchasing agent, members of the committee, members of the county
legislative body or other officials, employees, or members of the board of education
or highway commission shall not be financially interested or have any personal
beneficial interest, either directly or indirectly, in the purchase of any supplies,
materials, equipment or contractual services for the county.
(b) No firm, corporation, partnership, association or individual furnishing any such
supplies, materials, equipment or contractual services, shall give or offer, nor shall
the director or purchasing agent or any assistant or employee accept or receive
directly or indirectly from any person, firm, corporation, partnership or association
to whom any contract may be awarded, by rebate, gift or other otherwise, any
money or other things of value whatsoever, or any promise, obligation or contract for
future reward or compensation.
Date: April27,2026 Name: BRUCE Davie Garage Floor Coating of Nastiville, LLC
Please describe below any relationships, transactions, positions you hold (volunteer or
otherwise), or circumstances that you believe could contribute to a conflict of interest:
I have no conflict of interest to report.
I have the following conflict of interest to report (please specify any boards or
committees you (and/or your spouse) sit on, the name of your employer and any
businesses you or your spouse may own.
I hereby certify that the information set forth above is true and complete to the best of my
knowledge.
Date: April 27
Signature: Buse Davis
IRAN DIVESTMENT ACT CERTIFICATION
I understand that under the Iran Divestment Act, T.C.A. 12-12-101 - 12-12-113,
political subdivisions in Tennessee are prohibited from entering into any
procurement or contract over $1,000 with a person who engages in
investment activities in Iran. The state's chief procurement officer, as required
by T.C.A. 12-12-106, has created a list of persons who engage in investment
activities in Iran. Any person who is on the list is ineligible to contract with any
political subdivision of the State of Tennessee, and any such contract will be
considered void under T.C.A. 12-12-110. The list is published on the
Tennessee Department of General Services' website at:
https://www.tn.gov/content/dam/tn/generalservices/documents/cpo/library/c
po-library/public-information-
library/List of persons pursuant to Tenn. Code Ann. 12-12-
106 Iran Divestment Act updated with NY06-07-23.pdf
CERTIFICATION
By submission of this bid, each bidder and each person signing on behalf of
any bidder certifies, and in the case of a joint bid each party thereto certifies
as to its own organization, under penalty of perjury, that to the best of its
knowledge and belief that each bidder is not on the list created pursuant to
T.C.A 12-12-106.
Bidder Name: Garage Floor Coating of Nastiville, LLC (Brice DAVIES)
Bidder Signature; Draver Davis
Date: April 27, 2026
State of Tennessee
Non-Boycott of Israel Certification
The Bidder certifies that it is not currently engaged in and will not for the duration of the
contract engage in a boycott of Israel as defined by Tenn. Code § 12-4-119. This provision
shall not apply to contracts with a total value of less than two hundred fifty thousand
dollars ($250,000) or to contractors with less than ten (10) employees.
According to the law, a boycott of Israel means engaging in refusals to deal, terminating
business activities, or other commercial actions that are intended to limit commercial
relations with Israel, or companies doing business in or with Israel or authorized by,
licensed by, or organized under the laws of the State of Israel to do business, or persons or
entities doing business in Israel, when such actions are taken:
1. In compliance with, or adherence to, calls for a boycott of Israel, or
2. In a manner that discriminates on the basis of nationality, national origin, religion, or
other unreasonable basis, and is not based on a valid business reason. Tenn. Code
$ 12-4-119
Signature: Surce Davie
Print: BEUCE Davies
Date: April 27,
Phone/Email: 615-878-4320 garagefloorcoating. frasting agmail. cor
W-9
Request for Taxpayer
Form
Give form to the
(Rev. March 2024)
Identification Number and Certification
requester. Do not
Department of the Treasury
send to the IRS.
Internal Revenue Service
Go to www.irs.gov/FormW9 for instructions and the latest information.
Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below.
1 Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner's name on line 1. and enter the business/disregarded
entity's name on line 2.)
BJB Construction Company Inc
2 Business name/disregarded entity name, if different from above.
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Check
4 Exemptions (codes apply only to
only one of the following seven boxes.
certain entities, not individuals;
see instructions on page 3):
See Specific Instructions on page 3.
Individual/sole proprietor
C corporation
S corporation
Partnership
Trust/estate
LLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership)
Exempt payee code (if any)
Print or type.
Note: Check the "LLC" box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax
classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate
Exemption from Foreign Account Tax
box for the tax classification of its owner.
Compliance Act (FATCA) reporting
Other (see instructions)
code (if any)
3b If on line 3a you checked "Partnership" or "Trust/estate," or checked "LLC" and entered "P" as its tax classification,
(Applies to accounts maintained
and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check
outside the United States.)
this box if you have any foreign partners, owners, or beneficiaries. See instructions
5 Address (number, street, and apt. or suite no.). See instructions.
Requester's name and address (optional)
1373 Holly Tree Gap Rd
6 City, state, and ZIP code
Brentwood, TN. 37027
7 List account number(s) here (optional)
Part I Taxpayer Identification Number (TIN)
Social security number
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
-
-
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
or
TIN, later.
Employer identification number
Note: If the account is in more than one name, see the instructions for line 1. See also What Name and
Number To Give the Requester for guidelines on whose number to enter.
04 - 3777109
Part
II
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me): and
2. I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Sign
Signature of
Here
U.S. person
Debbie Benbow
Date 3/13/2026
General Instructions
New line 3b has been added to this form. A flow-through entity is
required to complete this line to indicate that it has direct or indirect
Section references are to the Internal Revenue Code unless otherwise
foreign partners, owners, or beneficiaries when it provides the Form W-9
noted.
to another flow-through entity in which it has an ownership interest. This
Future developments. For the latest information about developments
change is intended to provide a flow-through entity with information
related to Form W-9 and its instructions, such as legislation enacted
regarding the status of its indirect foreign partners, owners, or
after they were published, go to www.irs.gov/FormW9.
beneficiaries, so that it can satisfy any applicable reporting
requirements. For example, a partnership that has any indirect foreign
What's New
partners may be required to complete Schedules K-2 and K-3. See the
Partnership Instructions for Schedules K-2 and K-3 (Form 1065).
Line 3a has been modified to clarify how a disregarded entity completes
this line. An LLC that is a disregarded entity should check the
Purpose of Form
appropriate box for the tax classification of its owner. Otherwise, it
should check the "LLC" box and enter its appropriate tax classification.
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS is giving you this form because they
Cat. No. 10231X
Form W-9 (Rev. 3-2024)
State of Tennessee
14123171
BOARD FOR LICENSING ONTRACTORS
CONTRACTOR
BJB CONSTRUCTION COMPANY INC.
This is to certify that all requirements of the State of Tennessee have been met.
ID NUMBER: 61519
SEALTH OF THE STATEOF STATE OF
LIC STATUS: ACTIVE
IDV
EXPIRATION DATE: September 30, 2026
GOILEA AGRICULTURE 7
$473,240.00; BC MO IN-1313 *7796*
VIVIC
DEPARTMENT OF
COMMERCE AND INSURANCE
CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
02/12/2026
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE
OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the
terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT NAME: LISA WILSON
INSURANCE GROUP OF AMERICA LLC
SMALL BUSINESS
PHONE:
FAX: (615)905-1698
6640 CAROTHERS PKWY STE 160
E-MAIL ADDRESS: lisa.wilson@iga.biz
FRANKLIN, TN 37067
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A
Central Mutual
20230
INSURED
INSURER B
All America
20222
BJB CONSTRUCTION COMPANY INC
1373 HOLLY TREE GAP RD
INSURER C
BRENTWOOD, TN 37027
INSURER D
INSURER E
INSURER F
CERTIFICATE NUMBER
7018655
REVISION NUMBER
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE
ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF
SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
ADDL
SUBR
POLICY EFF
POLICY EXP
LTR
TYPE OF INSURANCE
INSR
WVD
POLICY NUMBER
(MM/DD/YYYY)
(MM/DD/YYYY)
LIMITS
A
GENERAL LIABILITY
Y
Y
9606838
8/8/2025
8/8/2026
EACH OCCURRENCE
$
1,000,000
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED PREMISES
$
300,000
(Ea occurrence)
CLAIMS-MADE
OCCUR
MED EXP (Any one person)
$
5,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PERSONAL & ADV INJURY
$
1,000,000
POLICY
PRO-
LOC
GENERAL AGGREGATE
$
2,000,000
JECT
PRODUCTS- COMP/OP AGG
$
2,000,000
B
AUTOMOBILE LIABILITY
Y
Y
9606837
8/8/2025
8/8/2026
COMBINED SINGLE LIMIT (Ea
$
1,000,000
accident)
ANY AUTO
BODILY INJURY (Per person)
$
ALL OWNED
SCHEDULED
BODILY INJURY (Per accident)
$
AUTOS
AUTOS
PROPERTY DAMAGE (Per
$
HIRED AUTOS
NON-OWNED
accident)
AUTOS
A
UMBRELLA LIABILITY
Y
Y
9606839
8/8/2025
8/8/2026
EACH OCCURRENCE
$
5,000,000
UMBRELLA
OCCUR
AGGREGATE
$
5,000,000
LIAB
EXCESS LIAB
CLAIMS-MADE
DED
RETENTION $
A
WORKERS COMPENSATION AND
9606841
8/8/2025
8/8/2026
WC STATUTORY LIMITS
OTHER
EMPLOYERS' LIABILITY
E.L. EACH ACCIDENT
$
1,000,000
ANY PROPRIETOR/PARTNERS/EXEC-
Y
UTIVE OFFICE/MEMBER EXCLUDED?
E.L. DISEASE- EA EMPLOYEE
$
1,000,000
(Mandatory in NH)
E.L DISEASE- POLICY LIMIT
$
1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES
Certificate Holders are additional insured per the attached endorsements.
Subject to all of the terms, conditions, exclusions and definitions of the above referenced policies as issued by the carrier(s).
Excluded proprietors, partners, executive officers, and members:
DEBBIE BENBOW
BRUCE BENBOW
CERTIFICATE HOLDER
CANCELLATION
BJB CONSTRUCTION COMPANY INC.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
1373 HOLLY TREE GAP RD
EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH
BRENTWOOD, TN 37027
THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
LISA WILSON
NATURE
BEYOND JUST BUILDERS
BJB
CONSTRUCTION COMPANY INC
BJB
1373 Holly Tree Gap Rd, Brentwood, TN. 37027
CONSTRUCTION
CONSTRUCTION
COMPANY
COMPANY
References:
1) Brent Stidham
Senior Maintenance Engineer
(Managing govt buildings in Brentwood TN)
City Of Brentwood
brent.stidham@brentwoodtn.gov
(615)533-5032
15+ Years as a customer
2) Ryan Edwards
Continuous Improvement Coordinator
Advanced Composites
Ryan.edwards@advcmp.com
(615)630-1843
15+ Years as a customer
3) Yvonne Parker
Sr. Specialist, Consumer Care National Facilities
T-Mobile
Yvonne.parker@t-mobile.com
(931)980-8867
8 Years as a customer
4) Wesley King
Service Manager
The Mathews Company
wking@themathewscompany.com
(615)394-8451
15+ Years as a customer
Office 615-457-3304
www.BJBConstruction.com
Specifications Part B
Epoxy Floor Coating
Scope:
Prep floors so there is no debris before application.
Apply 2 coats of two-component high solids, moisture-mitigating,
industrial epoxy floor coating.
The epoxy coating should be low odor and zero VOC.
Add full-chip media of customer's choosing from the supplier's
selection.
Apply 2 coats of a two-component polyaspartic-polyurea clear coat
providing a high gloss finish to a 5.0 mils dry film thickness per coat.
All labor and materials to complete this work shall be included in the
bid.
BID
All bid amounts should be quoted per square foot.
1. Bid per square foot of less than 1,000 square foot.
$20.34
2. Bid per square foot of 1,000 - 3,000 square feet.
$15.82
3. Bid per square foot greater than 3,000 square feet.
$13.56
Submitted By:
Name of Organization
BJB Construction Company Inc.
Submitted by (Name)
Nathaniel Benbow
Title
Estimator/ Principal Officer
Address
1373 Holly Tree Gap Rd, Brentwood, TN. 37027
Telephone
615-394-1411
Background Check Acknowledgement Form
Contractor is required to meet al TCA 49-5-406, local, state, and federal laws
regarding "workers on school properties." The Hickman County Board of
Education further requires that no prior felons, drug offenders, or sexual
registered offenders work on any school properties.
Contractors will be required to wear contractor provided identification when
on school premises. The contractor may be asked to provide proof of
background check.
Signature: Nathaniel Benbow
Print: Nathaniel Benbow
Title: Estimator/ Principal Officer
Date: 5/11/2026
Hickman County Government
Conflict of Interest Disclosure Form
The County Financial Management System of 1981 contains the most stringent conflict of
interest provisions. TCA $5-21-121 provides:
(a) The director, purchasing agent, members of the committee, members of the county
legislative body or other officials, employees, or members of the board of education
or highway commission shall not be financially interested or have any personal
beneficial interest, either directly or indirectly, in the purchase of any supplies,
materials, equipment or contractual services for the county.
(b) No firm, corporation, partnership, association or individual furnishing any such
supplies, materials, equipment or contractual services, shall give or offer, nor shall
the director or purchasing agent or any assistant or employee accept or receive
directly or indirectly from any person, firm, corporation, partnership or association
to whom any contract may be awarded, by rebate, gift or other otherwise, any
money or other things of value whatsoever, or any promise, obligation or contract for
future reward or compensation.
Date: 5/11/2026
Name: Nathaniel Benbow
Please describe below any relationships, transactions, positions you hold (volunteer or
otherwise), or circumstances that you believe could contribute to a conflict of interest:
I have no conflict of interest to report.
I have the following conflict of interest to report (please specify any boards or
committees you (and/or your spouse) sit on, the name of your employer and any
businesses you or your spouse may own.
I hereby certify that the information set forth above is true and complete to the best of my
knowledge.
Date: 5/11/2026
Signature: Nathaniel Benbow
IRAN DIVESTMENT ACT CERTIFICATION
I understand that under the Iran Divestment Act, T.C.A. 12-12-101 - 12-12-113,
political subdivisions in Tennessee are prohibited from entering into any
procurement or contract over $1,000 with a person who engages in
investment activities in Iran. The state's chief procurement officer, as required
by T.C.A. 12-12-106, has created a list of persons who engage in investment
activities in Iran. Any person who is on the list is ineligible to contract with any
political subdivision of the State of Tennessee, and any such contract will be
considered void under T.C.A. 12-12-110. The list is published on the
Tennessee Department of General Services' website at:
https://www.tn.gov/content/dam/tn/generalservices/documents/cpo/library/c
po-library/public-information-
library/List of persons pursuant to Tenn. Code Ann. 12-12-
106 Iran Divestment Act updated with NY06-07-23. pdf
CERTIFICATION
By submission of this bid, each bidder and each person signing on behalf of
any bidder certifies, and in the case of a joint bid each party thereto certifies
as to its own organization, under penalty of perjury, that to the best of its
knowledge and belief that each bidder is not on the list created pursuant to
T.C.A 12-12-106.
Bidder Name: Nathaniel Benbow
BJB Construction Company Inc.
Bidder Signature: Nathaniel Benbow
Date: 5/11/2026
State of Tennessee
Non-Boycott of Israel Certification
The Bidder certifies that it is not currently engaged in and will not for the duration of the
contract engage in a boycott of Israel as defined by Tenn. Code § 12-4-119. This provision
shall not apply to contracts with a total value of less than two hundred fifty thousand
dollars ($250,000) or to contractors with less than ten (10) employees.
According to the law, a boycott of Israel means engaging in refusals to deal, terminating
business activities, or other commercial actions that are intended to limit commercial
relations with Israel, or companies doing business in or with Israel or authorized by,
licensed by, or organized under the laws of the State of Israel to do business, or persons or
entities doing business in Israel, when such actions are taken:
1. In compliance with, or adherence to, calls for a boycott of Israel, or
2. In a manner that discriminates on the basis of nationality, national origin, religion, or
other unreasonable basis, and is not based on a valid business reason. Tenn. Code
§ 12-4-119
Signature: Nathaniel Benbow
Print: Nathaniel Benbow
Date: 5/11/2026
ї

## Table 1

| CONTACT NAME: David Michael Wiatr |  |
| --- | --- |
| PHONE (A/C, No, Ext): (615) 431-1262 | (A/C, FAX No): (615) 468-4712 |
| E-MAIL ADDRESS: frontdesk@bnainsurancegroup.com |  |

## Table 2

|  | INSURER(S) AFFORDING COVERAGE | -NAIC # |
| --- | --- | --- |
| INSURER A: | WILSON MUT INS CO | 19950 |
| INSURER B : | HANOVER AMER INS CO | 36064 |
| INSURER C : |  |  |
| INSURER D: |  |  |
| INSURER E: |  |  |
| INSURER F: |  |  |

## Table 3

| INSR LTR | TYPE OF INSURANCE | INSD | ADDLISUBR WVD | POLICY NUMBER | POLICY EFF (MM/DD/YYYY) | POLICY EXP (MM/DD/YYYY) |
| --- | --- | --- | --- | --- | --- | --- |
| A | [X] [X] [X] COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY JECT LOC OTHER: |  |  | 5000274758 | 07/18/2025 | 07/18/2026 |
| A | [X] AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON-OWNED AUTOS ONLY AUTOS ONLY |  |  | 5000274758 | 07/18/2025 | 07/18/2026 |
|  | UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS-MADE DED RETENTION $ |  |  |  |  |  |
| B | WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below | N/A |  | WZ5H689899 | 07/18/2025 | 07/18/2026 |
|  |  |  |  |  |  |  |

## Table 4

| LIMITS |  |
| --- | --- |
| EACH OCCURRENCE | $ 1,000,000 |
| DAMAGE TO RENTED PREMISES (Ea occurrence) | $ 100,000 |
| MED EXP (Any one person) | $ 5,000 |
| PERSONAL & ADV INJURY | $ 1,000,000 |
| GENERAL AGGREGATE | $ 2,000,000 |
| PRODUCTS - COMP/OP AGG | $ 2,000,000 |
|  | $ |
| COMBINED SINGLE LIMIT (Ea accident) | $ 1,000,000 |
| BODILY INJURY (Per person) | $ |
| BODILY INJURY (Per accident) | $ |
| PROPERTY DAMAGE (Per accident) | $ |
|  | $ |
| EACH OCCURRENCE | $ |
| AGGREGATE | $ |
|  | $ |
| [X] PER OTH- STATUTE ER |  |
| EL EACH ACCIDENT | $ 1,000,000 |
| E.L. DISEASE - EA EMPLOYEE | $ 1,000,000 |
| E.L. DISEASE - POLICY LIMIT | $ 1,000,000 |
|  |  |

## Table 5

| Policy Number | Policy Period | Coverage is Provided in the | Agency Code |
| --- | --- | --- | --- |
|  | From To |  |  |
| WZ5-H689899-04 | 07/18/2025 07/18/2026 | THE HANOVER AMERICAN INSURANCE COMPANY | 1802610 |

## Table 6

| LOCATION NUMBER | ADDRESS |
| --- | --- |
| 001 | 2913 CHERRYBARK CT HERMITAGE, TN 37076 |

## Table 7

| BUSINESS NUMBER | 214695 |
| --- | --- |
| RECEIPT NUMBER | 1054019 |
| THIS LICENSE EXPIRES | 05/15/2027 |

## Table 8

| BUSINESS NUMBER | 214695 |
| --- | --- |
| RECEIPT NUMBER | 1054019 |
| CLASSIFICATION | 3 |

## Table 9

| FROM | 01/01/2025 |
| --- | --- |
| TO | 12/31/2025 |

## Table 10

| BUSINESS NUMBER | 214695 |
| --- | --- |
| RECEIPT NUMBER | 0902519 |
| THIS LICENSE EXPIRES | 05/15/2026 |

## Table 11

|  | CITY | COUNTY |
| --- | --- | --- |
| TOTAL GROSS SALES |  |  |
| LESS DEDUCTIONS |  |  |
| BUSINESS TAX DUE (LESS CREDITS) |  |  |
| MINIMUM TAX |  |  |
| PENALTY |  |  |
| INTEREST |  |  |
| NEW LICENSE FEE |  | 15.00 |
| TOTAL TAX DUE |  | 15.00 |

## Table 12

| BUSINESS NUMBER | 214695 |
| --- | --- |
| RECEIPT NUMBER | 0902519 |
| CLASSIFICATION | 3 |

## Table 13

| FROM | STARTED |
| --- | --- |
| TO | 07/24/2019 |

## Table 14

| ISSUE DATE | 09/18/2025 |
| --- | --- |
| ORIGINAL ISSUE DATE | 07/24/2019 |
| ORIGINAL ISSUE USER | RMEYER |

## Table 15

| USER | RMEYER |
| --- | --- |
| STATION | WK208 |
| DRAWER | 267 |
| SITE | 1 |
| WORK DATE | 07/24/2019 |

## Table 16

| TOTAL DUE | $15.00 |
| --- | --- |
| CHECK | $30.00 |
| CHECK NO. | 103 |
| CHANGE | $15.00 |

## Table 17

| Name of Organization | Garage Floor Coating of Nashville, LLC |
| --- | --- |
| Submitted by (Name) | Bruce Davies |
| Title | Managing Member |
| Address | 2913 Cherrybark Ct. |
|  | Hermitage, TN 37076 |
| Telephone | (615) 878-4320 |

## Table 18

| Print: | BRUCE DAVIES |
| --- | --- |
| Title: | Managing Member |
| Date: | April 27, 2026 |

## Table 19

| Bidder Name: | Garage Floor Coating of Nastiville, LLC (Brice DAVIES) |
| --- | --- |
| Bidder Signature; | Draver Davis |
| Date: April | 27, 2026 |

## Table 20

|  | [X] 3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Check only one of the following seven boxes. Individual/sole proprietor C corporation S corporation Partnership Trust/estate | 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): |
| --- | --- | --- |
|  | LLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership) | Exempt payee code (if any) |
|  | Note: Check the "LLC" box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate box for the tax classification of its owner. Other (see instructions) | Exemption from Foreign Account Tax Compliance Act (FATCA) reporting code (if any) |
|  | 3b If on line 3a you checked "Partnership" or "Trust/estate," or checked "LLC" and entered "P" as its tax classification, and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check this box if you have any foreign partners, owners, or beneficiaries. See instructions | (Applies to accounts maintained outside the United States.) |

## Table 21

|  |  |  |
| --- | --- | --- |
|  | 5 Address (number, street, and apt. or suite no.). See instructions. | Requester's name and address (optional) |
|  | 1373 Holly Tree Gap Rd |  |
|  | 6 City, state, and ZIP code |  |
|  | Brentwood, TN. 37027 |  |
|  | 7 List account number(s) here (optional) |  |

## Table 22

| the line 1 to avoid | Social security number |
| --- | --- |
| Enter your TIN in the appropriate box. The TIN provided must match name given on backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a | - - or |
| TIN, later. | Employer identification number |
| Note: If the account is in more than one name, see the instructions for line 1. See also What Name and Number To Give the Requester for guidelines on whose number to enter. | 04 - 3777109 |

## Table 23

| Sign Here | Signature of U.S. person Debbie Benbow | Date 3/13/2026 |
| --- | --- | --- |

## Table 24

| CONTACT NAME: | LISA WILSON |
| --- | --- |
| PHONE: | FAX: (615)905-1698 |
| E-MAIL ADDRESS: | lisa.wilson@iga.biz |

## Table 25

|  |  |  |
| --- | --- | --- |
| INSURER(S) AFFORDING | COVERAGE | NAIC # |
| INSURER A | Central Mutual | 20230 |
| INSURER B | All America | 20222 |
| INSURER C |  |  |
| INSURER D |  |  |
| INSURER E |  |  |
| INSURER F |  |  |

## Table 26

| LIMITS |  |  |
| --- | --- | --- |
| EACH OCCURRENCE | $ | 1,000,000 |
| DAMAGE TO RENTED PREMISES (Ea occurrence) | $ | 300,000 |
| MED EXP (Any one person) | $ | 5,000 |
| PERSONAL & ADV INJURY | $ | 1,000,000 |
| GENERAL AGGREGATE | $ | 2,000,000 |
| PRODUCTS- COMP/OP AGG | $ | 2,000,000 |
| COMBINED SINGLE LIMIT (Ea accident) | $ | 1,000,000 |
| BODILY INJURY (Per person) | $ |  |
| BODILY INJURY (Per accident) | $ |  |
| PROPERTY DAMAGE (Per accident) | $ |  |
|  |  |  |
| EACH OCCURRENCE | $ | 5,000,000 |
| AGGREGATE | $ | 5,000,000 |
|  |  |  |
| [X] WC STATUTORY LIMITS |  | OTHER |
| E.L. EACH ACCIDENT | $ | 1,000,000 |
| E.L. DISEASE- EA EMPLOYEE | $ | 1,000,000 |
| E.L DISEASE- POLICY LIMIT | $ | 1,000,000 |

## Table 27

| INSR LTR | TYPE OF INSURANCE | ADDL INSR | SUBR WVD | POLICY NUMBER | POLICY EFF (MM/DD/YYYY) | POLICY EXP (MM/DD/YYYY) |
| --- | --- | --- | --- | --- | --- | --- |
| A | [X] [X] [X] [X] GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC JECT | Y | Y | 9606838 | 8/8/2025 | 8/8/2026 |
| B | [X] AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON-OWNED AUTOS | Y | Y | 9606837 | 8/8/2025 | 8/8/2026 |
| A | [X] [X] UMBRELLA LIABILITY UMBRELLA OCCUR LIAB EXCESS LIAB CLAIMS-MADE DED RETENTION $ | Y | Y | 9606839 | 8/8/2025 | 8/8/2026 |
| A | WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERS/EXEC- Y UTIVE OFFICE/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below |  |  | 9606841 | 8/8/2025 | 8/8/2026 |

## Table 28

| 1) | Brent Stidham Senior Maintenance Engineer (Managing govt buildings in Brentwood TN) City Of Brentwood brent.stidham@brentwoodtn.gov (615)533-5032 15+ Years as a customer |
| --- | --- |
| 2) | Ryan Edwards Continuous Improvement Coordinator Advanced Composites Ryan.edwards@advcmp.com (615)630-1843 15+ Years as a customer |
| 3) | Yvonne Parker Sr. Specialist, Consumer Care National Facilities T-Mobile Yvonne.parker@t-mobile.com (931)980-8867 8 Years as a customer |
| 4) | Wesley King Service Manager The Mathews Company wking@themathewscompany.com (615)394-8451 15+ Years as a customer |

## Table 29

| Name of Organization | BJB Construction Company Inc. |
| --- | --- |
| Submitted by (Name) | Nathaniel Benbow |
| Title | Estimator/ Principal Officer |
| Address | 1373 Holly Tree Gap Rd, Brentwood, TN. 37027 |
|  |  |
|  |  |
| Telephone | 615-394-1411 |

## Table 30

| Print: | Nathaniel Benbow |
| --- | --- |
| Title: | Estimator/ Principal Officer |
| Date: | 5/11/2026 |

## Table 31

| (a) | The director, purchasing agent, members of the committee, members of the county legislative body or other officials, employees, or members of the board of education or highway commission shall not be financially interested or have any personal beneficial interest, either directly or indirectly, in the purchase of any supplies, materials, equipment or contractual services for the county. |
| --- | --- |
| (b) | No firm, corporation, partnership, association or individual furnishing any such supplies, materials, equipment or contractual services, shall give or offer, nor shall the director or purchasing agent or any assistant or employee accept or receive directly or indirectly from any person, firm, corporation, partnership or association to whom any contract may be awarded, by rebate, gift or other otherwise, any money or other things of value whatsoever, or any promise, obligation or contract for future reward or compensation. |

## Table 32

| Print: | Nathaniel Benbow |
| --- | --- |
| Date: | 5/11/2026 |