1-Attachment A – Purchasing Forms to be downloaded, filled out and submitted with bid.pdf

AFFIDAVIT

STATE OF ______________________ )

) SS.

COUNTY OF ____________________ )

_________________________________of the city of ________________________________ County of ____________________ State of __________________being duly sworn on her or his oath, deposes and says;

1. That I am the _________________________ (Title of Affiant) of __________________________________(Name of Bidder) and have been authorized by said Bidder to make this Affidavit upon my best information and belief, after reasonable inquiry as to the representations herein.

2. No Officer, Agent or Employee of Jackson County, Missouri is financially interested directly or indirectly what Bidder is offering to sell to the County pursuant to this Invitation (though no representation is made regarding potential ownership of publicly traded stock of bidder).

3. If Bidder were awarded any contract, job, work or service for Jackson County, Missouri, no Officer, Agent or Employee of the

County would be interested in or receive any benefit from the profit or emolument of such.

4. Either Bidder is duly listed and assessed on the tax rolls of Jackson County, Missouri and is not delinquent in the payment of any taxes due to the County or Bidder did not have on December 31, 2025, any property subject to taxation by the County and if bidder is duly listed and assessed on the tax rolls of Jackson County, Missouri, bidder agrees to permit an audit of its records, if requested by the Jackson County Director of Assessment, as they relate to the assessment of Business Personal Property.

5. Bidder has not participated in collusion or committed any act in restraint of trade, directly or indirectly, which bears upon anyone's response or lack of response to the Invitation.

6. Bidder certifies and warrants that Bidder or Bidder's firm/organization is not listed on the General Services Administration's Report of Debarred and/or Suspended Parties.

7. Bidder certifies and affirms its enrollment and participation in a federal work authorization program with respect to the employees working in connection with the contracted services.

8. Bidder certifies and affirms that it does not knowingly employ any person who is an unauthorized alien in connection with the contracted services.

_______________________________ (Name of Bidder)

By: ____________________________ (Signature of Affiant)

_______________________________ (Title of Affiant)

Subscribed and sworn to before me this ______ day of _________________, 20____

NOTARY PUBLIC in and for the County of _______________________________(SEAL)

State of _____________________________

My Commission Expires: ______________________________________________

OFFICE OF THE COUNTY AUDITOR

COMPLIANCE REVIEW OFFICE

415 E 12TH STREET, 2ND FLOOR

KANSAS CITY, MISSOURI 64106

(816) 881-3302

FAX (816) 881-3340

COMPLIANCE@JACKSONGOV.ORG

WWW.JACKSONGOV.ORG/AUDITOR

CERTIFICATE OF COMPLIANCE INSTRUCTIONS:

All vendors doing business with Jackson County are required to obtain a Certificate of Compliance issued by the Jackson County Compliance Review Office.

A Certificate of Compliance is required to be submitted with any bid response.

Failure to comply with this requirement may result in the REJECTION of a bid.

Vendors may complete a

Certificate of Compliance Application by visiting https://www.jacksongov.org/Government/Departments/Com pliance-Review-Office/Certificate-of-Compliance

A Certificate of Compliance will certify that vendors meet the following requirements:

1. Are duly listed and assessed on the tax rolls of Jackson County and are not delinquent in the payment of any taxes due to the County, or do not have on December 31st of the previous year any property subject to taxation by Jackson

County.

2. Attest and agree to Chapter 6 of the Jackson County Code which prohibits discriminatory practices and promotes Equal Employment Opportunity by contractors doing business with Jackson County.

Certificate of Compliance Application must be submitted five (5) business days prior to a bid response deadline to allow sufficient time to process. A Certificate of

Compliance is not guaranteed if this timeline is not met.

QUESTIONS? Email compliance@jacksongov.org mailto:COMPLIANCE@JACKSONGOV.ORG http://www.jacksongov.org/AUDITOR https://www.jacksongov.org/Government/Departments/Compliance-Review-Office/Certificate-of-Compliance https://www.jacksongov.org/Government/Departments/Compliance-Review-Office/Certificate-of-Compliance mailto:compliance@jacksongov.org

STATEMENT OF CONTRACTOR'S QUALIFICATIONS

(Complete in full, Use attachments if necessary)

Name of Bidder:

Address with Zip Code:

Federal Tax I.D. Number:

Check One: Corporation Partnership Sole Proprietorship If SOLE PROPRIETORSHIP, state name, address, and phone number of owner:

If CORPORATION:

Date of Incorporation:

Name of State(s) in which incorporated:

President's Name:

Vice-President's Name:

Secretary's Name:

Treasurer's Name:

If PARTNERSHIP:

Is the Partnership: General Limited Association (Check one)

Date of Organization:

Name and addresses of all partners:

1.

2.

3.

GENERAL INFORMATION:

Percent of work to be done under the proposed contract by your own staff:

No. of Permanent Employees:

Geographical Limits of Operation:

No. of years in business:

Have you ever done business under a different name: Yes No (Check one) If Yes, give Name and Location:

Has contractor ever withdrawn or defaulted on a contractual obligation: Yes No (Check one) If Yes, state where and why:

STATEMENT OF CONTRACTOR'S QUALIFICATIONS - Continued

Has Contractor ever been sued for breach of any contract? Yes No (Check one) If Yes, Explain:

List Completed Contracts within the Past Three Years, Including Amount of Each:

List of Current Contracts, Including Amount of Each:

Customer Reference (state name, address, and phone number):

List each subcontractor you plan to use if awarded the contract. If no, so state.

SUBCONTRACTOR'S NAME & PHONE

ITEM OF WORK $ AMOUNT OF CONTRACT MBE/WBE

State any other relevant information concerning Contractor's history, credentials, responsibility, and capabilities (If none, so state):

DBE STATUS Indicate status claimed:

1. Minority Owned Business (MBE) YES____ NO____

African American____ Latino____ Native American____ Asian____ Pacific Islander____

2. Woman Owned Business (WBE) YES____ NO____

3. Small Business YES____ NO____

For consideration as an MBE, WBE or Small Business, a copy of any governmental entity or Minority Supplier Council certification must be attached.

Prepared by (print or type):

Title:

Signature:

Date:

ACKNOWLEDGMENT OF RECEIPT OF ADDENDA

We acknowledge the receipt of Addenda No(s) ______________ for this ITB. We understand that additional addenda may be issued up until the Question Response Deadline of April 28, 2026 and we will be responsible for checking the Bonfire Portal regularly for any new addenda issued.

Signature of Respondent Date

Company Name

Address

City, State, and Zip Phone

Bidder: ________________ Jackson County, Missouri Invitation to Bid No. 26-022

BIDDER’S QUOTATION SHEET

No. Description Estimated Yearly Quantity

Unit Price Manufacture & Package Unit Bid

Paper Products 01 Georgia Pacific #89480 enMotion

High Capacity Roll Towel, Brown, 800’ 6 Rolls/Case No Alternates or Comparables

270 Cases $

02 Georgia Pacific #23504 Envision Singlefold Paper Towels, Brown, 250/Pkg, 16 Pkgs/Case No Alternates or Comparables

50 Cases $

03 Georgia Pacific #26301 Envision High Capacity Roll Paper Towel, Brown, 800’ 6 Rolls/Case No Alternates or Comparables

1535 Cases $

04 Georgia Pacific #19378 Compact Coreless High Capacity 2-Ply Bathroom Tissue, 1,500 Sheets per Roll, 18 Rolls/Case No Alternates or Comparables

420 Cases $

05 Roses Southwest Papers #8863942156 2-Ply Toilet Paper, 96 Rolls/Case

1200 Cases $

06 Atlas Green Heritage #235 Recycled 2-Ply Toilet Tissue, 96 Rolls/Case

1078 Cases $

07 Hospeco HOS HG-5000 Health Gards Toilet Seat Cover, 250/Pkg, 20 Pkgs/Case

20 Cases $

08 Windsoft WIN 2360 2-Ply Facial Tissue, 12 Boxes/Case

100 Cases $

09 Novex® Multifold Recycled Towels

MANUFACTURERS ITEM #J6200

9.125" x 9.5", Kraft, 4000/cs

2080 Cases $

10 Novex® Magnolia 2-Ply Bath Tissue

MANUFACTURERS ITEM #J4000

96/cs

2080 Cases $

11 Tork, H5 Peak Serve Advanced Continuous Hand Towel, 7.91in x 8.85in, 1 ply, White pkg 12, 410 sheets

50 Cases $

Soap and Detergents

Bidder: ________________ Jackson County, Missouri Invitation to Bid No. 26-022

No. Description Estimated Yearly Quantity

Unit Price Manufacture & Package Unit Bid

12 Georgia Pacific #42711 enMotion Foam Soap W/Moisterizers 1200 ml each, 2 Each/Case No Alternates or Comparables

205 Cases $

13 Dial #8103 Foam Antibacterial Soap, 800 ml each, 8 Each/Case

200 Cases $

14 Dial #00184 Antibacterial Bar Soap, .64 oz/bar, 1000 Bars/Case

462 Cases $

15 Gojo #9656-06 Purell Hand Sanitizer, 800 ml/each, 8 Each/Case

250 Cases $

16 Kimberly Clark #KCC91298 Skin Cleanser W/PCMX, Antibacterial, 800 ml refill

2 Cases $

17 Premium Hand Cleanser – Soluble @ 75 degrees F for kitchen use

2 Cases $

18 Boardwalk® Mild Cleansing Pink Lotion Hand Soap Refill, Cherry Scent MANUFACTURERS ITEM #BWK410 4/cs

52 Cases $

19 Sunburst Solid Green 78 Glass & Neutral Cleaner - 2.5 lb.

MANUFACTURERS ITEM #1122S1

1560 Count $

20 Sunburst Revolution Odor Destroyer – Summer Fruit – 2.5 lb.

MANUFACTURERS ITEM # 1541S1

1560 Count $

21 Betco® PUSH All Purpose Cleaner and Odor Eliminator, Lemon and Sage Scent, 32 oz Bottle, MANUFACTURERS

ITEM #26071200 12/CS

26 Cases $

22 Suprox Multi-Purpose Peroxide Cleaner for use with Concentrated Dispener

10 Cases $

23 Top Clean Neutral Floor Cleaner for use with Concentrated Dispener

10 cases $

24 Window Clean for use with Concentrated Dispener

10 Cases $

25 Non-Acid Restroom Disinfectant/Cleaner for use with Concentrated Dispener

10 Cases $

Trash Can Liners 26 Berry Plastics #BER-PG63858XB, 38 x 58 Black Linear Low Density 1 Mil Can Liner, 60 Gallon Capacity

1700 Cases $

Bidder: ________________ Jackson County, Missouri Invitation to Bid No. 26-022

No. Description Estimated Yearly Quantity

Unit Price Manufacture & Package Unit Bid

100/Case 27 Jaguar Plastics #L2423L, Small Trash

Bags, Black, 24 x 23, .35 Mil Thick, 10 Gallon, 500/Case

600 Cases $

28 Liner, Can, Black, 38X58, 1.0Mil 100/Case

1560 Cases $

Gloves 29 Prime Source #75006220X Hands

Off, Vinyl Gloves, Latex Free, All Sizes, 100/Box, 8 Boxes/Case

500 Cases $

30 Kleenguard G-10 Powder-Free Latex Gloves, Beaded Cuff, Texturized Fingertips, 9.5” Length,

6.7 mils thick, Sizes Medium – Extra Large 100/Box

75 Cases $

31 AMBITEX Nitrile Gloves, Blk, 4 Mil – Small, MANUFACTURES ITEM

#N4201BLK

520 Cases $

32 AMBITEX Nitrile Gloves, Blk, 4 Mil – Medium, MANUFACTURES ITEM

#N4201BLK

520 Cases $

33 AMBITEX Nitrile Gloves, Blk, 4 Mil – Large, MANUFACTURES ITEM

#N4201BLK

520 Cases $

34 AMBITEX Nitrile Gloves, Blk, 4 Mil – X- Large, MANUFACTURES ITEM

#N4201BLK

520 Cases $

35 AMBITEX Nitrile Gloves, Blk, 4 Mil – 2X- Large, MANUFACTURES ITEM

#N4201BLK

520 Cases $

Brooms/Mops/Brushes/Pads/ Sponges

36 Talco #280128 Yellow Cellulose Sponge, Small, 6.25” L x 3.375” W x 1” H, 48/Case

800 Cases $

37 Zephyr #13524 Cotton Dustmop Head, 5 x 24” 6/Case

150 Cases $

38 Unisan #2016C Cotton Dustmop Head, #16 Cotton, 12/Case

700 Cases $

39 Premiere Pads #196 Medium Duty Scour Pad, 9” Length x 6” Width, Green, 20/Box

500 Cases $

Bidder: ________________ Jackson County, Missouri Invitation to Bid No. 26-022

No. Description Estimated Yearly Quantity

Unit Price Manufacture & Package Unit Bid

40 Unisan #636, Handle, 60”, Fiberglass, Black, Sold Individually

200 Each $

41 Impact Plastics #84, Handle, Plastic Speed Change, Orange, 64” Long, Sold Individually

200 Each $

42 Microfiber Cloth 12x12, 250 g wt.

package of 12 various colors

24 Cases $

43 Round Floor Pads – Black – 20” dia. 25 Cases $ 44 Round Floor Pad – Red – 20” dia. 25 Cases $ 45 Round Floor Pads – White – 20” dia. 25 Cases $ Floor Care 46 Johnson Diversey #5116002 Floor

Science Floor Stripper, Gallon Bottle, 4/Case

6 Cases $

47 Johnson Diversey #98391 Floor Science Finisher, Gallon Bottle, 4/Case

6 Cases $

Personal Hygiene Products 48 Oraline #4199 Toothpaste, Clear

Tube, 3.0 Oz/Tube 76 Tubes/Case No Alternates or Comparables

132 Cases $

49 Oraline #9002 Toothbrush, Clear, Anti-Shank, 76/Case No Alternates or Comparables

150 Cases $

50 Oraline #6002 Deodorant, Clear,

2.2 Oz/Each, 76/Case

No Alternates or Comparables

200 Cases $

51 Oraline #6001 Shampoo, Clear, 4.0 oz/Each, 76/Case No Alternates or Comparables

200 Cases $

52 Oraline #0012 Razors, 1 Blade, Anti- Shank, 100/Box, 10 Boxes/Case No Alternates or Comparables

100 Cases $

53 Hospeco #MT40 Sanitary Napkins, Maxithins, #4, 250/Case

200 Cases $

Disinfectants

Bidder: ________________ Jackson County, Missouri Invitation to Bid No. 26-022

No. Description Estimated Yearly Quantity

Unit Price Manufacture & Package Unit Bid

54 Diversey #2902593 Cleaner, All Purpose, Whistle 32 oz Bottle, 12/Case

2 Cases $

55 Dymon #23332 Liquid Alive, 32 oz Bottles, 12/Case

112 Cases $

56 3M #70-0711-6225-2 HB Quat Disinfectant Clnr. Cone, 25L, Twist N Fill

88 Cases $

57 Lysol #REC 04650 Disinfectant Spray, Original Scent, 19 oz Aerosol Can, 12/Case

2 Cases $

58 3M #70071592045 3M Glass Cleaner Concentrate, 1L, Twist N Fill, 6/Case

64 Cases $

59 Chicopee #8507 Wet Wipe, Chix Competitive Pink, 200/Case

116 Cases $

60 King #CLIP PERC Clippercide, Aerosol, 12 oz/can, 12/Case

5 Cases $

61 Clorox #35306 Cleaner/Degreaser, 409, 32 oz/bottle, 12/Case

26 Cases $

62 Citrus-Kleen #NCL-1095-29 Non- Butyl Cleaner Degreaser, 1 Gallon, 4/Case

25 Cases $

63 Sodium Hypochlorite 5.25% Chlorine Bleach used for sanitation (kitchen)

52 Cases $

64 Quaternary Ammonia Sanitizer – Soluble at 75 degrees F – Second Rinse-Auto-Chlor Sanitizing Solution

18 Cases $

65 Sunburst Bio Clean Neutral pH Detergent/Disinfectant -4.5 lb

MANUFACTURERS ITEM #5000S1

1560 Count $

66 Professional LYSOL® Brand Disinfectant Spray, Original Scent, 19 oz Aerosol Spray, MANUFACTURERS ITEM

#36241-04650 12/CS

26 Cases $

67 Spray Nine® Heavy Duty Cleaner/Degreaser/Disinfectant, Citrus Scent, 32 oz, Trigger Spray Bottle

MANUFACTURERS ITEM #26832 12/CS

75 Cases $

Bidder: ________________ Jackson County, Missouri Invitation to Bid No. 26-022

No. Description Estimated Yearly Quantity

Unit Price Manufacture & Package Unit Bid

68 Diversey™ Oxivir TB One-Step Disinfectant Cleaner, 32 oz Bottle, MANUFACTURERS ITEM # 4277285

12/CS

52 Cases $

Miscellaneous 69 Gamco Tank type soap dispenser

MANUFACTURERS ITEM #G16A

25 Each $

70 Torx Peak Serv Paper Towel Dispenser

– Mini

25 Each $

71 Krystal EHTS72MAN Eco-Fresh Hang Tags, Mango, 12 Each/Case

50 Cases $

72 Hospital Specialty Metered Aerosol Can, Assorted Scents, Delivers up to 3,400 metered sprays, 12 Cans/Case

2 Cases $

73 Karcher, BVL5/1 BP, 15", Backpack Vacuum

3 Each $

74 Karcher, Chariot™ 2 iScrub 20 Deluxe, pad driver, 36V/130 Ah batteries, 21A automatic charger, 20", Disc, Stand-On Floor Scrubber

3 Each $

75 Karcher, AP 100/50 M Multi-Surface Cleaning Machine

3 Each $

Bidder: ________________ Jackson County, Missouri Invitation to Bid No. 26-022

CATALOG DISCOUNTS

No. Description % Discount Offered 76 Paper Products % 77 Trash Bags and Plastic Items % 78 Cleaners, Deodorizers and Aerosols % 79 Floor Care Items % 80 Personal Hygiene % 81 Miscellaneous Supplies % 82 Miscellaneous Equipment %

SIGNATURE:

DATE:

NAME:

PHONE:

TITLE:

MOBILE:

EMAIL ADDRESS:

COMPANY NAME:

EXHIBIT F

BIDDER'S EXCEPTIONS

TO

SPECIFICATIONS

OF

JACKSON COUNTY, MISSOURI INVITATION TO BID NO. 26-022

Janitorial Supplies

Bidder’s attention is directed to Paragraph 4 of the General Conditions of this Invitation to Bid.

Read This Paragraph Carefully.

The following exceptions to the Specifications of Invitation to Bid for No. 26-022 are requested by the undersigned Bidder:

(Use additional pages as necessary.)

REFERENCE

PARA # & PAGE #

EXCEPTION REQUESTED

Name of Firm:

Signature of Bidder: (required)