1-Bid Forms EMW V2 (17).pdf

ATTACHMENT A

Certification Letter

(Form must be completed and returned with bid.)

I certify that I have read and understand the terms and conditions herein. I further state that I am and/or my company is capable, able to, and will provide the requested product(s) and/or service(s) described herein. I am the owner or agent of the company stated below and am authorized and empowered to contract. By my signature on this RFQ, I/we guarantee and certify that all items included in my bid meet or exceed specifications.

I certify that this bid is made without prior understanding, agreement, or connection with any corporation, firm or person submitting a bid for the same materials, supplies, equipment, or services and is in all respects fair and without collusion or fraud. I understand collusive bidding is a violation of State and Federal Law and can result in fines, prison sentences, and civil damage awards. I agree to abide by all conditions of this RFQ and certify that I am authorized to sign this bid for the Contractor.

SUBMITTED BY___________________________________ DATE _____________________

TITLE____________________________________EMAIL: ____________________________

COMPANY NAME_____________________________________________________________

ADDRESS_______________________________CITY______________ST_____ZIP________

TELEPHONE NUMBER____________________FAX NUMBER________________________

COMPANY WEBSITE _________________________________________________________

SIGNATURE _________________________________________________________________

DO YOU ACCEPT VISA? ______________

ADDITIONAL FEE IF PAYMENT MADE WITH VISA: _________________

ATTACHMENT B

Contractor Affidavit under O.C.G.A. § 13-10-91(b)(1)

By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A.

§ 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services on behalf of Bibb County School District has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-91. Furthermore, the undersigned contractor will continue to use the federal work authorization program throughout the contract period and the undersigned contractor will contract for the physical performance of services in satisfaction of such contract only with subcontractors who present an affidavit to the contractor with the information required by O.C.G.A.

§ 13-10-91(b). Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:

Federal Work Authorization User Identification Number Date of Authorization

Name of Contractor Name of Project

Name of Public Employer

I hereby declare under penalty of perjury that the foregoing is true and correct.

Executed on ______, ___, 201__ in ____________________(city), ______(state).

Signature of Authorized Officer or Agent

Printed Name and Title of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME

ON THIS THE ______ DAY OF ______________,201__.

NOTARY PUBLIC

My Commission Expires:

ATTACHMENT C

Certificate Regarding Debarment, Suspension, Ineligibility

The Bibb County School District is a recipient of Federal monies. As such we require that participating vendors not be debarred, suspended, ineligible or excluded from doing business with the Federal government or any agency thereof.

The prospective participant certifies, by submission of the bid, that neither it, nor its principals, is presently debarred, suspended, proposed for debarment, declared ineligible, or excluded from participation in this transaction by any Federal department or agency.

Organization Name

Name(s) and Title(s) of Authorized Representative(s)

Signature(s) Date

ATTACHMENT D

Non-Collusion Affidavit

Bibb County Board of Education, Macon GA 31208

I state that I am ____________________________ of ____________________________________

Title Name of Company

And that I am authorized to make this affidavit on behalf of my firm, and its owners, directors, and officers. I am the person responsible in my firm for the price(s) and the amount of this bid and I state that this bid is made in good faith.

I state that:

1. The price(s) and amounts of this bid have been arrived at independently and without consultation, communication or agreement with any other contractor, bidder, or potential bidder; neither the approximate price(s) have been disclosed nor will they be disclosed before bid opening to any other contractor, bidder or potential bidder.

2. No attempt has been made or will be made to induce any firm or person to refrain from bidding on this contract, or to submit a bid higher than this bid, or to submit any intentionally high or noncompetitive bid or other form of complimentary bid.

__________________________________________________, its affiliates, subsidiaries, officers, Name of Company

Directors and employees are not currently under investigation by any government agency and have not in the last three years been convicted or found liable for any act prohibited by State or Federal law in any jurisdiction, involving conspiracy or collusion with respect to bidding on any public contract.

I understand and my firm understands that any misstatement in this affidavit is and shall be treated as fraudulent concealment from the Bibb County Board of Education of the true facts relating to submission of bids for this contract.

Name/Date Title or Position

Signature

Attachment E

OFFEROR AFFIRMATION FORM:

Company Name: _____________________________________________________

RFI Name: _____________________________________________________ RFI Number: _____________________________________________________

After careful examination of the solicitation document in its entirety, ___________________and any addendum(s) issued, the undersigned proposes to satisfy all requirements in accordance with said documents.

For Consideration of this proposal, the undersigned hereby affirms that:

1. He/She is a duly authorized official of the offeror.

2. NO changes were made to the original RFI document,

3. The proposal is being submitted on behalf of the offeror in accordance with any terms and conditions set forth in this document.

4. The offeror will accept any awards made to it as a result of the proposal submitted here in for a minimum of one hundred and twenty (120) days following the date of submission.

5. The offeror will accept the terms and conditions set forth in the contract template attached here to.

If notified in writing by mail or delivery of the acceptance of the award, the undersigned agrees to furnish and deliver to the assigned procurement professional within five (5) days of the request, a certification of insurance indicating the coverage specified within this solicitation.

A contract shall be established which will set forth the terms of this agreement. The contract shall be interpreted, constructed, and give effect in all respects according to the laws of the State of Georgia.

Nondiscrimination in Employment: We, the supplier of goods, materials, equipment and services covered by this bid or contract, have not discriminated in the employment, in any way, against any person or person, or refused to continue the employment of any person or persons on account of their race, color, sex, religion, national origin, marital status, sexual orientation, age, or disability.

Respectfully Submitted, Company Name

Authorized Official Name Signature Title: ________________________________ Date: __________________________

E-mail Address:

The legal name of the bidder is:

PLEASE PRINT OR TYPE RESPONSE

Attachment F

CERTIFICATE OF NON-COLLUSION

By responding to this solicitation, the supplier understands and agrees to the following:

That the submitted response constitutes an offer, which when accepted in writing by the State

Entity, and subject to the terms and conditions of such acceptance, will constitute a valid and binding contract between the undersigned and the State Entity; and

That the supplier has read the specifications and requirements shown or referenced in the solicitation and that the supplier’s response is made in accordance with the provisions of such specifications and requirements except as expressly stated otherwise in the supplier’s response;

and

That the supplier guarantees and certifies that all items included in the supplier’s response meet or exceed any and all such stated specifications and requirements of the solicitation except as expressly stated otherwise in the supplier’s response; and

That, if awarded a contract, the supplier will deliver goods and/or services that meet or exceed the specifications and requirements of the solicitation except as expressly stated otherwise in the supplier’s response; and

That the response submitted by the supplier shall be valid and held open for a period of one hundred and twenty (120) days (or such other time period as identified in the solicitation) from the final solicitation closing date and that the response may be held open for an additional period of time subject to the supplier’s consent; and

That the supplier’s response is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a response for the same materials, supplies, equipment, or services and is in all respects fair and without collusion or fraud. The supplier understands and agrees that collusive bidding is a violation of state and federal law and can result in fines, prison sentences, and civil damage awards; and

That the provisions of the Official Code of Georgia Annotated, Sections 45-10-20 et seq. have not been violated and will not be violated in any respect.

DO NOT MODIFY THE BID/PROPOSAL CERTIFICATION TERMS IN ANY WAY. THIS FORM

MUST BE COMPLETED, SIGNED AND SUBMITTED WITH YOUR RESPONSE.

Contractor’s Full Legal Name:

(PLEASE TYPE OR PRINT)

Authorized Signature:

Printed Name and Title of Person

Signing:

Date:

Company Address:

FAX Number:

Email Address:

*This table must be completed in its entirety by the supplier.