1_-_ConsultantQuestionnaire-Federal.docx

City of Seattle Consultant Questionnaire Consultant’s Name: ______________________________________________________________

City of Seattle Consultant Questionnaire—Federal Aid Contracts Please have an officer or person eligible to represent the Consultant firm fill out and sign this form. Submittal of this Questionnaire with your proposal is an attestation that the information in this Questionnaire and within your submittal documents are true and valid. Provide prompt notice to the City if, at any time prior to contract award, any facts need to be corrected.

INSTRUCTIONS: This is a mandatory form. Submit this form with your response. Provide information to the extent this information is available. If your response is incomplete or requires further description, the City may request additional information within a specified deadline or may determine the missing information is immaterial.

Consultant Information

Consultant Billing Contact Person: Identify the person who will prepare and manage your invoices. This helps the City contract manager offer instructions that ensure your invoices are promptly paid. Be aware that any subconsultants must be paid within 30 days of invoice, regardless of City payment to prime.

Consultant Registration with City of Seattle

Verify your firm is registered into the City’s Online Business Directory (OBD) System and that your Taxpayer ID number and WMBE status are accurate. For help, call 206-684-727-8677.

http://www2.ci.seattle.wa.us/Consultantregistration/default.asp Yes |_| No|_|

Ownership

Does your firm comply – to the extent required - with the following City of Seattle Labor Standards requirements from Seattle Municipal Code Title 14:

1) City Paid and Sick Time labor standards, providing paid sick and safe time to eligible employees? Most employers must provide employees who have work hours in Seattle, with accrued paid sick and safe time. Payment of prevailing wages does not ensure compliance (SMC 14.16).

2) Minimum Wage labor standards which set wages for employees working within city limits (SMC 14.19).

3) Wage Theft labor standards which establish basic requirements for payment of wages and tips for employees working within city limits, including providing various payment documentation to employees (SMC 14.20).

If “No” please provide an explanation of the circumstances. The City may audit payroll records or interview workers to ensure compliance. For more information regarding these requirements, see Municipal Code Title 14 or http://www.seattle.gov/laborstandards, or call the Office of Labor Standards at 206.256.5297.

Has your firm ever been found by the City or any government agency, to have underpaid your workers or employees (this includes instances where you may have provided the restitution to make the worker whole)?

Does your product or service comply – to the extent required – with the Americans with Disabilities Act (ADA), as amended (42 U.S.C. Sec. 12101 et seq.) or Section 504 of the Rehabilitation Act of 1973 (Rehabilitation Act) as amended, (29 U.S.C § 701 et .seq.); the Washington Law Against Discrimination, (Wash. Rev. Code Ann. § 49.60), as amended and the most current Web Content Accessibility Guidelines?

Has your firm received complaints from any customer, employee, or end user that your firm’s software, product, or service is not compliant with the ADA, the Rehabilitation Act, the Washington Law Against Discrimination, or the most current Web Content Accessibility Guidelines within the last 2 years?

Disputes Specify yes or no.

Fair Chance Employment Ordinance Compliance. Criminal convictions alone are not a basis for rejecting a proposal or individual. The City may consider whether a conviction has material nexus to contract risks, and whether adjustments to work or assignments should be pursued accordingly. If background checks are needed for individuals who will perform work such as field crews, the City reserves the right to require such background checks. See Seattle Municipal Code Chapter 14.17 or policies at http://www.seattle.gov/laborstandards

Specify yes or no.

Within the past 24 months has your firm or any of its owners, principals, or officers been convicted of a felony criminal violation under any federal law? (Note: if the Consultant’s response is “yes”, the City, as Recipient, is required to refer the matter to FHWA for review if the Consultant is under consideration of contract award.)

Within the past ten years, has any owner, principal, or officer who will perform any of the work for the City been convicted of a crime?

Consultant certifies that to the best of its knowledge and belief and except as otherwise disclosed, he or she does not have any organizational conflict of interest which is defined as a situation in which the nature of work to be performed under this proposed contract and the bidder's organizational, financial, contractual, or other interests may, without some restriction on future activities: (a) Result in an unfair competitive advantage to the Consultant; or, (b) Impair the Consultant's objectivity in performing the contract work.

Consultant complies with SMC 2.04.601 (I-122) which reads “The measure would limit election campaign contributions from entities receiving City contracts totaling $250,000 or more, or from persons spending $5,000 or more for lobbying; require 24-hour reporting of electronic contributions; require paid signature gatherer identification, limit lobbying by former City officials; create a voluntary program for public campaign financing through $100 vouchers issued to registered voters funded by ten years of additional property taxes, with $3,000,000 (approximately $0.0194/$1000 assessed value) collected in 2016.

Provide and/or attach a list contracts your local firm held in the past five years, with sufficient detail for the City to understand the depth and breadth of your experience, with a particular emphasis on contracts with public agencies. The City may use this to assess your capability and experience at this particular type of product provision or service work. Specify the name/contact that can serve as a reference for each.

· If you have many such contracts, simply list.

· If you are a subsidiary of a national firm, summarize contracts for your local office.

Proposal Expiration

Consultant understands that Offers are valid until the City awards a Consultant Contract or rejects all offers

By signing below the Consultant certifies that its responses contained herein are accurate to the best of its knowledge.

Print Name and Title of Signor

Signature of Authorized Representative of Consultant:

City Non Disclosure Request

If you believe any statements or items you submit to the City as part of this bid/response are exempt from disclosure under the Washington Public Records Act, RCW Chapter 42.56, you must identify and list them below and provide the City with a copy of your bid/response with those portions redacted. Should the City receive a public records request for your bid/response, the City will first release the redacted version of the proposal to the requester. Requesters may accept the redacted proposal or decide to challenge all or some of the exemptions applied by the Consultant. If the requestor challenges the exemptions, the City provides you with notice and up to ten days to seek an injunction to prevent the release of the challenged portion of the record. This notice is a courtesy and not a legal obligation. Only records properly listed on this form and redacted will be protected and withheld for notice. All other records will be considered fully disclosable upon request.

The City will not withhold information or provide notice simply because your document is marked with a document header or footer, page stamp, or a generic statement that a document is non-disclosable, exempt, confidential, proprietary, or protected. You must very clearly and specifically identify each statement or item and the corresponding RCW exemption that applies. You may not identify the entire page, unless the entire page is within the exemption scope.

|_| I do not request any information be withheld.

|_| I request the following specific information be withheld. I understand that all other information will be considered public information. For each statement or item you intend to withhold, you must fill out every box below. You should not require an entire page withheld; only request the specific portion subject to the exemption.

Document Page:

Specify the page number on which the material is located within your submittal package Statement:

Repeat the text you request to be held as confidential, or attach a redacted version.

RCW Exemption:

Specify the RCW exemption including the subheading

For this request to be valid, you must specify the RCW provision or other State or Federal law that designates the documents as exempt from disclosure. Please refer to Chapter 42.56 of the Revised Code of Washington for the exemptions.

Equal Benefits Compliance Declaration (contracts > $49,000) Please declare one (1) option from the list below that describes the Contractor’s intent to comply with Seattle Municipal Code Chapter 20.45 should you win the contract.

Equal Benefits applies to any contractor location in the United States where substantive contract work is being performed (work directly related in a substantial way to the contract scope and deliverables).

|_| Option A The Contractor makes, or intends to make by the contract award date, all benefits available on an equal basis to its employees with spouses and its employees with domestic partners, and to the spouses and the domestic partners of employees, in every location within the United States where substantial work on contract will be performed.

|_| Option B The Contractor does not make benefits available to either the spouses or the domestic partners of its employees.

|_| Option C The Contractor has no employees.

|_| Option D Collective Bargaining Delay. Benefits are available on an equal basis to non-union workers, but union workers are subject to a collective bargaining agreement that does not provide equal benefits.

|_| Option E Open Enrollment Delay. The first open enrollment period for implementing Equal Benefits is not available until after contract execution and Contractor will provide a cash equivalent payment to eligible employees until Equal Benefits can be implemented.

|_| Option F Cash Equivalent Payment. The Contractor intends to provide a cash equivalent payment to eligible employees in lieu of making benefits available.

|_| No United States Presence The Contractor does not perform substantial work for the contract in any United State location.

|_| Non-Compliant The Contractor does not comply and does not intend to comply, and refuses all options provided above.

Equal Benefits Instructions Seattle Municipal Code Chapter 20.45 (SMC 20.45) requires companies executing a City contract to provide health and benefits that are the same or equivalent to domestic partners of employees as to spouses of employees, and of their dependents and family members.

1. Carefully fill out the Equal Benefits Declaration. It is essential to your standing in the evaluation process, so it is important to understand and complete the declaration properly.

2. The Buyer or Coordinator for the solicitation can answer any questions about this requirement or you may call the general office at 206-684-0444. Call before you submit your bid to ensure you’ve filled out the form correctly.

3. "Domestic Partner" is any person who is party to a same-sex or opposite-sex domestic partnership that is legally recognized in the place of jurisdiction where the union was established, including same-sex marriage, or registered as a Domestic Partner with the employer or government registry established by state or local law. If the employer does not have a registration system and does not intend to implement one, the City of Seattle has a registration system as an option: http://www.seattle.gov/leg/clerk/dpr.htm The City will review your responses and make a final determination. If the information you supply is conflicting or not clearly supported by the documentation that the City receives, the City may reject your entire submittal (bid or proposal) or may seek clarification to ensure the City properly classifies your compliance.

Companies that select “Non-Compliant” will be rejected, unless there is no competitor that is compliant, responsive and responsible. The City may also find a Bidder “Non-Compliant” upon inspection of their program. Be prepared with documentation to support your declaration. All contracts awarded by the City may be audited for equal benefits compliance. Non-compliance may result in the rejection of a bid or proposal, or termination of the contract.

FAS Revised 9/18/2023