1._Offeror_Information_&_Certifications.docx

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Attached to
RFP 18-807-26 | National Air Toxics Trends Station (NATTS) Sample Analysis
Solicitation number
RFP 18-807-26 | National Air Toxics Trends Station (NATTS) Sample Analysis
Issued by
Fairbanks North Star Borough, Alaska

About this file

This document is a Submittal Form A - Offeror Information form for a state solicitation, likely for the State of Alaska, involving a specific Request for Proposal (TRFP). The document requires potential contractors to provide comprehensive company and team information, including critical team member details, contact information, and acknowledgment of contract amendments. Offerors must disclose any potential conflicts of interest and are required to identify federal requirements applicable to the proposal.

The form includes sections for Alaska Bidder Preference Certification and requires a signature from a company officer authorized to bind the company. Key compliance elements include listing critical team members who cannot be replaced without written approval, acknowledging all contract amendments, and transparently disclosing any conflicts of interest that might impact the proposal's objectivity. The document suggests a rigorous evaluation process with potential disqualification for incomplete or non-compliant submissions, emphasizing the importance of thorough and accurate proposal preparation.

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SUBMITTAL FORM A – Offeror Information

PROJECT INFORMATION

TRFP Number:

Project Name:

OFFEROR INFORMATION

Company Name:

Address:

Tax ID:

Alaska Business License Number:

CONTACT INFORMATION

Provide contact information for the individual who can be contacted for clarification regarding this proposal:

Name:

Title:

Address:

Email:

Telephone:

CRITICAL TEAM MEMBERS

Provide the names of all critical team members that will be assigned to this contract. Note: These individuals cannot be removed or replaced from this project, or their positions, unless approved in writing the project director or procurement officer.

Name of Position 1

Name of Position 2

Name of Position 3

Name of Position 4

ADDENDA ACKNOWLEDGEMENT

The offeror acknowledges receipt of the following amendments and has incorporated the requirements of such amendments into their proposal. Failure to identify and sign for all amendments may subject the offeror to disqualification. The offeror must list all amendments (by number), then initial and date to confirm that you have received and incorporated them into your proposal (add more rows as necessary).

Number
Initials & Date
Number
Initials & Date
Number
Initials & Date

CONFLICT OF INTEREST STATEMENT

Indicate below whether or not the firm or any individuals that will work on the contract have a possible conflict of interest (e.g., currently employed by the State of Alaska or formerly employed by the State of Alaska within the past two years) and, if so, the nature of that conflict. The procurement officer reserves the right to consider a proposal non-responsive and reject it or cancel the award if any interest disclosed from any source could either give the appearance of a conflict or cause speculation as to the objectivity of services to be provided by the offeror.

Does the offeror, or any individuals who will work on this contract, have a possible conflict of interest?
□ Yes □ No

* Failure to answer may be grounds for disqualification.

If “Yes,” please provide additional information regarding the nature of that conflict:

FEDERAL REQUIREMENTS

Indicate below all known federal requirements that apply to the proposal, proposal evaluation, or contract:

ALASKA PREFERENCES

If you wish to claim any Alaska Preferences, please complete the Alaska Bidder Preference Certification Form that follows the signature section below.

SIGNATURE

This proposal must be signed by a company officer empowered to bind the company.

Printed Name

Title

Date

Signature

File details come from the government source that posted it. Updated .