1-RFP 3829 Required Submittals.pdf

RFP 3829 Page 1 of 8

EXHIBIT B

Legal Business Name:

Business Information

Date:

Address:

Street Address Suite #

City State ZIP Code

Contact:

Phone:

Length of time in business:

Length of time at current location: Federal Tax No.

California State Contractor’s License No.:

Department of Industrial Relations Registration No.:

Names and titles of officers of the Business:

Is your firm incorporated? No Yes

Name and remittance address that will appear on invoices:

Is your firm a sole proprietorship doing business under a different name? No Yes

If yes, please indicate sole proprietorship name and the name you are doing business under:

Title:

Email

RFP 3829 Page 2 of 8

BUSINESS REFERENCES EXHIBIT C

Proposer Business Name: Date:

Proposer shall provide a minimum of three (3) Customer References with three (3) or more years’ experience with the Proposer. Preferred references should be similar in size, scope, and complexity (to the contract requirements).

Reference 1 Name of Firm: Phone:

Address: Contact:

Project Title: Approx. Cost: $ Contact email:

Project Description:

Project Date: To:

Reference 2 Name of Firm: Phone:

Address: Contact:

Project Title: Approx. Cost: $ Contact email:

Project Description:

Project Date: To:

Reference 3 Name of Firm: Phone:

Address: Contact:

Project Title: Approx. Cost: $ Contact email:

Project Description:

Project Date: To:

Business References for

RFP 3829 Page 3 of 8

LIST OF SUBCONTRACTORS EXHIBIT D

Subcontractor #1 Information Legal Business Name:

Date:

Address:

Street Address Suite #

City State ZIP Code

California State Contractor’s License No.:

Department of Industrial Relations Registration No.

Subcontract Description:

Subcontractor #2 Information Legal

Street Address Suite #

City State ZIP Code

California State Contractor’s License No.:

Department of Industrial Relations

Subcontractor #3 Information Legal

Street Address Suite #

City State ZIP Code

California State Contractor’s License No.:

Department of Industrial Relations

RFP 3829 Page 4 of 8

EXHIBIT E

ADDITIONS, DELETIONS AND/OR EXCEPTIONS

Please state any and all Additions, Deletions and Exceptions that you are taking to any portion of this proposal. If not addressed below, then Eastern Municipal Water District assumes that the vendor will adhere to all terms and conditions listed.

EWMD will issue an Agreement in its standard form to the successful firm(s) for the services contemplated herein; a copy of which is attached hereto and incorporated herein. Any deletion, exception, or modification taken to EMWD contract terms and conditions will be evaluated, in addition to the specified criteria; and may, itself, result in non-acceptance by the EMWD. Any request for deletion, exception, or modification, if so taken, must be submitted at the time of proposal. Any asserted trade secrets or other proprietary information must be identified on this exhibit with specific page references within the proposal and/or supplemental information.

RFP 3829 Page 5 of 8

EXHIBIT F

QUALIFICATIONS AND EXPERIENCE

Please provide a summary of your qualifications and relevant experience as they relate to the scope of work. Past performance should demonstrate your ability to meet deadlines, including the ability to complete annual inspection requirements between October 1 and October 31.

RFP 3829 Page 6 of 8

EXHIBIT G

INSURANCE AFFIDAVIT

I, (Proposer/Company) have reviewed the Insurance Requirements (Rev. 05/2021) in its entirety and agree to furnish all insurance policies with designated limits, along with full endorsements, and waiver of subrogation, as stated in this Request for Proposal for the full term of the agreement.

I hereby agree to provide copies of insurance certificates, endorsements, and waiver of subrogation within fourteen (14) calendar days of the District’s notification of recommendation of award.

I understand and confirm that our firm is able to provide and maintain the coverage as specified.

Failure to maintain said coverage shall be sufficient cause for contract termination and shall result in termination of the awarded contract.

I understand that by signing this document, I (Proposer/Company) agree to all terms and conditions as stated in the Insurance Requirements (Rev. 05/2021).

☐ Check here if you DO NOT accept terms and conditions as stated in the Insurance Requirements (05/2021). Detail all Exceptions in, Additions, Deletions and/or Exceptions Form.

Authorized Representative’s Signature Name Authorized Representative’s Printed Name

Company Name Date

Mailing Address Telephone

City, State, Zip Code Email

RFP 3829 Page 7 of 8

EXHIBIT H

CONTRACTOR’S CAL/OSHA COMPLIANCE HISTORY AND SIC CODE

(This document is to be submitted with the proposal package) (rev. 10/08/18)

Contractor’s Standard Industry Code:

Contractor’s Name:

California State Contractor’s License #:

Contact Person:

Phone No:

Please answer the following questions:

1. Has the contractor been cited by Cal/OSHA or any regulatory agency for a violation related to safety or environmental issues within the past seven (7) years?

No Yes

2. Within the past ten (10) years has the contractor had a serious incident or fatality on a job site?

No Yes

* If yes to # 1 or #2, please provide information specific to the incident(s) and action(s) taken to ensure that there is not a repeat violation, or incident(s) (attach additional sheets if needed)

Contractor’s Representative signature:

FOR EMWD USE ONLY: Purchasing to forward to Risk Management for review

(Risk Management)

Approved: No Yes

Reviewed by (Risk Management)

(signature required)

RFP 3829 Page 8 of 8

SUBMITTAL CHECK-OFF LIST

Item Required Submittals Checklist Check

Off

1 RFP Price Form

2 Proposer’s Business Information

3 Proposer’s Business References

4 List of Subcontractors

5 Additions, Deletions, and/or Exceptions

6 Qualifications and Experience

7 Insurance Affidavit

8 CAL/OSHA Compliance History

Non-Disclosure Agreement