10-Attachment C- Respondent Information- Certification.pdf
PDF 260 KB Posted
- Attached to
- Fire Program CMAR
- Solicitation number
- CMAR-26-00270
- Issued by
- Hillsborough County, Florida
About this file
This is a Respondent Information and Certification form for Hillsborough County, Florida's Fire Program Construction Manager at Risk (CMAR) qualification proposal solicitation. The form requires respondents to provide their legal business name and entity type, contact person information, local and primary business addresses, and telephone and fax numbers. Respondents must certify their understanding of all RFQ requirements and commitment to compliance, confirm they are of lawful age with no undisclosed interests in the proposal, attest that the proposal is made without collusion or fraud, and verify they are not in arrears to Hillsborough County or in default on any obligations to the county. Additionally, respondents must confirm that no county-employed or county-paid personnel have any interest in the proposal, performance of the contract, or related supplies and materials, and certify receipt and examination of all amendments issued prior to opening.
The county anticipates selecting two qualified firms for upcoming Fire program projects with a combined project estimate of $2,000,000.00. A Small Business Enterprise (SBE) goal will be established once project design reaches 60-90% completion. The certification form requires an authorized representative to sign and seal the proposal in ink, with witness signatures and printed names and titles provided, and includes space for a corporate seal where appropriate. All statements made by the respondent must be true and accurate as of the proposal submittal date.
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Text version
Attachment C Respondent Information/Certification
1. Legal Name of Respondent. Indicate if the Respondent is a Corporation, Joint Venture, Partnership, etc.:
2. Name/title of contact person for the Respondent
3. Local business and mailing address:
4. Primary business and mailing address:
5. Telephone number: Fax:
The above-named Respondent affirms and declares:
A. That the Respondent understands all requirements of the RFQ and states that as a serious Respondent it will comply with all the stipulations included in the RFQ package.
B. That the Respondent is of lawful age and that no other person, firm or corporation has any interest in this Proposal or in the contract proposed to be entered into except as expressly stated below:
C. That this qualification proposal is made without any understanding, agreement, or connection with any other person, firm or corporation making a proposal for the same purpose, and is in all respects fair and without collusion or fraud except as expressly stated below:
D. That the Respondent is not in arrears to Hillsborough County upon debt or contract and is not a defaulter, as surety or otherwise, upon any obligation to Hillsborough County except as expressly stated below:
E. That no officer or employee or person whose salary is payable in whole or in part from the County Treasury is, shall be or become interested, directly or indirectly, surety or otherwise in this Proposal: in the performance of this Contract; in the supplies, materials, equipment, and work or labor to which they relate; or in any portion of the profits thereof.
F. That the Respondent has received and carefully examined all Amendment issued prior to Opening.
G. All statement made by the Respondent in the proposal are true and accurate as of the proposal submittal date.
IN WITNESS WHEREOF, this Proposal is hereby signed and sealed as of the date indicated.
ATTEST: RESPONDENT:
BY:___________________________________(SEAL)
Witness (Authorized signature in ink)
Witness (Printed name of signer)
(Printed Title of signer)
CORPORATE SEAL _______________________________________
(Where appropriate) (Date signed)
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