10510 RFQual Exhibit A SOQ Response Template.docx

10510 Exhibit A: Statement of Qualifications (SOQ)

Supplier’s Information

Supplier hereby acknowledges receipt of Addenda number(s) through .

To be considered for selection, a duly authorized agent of the Supplier must complete and sign this page and submit it with the Response. Signature below indicates that the Supplier has read and understands the requirements set forth in this Request for Qualifications (RFQ).

Signature:

Table of Contents

TAB 1: EXECUTIVE SUMMARY

Supplier will insert its executive summary in this section and limit it to one page. The executive summary must include:

· Facts about your business and background

· Number of years in business

· Markets that you serve

· Geographic sales regions and territories

· Water Treatment Chemicals Line Card, which is the list of the Water Treatment Chemicals your company produces, represents, and sells or a narrative with equivalent information - if submitting a line card, omit the narrative in this section and insert the line card in Tab 4.

TAB 2: COLORADO SECRETARY OF STATE CERTIFICATE OF GOOD STANDING

Please confirm that you are submitting the following required submission document and information in this tab.

TAB 3: W-9

Please confirm that you are submitting the following required submission document and information in this tab.

TAB 4: SUPPLIER LINE CARD

Please confirm that you are submitting the following required submission document and information in this tab.

Supplier Line Card (Optional if an equivalent narrative was provided in Tab 1.)

☐ Submitted ☐ Not Submitted ☐ Not Submitted; narrative provided in Tab 1

TAB 5: DESIGNATION OF ANY PROPRIETARY AND CONFIDENTIAL INFORMATION

Supplier acknowledges and has satisfied requirements of RFQ Section 3.2 Intent to Respond and Section 3.3 Designation Of Any Proprietary And Confidential Information.

|_| Yes, Proposer clearly designated any sentences, pages, or sections of the Proposal that the Proposer deems confidential or proprietary, and included it as a separate file on the same e-mail, marked “REDACTED ORIGINAL”.

|_| No, Proposer did not designate any sentences, pages, or sections of the Proposal confidential or proprietary. Proposers acknowledge that Denver Water may be required to disclose any or all of the documents submitted with a Proposal, pursuant to the Colorado Open Records Act, C.R.S. § 24-72-201.1, et seq.

TAB 6: PROFESSIONAL REFERENCES

Provide a minimum of three customer references that purchased services described in this RFQ within the past three years.

REFERENCE 1

REFERENCE 2

REFERENCE 3

TAB 7: SCHEDULE A – POLYDIALLYLDIMETHYLAMMONIUM CHLORIDE (PolyDADMAC) FOR COAGULANT AID ☐ No, I do not want to qualify any polymer products under this schedule.

☐ Yes, I want to qualify polymer product(s) under this schedule. By selecting this option, I understand that this SOQ is only for the schedule(s) and itemized product(s) that I confirm and list in the table below.

List the name of each product to be qualified under this schedule.

1.

2.

3.

4.

5.

Hover your cursor over the bottom of the last row in the table and click on the plus key when it appears to add more rows, if needed.

SOQ Response No. 10510 Statement of Qualifications (SOQ)

REV 7/22/24

SCHEDULE A: REQUIRED SUBMISSION DOCUMENTS CHECKLIST

The Supplier must complete the form below to confirm its submission of documents and information that are required to substantiate its Statement of Qualifications per itemized product it is submitting under this schedule. It is the responsibility of the Supplier to clearly label each submission document with the product name and insert it in this tab. All required documents must first be grouped as a set by product name AND secondly organized in sequence that each requirement is listed below. For example, if a supplier is submitting more than one product under this schedule it would insert Product 1 set of required 1-8 documents followed by Product 2 set of required 1-8 documents.

1. Insert the name of the polymer product that the sample represents

☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted

☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted

☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted

☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted

☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted

7. Technical/Product Data Sheet (TDS)

a. Polymer type

b. Active polymer concentration

c. Relative molecular weight based on the following relative scaled expressed in grams/mole:

i. Very High – greater than one million

ii. High – 0.2 to one million

iii. Medium – 0.05 to 0.2 million

iv. Low – less than 0.05 million

d. Charge type

e. Relative Charge Density

f. Product form

g. Appearance

h. Odor

i. Specific gravity or bulk density

j. Moisture content

k. Product viscosity (Brookfield)

l. Solution viscosity

m. Shelf life

n. Freezing Point

o. Freeze-thaw stability

p. pH of a solution

q. Volatile organic content

r. Product feeding guidelines

s. Total solids ☐ Submitted ☐ Not Submitted ☒ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted

☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted

Tracking number

TAB 8: SCHEDULE B – POLYACRYLAMIDE FOR FLOCCULANT AND/OR SLUDGE CONDITIONING AID

☐ No, I do not want to qualify any polymer products under this schedule.

☐ Yes, I want to qualify polymer product(s) under this schedule. By selecting this option, I understand that this SOQ is only for the schedule(s) and itemized product(s) that I confirm and list in the table below.

List the name of each product to be qualified under this schedule.

1.

2.

3.

4.

5.

Hover your cursor over the bottom of the last row in the table and click on the plus key when it appears to add more rows, if needed.

SCHEDULE B: REQUIRED SUBMISSION DOCUMENTS CHECKLIST

The Supplier must complete the form below to confirm its submission of documents and information that are required to substantiate its Statement of Qualifications per itemized product it is submitting under this schedule. It is the responsibility of the Supplier to clearly label each submission document with the product name and insert it in this tab. All required documents must first be grouped as a set by product name AND secondly organized in sequence that each requirement is listed below. For example, if a supplier is submitting more than one product under this schedule it would insert Product 1 set of required 1-8 documents followed by Product 2 set of required 1-8 documents.

1. Insert the name of the polymer product that the sample represents

☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted

☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted

☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted

☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted

☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted

7. Technical/Product Data Sheet (TDS)

a. Polymer type

b. Active polymer concentration

c. Relative molecular weight based on the following relative scaled expressed in grams/mole:

i. Very High – greater than one million

ii. High – 0.2 to one million

iii. Medium – 0.05 to 0.2 million

iv. Low – less than 0.05 million

d. Charge type

e. Relative Charge Density

f. Product form

g. Appearance

h. Odor

i. Specific gravity or bulk density

j. Moisture content

k. Product viscosity (Brookfield)

l. Solution viscosity

m. Shelf life

n. Freezing Point

o. Freeze-thaw stability

p. pH of a solution

q. Volatile organic content

r. Product feeding guidelines

s. Total solids ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted

☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted ☐ Submitted ☐ Not Submitted

TAB 9: SOQ FORMS

The required forms are listed below. Each of these forms must be completed for each polymer product that is submitted per schedule. For example, if a supplier is submitting two polymer products: product 1 and product 2, for Schedule A, a Product Information Form and Product Sample Submittal Form must be completed for each product.

· Product Information Form

· Product Sample Submittal Form

This section must be deleted prior to the Supplier’s SOQ submittal.

PRODUCT INFORMATION FORM

This form must be completed for EACH itemized product to be considered in this RFQ process.

1. What is the Polymer Brand Name?

☐ Schedule B: Polyacrylamide for Flocculant and/or Sludge Conditioning Aid

City, State:

Country:

Secondary Facility:

Tertiary Facility:

Country:

Supplier Name:

Supplier Name:

Country:

Domestic Raw Material: __%

7. Describe any supply chain and cost impacts that you anticipate from tariffs for the raw material used in this polymer.

City, State:

Backup Manufacturer Name:

City, State:

Secondary Backup Manufacturer Name:

City, State:

State:

Estimated Miles:

Common/Contract Carrier: ____%

11. What is the lead time of the polymer product to the Denver-metro area, from time of placing a purchase order?

12. Recommended percentage (%) solution.

13. Recommended range of appropriate doses.

14. Other potable water utility customers using this product and associated application data

a. Annual sale in pounds to the utility and MG treated annually

b. Representative source water turbidity, Total Organic Carbon (TOC), alkalinity at each utility

c. Maximum observed source water turbidity, TOC, alkalinity treated with this product at each utility

d. Primary coagulant uses with PolyDADMAC product(s)

e. Representative coagulant and polymer doses

f. Estimated Cost per ton

g. Estimated Cost per MG treated

h. Representative distribution system nitrosomine concentration

i. Are chloramines used for disinfection?

Email:

15. Any other details of product quality that may be beneficial to Denver Water.

PRODUCT SAMPLE SUBMITTAL FORM

Supplier Name

Date

Contact Name

Contact Title

Contact Email

Contact Phone

Polymer Product Name

Indicate the schedule for this polymer product. Check only one option.

☐ Schedule A: Polydiallyldimethylammonium Chloride (PolyDADMAC) for Coagulant Aid ☐ Schedule B: Polyacrylamide for Flocculant and/or Sludge Conditioning Aid

This sample is for the following season as described in the RFQ 10510, Section 1.4. Check only one option.

☐ Summer Product Samples Deadline ☐ Winter Product Samples Deadline ☐ Spring Product Samples Deadline

No Substitution of Polymer Products. This product sample was originally submitted for testing by the Statement of Qualifications (SOQ) Due Date stated in the RFQ 10510, Schedule of Events

☐ Yes ☐ No If, not, do not send the sample. Only the product samples submitted by the SOQ Due Date stated in the Schedule of Events will be considered for testing under the RFQ. The Supplier is not permitted to submit new polymer product samples at subsequent testing intervals that were not part of its initial submission. New polymer product samples will be rejected and returned to the Supplier at its expense.

By signing below, Insert Supplier Legal Name, the undersigned, acknowledges and agrees to the terms and conditions for product sample submittals for RFQ 10510.

Signature: ___________________________________________ Title: _______________________________________________ Date: _______________________________________________ image1.jpeg