1185237_211216 RFQ for Compactor Repairs.pdf

COUNTY OF DINWIDDIE, VIRGINIA

14010 BOYDTON PLANK RD

PO DRAWER 70

DINWIDDIE, VA 23841

http://www.dinwiddieva.us

REQUEST FOR QUOTATIONS

Repair of Waste Management Equipment

RFQ NUMBER: 22-121621

ISSUE DATE: December 16, 2021

DUE DATE/TIME: January 7, 2022 at 2 p.m.

Issued by: Hollie R. Casey

Telephone: 804-469-4500 x 2150

Email: hcasey@dinwiddieva.us

This solicitation is issued in accordance with the Virginia Public Procurement Act and the Small Purchasing guidelines set forth in the Dinwiddie County Purchasing Policies and Procedures.

Quotations may be submitted via the County’s website at www.dinwiddieva.us/purchasing, emailed to hcasey@dinwiddieva.us, or by hardcopy. PLEASE DO NOT FAIL TO SIGN AND DATE YOUR

QUOTATION. Send additional data or illustrations if necessary.

Dinwiddie County seeks quotes from qualified contractors to provide the following services.

A. Scope of Work

1. The County has eight waste convenience centers for citizens to dispose of trash. Each has two trash compactors. Most sites are open 7 days a week, 365 days of the year. The County seeks a contractor to provide as-needed repairs to the following waste management and recycling equipment:

a. Sixteen (16) Push Button Trash Compactors. All are Marathon Brand. Ten (10) of them are 220 volts, single phase and six (6) of them are 460 volts, 3 phase.

b. Selco Vertical Cardboard Baler

c. All future like equipment

2. All materials and parts shall be at cost or a percentage off list price.

3. A list of locations is below:

Main Waste Management Site, 10817 Wheelers Pond Road, Dinwiddie, VA 23841

Dinwiddie Manned Site, 13542 Boydton Plank Road, Dinwiddie, VA 23841

Ford Manned Site, 8701 Claystreet Road, Ford, VA 23850

Hart Road Manned Site, 19900 River Road, Sutherland, VA 23885

McKenney Manned Site, 11206 Marguerita D. Ragsdale, McKenney, VA 23872

Old Hickory Manned Site, 19522 McKenney Hwy, McKenney, VA 23882

Old Stage Road Manned Site, 14475 Old Stage Road, Dinwiddie, VA 23841

Rohoic Manned Site, 22578 Airpark Drive, North Dinwiddie, VA 23803

Wilson Manned Site, 2025 Springston Road, Wilson, VA 23894

B. General Information

1. Quotes shall be free of any federal, state or local taxes. Quotations must show unit price, total price, and grand total. In case of error in the extension of prices, the unit price shall govern.

C. Contractor Requirements

1. Contractor shall maintain a Contractors license through DPOR as required.

http://www.dinwiddieva.us/purchasing mailto:hcasey@dinwiddieva.us

2. Contractor shall have an active registration with the Virginia State Corporation Commission, if required.

3. Contractor shall obtain and maintain a Dinwiddie County Business License, if required.

D. Clarification of Terms or Specifications:

If any Vendor has questions about any specifications or other solicitation documents, the Vendor should contact the person issuing the RFQ whose name appears on the face of the solicitation no later than three working days before the due date. Any revisions to the solicitation will be made only by addendum issued by the person issuing the RFQ. All addenda are posted on the County’s website at www.dinwiddieva.us/purchasing. It is the Contractor’s responsibility to check for addenda.

E. Award:

Award will be made to the vendor that, in the County’s opinion, provides the best overall value. Best value will be based on price, availability, experience, and other information provided in the quotation. The

County reserves the right to award by item, groups or items or total, to reject any and all quotations in whole or in part, and to waive any informality or technical defect if, in its judgement, is in the best interests of the

County.

F. Term of Contract

Contract will be awarded to the successful vendor for an initial period of twelve (12) months, with the option for renewals under the terms, conditions and pricing of the original contract for up to three (3) additional twelve (12) month periods, unless either party gives written notification to the other party sixty

(60) days prior to expiration of the then-current term that they do not wish to renew. The contract(s) and any renewals of the contract(s) are subject to the availability of funds and annual appropriations by the

Board of Supervisors. Price increases, if any, shall negotiated at time of renewal.

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http://www.dinwiddieva.us/purchasing

PART A

GENERAL TERMS AND CONDITIONS

1. Laws, Regulations, and Courts.

A. This procurement is governed by the Virginia Public Procurement Act and the Dinwiddie County Purchasing

Policies and Procedures.

B. The Contractor shall comply with all federal, state and local laws, ordinances, rules, regulations, and lawful orders of any public authority bearing on the performance of the work and shall give all notices required thereby.

C. All solicitations or contracts issued by Dinwiddie County shall be governed by the laws of the Commonwealth of

Virginia. Jurisdiction and venue for any litigation arising out of or involving this agreement shall lie in the Circuit

Court of the County of Dinwiddie, Virginia, and such litigation shall be brought only in such courts. The County and the Contractor are encouraged to resolve any issues in controversy arising from contractual dispute using

Alternative Dispute Resolution (ADR) procedures (Code of Virginia, § 2.2-4366).

2. Taxes. Pursuant to Virginia Code Section 58.1-609.1(4), the County is exempt from the payment of Virginia state sales and use taxes. Vendors should not include such taxes in invoices presented to the County for payment. State sales and use tax certificates of exemption, Form ST-12, will be issued upon request.

3. Anti-Discrimination Statement by County. The County certifies that it shall not discriminate against any bidder, offeror or contractor because of race, religion, color, sex, sexual orientation, gender identity, national origin, age, disability, status as a service disabled veteran, faith-based organizational status, any other basis prohibited by state law relating to discrimination in employment or because the bidder or offeror employs ex-offenders unless the County has made a written determination that employing ex-offenders on the specific contract is not in its best interest. If Contractor is a faith-based organization, the organization shall not discriminate against any recipient of goods, services, or disbursements made pursuant to the contract on the basis of the recipient's religion, religious belief, refusal to participate in a religious practice, or on the basis of race, age, color, gender or national origin and shall be subject to the same rules as other organizations that contract with public bodies to account for the use of the funds provided; however, if the faith-based organization segregates public funds into separate accounts, only the accounts and programs funded with public funds shall be subject to audit by the public body. (Code of Virginia, § 2.2-4343.1E).

4. Anti-Discrimination Statement by Contractor.

A. During the performance of the contract, the Contractor agrees to the following provisions.

1. The Contractor will not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, disability, status as a service disabled veteran, or any other basis prohibited by state law relating to discrimination in employment, except where there is a bona fide occupational qualification reasonably necessary to the normal operation of the Contractor. The Contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices setting forth the provisions of this nondiscrimination clause.

2. The Contractor, in all solicitations or advertisements for employees placed by or on behalf of the Contractor, will state that such Contractor is an equal opportunity employer.

3. Notices, advertisements and solicitations placed in accordance with federal law, rule or regulation shall be deemed sufficient for the purpose of meeting these requirements.

B. The Contractor also agrees to include the provisions in every subcontract or purchase order over $10,000, so that the provisions will be binding upon each subcontractor or Contractor.

5. Immigration Reform and Control Act of 1986. Contractor certifies that it does not and will not during the performance of the contract knowingly employee unauthorized alien workers or otherwise violate the provisions of the

Federal Immigration Reform and Control Act of 1986.

6. Drug-Free Workplace. During the performance of this contract, the Contractor agrees to (i) provide a drug-free workplace for the Contractor's employees; (ii) post in conspicuous places, available to employees and applicants for employment, a statement notifying employees that the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana is prohibited in the Contractor's workplace and specifying the actions that will be taken against employees for violations of such prohibition; (iii) state in all solicitations or advertisements for employees placed by or on behalf of the Contractor that the Contractor maintains a drug-free workplace; and (iv) include the provisions of the foregoing clauses in every subcontract or purchase order of over

$10,000, so that the provisions will be binding upon each subcontractor or Contractor.

For the purposes of this section, “drug-free workplace” means a site for the performance of work done in connection with a specific contract awarded to a Contractor, the employees of whom are prohibited from engaging in the unlawful manufacture, sale, distribution, dispensation, possession or use of any controlled substance or marijuana during the performance of the contract.

7. Authorization to Transact Business in the Commonwealth. In order to contract with Dinwiddie County, contractors organized as a stock or nonstock corporation, limited liability company, business trust, or limited partnership or registered as a registered limited liability partnership shall be authorized to transact business in the Commonwealth as a domestic or foreign business entity if so required by Code of Virginia, Title 13.1 or Title 50 or as otherwise required by law. Pursuant to competitive sealed bidding or competitive negotiation, a bidder or offeror organized or authorized to transact business in the Commonwealth pursuant to Title 13.1 or Title 50 shall include in its bid or proposal the identification number issued to it by the State Corporation Commission. Any bidder or offeror that is not required to be authorized to transact business in the Commonwealth as a foreign business entity under Title 13.1 or Title 50 or as otherwise required by law shall include in its bid or proposal a statement describing why the bidder or offeror is not required to be so authorized. Any bidder or offeror that fails to provide the required information shall not be awarded a contract unless a waiver of this requirement is granted by the County Administrator. Any business entity as described above that enters into a contract with a public body pursuant to the Virginia Public Procurement Act shall not allow its existence to lapse or its certificate of authority or registration to transact business in the Commonwealth to be revoked or cancelled at anytime during the contract. Dinwiddie County may void any contract with a business entity if that entity fails to remain in compliance with the provisions of this section.

8. Indemnification. Contractor agrees to indemnify, defend and hold harmless the County of Dinwiddie, Virginia and their officers, agents, and employees from any claims, damages and actions of any kind or nature, whether at law or in equity, arising from or caused by the use of any materials, goods, or equipment of any kind or nature furnished by the

Contractor or any services of any kind or nature furnished by the Contractor, provided that such liability is not attributable to the sole negligence of the County or to failure of the County to use the materials, goods, infrastructure or equipment in the manner already and permanently described by the Contractor on the materials, goods, infrastructure or equipment delivered.

9. Insurance. Contractor certifies that it will have the following insurance coverage at the time the contract is awarded.

If any subcontractors are involved, the subcontractor will have workers’ compensation insurance in accordance with §§

2.2-4332 and 65.2-800 et seq. of the Code of Virginia. Contractor further certifies that the Contractor and any subcontractors will maintain this insurance coverage during the entire term of the contract and that all insurance coverage will be provided by insurance companies authorized to sell insurance in Virginia by the Virginia State

Corporation Commission. Subcontractors, if any, will maintain similar insurance coverage during the entire term of the contract.

Minimum Insurance Coverage and Limits Required:

1. Workers’ Compensation - Statutory requirements and benefits. Coverage is compulsory for employers of three or more employees, to include the employer. Contractors who fail to notify the County of increases in the number of employees that change their workers’ compensation requirements under the Code of Virginia during the course of the contract shall be in noncompliance with the contract.

2. Employer’s Liability - $100,000.

3. Commercial General Liability - $1,000,000 per occurrence and $2,000,000 in the aggregate. Commercial

General Liability is to include bodily injury and property damage, personal injury and advertising injury, products and completed operations coverage. The “County of Dinwiddie, Virginia, its Officers, agents, and employees” shall be added as additional insured on a primary basis and so endorsed on the policy. Such additional insured status shall be primary without participation by County’s insurers.

4. Automobile Liability - $1,000,000 combined single limit.

5. Professional Liability - $1,000,000 per occurrence.

10. Debarment Status. The Contractor certifies that it is not currently debarred from submitting proposals or bids on contracts by any department, agency or political subdivision of (i) the Commonwealth of Virginia, (ii) any other state, or (iii) the federal government, nor is it an agent of any person or entity that is currently debarred from submitting bids or proposals on contracts by the same.

11. Payment.

A. Contractor shall provide the County with a complete and accurate IRS Form W-9.

B. Invoices for products/services ordered, delivered, and accepted shall be submitted by the contractor to Dinwiddie

County Accounts Payable via email to accounting@dinwiddieva.us or via postal mail to P.O. Drawer 70, Dinwiddie, VA 23841.

C. Unless otherwise specified, any payment terms requiring payment in less than 30 days will be regarded as requiring payment 30 days after correct invoice or delivery, whichever occurs last. This shall not affect offers of discounts for payment in less than 30 days, however.

D. The preferred method of payment for invoices under $5,000 is with a VISA Credit Card. If the vendor accepts

VISA payments, they must do so without any fees.

E. Unless otherwise provided under the terms of the contract, interest shall accrue at the rate of one percent (1%) per month.

F. Date of payment is deemed to be (1) the date of postmark in all cases where payment is made by mail, or (2) the date of offset when offset proceedings have been instituted as authorized under the Virginia Debt Collection Act.

G. Unreasonable Charges. Under certain emergency procurements and for most time and material purchases, final job costs cannot be accurately determined at the time orders are placed. In such cases, Contractors should be put on notice that final payment in full is contingent on a determination of reasonableness with respect to all invoiced charges. Charges which appear to be unreasonable will be researched and challenged, and that portion of the invoice held in abeyance until a settlement can be reached. Upon determining that invoiced charges are not reasonable, the

County shall promptly notify the Contractor, in writing, as to those charges which it considers unreasonable and the basis for the determination. A Contractor may not institute legal action unless a settlement cannot be reached within thirty (30) days of notification. The provisions of this section do not relieve the County of its prompt payment obligations with respect to those charges which are not in dispute (Code of Virginia, § 2.2-4363).

H. The Contractor is obligated to: (1) pay the subcontractor(s) within seven (7) days of the Contractor’s receipt of payment from the County for the proportionate share of the payment received for work performed by the subcontractor(s) under the contract; or (2) notify the County and the subcontractor(s) within seven days, in writing of the Contractor’s intention to withhold all or a part of the subcontractor’s payment with the reason for nonpayment.

I. The Contractor is obligated to pay the subcontractor(s) interest at the rate of one percent (1%) per month on all amounts owed by the Contractor that remain unpaid after seven days following receipt by the contractor of payments from the County, except for amounts withheld as states in Section g above.

J. These provisions apply to each sub-tier Contractor performing under the primary contractor. A contractor’s obligation to pay an interest charge to a subcontractor shall not be construed to be an obligation of the County. A contract modification shall not be made for the purpose of providing reimbursement for the interest charge. A cost reimbursement claim shall not include any amount for reimbursement for the interest charge.

12. Availability of Funds. It is understood and agreed between the parties that the County shall be bound hereunder only to the extent of the funds available, or which may hereafter become available. The contract will be contingent upon annual appropriations by the Board of Supervisors of Dinwiddie County. Failure of the Board of Supervisors to appropriate adequate funds for the terms of the contract shall result in the immediate cancellation of the contract. There shall be no penalty should the Board fail to make annual appropriations for the contract.

13. Assignment of Contract. A contact shall not be assignable by the Contractor in whole or in part without the written consent of the County.

14. Default. It shall be the Contractor’s responsibility to make sure that all work is adequately completed as required. In case of failure to deliver goods or services in accordance with the contract terms and conditions, the County, after five

(5) days have passed from the date of delivery of written notice, may procure them from other sources and hold the

Contractor responsible for any resulting additional purchase and administrative costs. This remedy shall be in addition to any other remedies which the County may have.

15. Changes to the Contract. All contract modifications must be approved by the Dinwiddie County Administrator or his designee. The County will not assume responsibility for the cost of any changes made without proper consent. No mailto:accounting@dinwiddieva.us fixed-price contract may be increased by more than twenty-five percent (25%) or $50,000, whichever is greater, without advance approval of the Dinwiddie County Board of Supervisors.

Changes can be made to the contract in any of the following ways:

A. The parties may agree in writing to modify the terms, conditions, or scope of the contract. Any additional goods or services to be provided shall be of a sort that is ancillary to the contract goods or services, or within the same broad product or service categories as were included in the contract award. Any increase or decrease in the price of the contract resulting from such modification shall be agreed to by the parties as a part of their written agreement to modify the scope of the contract.

B. The County may order changes within the general scope of the contract at any time by written notice to the

Contractor. Changes within the scope of the contract include, but are not limited to, things such as services to be performed, the method of packing or shipment, and the place of delivery or installation. The Contractor shall comply with the notice upon receipt, unless the Contractor intends to claim an adjustment to compensation, schedule, or other contractual impact that would be caused by complying with such notice, in which case the

Contractor shall, in writing, promptly notify the County of the adjustment to be sought, and before proceeding to comply with the notice, shall await the County’s written decision affirming, modifying, or revoking the prior written notice. If the County decides to issue a notice that requires an adjustment to compensation, the Contractor shall be compensated for any additional costs incurred as the result of such order and shall give the County a credit for any savings. Said compensation shall be determined by one of the following methods:

1. By mutual agreement between the parties in writing; or

2. By agreeing upon a unit price or using a unit price set forth in the contract, if the work to be done can be expressed in units, and the Contractor accounts for the number of units of work performed, subject to the

County’s right to audit the Contractor’s records and/or to determine the correct number of units independently; or

3. By ordering the Contractor to proceed with the work and keep a record of all costs incurred and savings realized. A markup for overhead and profit may be allowed if provided by the contract. The same markup shall be used for determining a decrease in price as the result of savings realized. The Contractor shall present the County with all vouchers and records of expenses incurred and savings realized. The County shall have the right to audit the records of the Contractor as it deems necessary to determine costs or savings. Any claim for an adjustment in price under this provision must be asserted by written notice to the County within thirty (30) days from the date of receipt of the written order from the County. Neither the existence of a claim nor a dispute resolution process, litigation or any other provision of this contract shall excuse the Contractor from promptly complying with the changes ordered by the County or with the performance of the contract generally.

16. Termination of Contract.

A. Termination for Cause.

1. If the Contractor should be adjudged as bankrupt, or if he should make a general assignment for the benefit of his creditors, or if a receiver should be appointed on account of his insolvency, the County may terminate the contract. If Contractor violates any provision of the Virginia Governmental Fraud Act, the County may terminate the contract. If the Contractor should persistently or repeatedly refuse or should fail, except in cases for which extension of time is provided, to supply enough properly skilled workmen or proper materials, or if he should fail to make prompt payment to subcontractors or suppliers of material or labor, or persistently disregards laws, ordinances, or the written instructions of the County, or otherwise be guilty of a substantial violation of any provision of the contract, then the County may terminate the contract. The County retains the sole discretion to determine any violation of this section.

2. Prior to termination of the contract, the County shall give the Contractor and his surety ten (10) calendar days written notice, during which the Contractor and/or his surety may rectify the cause of the termination. If rectified to the satisfaction of the County within said ten (10) days, the County may rescind its notice of termination. If it does not, the termination for cause shall become effective at the end of the ten-day (10) notice period. In the alternative, the County may postpone the effective date of the termination notice, at its sole discretion, if it should receive reassurances from the Contractor and/or its surety that the causes of termination will be remedied in a time and manner which the County finds acceptable. If at any time more than ten (10) days after the notice of termination, the County determines that Contractor and/or its surety has not or is not likely to rectify the causes of termination in an acceptable manner or within the time allowed, then the County may immediately terminate the contract for cause by giving written notice to the Contractor and its surety. This decision shall be final and not subject to an appeal to any court of law or equity. In no event shall termination for cause terminate the obligations of the Contractor’s surety on its payment and performance bonds.

3. Notice of terminations, whether initial or given after a period of postponement, may be served upon the

Contractor and the surety by mail or any other means at their last known places of business in Virginia or elsewhere, by delivery to any officer or management/supervisory employee of either wherever they may be found, or, if no such officer, employee or place of business is known or can be found by reasonable inquiry within three (3) days, by posting the notice at the job site. Failure to accept or pick up registered or certified mail addressed to the last known address shall be deemed to be delivery.

4. Upon termination of the contract, the County shall take possession of its property and of all materials, tools, and appliances thereon and finish the work by whatever method the County may deem expedient. In such case, the Contractor shall not be entitled to receive any further payment. If the expense of finishing the work, including compensation for additional managerial and administrative services shall exceed the unpaid balance of the contract price, the Contractor shall pay the difference to the County, together with any other expenses of terminating the contract and having it completed by others.

5. Termination of the contract under this section is without prejudice to any other right or remedy of the County.

B. Termination for Convenience

1. County may terminate this contract at any time without cause, in whole or in part, upon giving the Contractor notice of such termination. Upon such termination, the Contractor shall immediately cease work and remove from the project site all of its labor forces and such of its materials as County elects not to purchase or to assume in the manner hereinafter provided. Upon such termination, the Contractor shall take such steps as

County may require to assign to the County the Contractor’s interest in all subcontracts and purchase orders designated by County. After all such steps have been taken to County’s satisfaction, the Contractor shall receive as full compensation for termination and assignment the following:

All amounts then otherwise due under the terms of this contract as of the latest request for payment, Amounts due for work performed subsequent to the latest request for payment through the date of termination, and

Reasonable compensation for the actual cost of demobilization incurred by the Contractor as a direct result of such termination. The Contractor shall not be entitled to any compensation for lost profits or for any other type of contractual compensation or damage other than those provided by the preceding sentence. Upon payment of the forgoing, County shall have no further obligations to the Contractor of any nature.

2. In no event shall termination for the convenience of the County terminate the obligations of the Contractor’s surety on its payment and performance bonds.

17. Contractual Disputes. Disputes and claims arising under this agreement shall be processed pursuant to the Code of

Virginia Section 2.2-4363.

18. Audit. The contractor shall retain all books, records, and other documents relative to this contract for five (5) years after final payment from the County, or until audited by the County, whichever is sooner. The agency, its authorized agents, and/or state auditors shall have full access to and the right to examine any of said materials during said period.

19. Patents, Copyright and Trademark. The Contractor shall obtain all licenses necessary to use any invention, article, appliance, process, or technique of whatever kind and shall pay all royalties and license fees. The Contractor shall indemnify, defend, hold and save harmless the County, its officers, agents, and employees, from any loss or liability for or on account of such infringement.

20. COVID-19.

The Contractor is required to adhere in all respects to all federal, state, and local COVID-19 regulations, including, but not limited to, Executive Orders issued by the Governor of Virginia, the rules promulgated by the Virginia

Department of Labor and Industry (“DOLI Rules”), and the Dinwiddie County Infectious Disease (COVID-19)

Preparedness and Response Plan (the “Required Local Plan”). The Contractor acknowledges it will comply with the documents set forth on Dinwiddie County’s Purchasing Page, which can be found at www.dinwiddieva.us/Purchasing including any changes that may be made to such documents in the future. In the event of conflict between COVID-19 provisions, the strictest provision shall govern. Without limiting the foregoing, the Contractor shall abide by the following:

A. Sick and Exposed Persons to Stay at Home. Pursuant to the DOLI Rules and the Required Local Plan, employees or other persons associated with the Contractor who are known or suspected to be infected with the SARS-CoV-2 virus or who live with or have had close contact with individuals who have had COVID-19 symptoms or signs in the last 14 days shall be sent home, stay home, and stay away from the work site until they are cleared to return to work as set forth in the DOLI Rules or, in the case of exposed persons, the rules for return to work shall be the same as those for County employees in the Required Local Plan. Symptoms and signs of COVID-19 include the following: unexplained cough, fever (100 degrees Fahrenheit or higher) or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, bluish lips or face, unexplained nausea, vomiting, or diarrhea. Other unexplained symptoms could also be an indication of

COVID-19.

B. Notice to County Required of Positive COVID-19 Tests at County Government Sites. Pursuant to the DOLI

Rules and the Required Local Plan, the Contractor is required by law to advise the County within 24 hours in the event that an employee of the Contractor or someone associated with the Contractor who was present at a place of employment owned or operated by the Dinwiddie County Government tests positive for COVID-19. All such reports of positive COVID-19 tests shall be made to Crystal Spain, Director of Human Resources at (804) 469-

4500, extension 2161.

C. Subcontractors. The Contractor is responsible for ensuring that its subcontractors comply with all the foregoing requirements.

PART B

QUOTE FORM

RFQ-22-121621 Repair of Waste Management Equipment

If more space is required to furnish a description of the commodities and/or services or other information, the

Vendor may attach a letter thereto which will be made a part of the quotation. All quotations must be submitted and plainly marked using the RFQ number and date. Verbal quotations will not be accepted.

Vendor declares that the quotation is not made in connection with any other vendor submitting a quotation for the same commodity or commodities, and that the quotation is bona fide and is in all respects fair and without collusion or fraud.

All quotations must be signed by a responsible officer or employee, authorized by the Contractor/Vendor, and must include the firm’s legal name. Obligations assumed by such signature must be fulfilled.

Submission Date:______________________________

Federal Tax ID#: DPOR License #:

Name of firm: Phone #:

By (signature):

Type/Print Name: Address:

Email Address:

No of Full-Time Employees: No of Part-Time Employees:

Hours of Operation:

Please list all subcontractors, if any:

Company Name DPOR License #

Please provide a brief description of the company’s experience:

Please provide a list of product types and brands that the company is certified to work on:

Please provide a description of your experience working with local government entities:

Item No. Description Hourly Rate

1 Hourly Rate for Repairs

(Monday-Friday 8:30 am – 5:00 pm)

2 Hourly Rate for Repairs

(After hours, weekends and holidays)

3 Materials. (At Cost or a % off list price)

Virginia State Corporation Commission (SCC) registration information. The bidder:

is a corporation or other business entity with the following SCC identification number: OR-is not a corporation, limited liability company, limited partnership, registered limited liability partnership, or business trust -OR-is an out-of-state business entity that does not regularly and continuously maintain as part of its ordinary and customary business any employees, agents, offices, facilities, or inventories in Virginia (not counting any employees or agents in Virginia who merely solicit orders that require acceptance outside Virginia before they become contracts, and not counting any incidental presence of the bidder in Virginia that is needed in order to assemble, maintain, and repair goods in accordance with the contracts by which such goods were sold and shipped into

Virginia from bidder’s out-of-state location) -OR-is an out-of-state business entity that is including with this bid an opinion of legal counsel which accurately and completely discloses the unders-igned bidder’s current contacts with Virginia and describes why those contacts do not constitute the transaction of business in Virginia within the meaning of § 13.1-757 or other similar provisions in

Titles 13.1 or 50 of the Code of Virginia.

**NOTE** >> Check the following box if you have not completed any of the foregoing options but currently have pending before the SCC an application for authority to transact business in the Commonwealth of Virginia and wish to be considered for a waiver to allow you to submit the SCC identification number after the due date for bids (the

Commonwealth reserves the right to determine in its sole discretion whether to allow such waiver):

REFERENCES

Vendors shall supply three (3) references that list a brief description of the same type of work and requirements for area(s) of similar size or larger, satisfactorily completed with dates of service or contract period, location, names, addresses, and phone numbers of Owners. Offerors shall only indicate references they have worked with in the past two (2) years. A separate page of references is acceptable if needed for additional space.

Reference #1

Name of County, City, Agency or Firm:

Address:

Contact with Title: Telephone:

Types of services provided:

Contract Dates: From To

Reference #2

Reference #3