12217 Attachment A Champoeg State Heritage Park Reservoir Replacement Fillable Form.docx

NOTE: This template uses content control to fill in items like a form.

· [Gray] highlighted text reflects boxes that can be filled in and dropdowns for choosing an option (indicated by the word “choose”). Use the TAB key to jump quickly between these fillable item boxes.

(**See instructions on Attachment A for providing the attachment as a protected Word document for Bidders to fill out like a form.)

· [Yellow] highlighted text reflects general drafting notes to the Agency personnel who are using the template, including when consultation with DOJ is appropriate.

· Please note: DOJ review and authorization to release is still required for ITB that utilize this template in accordance with the requirements of OAR 137-045-0035 (e.g., procurements in excess of $250,000).

ATTACHMENT A

BID PACKAGE FORMS

· FORM A-1: BIDDER INFORMATION AND CERTIFICATIONS FORM

· FORM A-2: PRICING FORM

· FORM A-3: BID SECURITY FORM

· FORM A-4: FIRST-TIER SUBCONTRACTOR FORM

[Drafting Note: If you want to provide Attachment A – Bid Package Forms as a Word document to allow Bidder to fill them out as forms, follow these instructions:

1. Complete all necessary edits prior to follow the next steps.

2. Go to “Review” tab

3. Select “Restrict Editing”

4. Under “2. Editing Restrictions”

a. Click the checkbox “Allow only this type of editing in the document:”

b. Choose the dropdown “Filling in Forms”

5. Under “3. Start Enforcement”

a. Click the button “Yes, Start Enforcing Protection”]

ATTACHMENT A

FORM A-1 — BIDDER INFORMATION AND CERTIFICATIONS FORM

ITB S-63400-00011750

Champoeg State Heritage Park Reservoir Replacement Project

[Note to Bidders: If additional space or lines are needed attach an additional page to the end of the form.]

Business Name: [ ]

Is Bidder authorized to transact business by the Oregon Secretary of State? Yes ☐ / No ☐

· If yes, provide business registry number or otherwise describe authorization:

Business Owner(s) Name: [ ]

Business Address: [ ]

Bidder is a: (select one)

Telephone Number: [ ]

Email Address: [ ]

Federal Employer Identification Number (“FEIN”) Number: [ ]

Bidders must be licensed with the State of Oregon Construction Contractors Board (“CCB”) prior to bidding on Public Improvement Contracts (OAR 137-049-0200). FAILURE TO COMPLY WITH THIS REQUIREMENT WILL RESULT IN BID REJECTION. Contractor certifies that each of its subcontractors participating in the Project will be similarly registered with the CCB before each subcontractor commences Work under the Contract.

CCB REGISTRATION NO.: [ ]

EXPIRATION DATE OF CCB NO.: [ ]

Contract Authorized Representative Name: [ ]

If Bidder is a joint venture or partnership, the individual named above must be authorized to sign on its behalf and execute agreements. Additionally, upon request, Bidder shall provide a copy of the joint venture agreement or partnership agreement evidencing authority to Bid and to enter into the resulting Contract that may be awarded, together with corporate resolutions (if applicable) evidencing corporate authority to participate as a joint venture or partnership.

PUBLIC WORKS BOND

Pursuant to ORS 279C.830(2) and OAR 839-025-0015, Contractor and every subcontractor shall have a Public Works bond filed with the CCB before starting Work on the Project. This bond is in addition to Performance Bond and Payment Bond requirements.

Name of Public Works Bonding Company: [ ]

Agent Name/Phone: [ ] / [ ]

Public Works Bond Number: [ ]

If exempt from this requirement under ORS 279C.836(4), (7), (8), or (9), list applicable exemption and describe:

[choose exemption]: [provide description]

SUBCONTRACTORS CERTIFIED UNDER ORS 200.055

Agency promotes and applies a policy of diversity, equity, and inclusion in public contracting by engaging in efforts to increase public contracting opportunities for businesses and enterprises that the Certification Office for Business Inclusion and Diversity has certified under ORS 200.055.

Provide the company name(s) of any subcontractor certified under ORS 200.055 as a disadvantaged business enterprise, a minority-owned business, a woman-owned business, an emerging small business, or a veteran-owned business, that Bidder intends to utilize in the performance of this Contract.

Name: [ ]

Name: [ ]

Name: [ ]

Name: [ ]

Name: [ ]

RESPONSIBILITY INQUIRY

Bidder may add additional lines to this section and form as needed to provide the required information.

1. Does Bidder have available the appropriate financial, material, equipment, facility, and personnel resources and expertise, or ability to obtain the resources and expertise, necessary to demonstrate the capability of Bidder to meet all contractual responsibilities?

Yes ☐ / No ☐

2. Within the last 5 years, how many contracts of a similar nature has Bidder completed that, to the extent that the costs associated with and time available to perform the contract remained within Bidder′s control, Bidder stayed within the time and budget allotted, and there were no contract claims by any party? Number of contracts: [insert #]

How many contracts did not meet those standards? Number of contracts: [insert #]

If any contracts did not meet those standards, please provide an explanation:

Has Bidder been debarred or otherwise disqualified from bidding on contracts by any state, local, or federal agency under any state or federal law? Yes ☐ / No ☐

If yes, please provide an explanation:

3. Within the last 3 years, has Bidder had:

a. any contracts terminated for default by any government agency, or

b. any lawsuits filed against it by creditors or involving contract disputes?

Yes ☐ / No ☐

If yes, please provide an explanation: (With regard to judgments, include jurisdiction and date of final judgment or dismissal.)

4. Within the last 3 years has Bidder been criminally or civilly charged, indicted, or convicted in connection with:

a. obtaining, attempting to obtain, or performing a public (federal, state, or local) contract or subcontract,

b. violation of federal or state antitrust statutes relating to the submission of Bids or Proposals, or

c. embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, or receiving stolen property?

Yes ☐ / No ☐

If yes, indicate the jurisdiction, date of indictment, charge or judgment, and names and summary of charges below:

Does Bidder have any outstanding or pending judgments against it? Yes ☐ / No ☐

If yes, please provide an explanation:

5. Is Bidder experiencing financial distress or having difficulty securing financing?

Yes ☐ / No ☐

If yes, please provide an explanation:

6. Does Bidder have sufficient cash flow to fund day-to-day operations throughout the proposed contract period?

Yes ☐ / No ☐

If no, please provide an explanation:

Within the last 3 years, has Bidder filed a bankruptcy action, filed for reorganization, made a general assignment of assets for the benefit of creditors, or had an action for insolvency instituted against it?

Yes ☐ / No ☐

If yes, provide the filing dates, jurisdictions, type of action, ultimate resolution, and dates of judgment or dismissal, if applicable:

Does Bidder have all required licenses, insurance and/or registrations, if any, and is Bidder legally authorized to do business in the State of Oregon? Yes ☐ / No ☐

If no, please provide an explanation:

7. Pay Equity Certificate. This certificate is required if Bidder employs 50 or more full-time workers and the resulting Contract price is estimated to exceed $500,000. Does a current authorized representative of Bidder possess an unexpired Pay Equity Certificate issued by the Department of Administrative Services?

Yes ☐ / No ☐ / Not Applicable ☐

[If the certificate was provided with the Bid or Proposal submitted for a solicitation related to the prospective contract, then it is not necessary to resubmit it. Just indicate “see Bid” or “see Proposal” in the response field. Otherwise, if applicable, submit a copy of the certificate with this form.]

Does Bidder have documented diversity, equity and inclusion values and practices as required pursuant to Executive Order 22-15? Yes ☐ / No ☐

8. Within the last 3 years has the Offeror, or any officer, partner, agent or employee of Offeror been found to have violated any state or federal prevailing wage statute or regulation (including the federal Davis-Bacon and related Acts and ORS 279C.800 – ORS 279C.870) in any Final Order of the Oregon Bureau of Labor and Industries or the United States Department of Labor, or by any court of competent jurisdiction?

Yes ☐ / No ☐

If yes, provide copies of the final order(s) or judgment in which this occurred and explain in detail:

(a) The circumstances behind any violation, including the amount(s) not paid

(b) Whether the amount(s) have now been paid

(c) The reasons for the violation

(d) All efforts undertaken to ensure that future violations will not occur

Response:

RECORD OF SATISFACTORY PERFORMANCE

Bidder must demonstrate that it has completed previous contracts of a similar nature with a satisfactory record of performance. Bidder shall provide the information below for 3 different projects completed within the last 3 years that demonstrate Bidder’s experience with projects of similar size, scope, and complexity to the Project that is the subject of this ITB. Bidder must provide contact information for the individual who can describe the quality of workmanship and service that the Bidder provided on current and past projects of similar size and complexity.

Agency reserves the right to choose and investigate any contact or reference (whether or not furnished by the Bidder), and to investigate past performance with respect to its successful performance of similar projects, compliance with specifications and contractual obligations, its completion or delivery of service on schedule, and its lawful payment of suppliers, subcontractors, and employees.

Bidder may add additional lines to this form as needed to provide the required information.

Project #1

Description of Project: [ ]

Project Location: [ ]

Project Date: [ ]

Contract Amount: [ ]

Project Owner: [ ]

Project Contact: [name], [phone], [email]

Did the project owner ever find that you were materially deficient in contract performance?

Yes ☐ / No ☐

If yes, (i) was the deficient performance expressly excused under the terms of the contract, or (ii) did you take appropriate corrective action? Please provide an explanation:

Did you stay within the contract time and budget to the extent the costs associated with and time available to perform a previous contract were within your control? Yes ☐ / No ☐

Project #2

Description of Project: [ ]

Project Location: [ ]

Project Date: [ ]

Contract Amount: [ ]

Project Owner: [ ]

Project Contact: [name], [phone], [email]

Did the project owner ever find that you were materially deficient in contract performance?

Yes ☐ / No ☐

If yes, (i) was the deficient performance expressly excused under the terms of the contract, or (ii) did you take appropriate corrective action? Please provide an explanation:

Did you stay within the contract time and budget to the extent the costs associated with and time available to perform a previous contract were within your control? Yes ☐ / No ☐

Project #3

Description of Project: [ ]

Project Location: [ ]

Project Date: [ ]

Contract Amount: [ ]

Project Owner: [ ]

Project Contact: [name], [phone], [email]

Did the project owner ever find that you were materially deficient in contract performance?

Yes ☐ / No ☐

If yes, (i) was the deficient performance expressly excused under the terms of the contract, or (ii) did you take appropriate corrective action? Please provide an explanation:

Did you stay within the contract time and budget to the extent the costs associated with and time available to perform a previous contract were within your control? Yes ☐ / No ☐

CERTIFICATIONS OF BIDDER’S DULY AUTHORIZED REPRESENTATIVE

THIS BID MUST BE SIGNED BY AN AUTHORIZED REPRESENTATIVE OF THE BIDDER

The undersigned acknowledges, attests, and certifies individually and on behalf of the Bidder that:

(1) The undersigned is a duly authorized representative of the Bidder, has been authorized by Bidder to make all representations, attestations, and certifications contained in this Bid and all Addenda, if any, issued;

(2) Bidder, acting through its authorized representatives, has read and understands all Bid instructions, Specifications, Plans, terms and conditions contained in this Bid document (including all listed attachments and Addenda, if any, issued);

(3) The Bid submitted is in response to the specific language contained in the ITB, and Bidder has made no assumptions based upon either (a) verbal or written statements not contained in the ITB, or (b) any previously issued ITB, if any;

(4) The State shall not be liable for any claims or be subject to any defenses asserted by Bidder based upon, resulting from, or related to, Bidder’s failure to comprehend all requirements of the ITB;

(5) The State shall not be liable for any expenses incurred by Bidder in preparing and submitting its Bid or in participating in the Bid evaluation/selection process;

(6) The Bidder agrees to be bound by and comply with all applicable requirements of ORS 279C.800 through ORS 279C.870 and the administrative rules of the Bureau of Labor and Industries (“BOLI”) regarding prevailing wage rates;

(7) The Bid was prepared independently from all other Bidders, and without collusion, fraud, or other dishonesty;

(8) Bidder is bound by and will comply with all requirements, Specifications, Plans, terms and conditions contained in this Bid (including all listed attachments and Addenda, if any, issued);

(9) Bidder will furnish the designated item(s) or service(s) in accordance with the Specifications, Plans and requirements, and will comply in all respects with the terms of the resulting Contract upon award;

(10) Bidder represents and warrants that Bidder has the power and authority to enter into and perform the Contract and that the Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms;

(11) Bidder has no undisclosed liquidated or delinquent debt owed to the State or any department or agency of the State;

(14) Bidder has not discriminated and will not discriminate against any disadvantaged business enterprise, minority-owned business, women-owned business, emerging small business, or veteran-owned business (as those terms are defined in ORS 200.005), in obtaining any required subcontracts;

(15) Bidder has a written policy and practice that meets the requirements described in ORS 279A.112 for preventing sexual harassment, sexual assault and discrimination against employees who are members of a “protected class”; and

[Insert the following two certifications, 16 and 17, if required and delete the “and” above, otherwise delete and renumber 18 to 16.]

(16) If awarded a Contract, Bidder agrees to perform a CRC for each Contractor and subcontractor employee before that employee will be allowed access to the State-owned building or be authorized to perform any Work under the Contract per ORS 406.055;

(167) If awarded a Contract, Bidder agrees and acknowledges each Contractor and subcontractor will comply with the prohibition on aerosolizing, smoking or vaporizing when in a public place per ORS 433.845; and

(17)8) All affirmations and certifications contained within the Bid, including those in this Bidder Information and Certification Form and the Pricing Form, are true and correct.

ACKNOWLEDGMENT OF ADDENDA

(must be completed by Bidder as a matter of responsiveness)

Bidder acknowledges and agrees: (select one option) ☐ Addenda No. [insert #] to No. [insert #] have been issued for this ITB.

☐ Addenda have not been issued for this ITB.

If addenda have been issued, Bidder has received and duly considered all addenda. Bidder acknowledges and agrees to the terms of all such Addenda as those terms revise the terms, conditions, Plans and Specifications of this ITB.

SIGNATURE OF BIDDER’S DULY AUTHORIZED REPRESENTATIVE

(Legal Business Name)

FORM A-2 — PRICING FORM

ITB S-63400-00011750

Champoeg State Heritage Park Reservoir Replacement Project

[Drafting Note: For procurement staff - In OregonBuys the items tab needs to be configured appropriately to direct Bidders to Pricing Form and eliminate inconsistencies between OregonBuys and Pricing Form. In the items tab, a minimum of 1 item is required. Therefore, 1.) create 1 item, 2.) chose the most appropriate NIGP code for the project (i.e. construction services, general), 3.) select “Disable Pricing on Quote”, 4.) enter 1 in quantity, and 5.) enter the following into the description field: Bidders must complete Attachment A, Form A-2, Pricing Form and include in their Bid Package submittal.]

PRICING SUBMITTAL INSTRUCTIONS:

Bidder shall enter pricing and other required information for all Bid Items listed in this Pricing Form. If this Pricing Form is replaced by Addendum, Bidders shall use the Addendum form to provide pricing and other required information. If the Pricing Form is only modified by Addendum, Bidders shall follow the instructions in the Addendum for making modifications to the Pricing Form. Failure to supply the required information in the Pricing Form, as modified by subsequent Addenda, may result in Bid rejection as nonresponsive.

All Work described in the Contract Documents but not specifically itemized in the Pricing below is considered incidental to the Work, and Bidder agrees to furnish all necessary plant, labor, equipment, accessories, materials, permits, and perform all incidental Work at no additional cost to the Agency. Contractor shall furnish all temporary facilities such as power, lights, heat, telephone, potable water, portable toilets, and job office as needed to perform the Work at no additional charge to the Agency.

NOTE: Bid price is total contract price including contractor’s profit and overhead. Items not explicitly listed in the bid schedule above are considered incidental.

The undersigned understands that the State reserves the right to increase or decrease the above quantities at the same unit prices as shown or to remove items as necessary to meet budgetary constraints. The undersigned has carefully examined the Contract Documents and the site of the work, and agrees to furnish all necessary plant, labor, equipment, accessories, materials, permits, and perform all operations shown and specified in accordance with the Contract Documents for the price(s) set herein.

Bid submitted by:

(Legal Business Name)

FORM A-3 — BID SECURITY FORM

STATE OF OREGON

STANDARD PUBLIC IMPROVEMENT CONTRACT

BID BOND

We, [_______________], as “Principal,” (Name of Principal) and [_______________], a [_______________] Corporation, (Name of Surety) authorized to transact Surety business in Oregon, as “Surety,” hereby jointly and severally bind ourselves, our respective heirs, executors, administrators, successors and assigns to pay unto the State of Oregon (“Obligee”) the sum of ($[_______________]) [_______________] dollars.

WHEREAS, the condition of the obligation of this bond is that Principal has submitted its proposal or bid to an agency of the Obligee in response to Obligee’s procurement document (No. ) for the project identified as: which proposal or bid is made a part of this bond by reference, and Principal is required to furnish bid security in an amount equal to 10% of the total amount of the bid pursuant to the procurement document and ORS 279C.365(5) for competitive bidding or 279C.400(5) for competitive proposals. Comment by Biesack Jennifer: To insert Comment by HERRON Joshua A * OPRD: done

NOW, THEREFORE, if the proposal or bid submitted by Principal is accepted, and if a contract pursuant to the proposal or bid is awarded to Principal, and if Principal enters into and executes such contract within the time specified in the procurement document and executes and delivers to Obligee its good and sufficient performance and payment bonds required by Obligee, as well as any required proof of insurance, within the time fixed by Obligee, then this obligation shall be void; otherwise, it shall remain in full force and effect.

IN WITNESS WHEREOF, we have caused this instrument to be executed and sealed by our duly authorized legal representatives this [_______________] day of [_______________], 20[__].

PRINCIPAL: [_______________] SURETY: [_______________]

BY: BY ATTORNEY-IN-FACT:

[_______________] [_______________] Signature Name

ATTACHMENT A

FORM A-4 — FIRST-TIER SUBCONTRACTOR DISCLOSURE FORM

ITB S-63400-

PROJECT NAME:

BID #: BID OPENING: Date: Time: Comment by Biesack Jennifer: Complete form boxes

Pursuant to ORS 279C.370 and OAR 137-049-0360, Bidders are required to disclose the following information about certain first-tier subcontractors:

(a) The subcontractor's name,

(b) Dollar value of the subcontract, and

(c) The category of work that the subcontractor would be performing.

If the Bidder will not be using any subcontractors that are subject to the above disclosure requirements, the Bidder is required to indicate "NONE”.

This form must be completed and submitted to Agency by the Bidder with the Bid by the Bid Opening Date or within 2 working hours after the advertised Bid Opening Date. Compliance with the disclosure and submittal requirements is a matter of responsiveness. Bids that are submitted by Closing, but for which the disclosure submittal has not been made by the specified deadline, are not responsive and will not be considered for Contract award.

Agency MUST REJECT A BID IF THE BIDDER FAILS TO SUBMIT THIS DISCLOSURE FORM WITH THIS INFORMATION BY THE STATED DEADLINE.

Substitution of disclosed first-tier subcontractors shall be made only in accordance with ORS 279C.585.

SUBCONTRACTOR NAME CATEGORY OF WORK DOLLAR VALUE

(Legal Business Name)

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