159060FillableForms.pdf

SBSP-IFB PIM-40

ATTACHMENT _____

Small Business Subcontracting Plan

IFB # ____________

It is the goal of the Commonwealth that over 42% of its purchases be made from small businesses. All potential bidders are required to include this document with their bid response in order to be considered responsive.

Small Business: "Small business (including micro)” means a business which holds a certification as such by the Virginia Department of Small Business and Supplier Diversity (DSBSD) on the due date for bids.

This shall also include DSBSD-certified women- owned and minority-owned businesses and businesses with DSBSD service disabled veteran owned status when they also hold a DSBSD certification as a small business on the bid due date. Currently, DSBSD offers small business certification and micro business designation to firms that qualify.

Certification applications are available through DSBSD online at www.SBSD.virginia.gov (Customer Service).

Bidder Name:

Preparer Name: Date:

Who will be doing the work: □ I plan to use subcontractors □ I plan to complete all work

Instructions A. If you are certified by the DSBSD as a micro/small business, complete only Section A of this form.

B. If you are not a DSBSD-certified small business, complete Section B of this form. For the bid to be considered and the bidder to be declared responsive, the bidder shall identify the portions of the contract that will be subcontracted to DSBSD-certified small business for the initial contract period in relation to the bidder’s total price for the initial contract period in Section B.

Section A If your firm is certified by the DSBSD provide your certification number and the date of certification.

Certification number: Certification Date:

Section B If the “I plan to use subcontractors box is checked,” populate the requested information below, per subcontractor to show your firm's plans for utilization of DSBSD-certified small businesses in the performance of this contract for the initial contract period in relation to the bidder’s total price for the initial contract period. Certified small businesses include but are not limited to DSBSD-certified women-owned and minority-owned businesses and businesses with DSBSD service disabled veteran-owned status that have also received the DSBSD small business certification. Include plans to utilize small businesses as part of joint ventures, partnerships, subcontractors, suppliers, etc. It is important to note that these proposed participation will be incorporated into the subsequent contract and will be a requirement of the contract. Failure to obtain the proposed participation percentages may result in breach of the contract.

SBSP-IFB PIM-40

B. Plans for Utilization of DSBSD-Certified Small Businesses for this Procurement

Subcontract #1

Company Name: SBSD Cert #:

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Value % (Initial Term): Contact Address:

Description of Work:

Subcontract #2

Company Name: SBSD Cert #:

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Value % (Initial Term): Contact Address:

Description of Work:

Subcontract #3

Company Name: SBSD Cert #:

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Value % (Initial Term): Contact Address:

Description of Work:

Subcontract #4

Company Name: SBSD Cert #:

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Value % (Initial Term): Contact Address:

Description of Work:

Subcontract #5

Company Name: SBSD Cert #:

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Value % (Initial Term): Contact Address:

Description of Work:

IFB#:

Administrative Services Division/Procurement

ATTACHMENT B

VENDOR QUALIFICATION/ EQUIPMENT

INVENTORY CERTIFICATION

All bidders responding to this IFB are required to complete equipment information for each piece of equipment listed in question #4.

Failure to complete this attachment may render the bid non-responsive.

1. Name of Business:

2. Name of Owner or Chief Executive Officer: Telephone Number:

3. How many years has the firm been in the business of performing the services called for in this IFB?

4. All equipment that will require inspection by VDOT prior to Notice of Award is listed below.

• In Column 1 place an “O” beside each piece of owned equipment. Place N/A in any block (YEAR/MAKE/MODEL/CAPACITY/ID#/VIN) that does not apply for owned equipment

• In Column 1 place an “R” beside each piece of equipment that will be rented/leased or sub-contracted

• In Column 1 place a “P” beside each piece of equipment that is to be purchased.

• For rented, subcontracted or purchased equipment no detail (Year/Make/Model/Capacity/ID#VIN) is required at time of bid submission.

• See #5 for rented/leased, sub-contracted or purchased equipment requirements.

• VDOT may inspect any equipment used in the performance of this contract at any time during the performance of this contract. Any substitutes for equipment listed below must be inspected and approved prior to being used in performance of this contract.

“O” “R” “P” DESCRIPTION YEAR MAKE MODEL CAPACITY ID #/VIN

Lot 1 - Tandem Axle trucks w/plows, saddle tanks and

Spreaders

Lot 1 - Tandem Axle trucks w/plows, saddle tanks and

Spreaders

Lot 2 - Single Axle Trucks w/plows, saddle tanks, and

Spreaders Lot 2 - Tandem Axle trucks w/plows, saddle tanks and

Spreaders Lot 3 - Tandem Axle trucks w/plows, saddle tanks and

Spreaders

Lot 3 - Tandem Axle trucks w/plows, saddle tanks and

Spreaders

Lot 3 - Tandem Axle trucks w/plows, saddle tanks and

Spreaders

Administrative Services Division/Procurement

Lot 4 - Tandem Axle trucks w/plows, saddle tanks and

Spreaders

Lot 4 - Tandem Axle trucks w/plows, saddle tanks and

Spreaders

Lot 4 - Tandem Axle trucks w/plows, saddle tanks and

Spreaders

Lot 5 - Tandem Axle trucks w/plows, saddle tanks and

Spreaders

Lot 5 - Single Axle Trucks w/plows, saddle tanks, and

Spreaders

Lot 5 - Ton Truck w/plow and

Spreader

Lot 6 - Tandem Axle trucks w/plows, saddle tanks and

Spreaders

Lot 6 - Single Axle Trucks w/plows, saddle tanks, and

Spreaders

Lot 6 - Ton Truck w/plow and

Spreader

Lot 7 - Tandem Axle trucks w/plows, saddle tanks and

Spreaders

Lot 7 - Single Axle Trucks w/plows, saddle tanks, and

Spreaders

Lot 8 - Tandem Axle trucks w/plows, saddle tanks and

Spreaders

Lot 8 - Tandem Axle trucks w/plows, saddle tanks and

Spreaders

Lot 8 - Tandem Axle trucks w/plows, saddle tanks and

Spreaders

Lot 9 - Tandem Axle trucks w/plows, saddle tanks and

Spreaders

Lot 9 - Tandem Axle trucks w/plows, saddle tanks and

Spreaders

Lot 9 ‐ Single Axle Trucks w/plows, saddle tanks, and

Spreaders

Lot 10 ‐ Ton Truck w/plow and

Spreader

Lot 10 ‐ Ton Truck w/plow and

Spreader

Lot 11 ‐ Motorgrader 100‐149

HP

5. Rented, leased equipment: Prior to Notice of Intent to Award VDOT shall require the bidder to provide a letter from the applicable entity on company letterhead stating the type of equipment with detailed equipment description and availability for the duration of the contract period, for any equipment intended for use to perform services of this IFB. This letter must be provided to the Contract Officer within 2 business days of request, or the bidder will be deemed non-responsive.

Sub-Contracted equipment: Prior to Notice of Intent to Award VDOT shall require the bidder to complete the sub-contracting form identifying the company they intend to use for sub-contracting and listing of the equipment. This form must be provided to the Contract Officer within 2 business days of request, or the bidder will be deemed non-responsive.

Future equipment purchase: Prior to Notice of Intent to Award, VDOT shall require the bidder to provide proof of purchase with detailed equipment description and confirmed delivery date for any equipment intended for use to perform services of this IFB.

This proof of purchase must be provided to the Contract Officer within 2 business days of request, or the bidder will be deemed non-responsive. All purchased equipment must be available by date of award.

6. Is any of the equipment listed above currently committed on any other contract (VDOT / non VDOT) contracts? Yes No If yes, identify which equipment (year, make, model, ID/VIN), where the equipment is committed, contract number(s), name the party to the contract and location.

ATTACHMENT C

Administrative Services/Procurement

State Corporation Commission Form

Failure to complete and return this attachment may result in your bid being deemed NON-RESPONSIVE.

IFB #:

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 undersigned 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):

ATTACHMENT D

IFB# ________

NORMAL AND EMERGENCY

CONTACTS

Send Contracts To:

Bidder's Name/Title Primary Phone Number

Bidder's Mailing Address E-mail Address

Contact Person’s Name

Cellular Telephone Number

Telephone Number – Normal Work Hours

Telephone Number – After Work Hours

Fax Number

E-mail Address

Contact Person’s Name

Cellular Telephone Number

Telephone Number – Normal Work Hours

Telephone Number – After Work Hours

Fax Number

E-mail Address

Contact Person’s Name

Cellular Telephone Number

Telephone Number – Normal Work Hours

Telephone Number – After Work Hours

Fax Number

E-mail Address

ATTACHMENT E

Administrative Services/Procurement

IFB #:

SUBCONTRACTOR APPROVAL REQUEST

No portion of the work (including equipment) shall be subcontracted to another firm or individual without prior written consent of Virginia Department of Transportation (herein referred to as VDOT). In the event that the contractor desires to subcontract some part of the work specified herein, the contractor shall furnish VDOT with the names, qualifications, and experience of their proposed subcontractors for agency approval. The primary contractor shall, however, remain fully liable and responsible for the work performed by its subcontractor(s) and shall assure compliance with all requirements of the contract.

List proposed subcontractor(s), including name, address, contact person, and type of work to be performed under this contract below.

FIRM INDIVIDUAL’S

NAME & ADDRESS

CONTACT PERSON AND

PHONE NUMBER

TYPE OF WORK TO BE

PERFORMED

TYPE OF EQUIPMENT PROPOSED SUBCONTRACTOR WILL PROVIDE

QUALIFICATIONS / EXPERIENCE LEVEL OF PROPOSED SUBCONTRACTOR

Please indicate which above proposed subcontractors are certified (with DSBSD) as Small, Women Owned or

Minority Businesses.

Certification Number(s):

FOR VDOT USE ONLY:

The proposed subcontractor(s) listed above is/are approved and accepted under the terms and conditions of the contract requirements herein.

Signature of Authorized VDOT Representative Date Telephone Number

ATTACHMENT F

IFB#:

ADDITIONAL EQUIPMENT OFFERED

If you wish to offer additional equipment over the required minimum, you must list the equipment below.

PRICES WILL BE PAID AT THE SAME BID PRICE FOR THE LOT NUMBER/NUMBERS

BIDS ARE SUBMITTED FOR.

LOT # DESCRIPTION YEAR MAKE MODEL CAPACITY