159146 Attachments.pdf
PDF 1 MB Posted
- Attached to
- IFB 159146 - Delivered Aggregate
- Solicitation number
- 75385
- Issued by
- Goochland County, Virginia
About this file
This document contains attachments for IFB 159146 - Delivered Aggregate, a state and local contract opportunity issued by the Virginia Department of Transportation (VDOT) for the Wytheville Residency of the Bristol District. The solicitation requests bids for the delivery of aggregate materials. The attachments include the State Corporation Commission (SCC) registration form, contacts for normal and emergency situations, a small business subcontracting plan, a quarry source of material form, and a subcontractor approval request form.
The contract term is for the initial period, with potential renewal options. Bidders must provide their SCC identification number or indicate if they are exempt. They must also designate primary, secondary, and after-hours contacts. Bidders not certified as small businesses by the Virginia Department of Small Business and Supplier Diversity (DSBSD) must detail their plans to utilize DSBSD-certified small, women-owned, minority-owned, and service-disabled veteran-owned businesses as subcontractors. The quarry source of material form requires bidders to list their material sources and contact information. Finally, the subcontractor approval request form must be completed for any work the prime contractor wishes to subcontract.
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Administrative Services/Procurement
Bristol District/
IFB #
ATTACHMENT A
STATE CORPORATION COMMISSION FORM
Failure to complete and return this attachment may result in your bid being deemed NON-RESPONSIVE.
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):
IFB #
ATTACHMENT B
NORMAL AND EMERGENCY CONTACTS
Send Contracts To:
Bidder's Name/Title Primary Phone
Number
Bidder's
Address:
Bidder’s Mailing
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
IFB #
ATTACHMENT C
SMALL BUSINESS SUBCONTRACTING PLAN
It is the goal of the Commonwealth that over 42% of its purchases be made from small businesses. All potential bidders are required to return 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 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.
Bidders which are small businesses themselves will receive the maximum available points for the small business participation plan evaluation criterion, and do not have any further subcontracting requirements.
Bidders which are not certified small businesses will be assigned points based on proposed expenditures with
DSBSD-certified small businesses for the initial contract period in relation to the bidder’s total price for the initial contract period.
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.
IFB #
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
Contact Name: SBSD Certification:
Contact Phone: Contact Email:
Subcontract #3
Contact Name: SBSD Certification:
Contact Phone: Contact Email:
Subcontract #4
Contact Name: SBSD Certification:
Contact Phone: Contact Email:
Subcontract #5
Contact Name: SBSD Certification:
Contact Phone: Contact Email:
IFB #
ATTACHMENT D
QUARRY SOURCE OF MATERIAL
DISTRICT: _______________________________________________________________________________
SOURCE OF MATERIAL: __________________________________________________________________
PHONE NUMBER TO PLACE ORDERS:______________________________________________________
DISTRICT: _______________________________________________________________________________
SOURCE OF MATERIAL: __________________________________________________________________
PHONE NUMBER TO PLACE ORDERS:______________________________________________________
DISTRICT: _______________________________________________________________________________
SOURCE OF MATERIAL: __________________________________________________________________
PHONE NUMBER TO PLACE ORDERS:______________________________________________________
DISTRICT: _______________________________________________________________________________
SOURCE OF MATERIAL: __________________________________________________________________
PHONE NUMBER TO PLACE ORDERS:______________________________________________________
DISTRICT: _______________________________________________________________________________
SOURCE OF MATERIAL: __________________________________________________________________
PHONE NUMBER TO PLACE ORDERS:______________________________________________________
DISTRICT: _______________________________________________________________________________
SOURCE OF MATERIAL: __________________________________________________________________
PHONE NUMBER TO PLACE ORDERS:______________________________________________________
IFB #
ATTACHMENT E
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):
Cer Certificat
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
| Bristol SCC form |
| Bristol Normal and Emergency Contacts 11-4 |
| Bristol Quarry Source Attachment |
| Bristol Subcontractor form |
| Virginia State Corporation Commission SCC registration information The bidder: |
| is a corporation or other business entity with the following SCC identification number: |
| Check Box10: Off |
| Group11: Off |
| Send Contracts To Bidders NameTitle: |
| Primary Phone Number: |
| Bidders Email Address: |
| Bidders Mailing Address: |
| Contact Persons Name: |
| Cellular Telephone Number: |
| Telephone Number Normal Work Hours: |
| Telephone Number After Work Hours: |
| Fax Number: |
| Email Address: |
| Contact Persons Name_2: |
| Cellular Telephone Number_2: |
| Telephone Number Normal Work Hours_2: |
| Telephone Number After Work Hours_2: |
| Fax Number_2: |
| Email Address_2: |
| Contact Persons Name_3: |
| Cellular Telephone Number_3: |
| Telephone Number Normal Work Hours_3: |
| Telephone Number After Work Hours_3: |
| Fax Number_3: |
| Email Address_3: |
| IFB Title: Delivered Aggregate |
| DISTRICT: |
| SOURCE OF MATERIAL: |
| PHONE NUMBER TO PLACE ORDERS: |
| DISTRICT_2: |
| SOURCE OF MATERIAL_2: |
| PHONE NUMBER TO PLACE ORDERS_2: |
| DISTRICT_3: |
| SOURCE OF MATERIAL_3: |
| PHONE NUMBER TO PLACE ORDERS_3: |
| DISTRICT_4: |
| SOURCE OF MATERIAL_4: |
| PHONE NUMBER TO PLACE ORDERS_4: |
| DISTRICT_5: |
| SOURCE OF MATERIAL_5: |
| PHONE NUMBER TO PLACE ORDERS_5: |
| DISTRICT_6: |
| SOURCE OF MATERIAL_6: |
| PHONE NUMBER TO PLACE ORDERS_6: |
| NAME ADDRESS 1: |
| NAME ADDRESS 2: |
| NAME ADDRESS 3: |
| NAME ADDRESS 4: |
| PHONE NUMBER 1: |
| PHONE NUMBER 2: |
| PHONE NUMBER 3: |
| PHONE NUMBER 4: |
| TYPE OF WORK TO BE PERFORMED 2: |
| TYPE OF WORK TO BE PERFORMED 3: |
| TYPE OF WORK TO BE PERFORMED 4: |
| TYPE OF WORK TO BE PERFORMED 5: |
| TYPE OF EQUIPMENT PROPOSED SUBCONTRACTOR WILL PROVIDE 1: |
| TYPE OF EQUIPMENT PROPOSED SUBCONTRACTOR WILL PROVIDE 2: |
| QUALIFICATIONS EXPERIENCE LEVEL OF PROPOSED SUBCONTRACTOR 1: |
| QUALIFICATIONS EXPERIENCE LEVEL OF PROPOSED SUBCONTRACTOR 2: |
| 1: |
| 2: |
| Division/Residency: Wytheville Residency |
| Description: Delivered Aggregate |
| IFB#: 159146 |
| Bidder Name: |
| Preparer Name: |
| Date: |
| Certification number: |
| Certification Date: |
| Check Box5: Off |
| Check Box6: Off |
| Company Name: |
| SBSD Cert: |
| Contact Name: |
| SBSD Certification: |
| Contact Phone: |
| Contact Email: |
| Value Initial Term: |
| Contact Address: |
| Description of Work: |
| Company Name_2: |
| SBSD Cert_2: |
| Contact Name_2: |
| SBSD Certification_2: |
| Contact Phone_2: |
| Contact Email_2: |
| Value Initial Term_2: |
| Contact Address_2: |
| Description of Work_2: |
| Company Name_3: |
| SBSD Cert_3: |
| Contact Name_3: |
| SBSD Certification_3: |
| Contact Phone_3: |
| Contact Email_3: |
| Value Initial Term_3: |
| Contact Address_3: |
| Description of Work_3: |
| Company Name_4: |
| SBSD Cert_4: |
| Contact Name_4: |
| SBSD Certification_4: |
| Contact Phone_4: |
| Contact Email_4: |
| Value Initial Term_4: |
| Contact Address_4: |
| Description of Work_4: |
| Company Name_5: |
| SBSD Cert_5: |
| Contact Name_5: |
| SBSD Certification_5: |
| Contact Phone_5: |
| Contact Email_5: |
| Value Initial Term_5: |
| Contact Address_5: |
| Description of Work_5: |
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