160888 Fillable Attachments.pdf

179 KB Posted

Attached to
IFB#160888 - Asphalt Milling & Patching Services
Solicitation number
IFB-119168
Issued by
Campbell County, Virginia

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Written by GovTribe AI ·

This document comprises fillable bid attachment forms required by the Virginia Department of Transportation (VDOT) for solicitation IFB #160888, which seeks qualified firms to provide paving crews for asphalt milling and patching services on Interstate 77 in Carroll County within the Salem District. The bid submission deadline was May 21, 2026, approximately three weeks after the April 29, 2026 posting date. The attachments must be completed and returned with all bid responses; failure to do so may result in bid rejection or a determination of non-responsiveness. The required forms include State Corporation Commission registration documentation, a Small Business Subcontracting Plan, Subcontractor Approval Request forms, and Normal and Emergency Contacts information, each of which must be properly executed by the bidder's authorized representative.

The Commonwealth of Virginia has established a goal that over 42 percent of its purchases be made from small businesses certified by the Virginia Department of Small Business and Supplier Diversity (DSBSD). Bidders must identify any proposed subcontractors and provide their DSBSD certification status and details, including company names, certification numbers, contact information, and the percentage value of work allocated to each subcontractor during the initial contract term. All subcontracting requires prior written approval from VDOT, and the primary contractor remains fully liable for all subcontracted work. The forms also require bidders to provide complete contact information for normal business operations and emergency situations, including names, titles, phone numbers, email addresses, and mailing addresses for all key points of contact. Out-of-state business entities must either provide their SCC identification number or submit a legal opinion detailing their Virginia business activities and explaining why such activities do not constitute transacting business in Virginia under applicable state law.

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ATTACHMENT _____

State Corporation Commission Form Failure to complete and return this attachment may result in your bid being REJECTED or deemed NON-RESPONSIVE.

Solicitation #:

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):

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

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:

ATTACHMENT ______

Solicitation #:

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 ____

NORMAL AND EMERGENCY CONTACTS

Solicitation # ___________

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

Fax Number

E-mail Address

Failure to complete and return this attachment may result in your bid being deemed NON-RESPONSIVE.
-OR-
ATTACHMENT Subcontracting Approval Request.pdf
Solicitation #:
FIRM INDIVIDUAL’S
TYPE OF EQUIPMENT PROPOSED SUBCONTRACTOR WILL PROVIDE
FOR VDOT USE ONLY:
ATTACHMENT Normal and Emergency Contacts.pdf
NORMAL AND EMERGENCY CONTACTS
Solicitation # ___________
The bidder:
is a corporation or other business entity with the following SCC identification number:
OR: Off
is not a corporation limited liability company limited partnership registered limited liability partnership or: Off
is an outofstate business entity that does not regularly and continuously maintain as part of its ordinary and: Off
is an outofstate business entity that is including with this bid an opinion of legal counsel which accurately and: Off
undefined: Off
SCC: A
SBSP: B
IFB: 160888
Bidder Name:
Preparer Name:
Date:
I plan to use subcontractors: Off
I plan to complete all work: Off
Certification number:
Certification Date:
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:
Solicitation: 160888
NAME ADDRESS 1:
NAME ADDRESS 2:
NAME ADDRESS 3:
NAME ADDRESS 4:
PHONE NUMBER 1:
PHONE NUMBER 2:
PHONE NUMBER 3:
PHONE NUMBER 4:
PERFORMED 1:
PERFORMED 2:
PERFORMED 3:
PERFORMED 4:
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:
Certification Numbers 1:
Certification Numbers 2:
The proposed subcontractors listed above isare approved and accepted under the terms and conditions of the:
contract requirements herein:
Telephone Number:
SUB: C
CONTACTS: D
Send Contracts To Bidders NameTitle:
Primary Phone Number:
Bidders Mailing Address:
Email Address:
Contact Persons Name:
Cellular Telephone Number:
Telephone Number Normal Work Hours:
Telephone Number After Work Hours:
Fax Number:
Email Address_2:
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_3:
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_4:

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