161059 Fillable Attachments.pdf
PDF 321 KB Posted
- Attached to
- IFB#161059 Salt Pond Liner Replacements
- Solicitation number
- IFB-123883
- Issued by
- Floyd County, Virginia
About this file
This document comprises fillable attachment forms required for bid submission to the Virginia Department of Transportation (VDOT) for Solicitation #161059, which concerns salt pond liner replacements at two VDOT Salem District facilities in Axton and Glade Hill, Virginia. The project involves furnishing and installing geosynthetic membrane protection barrier liners and HDPE geomembranes. The attachments establish mandatory submission requirements for bidders, including completion of State Corporation Commission registration verification, small business subcontracting plans, subcontractor approval requests, normal and emergency contact information, and references demonstrating prior similar work experience. Bidders must provide at least three references for organizations where similar goods and services have been provided, including complete contact information. Failure to complete and return all required attachments may result in bids being rejected or deemed non-responsive.
The attachments establish that the Commonwealth of Virginia has set a goal of procuring over 42 percent of purchases from small businesses certified by the Virginia Department of Small Business and Supplier Diversity (DSBSD). Bidders must declare whether they are DSBSD-certified micro or small businesses, women-owned or minority-owned businesses, or service-disabled veteran-owned businesses, and identify proposed subcontractors with their certification numbers and anticipated percentage values for the initial contract term. All subcontracting requires prior written consent from VDOT, with the primary contractor remaining fully liable for subcontractor performance and compliance. The primary contractor must maintain normal and emergency contact information for VDOT communication and send contract correspondence to designated personnel.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 161059 IFB.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
ATTACHMENT A
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 B
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 C
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 D
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 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
Solicitation # ____________
REFERENCES
Bidders should provide a list of at least 3 references where similar goods and/or services have been provided. Each reference shall include the name of the organization, the complete mailing address, the name of the contact person, the email, and the telephone/fax number.
FIRM’S NAME AND ADDRESS CONTACT PERSON EMAIL ADDRESS TELEPHONE / FAX #
| Failure to complete and return this attachment may result in your bid being deemed NON-RESPONSIVE. |
| -OR- |
| 161059 IFB Attachment C Subcontracting Approval Request.pdf |
| Solicitation #: |
| FIRM INDIVIDUAL’S |
| TYPE OF EQUIPMENT PROPOSED SUBCONTRACTOR WILL PROVIDE |
| FOR VDOT USE ONLY: |
| 161059 IFB Attachment D Normal and Emergency Contacts.pdf |
| NORMAL AND EMERGENCY CONTACTS |
| Solicitation # ___________ |
| 161059 IFB Attachment E References.pdf |
| ATTACHMENT _____ |
| 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 |
| ATTACHMENT: |
| IFB: 161059 |
| 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: 161059 |
| 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: |
| contract requirements herein: |
| The proposed subcontractors listed above isare approved and accepted under the terms and conditions of the: |
| Telephone Number: |
| 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: |
| FIRMS NAME AND ADDRESSRow1: |
| CONTACT PERSONRow1: |
| EMAIL ADDRESSRow1: |
| TELEPHONE FAX Row1: |
| FIRMS NAME AND ADDRESSRow2: |
| CONTACT PERSONRow2: |
| EMAIL ADDRESSRow2: |
| TELEPHONE FAX Row2: |
| FIRMS NAME AND ADDRESSRow3: |
| CONTACT PERSONRow3: |
| EMAIL ADDRESSRow3: |
| TELEPHONE FAX Row3: |
File details come from the government source that posted it. Updated .