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):

IFB 161150

SBSP-IFB PIM-40

ATTACHMENT __B___

Small Business Subcontracting Plan

IFB # _161150__

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:

Administrative Services Division/Procurement

IFB #: 161150

ATTACHMENT C

VENDOR QUALIFICATION / EQUIPMENT

INVENTORY CERTIFICATION

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

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

VDOT is unable to review an inventory list or other documentation other than those specified below in #4 in order to confirm that the offered equipment meets the required specifications.

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 required equipment is listed in the table below and will require verification prior to issuance of a Notice of Intent to Award.

• OWNED Equipment:

• In the first column, place an “O” beside each piece of owned equipment.

• Complete the YEAR/MAKE/MODEL/CAPACITY/ID#/VIN; place N/A next to equipment for which a column does not apply.

• Verification will be in-person: Prior to the Notice of Intent to Award, VDOT will evaluate the owned equipment as specified in the IFB.

• RENTED/LEASED Equipment:

• In the first column place an “R” beside each piece of equipment that will be rented/leased

• Verification will be by rental agreement: Prior to the Notice of Intent to Award, the bidder shall provide a signed letter from the applicable rental entity on company letterhead stating the type of equipment with detailed equipment description(s) and quantity(ies) as well as the availability for the duration of the contract period, for any equipment intended for use to perform services of this IFB. This letter shall be provided to the Contract Officer within 2 business days of request, or the bidder will be deemed non-responsive.

• SUBCONTRACTED Equipment:

• In the first column place an “S” beside each piece of equipment that will be subcontracted.

• Verification will be by Subcontractor Approval Request Form Attachment : Prior to the Notice of

Intent to Award, the bidder shall complete a separate Subcontractor Approval Request Form for each company they intend to subcontract equipment from, providing detailed equipment description(s) and quantity(ies) under “Type of Equipment Proposed Subcontractor Will Provide.” This form shall be provided to the Contract Officer within 2 business days of request or the bidder will be deemed non-responsive.

• FUTURE PURCHASE Equipment:

• In the first column place a “P” beside each piece of equipment that is to be purchased.

• Verification will be by proof of purchase: Prior to Notice of Intent to Award, the bidder shall provide proof of purchase with detailed equipment description(s) and quantity(ies), as well as a confirmed delivery date for any equipment intended for use to perform services of this IFB. This proof of purchase shall 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.

“O” “R” “S” “P”

DESCRIPTION YEAR MAKE MODEL CAPACITY ID #/VIN

Service Location #1 – One (1) Rubber Tire Loader (minimum 100 horsepower with 3.0 cubic yard capacity bucket) with Operator

Service Location #2 – One (1) Rubber

Tire Loader (minimum 100

Service Location #1 – One (1) Rubber capacity bucket) with Operator and

Service Location #1 - One (1) 4- Wheel Drive Pickup or SUV to be utilized as a Shadow Vehicle with

Operator

NA

Service Location #2 – One (1) Rubber

Service Location #2 - One (1) 4-utilized as a Shadow Vehicle with

Service Location #1 – One (1)

Backhoe (4-wheel drive with minimum

1.0 cubic yard capacity bucket) with

Service Location #2 – One (1)

Service Location #1 – One (1)

Operator and

Service Location #1 – One (1) 4-utilized as a Shadow Vehicle with

Service Location #2 – One (1) utilized as a Shadow Vehicle with

Service Location #1 – One (1) Motor

Grader (minimum 100 horsepower with center blade) with Operator

“O” “R” “S” “P”

DESCRIPTION YEAR MAKE MODEL CAPACITY ID #/VIN

Service Location #2 – One (1) Motor with center blade) with Operator

Service Location #1 – One (1) Motor with center blade) with Operator and

Service Location #1One (1) 4-Wheel Drive Pickup or SUV to be utilized as a Shadow Vehicle with Operator

Service Location #2 – One (1) Motor with center blade) with Operator and utilized as a Shadow Vehicle with

5. 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 __D____

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

IFB 161150

ATTACHMENT __E__

NORMAL AND EMERGENCY CONTACTS

Solicitation # _IFB 161150__

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 ___F__

Solicitation # _161150___

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 #

ATTACHMENT _G__

VIRGINIA CODE RED OZONE DAYS

Solicitation # _IFB 161150__

The contactor shall suspend the use of gasoline and diesel tractors, powered mowers, weed eaters, wood chippers, chainsaws, sprayer rigs and other similar field/yard maintenance equipment in ozone non-attainment or maintenance areas on predicted “code red ozone days”. The ozone season in Virginia is from May through September. The number of “code red ozone days” varies, but typically does not exceed ten (10) per season. The following counties are subject to this provision:

Commonwealth of Virginia Ozone Nonattainment, Maintenance, and Early Action Compact Areas

Ozone Nonattainment Area: An area that exceeds the Environmental Protection Agency’s (EPA) National Ambient Air Quality Standards (NAAQS) for ozone.

Ozone Maintenance Area: An area that that has previously exceeded the EPA NAAQS for ozone, but has since come back into compliance and has adopted an ozone maintenance plan.

Ozone Early Action Compact Area: An area that has previously exceeded the EPA NAAQS for ozone, but voluntarily opted-in to the Early Action Compact program to avoid an official ozone nonattainment designation.

Table 1. Jurisdictions by VDOT District located in either an Ozone Nonattainment, Maintenance, or Early Action

Compact area.

* 8-hour ozone Early Action Compact Area

DISTRICT

Northern Virginia Fredericksburg Staunton Hampton

Roads Richmond Salem

JU

R

IS

D

IC

T

IO

N

Alexandria Arlington Fairfax (County & City) Falls Church Loudoun Manassas Manassas Park Prince William

Fredericksburg Spotsylvania Stafford Gloucester

Frederick* Winchester*

Chesapeake Hampton Isle of Wight James City Newport News Norfolk Poquoson Portsmouth Suffolk Virginia Beach Williamsburg York

Charles City Chesterfield Colonial Heights Hanover Henrico Hopewell Petersburg Prince George Richmond

Botetourt* Roanoke (County & City)* Salem* Vinton*