2-Attachment No. 2 REQ-0009121 Vendor Certifications Solicitation.docx

GLWA Procurement

Form Effective Date:

7/1/2024 Form Document #:

FSA_PRO_SUP_0002

Form Revision Date:

12/12/2024 Form Revision#:

Document Title:

Vendor Certifications Solicitation Document Owner/Department:

Procurement Team

Requisition No.: _ REQ-0009121_______________________________________________________________________________

Contract Title: __Sodium Bisulfite_______________________________________________________________________________

Vendor Certifications Regarding Debarment, Equal Opportunity, Non-Collusion, Agreement to Contract Terms and Conditions, and Administrative Requirements

I, the undersigned, am a representative of ___________________________________________________________________, (“Vendor”), and affirm that I am authorized to make the following certifications on behalf of Vendor, its owners, and principals. Vendor acknowledges that the below certifications are material to this solicitation and any contract or purchase order (collectively, “Contract”) resulting therefrom and will be relied on by the Great Lakes Water Authority (“GLWA”) in awarding the Contract. Vendor acknowledges that any fraud, misrepresentation, or falsification in these certifications is and shall be treated as fraudulent concealment from GLWA of the true facts relating to the submission of Vendor’s offer and subject Vendor to certain penalties, including loss of the Contract or debarment, as further stated herein.

Part I. Debarment Certification

A. Debarment Pursuant to Federal Law.

Vendor certifies, to the best of its knowledge and belief, that it and its principals:

1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in transactions under federal non-procurement programs by any federal department or agency;

2. Have not, within the three-year period preceding Vendor’s offer on this solicitation, had one or more public transactions (federal, state, or local) terminated for cause or default; and

3. Are not presently indicted or otherwise criminally or civilly charged by a government entity (federal, state, or local) and have not, within the three-year period preceding Vendor’s offer on this solicitation, been convicted of or had a civil judgment rendered against it:

Vendor understands that a false statement on this Debarment Certification may be grounds for the rejection of Vendor’s offer under this solicitation or the termination of an award thereunder. In addition, under 18 U.S.C. §1001, a false statement may result in a fine or imprisonment for up to five years, or both.

B. Debarment Pursuant to GLWA Procurement Policy.

Vendor certifies that:

1. It has read and understands the GLWA Procurement Policy (“Policy”) located at glwater.org/vendors, and in particular, Section 13 – Vendor Suspension/Debarment.

2. No federal, state, or local government entity has found Vendor (as defined in footnote 2 of the Policy) in violation of Section 13.1(a) through (p) in the past three (3) years.

☐ Vendor is unable to certify each of the above statements. Attached is Vendor’s explanation.

Part II. Equal Opportunity Certification

Part III. Non-Collusion Certification

Vendor certifies that:

1. The prices in and amount of this offer have been arrived at independently and without consultation, communication, or agreement with any other vendor or potential vendor.

2. Neither the prices nor the amount of this offer, and neither the approximate prices nor the approximate amount of this offer, have been disclosed to any other firm or person that is a vendor or potential vendor to this solicitation, and the same shall not be disclosed before bid opening.

3. No attempt has been made or will be made to induce any firm or person to refrain from offering on this solicitation, or to submit a cost higher than this offer, or to submit any intentionally high or noncompetitive offer or other form of complementary offer.

4. The offer of Vendor is made in good faith and fair dealing and not pursuant to any agreement or discussion with, or inducement from, any firm or person.

5. Vendor, its affiliates, subsidiaries, principals, officers, directors, partners, members, and employees are not currently under investigation by any governmental agency and have not in the last four years been convicted of or found liable in any jurisdiction for any act prohibited by state or federal law involving conspiracy or collusion with respect to public contracting, except as follows: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________.

PART IV. Certification of Agreement to Contract Terms and Conditions

Vendor certifies that:

1. Vendor’s submission of this offer constitutes its understanding of the requirements of the solicitation, including any addenda issued thereto, and full acceptance of all terms and conditions of the Contract and Vendor makes its offer subject thereto.

Part V. Administrative Requirements Certification

Vendor certifies that:

1. Its response to the solicitation, including pricing, shall remain valid for a period of six (6) months after the due date, which period may be extended upon written agreement between GLWA and Vendor. If Vendor refuses to agree to any such extension, GLWA may disqualify Vendor from further consideration under the solicitation provided, however, that the failure to agree to any such extension shall not constitute grounds for forfeiting Vendor’s bid security, if any.

2. It has acquired or has the capacity to acquire the insurance and/or bonds required by the Contract.

Accordingly, Vendor, by its authorized signature below, acknowledges its agreement with each certification contained in this “Vendor Certifications” document.

Vendor: ___________________________________________________________

Signature: ___________________________________________________________

Print Name: ___________________________________________________________

Title: ___________________________________________________________

Dated: ___________________________________________________________

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