2-Certification Addendum Acknowledgement Form.pdf
PDF 110 KB Posted
- Solicitation number
- RFB-26-111
- Issued by
- Yuma County, Arizona
About this file
This document is a Certification & Addenda Acknowledgement Form from the City of Yuma's Procurement Division for a solicitation referenced as RFB-26-111, dated November 6, 2024. The project involves the purchase and delivery of aluminum irrigation pipe and fittings. The form requires potential responders to acknowledge and confirm their understanding of the solicitation documents, including any addenda that may be posted on the city's Bonfire Procurement Portal.
The document outlines several key certification requirements for responders, including non-discrimination commitments, ethical standards regarding interactions with public servants, and authorization to bind the company to the contract. Responders must complete the form by providing company details, contact information, and an authorized signature, which confirms receipt and consideration of all addenda. The form must be uploaded to the Procurement Portal as part of the bidding process for this specific procurement opportunity.
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Text version
Procurement Division
November 6, 2024
Certification & Addenda Acknowledgement Form
Solicitation addenda are posted on the City of Yuma’s Bonfire Procurement Portal identified as:
Ref #: _____________
Project: _______________________________________________________________________________
Any changes to the solicitation document will be in the form of an Addendum. It is the responsibility of the Responder to check the Yuma Procurement Portal for any addenda to the solicitation. The City will not be held responsible if a Responder fails to receive any addenda issued. Any City changes must be in writing.
Submission of Response: The undersigned representative offers and agrees to provide goods and/or services in compliance with all solicitation documents.
Offer Date: ________________________
Responder Company Name Contact Phone #
Address Printed Name
City, State, ZIP Title
Contact Email Address Signature of Person Authorized to Sign Offer
By signing above, the representative certifies:
1. The Responder company will not discriminate against any employee, or applicant for employment in violation of Federal Executive Order 11246 or A.R.S. 3101461 Et. Seq.
2. The Responder company has not given, offered to give, a loan, a gratuity, a special discount, a tip, or any favor, or service to a public servant in connection with the submitted bid.
3. The Representative signing this certification has the authority to bind the Responder to this contract.
4. The Representative’s signature confirms receipt and consideration of all information contained in any addenda.
Upload this document to the Procurement Portal for the associated solicitation.
| Ref 1: RFB-26-111 |
| Ref 2: Purchase and Delivery of Aluminum Irrigation Pipe and Fittings |
| Responder Company Name: |
| Contact Phone: |
| Address: |
| Printed Name: |
| City State ZIP: |
| Title: |
| Contact Email Address: |
| Date1_af_date: |
File details come from the government source that posted it. Updated .