2-Certification Addendum Acknowledgement Form.pdf
PDF 135 KB Posted
- Attached to
- RFB-26-182 20' Enclosed Cargo Trailer
- Solicitation number
- RFB-26-182
- Issued by
- Yuma County, Arizona
About this file
This is a Certification & Addenda Acknowledgement Form issued by the City of Yuma, Arizona Procurement Division for solicitation RFB-26-182 regarding a 20' Enclosed Cargo Trailer. The form serves as the official response document through which potential responders acknowledge receipt of all solicitation materials and any addenda posted to the City of Yuma's Bonfire Procurement Portal. Responders are required to complete this form with company information, contact details, and authorized representative signature to submit their offer for goods and/or services in compliance with all solicitation requirements. The City emphasizes that responders are solely responsible for monitoring the Bonfire Procurement Portal for any addenda and that failure to receive posted addenda does not relieve the responder of compliance obligations.
By executing this certification form, the responder's authorized representative attests to four key requirements: non-discrimination in employment practices in accordance with Federal Executive Order 11246 and Arizona Revised Statutes Section 31-01461 et seq.; that no gratuities, loans, favors, or improper benefits have been offered to public servants in connection with the bid submission; that the signing representative possesses authority to bind the company to the contract; and that the signature confirms receipt and consideration of all addenda. Responders must upload the completed and signed form to the Procurement Portal associated with the solicitation.
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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-26-182 |
| Ref 2: 20' Enclosed Cargo Trailer |
| 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 .