2-Certification Addendum Acknowledgement Form.pdf
PDF 128 KB Posted
- Solicitation number
- RFB-26-287
- Issued by
- Yuma County, Arizona
About this file
This is a Certification & Addenda Acknowledgement Form issued by the City of Yuma Procurement Division on November 6, 2024, for solicitation RFB-26-287 titled "Kitchen Remodel for Fire Station No. 2 and Fire Station No. 5." The form documents that respondents must acknowledge receipt and consideration of all addenda posted to the City of Yuma's Bonfire Procurement Portal. The project involves providing all labor, materials, and services necessary for kitchen cabinetry replacement and associated components at two fire stations, including demolition of existing cabinetry, fabrication and installation of new commercial-grade laminate cabinets, and installation of new stainless-steel countertops at Fire Station No. 5. The form serves as the official submission document confirming the bidder's offer to provide goods and services in compliance with all solicitation requirements.
By executing this form, the respondent certifies compliance with Federal Executive Order 11246 and Arizona Revised Statutes 3101461 regarding non-discrimination in employment, confirms that no improper gifts, loans, gratuities, or special considerations have been offered to public servants in connection with the bid, and verifies that the signatory has authority to bind the responding company to the contract. The form requires submission to the Procurement Portal and includes fields for company information, contact details, authorized representative identification, and signature confirmation that all addenda have been reviewed and considered.
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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-26-287 |
| Ref 2: Kitchen Remodel for Fire Station No. 2 and Fire Station No. 5 |
| 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 .