2-Certification Addendum Acknowledgement Form.pdf
PDF 129 KB Posted
- Attached to
- 2 Stage Compressor
- Solicitation number
- RFB-26-169
- Issued by
- Yuma County, Arizona
About this file
This is a Certification & Addenda Acknowledgement Form from the City of Yuma's Procurement Division dated November 6, 2024, related to the solicitation for a 2 Stage Compressor (RFB-26-169). The form serves as the official submission document for responders bidding on the City of Yuma's request for bids for a 15 horsepower compressor. Responders are required to complete all fields on the form, including company name, contact information, address, authorized representative details, and offer date. The form emphasizes that responders must monitor the City of Yuma's Bonfire Procurement Portal for any addenda issued to the solicitation, as the City will not be held responsible for responders who fail to receive posted addenda. By signing the form, responders acknowledge receipt and consideration of all information contained in any addenda and certify their compliance with all applicable solicitation documents.
The certification section of the form requires responders to affirm compliance with Federal Executive Order 11246 and Arizona Revised Statutes Section 31-01461 regarding non-discrimination in employment, confirm that no improper gifts, favors, or considerations have been offered to public servants in connection with the bid, and verify that the signing representative has authority to bind the company to the contract. Responders must upload the completed and signed form to the Procurement Portal for the associated solicitation. No pricing information, set-asides, award dates, contract terms, or other financial details are specified in this acknowledgement form.
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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-26-169 |
| Ref 2: 2 Stage Compressor |
| 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 .