2-D. Required Forms.docx

BID SUBMISSION FORM

This Bid is submitted by:

Company Legal Name:

Representative (printed):

Address:

City/State/Zip:

Email address:

Telephone:

By signing above, the Bidder agrees that the City reserves the right to reject any and all Bids, to award multiple Contracts by line item, combination of items, or grand total according to the best interest of the City, to waive formalities, technicalities, to recover and re-bid this ITB. Bids are valid for one hundred twenty (120) calendar days from Bid Opening.

The representative signing above hereby certifies and agrees that the following information is correct:

1. Bid/Bid document has been signed by authorized bidder/proposer official.

2. Bid/Bid package has been properly labeled per the instructions. (See Section 1.6)

3. Bid/Bid package contains all of the Bid/Bid Response Package Forms:

I, the undersigned, hereby acknowledge that my company was given the opportunity to provide exceptions to the Sample Contract as provided in the ITB. As such, I have elected to do the following:

I, the undersigned, hereby acknowledge that my company was given the opportunity to indicate any Trade Secret materials or Personally Identifiable Information (“PII”) as detailed in Section 1.6.3. I understand that the City is legally obligated to provide my Bid documents, excluding any appropriately marked Trade Secret information and PII, upon request by any member of the public. As such, my company has elected as follows:

The following section(s) of the of the Bid are marked as Trade Secret or PII:

No portion of the Bid is marked as Trade Secret or PII.

Representative (signed):

NON-DISCRIMINATION PROVISION

All requests for bids or Bids issued for City contracts shall include a certification to be completed by the Bidder or Proposer in substantially the following form:

The undersigned Bidder or Proposer hereby certifies and agrees that the following information is correct:

NAME OF COMPANY:

BY: TITLE:

SIGNATURE OF AUTHORIZED OFFICIAL:

DATE:

REFERENCES FORM

Company Name: ____________________________________________________________ List three (3) clients excluding the City of Charlotte, for whom you have provided services similar to those outlined in this Invitation to Bid, for reference check:

NAME OF FIRM:

ADDRESS OF FIRM:

CONTACT PERSON:

TELEPHONE NUMBER:

EXCEPTIONS FORM

The undersigned Bidder agrees to provide all Products and Services requested in the ITB for the price(s) set forth in the Pricing Sheet, all in strict conformity with the terms, conditions and specifications set forth in the ITB (including any addenda or amendments), subject only to the exceptions stated in the chart below. Exceptions representing material changes to Bid terms are grounds for rejection of the Bidder’s Bid.

ITB Section Number ITB Section Title Exception and Proposed Change to ITB

Date:

Company:

By:

Signature:

Print name and title of signatory

CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS

The bidder, contractor, or subcontractor, as appropriate, certifies to the best of its knowledge and belief that neither it nor any of its officers, directors, or managers who will be working under the Contract, or persons or entities holding a greater than (ten percent) 10% equity interest in it (collectively “Principals”):

1. Are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal or state department or agency in the United States;

2. Have within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state anti-trust or procurement statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

3. Are presently indicted for or otherwise criminally or civilly charged by a government entity, (federal, state or local) with commission of any of the offenses enumerated in paragraph 2 of this certification; and

4. Have within a three-year period preceding this application/proposal had one or more public transactions (federal, state or local) terminated for cause or default.

I understand that a false statement on this certification may be grounds for rejection of this proposal or termination of the award or in some instances, criminal prosecution.

· I hereby certify as stated above:

(Print Name) Signature

Title Date

· I am unable to certify to one or more the above statements. Attached is my explanation. [Check box if applicable]

(Print Name) Signature

BYRD ANTI-LOBBYING CERTIFICATION

The undersigned certifies, to the best of their knowledge and belief, that:

1. No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of and Federal contract, grant, loan, or cooperative agreement.

2. If any funds other than federal appropriated funds have been paid or will be paid to any person for making lobbying contacts to an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form—LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions [as amended by "Government wide Guidance for New Restrictions on Lobbying," 61 Fed. Reg. 1413 (1/19/96)].

3. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including all subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction by 31 U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

___________________________________ (the “Company”) certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Company understands and agrees that the provisions of 31 U.S.C. A 3801, et seq., apply to this certification and disclosure, if any.

(Print Name) Company Name

Authorized Signature Address

BUY AMERICA CERTIFICATION

ITB # 269-2026-2067

BUS TRANSAXLE RECONDITIONING SERVICES

COMPLIANCE FORM

Certificate for Compliance with 49 U.S.C. 5323(j)(1) (Procurement of Steel, Iron, or Manufactured Products)

The Bidder hereby certifies that it will comply with the requirements of 49 U.S.C. 5323(j)(1) and the applicable regulations in 49 CFR Part 661.

Date:

Signature:

Company Name:

Title:

NON COMPLIANCE FORM

Certificate for Non-Compliance with 49 U.S.C. 5323(j)(1) (Procurement of Steel, Iron, or Manufactured Products)

The Bidder hereby certifies that it cannot comply with the requirements of 49 U.S.C. 5323(j)(1) and the applicable regulations in 49 CFR 661, but it may qualify for an exception pursuant to 49 U.S.C. 5323(j)(2)(A), 5323(j)(2)(B), or 5323(j)(2)(D), and 49 CFR 661.7.

Date:

Signature:

Company Name:

Title:

Identify items that are non-compliant in the space below:

NOTICE TO BIDDERS:

Your bid cannot be considered unless one of the above certifications is signed and returned with the bid. If you submit an incomplete Buy America certificate or an incorrect certificate of non-compliance through an inadvertent or clerical error, you may submit to the FTA Chief Counsel, on the day of the Bid Opening, a written explanation of the circumstances surrounding the submission of the incomplete or incorrect certification.

ADDENDA RECEIPT CONFIRMATION

RFP # 269-2026-2067

Please acknowledge receipt of all addenda by including this form with your Proposal. All addenda will be posted to the Bonfire Website.

I certify that this proposal complies with the Specifications and conditions issued by the City except as clearly marked in the attached copy.