2. RFP Appendix 1-4.pdf

APPENDIX 1: CONFLICT OF INTEREST STATEMENT

Indicate below whether or not the firm or any individuals that will work on the contract has a possible conflict of interest (e.g., currently employed by the State of Alaska or formerly employed by the State of Alaska within the past two years) and, if so, the nature of that conflict. The Contract Manager reserves the right to consider a proposal non-responsive and reject it or cancel the award if any interest disclosed from any source could either give the appearance of a conflict or cause speculation as to the objectivity services to be provided by the offeror.

Does the offeror, or any individuals that will work on this contract, have a possible conflict of interest? □ Yes □ No

* Failure to answer may be grounds for disqualification.

If “Yes”, please provide additional information regarding the nature of that conflict:

FEDERAL REQUIREMENTS

Indicate below all known federal requirements that apply to the proposal, proposal evaluation, or contract:

ALASKA PREFERENCES

If you wish to claim any Alaska Preferences, please complete the Alaska Bidder Preference Certification Form that follows the below signature section.

SIGNATURE

This proposal must be signed by a company officer empowered to bind the company.

Printed Name

Title

Date

Signature

APPENDIX 2

ALASKA BIDDER PREFERENCE CERTIFICATION

AS 36.30.321(a) / AS 36.30.990(2)

BUSINESS NAME:

Alaska Bidder Preference: Do you believe that your firm qualifies for the Alaska Bidder Preference?

□ Yes □ No

Alaska Veteran Preference: Do you believe that your firm qualifies for the Alaska Veteran Preference?

□ Yes □ No

Please list any additional Alaska Preferences below that you believe your firm qualifies for.

1. 2. 3. 4. 5. 6.

To qualify for and claim the Alaska Bidder Preference you must answer YES to all questions below in the Alaska Bidder Preference Questions section. To qualify for and claim the Alaska Veteran Preference, you must answer YES to these questions as well as answer YES to all the questions in the Alaska Veteran Preference section. A signed copy of this form must be included with your bid or proposal no later than the deadline set for receipt of bids or proposals.

If you are submitting a bid or proposal as a JOINT VENTURE, all members of the joint venture must complete and submit this form before the deadline set for receipt of bids or proposals. AS 36.30.990(2)(E)

If the procuring agency is unable to verify a response, the preference may not be applied. Knowingly or intentionally making false or misleading statements on this form, whether it succeeds in deceiving or misleading, constitutes misrepresentation per AS 36.30.687 and may result in criminal penalties.

Alaska Bidder Preference Questions:

1. Does your business hold a current Alaska business license per AS 36.30.990(2)(A)?

☐ YES ☐ NO

a. If YES, enter your current Alaska business license number:

2. Is your business submitting a bid or proposal under the name appearing on the Alaska business license noted in Question 1 per AS 36.30.990(2)(B)?

☐ YES ☐ NO

3. Has your business maintained a place of business within the state staffed by the bidder or offeror or an employee of the bidder or offeror for a period of six months immediately preceding the date of the bid or proposal per AS 36.30.990(2)(C)?

http://www.akleg.gov/basis/statutes.asp#36.30.321 http://www.akleg.gov/basis/statutes.asp#36.30.990 http://www.akleg.gov/basis/statutes.asp#36.30.990 http://www.akleg.gov/basis/statutes.asp#36.30.990 http://www.akleg.gov/basis/statutes.asp#36.30.687 http://www.akleg.gov/basis/statutes.asp#36.30.990 http://www.akleg.gov/basis/statutes.asp#36.30.990

☐ YES ☐ NO

a. If YES, please complete the following information:

Place of Business Street Address:

City:

ZIP:

“Place of business” is defined as a location at which normal business activities are conducted, services are rendered, or goods are made, stored, or processed; a post office box, mail drop, telephone, or answering service does not, by itself, constitute a place of business per 2 AAC 12.990(b)(3).

Do you certify that the Place of Business described in Question 3A meets this definition?

☐ YES ☐ NO

The bidder or offeror, or at least one employee of the bidder or offeror, must be a resident of the state under AS 16.05.415(a) per 2 AAC 12.990(b)(7).

A. Do you certify that the bidder or offeror OR at least one employee of the bidder or offeror is physically present in the state with the intent to remain in Alaska indefinitely and to make a home in the state per AS 16.05.415(a)(1)?

☐ YES ☐ NO

B. Do you certify that that the resident(s) used to meet this requirement has maintained their domicile in Alaska for the 12 consecutive months immediately preceding the deadline set for receipt of bids or proposals per AS 16.05.415(a)(2)?

☐ YES ☐ NO

C. Do you certify that the resident(s) used to meet this requirement is claiming residency ONLY in the state of Alaska per AS 16.05.415(a)(3)?

☐ YES ☐ NO

D. Do you certify that the resident(s) used to meet this requirement is NOT obtaining benefits under a claim of residency in another state, territory, or country per AS 16.05.415(a)(4)?

☐ YES ☐ NO

Per AS 36.30.990(2)(D), is your business (CHOOSE ONE):

A. Incorporated or qualified to do business under the laws of the state?

☐ YES ☐ NO

B. If YES, enter your current Alaska corporate entity number: Click or tap here to enter text.

C. A sole proprietorship AND the proprietor is a resident of the state?

☐ YES ☐ NO

D. A limited liability company organized under AS 10.50 AND all members are residents of the state?

☐ YES ☐ NO

a. Please identify each member by name:

E. A partnership under former AS 32.05, AS 32.06, or AS 32.11 AND all partners are residents of the state?

☐ YES ☐ NO

http://www.akleg.gov/basis/aac.asp#2.12.990 http://www.akleg.gov/basis/aac.asp#2.12.990 http://www.akleg.gov/basis/statutes.asp#16.05.415 http://www.akleg.gov/basis/aac.asp#2.12.990 http://www.akleg.gov/basis/statutes.asp#16.05.415 http://www.akleg.gov/basis/statutes.asp#16.05.415 http://www.akleg.gov/basis/statutes.asp#16.05.415 http://www.akleg.gov/basis/statutes.asp#16.05.415

a. Please identify each member by name:

Alaska Veteran Preference Questions:

Per AS 36.30.321(F), is your business (CHOOSE ONE):

A. A sole proprietorship owned by an Alaska veteran?

☐ YES ☐ NO

B. A partnership under AS 32.06 or AS 32.11 AND a majority of the partners are Alaska veterans?

☐ YES ☐ NO

C. A limited liability company organized under AS 10.50 AND a majority of the members are Alaska veterans?

☐ YES ☐ NO

D. A corporation that is wholly owned by individuals, AND a majority of the individuals are Alaska veterans?

☐ YES ☐ NO

Per AS 36.30.321(F)(3) “Alaska veteran” is defined as an individual who:

1. Served in the Armed forces of the United States, including a reserve unity of the United States armed forces; or

2. Alaska Territorial Guard, the Alaska Army National Guard, the Alaska Air Nations Guard, or the Alaska Naval Militia; and

3. Was separated from service under a condition that was not dishonorable.

Do you certify that the individual(s) indicated as Alaska Veteran(s) meet this definition and can provide documentation of their service and discharge if necessary?

☐ YES ☐ NO

SIGNATURE

By signature below, I certify under penalty of law that I am an authorized representative of Click or tap here to enter text. and all information on this form is true and correct to the best of my knowledge.

Printed Name

Title http://www.akleg.gov/basis/statutes.asp#36.30.321 http://www.akleg.gov/basis/statutes.asp#36.30.321

APPENDIX 3: SUBCONTRACTORS

Please complete the form below if using subcontractors. During contract negotiation, the state may require a signed written statement from each subcontractor that clearly verifies the subcontractor is committed to performing the services required by the contract. Prior to contract award, the state will also require evidence that a subcontractor possesses a valid Alaska business license if they will be performing work within Alaska.

Subcontractor Function

Subcontractor Name Address % of Work Performing

APPENDIX 4: CERTIFICATIONS

No Criteria Response*

1 The offeror is presently engaged in the business of providing the services & work required in this RFP. True | False

2 The offeror confirms that it has the financial strength to perform and maintain the services required under this RFP. True | False

3 The offeror accepts the terms and conditions set out in the RFP and agrees not to restrict the rights of the state. True | False

4 The offeror confirms that they can obtain and maintain all necessary insurance as required on this project. True | False

The offeror certifies that all services provided under this contract by the contractor and all subcontractors shall be performed in the United States.

True | False

The offeror is not established and headquartered or incorporated and headquartered, in a country recognized as Tier 3 in the most recent United States Department of State’s Trafficking in Persons Report.

True | False

7 Offeror complies with the American with Disabilities Act of 1990 and the regulations issued thereunder by the federal government. True | False

8 Offeror complies with the Equal Employment Opportunity Act and the regulations issued thereunder by the federal government. True | False

9 Offeror complies with the applicable portion of the Federal Civil Rights Act of 1964. True | False

10 The offeror can provide (if requested) financial records for the organization for the past three years. True | False

11 The offeror has not had any contracts terminated by the State of Alaska (within the past five years). True | False

The offeror certifies that it is not currently debarred, suspended, proposed for debarment, or declared ineligible for award by any public or federal entity.

True | False

The offeror certifies that they will not support or participate in a boycott of Israel. Failure to comply with this requirement may cause the state to reject the proposal as non-responsive or cancel the contract.

True | False

The offeror certifies that they do not have any governmental or regulatory action against their organization that might have a bearing on their ability to provide services to the state.

True | False

The offeror certifies, within the last five years, they have not been convicted or had judgment rendered against them for: fraud, embezzlement, theft, forgery, bribery, falsification or destruction of records, false statements, or tax evasion.

True | False

The offeror does not have any judgments, claims, arbitrations or suits pending/outstanding against your company in which an adverse outcome would be material to the company.

True | False

17 The offeror is not (now or in the past) been involved in bankruptcy or reorganized proceeding. True | False

18 Offeror certifies they comply with the laws of the State of Alaska. True | False

19 Offeror confirms their proposal will remain valid and open for at least 90 days. True | False

* Failure to answer or answering “False” may be grounds for disqualification. For any “False” responses, provide clarification (up to 250 word maximum for each “False” clarification) below (add rows as necessary).

Section Clarification

Printed Name

Title