2-Exhibits RFP 3851.pdf

RFP#3851

RFP #3851 PRICE FORM

PROPOSER BUSINESS NAME _

Item

Description

Price

1.

Backflow Testing & Certification

$ /each

2.

Revisit Cost – due to inaccessibility of device on first call.

Reason for inaccessibility must be supported with photo and brief description of scenario.

$ /each

3.

Administrative support for backflow testing and certification services

$ /hr

4.

Materials Mark-Up %

5.

Repair Services:

Regular Labor Rate per hr.

6.

Repair Services:

Overtime Labor Rate Including Weekends and Holidays per Hr.

7.

Miscellaneous Charges – Explain

8.

Contractor can meet EMWD’s response time of four (4) business hours within initial request for availability to perform Initial & Non-Compliant Testing?

Yes _______

No________

9.

Contractor can meet EMWD’s requirement to complete initial testing within two (2) business days?

10.

Contractor can meet EMWD’s requirement to complete high-volume of non-compliant testing within five (5) business days?

Price(s) shall include all labor, equipment, materials, transportation, overhead, travel, profit, insurance, sales and other taxes, licenses, incidentals, and all other related costs necessary to meet the work requirements.

EMWD encourages a discount for early payment and will include such offers in the evaluation criteria. If a discount is offered, terms are: % discount if paid in full within days.

The undersigned as Proposer, declares that the only persons or parties interested in this proposal are made without collusion with any person, firm or corporation. Your signature on this document, should you be awarded the contract as defined in this RFP, signifies that you have fully read and understood this proposal and will comply with all specifications, conditions, unit prices, terms, and delivery of the proposal unless otherwise noted in the “exceptions” portion of the proposal.

Name of Offeror (Firm):

Title:

Authorized Signature:

Date:

Printed/Typed Name:

Mailing Address:

Phone:

City, State, Zip:

Fax:

E-Mail

PROPOSER’S BUSINESS INFORMATION

Busi

Legal Business ness Information

Street Address Suite #

City State ZIP Code

Contact: Title:

Phone: Email

Length of time in business:

Length of time at current location:

Federal Tax No.

Names and titles of officers of the Business:

Is your firm incorporated? No Yes

Name and remittance address that will appear on invoices:

Is your firm a sole proprietorship doing business under a different name?

No Yes

If yes, please indicate sole proprietorship name and the name you are doing business under:

California State Contractor’s License No.:

Department of Industrial Relations Registration No.:

BUSINESS REFERENCES

RFP#3851

Business References f Proposer Business Name:

or

Date:

Proposer shall provide a minimum of three (3) Customer References with five (5) or more years’ experience with the Proposer. Preferred references should be similar in size, scope, and complexity (to the contract requirements).

Reference 1 Name of Firm: Phone:

Address: Contact:

Project Title: Approx. Cost: $ Contact email:

Project Description:

Project Date: To:

Reference 2 Name of Firm: Phone:

Address: Contact:

Project Title: Approx. Cost: $ Contact email:

Project Description:

Project Date: To:

Reference 3 Name of Firm: Phone:

Address: Contact:

Project Title: Approx. Cost: $ Contact email:

Project Description:

Project Date: To:

LIST OF SUBCONTRACTORS

Subcontractor #1 Information Legal Business

Street Address Suite #

City State ZIP Code

California State Contractor’s License No.:

Department of Industrial Relations Registration No.

Subcontract Description:

Subcontractor #2 Information

Street Address Suite #

City State ZIP Code

California State Contractor’s License No.:

Department of Industrial Relations

Subcontractor #3 Information

Street Address Suite #

City State ZIP Code

California State Contractor’s License No.:

Department of Industrial Relations

ADDITIONS, DELETIONS AND/OR EXCEPTIONS

Please state any and all Additions, Deletions and Exceptions that you are taking to any portion of this proposal. If not addressed below, then Eastern Municipal Water District assumes that the vendor will adhere to all terms and conditions listed.

District will issue an Agreement in its standard form to the successful firm(s) for the services contemplated herein; a copy of which is attached hereto and incorporated herein. Any deletion, exception, or modification taken to District contract terms and conditions will be evaluated, in addition to the specified criteria; and may, itself, result in non-acceptance by the District. Any request for deletion, exception, or modification, if so taken, must be submitted at the time of proposal. Any asserted trade secrets or other proprietary information must be identified on this exhibit with specific page references within the proposal and/or supplemental information.

QUALIFICATIONS AND EXPERIENCE

INSURANCE AFFIDAVIT

I, (Proposer/Company) have reviewed the Insurance Requirements (Rev. 06/2025) in its entirety and agree to furnish all insurance policies with designated limits, along with full endorsements, and waiver of subrogation, as stated in this Request for Proposal for the full term of the agreement.

I hereby agree to provide copies of insurance certificates, endorsements, and waiver of subrogation within fourteen (14) calendar days of the District’s notification of recommendation of award.

I understand and confirm that our firm is able to provide and maintain the coverage as specified.

Failure to maintain said coverage shall be sufficient cause for contract termination and shall result in termination of the awarded contract.

I understand that by signing this document, I (Proposer/Company) agree to all terms and conditions as stated in the Insurance Requirements (Rev. 06/2025).

☐ Check here if you DO NOT accept terms and conditions as stated in the Insurance Requirements (06/2025). Detail all Exceptions in, Additions, Deletions and/or Exceptions Form.

Authorized Representative’s Signature Name Authorized Representative’s Printed Name

Company Name Date

Mailing Address Telephone

City, State, Zip Code Email

CONTRACTOR’S CAL/OSHA COMPLIANCE HISTORY AND SIC CODE

(This document is to be submitted with the proposal package) (rev. 10/08/18)

Contractor’s Standard Industry Code:

Contractor’s Name:

California State Contractor’s License #:

Contact Person:

Phone No:

Please answer the following questions:

1. Has the contractor been cited by Cal/OSHA or any regulatory agency for a violation related to safety or environmental issues within the past seven (7) years?

2. Within the past ten (10) years has the contractor had a serious incident or fatality on a job site?

* If yes to # 1 or #2, please provide information specific to the incident(s) and action(s) taken to ensure that there is not a repeat violation, or incident(s) (attach additional sheets if needed)

Contractor’s Representative signature:

FOR EMWD USE ONLY: Purchasing to forward to Risk Management for review

(Risk Management)

Approved: No Yes

Reviewed by (Risk Management)

(signature required)

SUBMITTAL CHECK-OFF LIST

Item Required Submittals Checklist Check

Off

RFP Price Form

Proposer’s Business Information

Business References

List of Subcontractors

Additions, Deletions, and/or Exceptions

Qualifications and Experience

Insurance Affidavit

CAL/OSHA Compliance History

License/Certificates

Other items as applicable

SUBMITTAL CHECK-OFF LIST