2-Exhibits RFQ 3925.pdf

RFQ#3925

RFQ#3925 PRICE FORM

UNDERGROUIND PIPING SERVICES

PROPOSER BUSINESS NAME

Item Description

1.

Please provide a Rate Schedule for all labor categories envisioned to provide the Underground Piping Services for which you indicated above. Attach these documents to this Price Form.

2.

For all unscheduled/urgent work within the District’s service area, please provide your response time (Hrs.)

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.

The District 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 Address:

RFQ#3925 FRICE FORM

FACILITIES MECHANICAL SERVICES

PROPOSER BUSINESS NAME

Item Description

1.

Please provide a Rate Schedule for all labor categories envisioned to provide the Underground Piping Services for which you indicated above. Attach these documents to this Price Form.

2.

For all unscheduled/urgent work within the District’s service area, please provide your response time (Hrs.)

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.

The District 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 Address:

PROPOSER’S BUSINESS INFORMATION

Legal Business Name: Date:

Address:

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:

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

Business Information

California State Contractor’s Licenses No:

Department of Industrial Relations Registration No.:

Is your firm a sole proprietorship doing business under a different name? No Yes

QUALIFICATIONS AND EXPERIENCE

BUSINESS REFERENCES FOR UNDERGROUND PIPING SERVICES

RFQ#3925

Business References f Proposer Business Name:

or

Date:

Proposer shall provide a minimum of six (6) Customer References with Choose (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:

BUSINESS REFERENCES FOR UNDERGROUND PIPING SERVICES

RFQ#3925

Business References f Proposer Business Name:

or

Date:

Proposer shall provide a minimum of six (6) 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 4 Name of Firm: Phone:

Address: Contact:

Project Title: Approx. Cost: $ Contact email:

Project Description:

Project Date: To:

Reference 5 Name of Firm: Phone:

Address: Contact:

Project Title: Approx. Cost: $ Contact email:

Project Description:

Project Date: To:

Reference 6 Name of Firm: Phone:

Address: Contact:

Project Title: Approx. Cost: $ Contact email:

Project

Project Date: To:

BUSINESS REFERENCES FOR FACILITIES MECHANICAL SERVICES

RFQ#3925

Business References Form Proposer Business Name:

Date:

Proposer shall provide a minimum of six (6) 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

BUSINESS REFERENCES FOR FACILITIES MECHANICAL SERVICES

Business References Form Proposer Business Name: Date:

Proposer shall provide a minimum of six (6) 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 4 Name of Firm: Phone:

Address: Contact:

Project Title: Approx. Cost: $ Contact email:

Project Description:

Project Date: To:

Reference 5 Name of Firm: Phone:

Address: Contact:

Project Title: Approx. Cost: $ Contact email:

Project Description:

Project Date: To:

Reference 6 Name of Firm: Phone:

Address: Contact:

Project Title: Approx. Cost: $ Contact email:

Project

LIST OF SUBCONTRACTORS

RFQ#3925

Subcontractor #1 Information Legal Business Name: Date:

Address:

Street Address Suite #

City State ZIP Code

California State Contractor’s License No.:

Department of Industrial Relations Registration No.

Subcontract Description:

Subcontractor #2 Information Legal Business Name: Date:

Address:

Street Address Suite #

City State ZIP Code

California State Contractor’s Licenses No:

Department of Industrial Relations Registration No.

Subcontract Description:

Subcontractor #3 Information Legal Business Name: Date:

Address:

Street Address Suite #

City State ZIP Code

California State Contractor’s Licenses No:

Department of Industrial Relations Registration No.

Subcontract Description:

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.

LIST OF OWNED EQUIPMENT

RFQ#3925

RFQ# 3925, ON CALL CONSTRUCTION SERVICES

UNDERGROUND PIPING SERVICES

Item Description

1. Provide a list of equipment owned envisioned to provide Underground Piping Service (Please limit equipment list to five (5) pages.)

LIST OF OWNED EQUIPMENT

RFQ#3925

RFQ# 3925, ON CALL CONSTRUCTION SERVICES

FACILITIES MECHANICAL SERVICES

Item Description

1. Provide a list of equipment owned envisioned to provide Facilities Mechanical Service (Please limit equipment list to five (5) pages.)

LETTER OF BOND ABILITY

Please attach your company’s letter of Bond Ability.

RFQ# 3925

INSURANCE AFFIDAVIT

I, (Proposer/Company) have reviewed the Insurance Requirements (Rev. 03/2022) 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. 03/2022).

☐ Check here if you DO NOT accept terms and conditions as stated in the Insurance

Requirements (03/2022). 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)

RFQ#3925

Date: Contractor’s Standard Industry Code:

Contractor’s Name: California State Contractor’s License #:

Address:

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?

No Yes

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

No Yes

* 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: Date:

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

Date:

(Risk Management) Approved: No Yes

Reviewed by (Risk Management) (signature required)

CONTRACTOR’S CAL/OSHA COMPLIANCE HISTORY AND SIC CODE

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

RFQ#3925

Date: Contractor’s Standard Industry Code:

Contractor’s Name: California State Contractor’s License #:

Address:

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?

No Yes

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

No Yes

* 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: Date:

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

Date:

(Risk Management) Approved: No Yes

Reviewed by (Risk Management) (signature required)

FEMA CERTIFICATIONS

ADDENDUM FOR CONTRACT FUNDED BY FEMA

The following certifications and provisions are required and apply when Eastern Municipal Water District (EMWD) expends federal funds for any contract resulting from this procurement process. Accordingly, the parties agree that the following terms and conditions apply to the Contract between EMWD and (“Vendor”) in all situations where Vendor has been paid or will be paid with federal funds:

REQUIRED CONTRACT PROVISIONS FOR NON-FEDERAL ENTITY CONTRACTS UNDER FEDERAL AWARDS

APPENDIX II TO 2 CFR PART 200

(A) Contracts for more than the simplified acquisition threshold currently set at $250,000, which is the inflation adjusted amount determined by the Civilian Agency Acquisition Council and the Defense Acquisition Regulations Council (Councils) as authorized by 41 U.S.C. 1908, must address administrative, contractual, or legal remedies in instances where contractors violate or breach contract terms, and provide for such sanctions and penalties as appropriate.

Pursuant to Federal Rule (A) above, when EMWD expends federal funds, EMWD reserves all rights and privileges under the applicable laws and regulations with respect to this procurement in the event of breach of contract by either party.

Does Vendor agree? YES Initials of Authorized Representative of Vendor

(B) Termination for cause and for convenience by the grantee or sub grantee including the manner by which it will be effected and the basis for settlement. (All contracts in excess of $10,000)

Pursuant to Federal Rule (B) above, when EMWD expends federal funds, EMWD reserves the right to immediately terminate any agreement in excess of $10,000 resulting from this procurement process in the event of a breach or default of the agreement by Vendor in the event Vendor fails to: (1) meet schedules, deadlines, and/or delivery dates within the time specified in the procurement solicitation, contract, and/or a purchase order; (2) make any payments owed; or (3) otherwise perform in accordance with the contract and/or the procurement solicitation. EMWD also reserves the right to terminate the contract immediately, with written notice to vendor, for convenience, if EMWD believes, in its sole discretion that it is in the best interest of EMWD to do so. Vendor will be compensated for work performed and accepted and goods accepted by EMWD as of the termination date if the contract is terminated for convenience of EMWD. Any award under this procurement process is not exclusive and EMWD reserves the right to purchase goods and services from other vendors when it is in EMWD’s best interest.

Does Vendor agree? YES Initials of Authorized Representative of Vendor

(C) Equal Employment Opportunity. Except as otherwise provided under 41 CFR Part 60, all contracts that meet the definition of “federally assisted construction contract” in 41 CFR Part 60-1.3 must include the equal opportunity clause provided under 41 CFR 60-1.4(b), in accordance with Executive Order 11246, “Equal Employment Opportunity” (30 FR 12319, 12935, 3 CFR Part, 1964-1965 Comp., p. 339), as amended by Executive Order 11375, “Amending Executive Order 11246 Relating to Equal Employment Opportunity,” and implementing regulations at 41 CFR part 60, “Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor.”

Pursuant to Federal Rule (C) above, when EMWD expends federal funds on any federally assisted construction contract, the equal opportunity clause is incorporated by reference herein.

Does Vendor agree to abide by the above? YES Initials of Authorized Representative of Vendor

(D) Compliance with the Davis-Bacon Act.

a. All transactions regarding this contract shall be done in compliance with the Davis-Bacon Act (40 U.S.C. 3141-

3144, and 3146-3148) and the requirements of 29 C.F.R. pt. 5 as may be applicable. The contractor shall comply with 40 U.S.C. 3141-3144, and 3146-3148 and the requirements of 29 C.F.R. pt. 5 as applicable.

b. Contractors are required to pay wages to laborers and mechanics at a rate not less than the prevailing wages specified in a wage determination made by the Secretary of Labor.

c. Additionally, contractors are required to pay wages not less than once a week.

Does Vendor agree to abide by the above? YES Initials of Authorized Representative of Vendor

(E) Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708). Where applicable, all contracts awarded by the non-Federal entity in excess of $100,000 that involve the employment of mechanics or laborers must include a provision for compliance with 40 U.S.C. 3702 and 3704, as supplemented by Department of Labor regulations (29 CFR Part 5). Under 40 U.S.C. 3702 of the Act, each contractor must be required to compute the wages of every mechanic and laborer on the basis of a standard work week of 40 hours. Work in excess of the standard work week is permissible provided that the worker is compensated at a rate of not less than one and a half times the basic rate of pay for all hours worked in excess of 40 hours in the work week. The requirements of 40 U.S.C. 3704 are applicable to construction work and provide that no laborer or mechanic must be required to work in surroundings or under working conditions which are unsanitary, hazardous or dangerous. These requirements do not apply to the purchases of supplies or materials or articles ordinarily available on the open market, or contracts for transportation or transmission of intelligence.

Pursuant to Federal Rule (E) above, when EMWD expends federal funds, Vendor certifies that Vendor will be in compliance with all applicable provisions of the Contract Work Hours and Safety Standards Act during the term of an award for all contracts by EMWD resulting from this procurement process.

Does Vendor agree? YES Initials of Authorized Representative of Vendor

(F) Compliance with the Copeland “Anti-Kickback” Act.

a. Contractor. The contractor shall comply with 18 U.S.C. § 874, 40 U.S.C. § 3145, and the requirements of 29

C.F.R. pt. 3 as may be applicable, which are incorporated by reference into this contract.

b. Subcontracts. The contractor or subcontractor shall insert in any subcontracts the clause above and such other clauses as FEMA may by appropriate instructions require, and also a clause requiring the subcontractors to include these clauses in any lower tier subcontracts. The prime contractor shall be responsible for the compliance by any subcontractor or lower tier subcontractor with all of these contract clauses.

c. Breach. A breach of the contract clauses above may be grounds for termination of the contract, and for debarment as a contractor and subcontractor as provided in 29 C.F.R. § 5.12.”

Does Vendor agree? YES Initials of Authorized Representative of Vendor

(G) Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33 U.S.C. 1251-1387), as amended— Contracts and sub grants of amounts in excess of $150,000 must contain a provision that requires the non-Federal award to agree to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act (42 U.S.C.

7401-7671q) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251- 1387). Violations must be reported to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA).

Pursuant to Federal Rule (G) above, when federal funds are expended by EMWD, Vendor certifies that during the term of an award for all contracts by EMWD resulting from this procurement process, Vendor agrees to comply with all applicable requirements as referenced in Federal Rule (G) above.

Does Vendor agree? YES Initials of Authorized Representative of Vendor

(H) Debarment and Suspension (Executive Orders 12549 and 12689)—A contract award (see 2 CFR 180.220) must not be made to parties listed on the government wide exclusions in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR part 1986 Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p. 235), “Debarment and Suspension.” SAM Exclusions contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549.

Pursuant to Federal Rule (H) above, when federal funds are expended by EMWD, Vendor certifies that during the term of an award for all contracts by EMWD resulting from this procurement process, Vendor certifies that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation by any federal department or agency.

Does Vendor agree? YES Initials of Authorized Representative of Vendor

(I) Byrd Anti-Lobbying Amendment (31 U.S.C. 1352)—Contractors that apply or bid for an award exceeding $100,000 must file the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C. 1352. Each tier must also disclose any lobbying with non-Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the non-Federal award.

Pursuant to Federal Rule (I) above, when federal funds are expended by EMWD, Vendor certifies that during the term and after the awarded term of an award for all contracts by EMWD resulting from this procurement process, the vendor certifies that it is in compliance with all applicable provisions of the Byrd Anti-Lobbying Amendment (31 U.S.C. 1352).

The undersigned further certifies that:

(1) No Federal appropriated funds have been paid or will be paid for on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any 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 a Federal contract, the making of a Federal grant, the making of a Federal loan, the entering into a cooperative agreement, and the extension, continuation, renewal, amendment, or modification of a 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 influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of congress, or an employee of a Member of Congress in connection with this Federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying”, in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award documents for all covered sub-awards exceeding $100,000 in Federal funds at all appropriate tiers and that all subrecipients shall certify and disclose accordingly.

Does Vendor agree? YES Initials of Authorized Representative of Vendor

(J) Procurement of Recovered Materials – When federal funds are expended, EMWD and its contractors must comply with section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act.

The requirements of Section 6002 include: (1) procuring only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition, where the purchase price of the item exceeds $10,000 or the value of the quantity acquired during the preceding fiscal year exceeded $10,000; (2) procuring solid waste management services in a manner that maximizes energy and resource recovery; and (3) establishing an affirmative procurement program for procurement of recovered materials identified in the EPA guidelines.

Pursuant to Federal Rule (J) above, when federal funds are expended by EMWD, as required by the Resource Conservation and Recovery Act of 1976 (42 U.S.C. § 6962(c)(3)(A)(i)), the vendor certifies, by signing this document, that the percentage of recovered materials content for EPA-designated items to be delivered or used in the performance of the contract will be at least the amount required by the applicable contract specifications or other contractual requirements.

Does vendor agree? YES Initials of Authorized Representative of vendor

RECORD RETENTION REQUIREMENTS FOR CONTRACTS INVOLVING FEDERAL FUNDS

When federal funds are expended by EMWD for any contract resulting from this procurement process, Vendor certifies that it will comply with the record retention requirements detailed in 2 CFR § 200.333. Vendor further certifies that it will retain all records as required by 2 CFR § 200.333 for a period of three years after grantees or subgrantees submit final expenditure reports or quarterly or annual financial reports, as applicable, and all other pending matters are closed.

Does Vendor agree? YES Initials of Authorized Representative of Vendor

CERTIFICATION OF COMPLIANCE WITH THE ENERGY POLICY AND CONSERVATION ACT

When EMWD expends federal funds for any contract resulting from this procurement process, Vendor certifies that it will comply with the mandatory standards and policies relating to energy efficiency which are contained in the state energy conservation plan issued in compliance with the Energy Policy and Conservation Act (42 U.S.C. 6321 et seq.; 49 C.F.R. Part 18).

Does Vendor agree? YES Initials of Authorized Representative of Vendor

CERTIFICATION OF EQUAL EMPLOYMENT STATEMENT

It is the policy of EMWD not to discriminate on the basis of race, color, national origin, gender, limited English proficiency or handicapping conditions in its programs. Vendor agrees not to discriminate against any employee or applicant for employment to be employed in the performance of this Contract, with respect to hire, tenure, terms, conditions and privileges of employment, or a matter directly or indirectly related to employment, because of age (except where based on a bona fide occupational qualification), sex (except where based on a bona fide occupational qualification) or race, color, religion, national origin, or ancestry. Vendor further agrees that every subcontract entered into for the performance of this Contract shall contain a provision requiring non-discrimination in employment herein specified, binding upon each subcontractor. Breach of this covenant may be regarded as a material breach of the Contract.

Does Vendor agree? YES Initials of Authorized Representative of Vendor

CERTIFICATION OF ACCESS TO RECORDS – 2 C.F.R. § 200.336

Vendor agrees that EMWD’s Inspector General or any of their duly authorized representatives shall have access to any books, documents, papers and records of Vendor that are directly pertinent to Vendor’s discharge of its obligations under the Contract for the purpose of making audits, examinations, excerpts, and transcriptions. The right also includes timely and reasonable access to Vendor’s personnel for the purpose of interview and discussion relating to such documents.

Does Vendor agree? YES Initials of Authorized Representative of Vendor

CERTIFICATION OF APPLICABILITY TO SUBCONTRACTRS

Vendor agrees that all contracts it awards pursuant to the Contract shall be bound by the foregoing terms and conditions.

Does Vendor agree? YES Initials of Authorized Representative of Vendor

VENDOR AGREES TO COMPLY WITH ALL APPLICABLE FEDERAL, STATE, AND LOCAL LAWS, RULES, REGULATIONS, AND ORDINANCES. IT IS FURTHER ACKNOWLEDGED THAT VENDOR CERTIFIES COMPLIANCE WITH ALL PROVISIONS, LAWS, ACTS, REGULATIONS, ETC. AS SPECIFICALLY NOTED ABOVE.

Vendor’s Name:

Address, City, State, and Zip Code:

Printed Name and Title of Authorized Representative:

Email Address:

Signature of Authorized Representative:

Date:

Phone Number: Fax Number:

SUBMITTAL CHECK-OFF LIST

Item Required Submittals Checklist Check

Off

1 RFQ Price Form

2 Business Information

3 Business References

4 List of Subcontractors

5 Additions, Deletions, and/or Exceptions

6 Qualifications and Experience

7 List of Owned Equipment

8 Letter of Bond Ability

9 Insurance Affidavit

10 CAL/OSHA Compliance History

11 FEMA Certifications Addendum Form

12 Other items as applicable

SUBMITTAL CHECK-OFF LIST