2-iRFB Bid Forms.pdf

Inland Empire Health Plan

(IEHP)

00 41 43 – BID FORMS

BID ACKNOWLEDGMENT

Name of Bidder: ________________________________________________________________

The undersigned, having carefully examined the proposed site and all of the Contract Documents for the [***INSERT BID NAME***] project, proposes and agrees to furnish all tools, equipment, services, apparatus, facilities, transportation, labor and materials necessary to complete the project in strict conformity with all of the Contract Documents for the total bid price indicated herein.

The undersigned hereby agrees to sign the Contract and furnish the necessary bonds and certificates of insurance within ten (10) working days after IEHP provides the successful bidder with the Notice of Award.

Upon receipt of the signed Contract and other required documents, the Contract will be executed by IEHP, after which IEHP will prepare a letter giving Contractor Notice to Proceed. The official starting date shall be the date of the Notice to Proceed, unless otherwise specified.

The undersigned certifies that it is licensed in accordance with the California law, License No. _________, Expiration Date _______, class of license _____ and that it is registered with the Department of Industrial Relations to perform public works, Registration No.__________, Expiration Date ________. If the bidder is a joint venture, each member of the joint venture must include the above information.

The undersigned acknowledges receipt, understanding, and full consideration of the following addenda:

Addendum No. Date:

Addendum No. Date:

Addendum No. Date:

1. The following are attached:

A. Bid Summary form

B. Designation of Subcontractors form

C. Bid Guarantee

D. Bidder Information and Experience form

E. Noncollusion Declaration form

F. Iran Contracting Act Certification form

G. Public Works Contractor Registration Certification form

H. Contractor’s Certificate Regarding Workers’ Compensation form

I. California Contractor’s State License Board (CSLB) License

I hereby certify under penalty of perjury under the laws of the State of California that all of the information submitted in connection with this Bid and all of the representations made herein are true and correct.

Executed at _________________________, on this ____ day of __________, _____.

(Name of Bidder)

(Name and Title)

(Signature)

BID FORMS

BID SUMMARY

TOTAL BASE BID

The undersigned agrees to perform all work required for this project for the sum of:

(In Numbers)

(In Written Form)

In case of discrepancy between the written price and the numerical price, the written price shall prevail.

This Bid Form constitutes a firm offer to IEHP, which cannot be withdrawn for the number of calendar days indicated in the Request for Bids from and after the Bid opening, or until a Contract for the work is fully executed by IEHP and a third party, whichever is earlier.

The Base Bid shall include all tools, equipment, services, apparatus, facilities, transportation, labor and materials. This includes all applicable taxes, permits, licenses, insurance and bond costs, and all other costs incidental or related to the work.

The following percentage information must also be provided for the Base Bid (though it will not be used in awarding the contract):

Labor: % Materials: % Other: %

All three must total 100%.

DESIGNATION OF SUBCONTRACTORS

1. The subcontractor listed below will perform work or labor or render service to the contractor in or about the construction of the work or improvement, or are subcontractors licensed by the State of California who will, under subcontract to the contractor, specially fabricate and install a portion of the work or improvement according to detailed drawings contained in the Contract Documents, in an amount in excess of one-half of one percent (1/2 of 1%) of the contractor’s total bid.

2. In compliance with the Subletting and Subcontracting Fair Practices Act Chapter 4

(commencing at § 4100), Part 1, Division 2 of the California Public Contract Code, the Bidder shall set forth below:

A. The name and the location of the place of business;

B. The California contractor license number;

C. The DIR public works contractor registration number;

D. The portion of the work which will be done by each subcontractor; and

E. The cost of the work.

3. If a Bidder fails to specify a subcontractor or if a contractor specifies more than one subcontractor for the same portion of work, then the Bidder shall be deemed to have agreed that it is fully qualified to perform that portion of work and that it shall perform that portion itself.

Portion of Work

Name of

Subcontractor Location of

Business

CSLB

Contractor License No.

DIR

Registration

Number

Cost of

Portion of

Name of

Subcontractor Location of

Business

CSLB

Contractor License No.

DIR

Registration

Number

Cost of

NON-COLLUSION DECLARATION

(Public Contract Code § 7106)

The undersigned declares:

I am the of , the party making the foregoing bid.

The bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The bid is genuine and not collusive or sham. The bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham bid. The bidder has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding. The bidder has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid price of the bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or of that of any other bidder.

All statements contained in the bid are true. The bidder has not, directly or indirectly, submitted its bid price of any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham bid, and has not paid, and will not pay, any person or entity for such purpose.

Any person executing this declaration on behalf of a bidder that is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the bidder.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that this declaration is executed on [date], at [city], [State], [Signature of Declarant]

[Printed Name of Person Signing]

[Name of Bidder]

[Office or Title]

Iran Contracting Act Certification

(Public Contract Code § 2200 et seq.)

As required by California Public Contract Code § 2204, the Contractor certifies subject to penalty for perjury that the option checked below relating to the Contractor’s status in regard to the Iran Contracting Act of 2010 (Public Contract Code § 2200 et seq.) is true and correct:

The Contractor is not:

1. identified on the current list of person and entities engaged in investment activities in Iran prepared by the California Department of General Services in accordance with subdivision (b) of Public Contract Code § 2203; or

2. a financial instruction that extends, for 45 days or more, credit in the amount of $20,000,000 or more to any other person or entity identified on the current list of persons and entities engaging in investment activities in Iran prepared by the California Department of General Services in accordance with subdivision (b) of Public Contract Code § 2203, if that person or entity uses or will use the credit to provide goods or services in the energy sector in Iran.

IEHP has exempted the Contractor from the requirements of the Iran Contracting Act of 2010 after making a public finding that, absent the exemption, IEHP will be unable to obtain the goods and/or services to be provided pursuant to the Contract.

The amount of the Contract payable to the Contractor for the Project does not exceed $1,000,000.

Signature:

Printed Name:

Title:

Firm Name:

Date:

Note: In accordance with Public Contract Code § 2205, false certification of this form shall be reported to the California Attorney General and may result in civil penalties equal to the greater of $250,000 or twice the Contract amount, termination of the Contract and/or ineligibility to bid on contracts for three years.

Public Works Contractor Registration Certification

Pursuant to Labor Code §§ 1725.5 and 1771.1, all contractors and subcontractors that wish to bid on, be listed in a bid proposal, or enter into a contract to perform public work must be registered with the Department of Industrial Relations. See http://www.dir.ca.gov/Public- Works/PublicWorks.html for additional information.

No bid will be accepted, nor any contract entered into without proof of the Contractor’s and Subcontractors’ current registration with the Department of Industrial Relations to perform public work.

Bidder hereby certifies that it is aware of the registration requirements set forth in Labor Code §§ 1725.5 and 1771.1 and is currently registered as a contractor with the Department of Industrial Relations.

Name of Bidder:

DIR Registration Number:

DIR Registration Expiration:_________________________

Bidder further acknowledges:

Bidder shall maintain a current DIR registration for the duration of the project.

Bidder shall include the requirements of Labor Code §§ 1725.5 and 1771.1 in its contract with subcontractors and ensure that all subcontractors are registered at the time of bid opening and maintain registration status for the duration of the project.

Failure to submit this form or comply with any of the above requirements may result in a finding that the bid is non-responsive.

Name of Bidder

Signature

Name and Title

Dated

Contractor’s Certificate Regarding Workers’ Compensation

I am aware of the provisions of § 3700 of the Labor Code which require every employer to be insured against liability for workers’ compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this Contract.

Name of Bidder

Signature

Name

Title

Dated ______________________________

END OF BID FORMS