2_of_3_MNDOT_Attachments_A-D_.docx

ATTACHMENT A: RESPONDER DECLARATIONS

(Return with Bid) The undersigned certifies, to the best of his or her knowledge and belief, that:

A. Response Contents. The information provided is true, correct, and reliable for purposes of evaluation for potential contract award. The submission of inaccurate or misleading information may be grounds for disqualification from the award as well as subject the Responder to suspension or debarment proceedings as well as other remedies available by law.

B. Authorized Signature. The appropriate person(s) have submitted the Response on behalf of the Responder as required by applicable articles, bylaws, resolutions, minutes, and ordinances.

C. Non-Collusion Certification.

1. The Response has been arrived at by the Responder independently and has been submitted without collusion and without any agreement, understanding or planned common course of action with any other vendor designed to limit fair or open competition; and

2. The contents of the Response have not been communicated by the Responder or its employees or agents to any person not an employee or agent of the Responder and will not be communicated to any other individual prior to the due date and time of this Solicitation. Any evidence of collusion among Responders in any form designed to defeat competitive responses will be reported to the Minnesota Attorney General for investigation and appropriate action.

D. Organizational Conflicts of Interest. To the best of Responder’s knowledge and belief, and except as otherwise disclosed, there are no relevant facts or circumstances which could give rise to an organizational conflict of interest. An organizational conflict of interest exists when, because of existing or planned activities or because of relationships with other persons,

1. a vendor is unable or potentially unable to render impartial assistance or advice to the State;

2. the vendor’s objectivity in performing the contract work is or might be otherwise impaired; or

3. the vendor has an unfair competitive advantage.

If after award, an organizational conflict of interest is discovered, an immediate and full disclosure in writing must be made to the State’s Chief Procurement Officer which must include a description of the action which the contractor has taken or proposes to take to avoid or mitigate such conflicts. If an organization conflict of interest is determined to exist, the State may, at its discretion, cancel the contract. In the event the Contractor was aware of an organizational conflict of interest prior to the award of the contract and did not disclose the conflict to OSP, the State may terminate the contract for default. Organizational conflicts of interest terms apply to any subcontractors for this work.

E. Copyrighted Material Waiver. By signing its Response, the Responder certifies that it has obtained all necessary approvals for the reproduction and distribution of the contents of its response.

By signing this form, Responder acknowledges and certifies compliance with all applicable requirements indicated above.

Company Name:

Signature:

ATTACHMENT B: PRICING

1. Pricing.

A price schedule document will not be used for this solicitation. Responders must enter their bid price(s) in SWIFT at the unit line level. If a responder needs assistance with entering their proposal, they may contact the Vendor Assistance Help Desk at (651) 201-8100, option #1, and then option #1 again.

2. Alterations or Erasures. The State reserves the right to reject a response containing an alteration or erasure of any price used to determine the lowest responsible responder unless the alteration or erasure is done in a manner that is clear and authenticated by an authorized representative of the Responder. An acceptable way to make an alteration or erasure is to cross out the price, print the correction in ink adjacent to it, and have an authorized representative of the Responder initial and date that correction.

ATTACHMENT C: VETERANS PREFERENCE FORM

PRIME CONTRACTOR RESPONSE

STATE OF MINNESOTA

VETERAN-OWNED PREFERENCE FORM

Unless a greater preference is applicable and allowed by law, in accordance with Minn. Stat. §16C.16, subd. 6a, the Commissioner of Administration will award a 6% preference on state procurement to certified small businesses that are majority owned and operated by veterans.

Veteran-Owned Preference Requirements - See Minn. Stat. § 16C.19(d):

1) The business has been certified by the Office of Equity Procurement (OEP) as being a veteran-owned or service-disabled veteran-owned small business.

or

2) The principal place of business is in Minnesota and the US Small Business Administration verifies the business as being a veteran-owned or service-disabled veteran-owned small business under Public Law 109-461 and Code of Federal Regulations, title 13, part 128. (Supported By Documentation).

Statutory requirements and appropriate documentation must be met by the solicitation response due date and time to be awarded the veteran-owned preference. The preference applies only to the first $2,000,000 of a solicitation response.

Claim the Preference

By signing below I confirm that:

My company is claiming the veteran-owned preference afforded by Minn. Stat. § 16C.16, subd. 6a. By making this claim, I verify that:

· The business has been certified by the Office of Equity in Procurement (OEP) as being a veteran-owned or service-disabled veteran-owned small business.

or

· My company’s principal place of business is in Minnesota and the US Small Business Administration verifies my company as being a veteran-owned or service-disabled veteran-owned small business. (Supported By Attached Documentation)

Name of Company: Date:

Authorized Signature: Telephone:

Printed Name: Title:

Attach documentation, sign, and return this form with your solicitation response to claim the veteran-owned preference.

ATTACHMENT D: RESPONDER SUBMITTALS

(Return with Bid) [Items in RED text are optional, and may be modified or removed as needed]

1. What prompt pay discounts will you offer? If other, specify the terms in the comments section.

Options:

2. Delivery Time Frame: What is the delivery/work completion time frame in calendar days after receipt of order (A.R.O)?

3. Responder’s Contact Information:

Provide the contact information for the representative responsible to sign the contract and the contact for the representative receiving purchase orders.

4. Specifications:

Do you meet or exceed the specifications called for in the Exhibit C: Section 2, Specifications?

|_| Yes |_| No, detail exceptions below.

If no exceptions are detailed below your response will be held in strict compliance with the specifications. Exceptions detailed in other locations within the response will not be considered.

WARNING: Any exceptions taken may be cause for rejection of your response or portions thereof.

A response to this question is required. Your bid won't be accepted if a response is not provided.

Exceptions:

Other comments:

5. Make and Model: List the year, make, and model of the equipment offered.

6. Distributor or Manufacturer’s Rep: Review item 17 of the RFP Section 6, Solicitation Terms, and provide the applicable documentation. Indicate your status via the options below.

7. Warranty Information: What warranty are you offering with this product? If applicable, please include any warranty on materials AND labor/workmanship.