2-Quote Forms for Electronic Submissions.pdf

SUBMITTALS CHECKLIST

The Submittal Checklist below is for electronic submissions ONLY. Its purpose is to help ensure that you include all the submittals necessary to complete a thorough evaluation of your proposal, we suggest that you utilize this checklist as a reminder to yourself to ensure all forms are completed and submitted through Public Purchase. Questions about Electronic Submissions can be submitted by emailing Purchasing.Agent@Allentownpa.gov.

DESCRIPTION OF SUBMITTAL REF PAGE NO.

Signature Page Page 1

Qualification Statement Page 2, 3, 4

Work Experience Page 5

Contractor's Certification Page 6

MBE/WBE Form Page 7, 8

Political Contribution Disclosure Form Page 9

Remember to complete the Proposal Page on Public Purchase. Submissions without a completed Proposal Page on Public Purchase will not be considered. Electronic Submissions are encouraged.

Remember to direct any/all bid questions using the Public Purchase Website.

Utilizing this site will guarantee questions are documented and answered quickly and promptly electronically or responded to, in form of an addendum.

Remember to check Public Purchase for any Addenda that may have been issued regarding this bid.

SIGNATURE PAGE

CITY OF ALLENTOWN

PURCHASING OFFICE

435 HAMILTON STREET

ALLENTOWN, PA 18101

QUOTE NO. PAGE 1

FIRM NAME (must be filled in)

To: The City of Allentown, Pennsylvania

The Undersigned, having examined the Specifications, Standard Requirements and all other documents and being familiar with the various conditions under which these services and/or supplies are to be used, agrees to all terms and conditions set forth in the bid and to furnish all labor, material, tools, equipment and services to furnish the requirements called for in the bid, for the prices stated.

The Undersigned hereby certifies that this response is genuine and not fraudulent or made in the interest of or on behalf of any person, firm, or corporation, not herein named, and that the undersigned has not, directly or indirectly, induced or solicited any Bidder to submit a false or fraudulent bid or prohibited any other person, firm or corporation from bidding and that the undersigned has not, in any manner, sought by collusion to secure for himself any advantage over any Bidder.

A signed Bid/quote submitted to the City obligates the bidder to all terms and conditions stated within the bid/quote document

Company Name

Address

Signature Printed Name

Title

Email

Phone P.O. Email ______

TRADING AND DOING BUSINESS AS (Check One)

{ } Individual

{ } Partnership

{ } Corporation

Federal I.D.# or Social Security #

Addendum #1 (date)

Addendum #2 (date)

Addendum #3 (date)

QUALIFICATION

STATEMENT

CITY OF ALLENTOWN

PURCHASING OFFICE

435 HAMILTON STREET

ALLENTOWN, PA 18101

QUOTE NO. PAGE 2

CONTRACTORS QUALIFICATION STATEMENT

NAME

ADDRESS

TELEPHONE DATED

EXPLANATORY

Before any bids are deemed to be properly submitted to the City of Allentown, Pennsylvania, it will be required that each and every question herein contained be answered, giving specific, definite and detailed information.

An answer must not be evasive, indefinite or general.

Qualifications of Bidders: After the bid opening, the City of Allentown may make such investigation as it deems necessary to determine the ability of the bidders to perform the work, and the bidders shall furnish to the City of Allentown all such information and data for this purpose as the City may request. The City of Allentown reserves the right to reject any bid if the evidence submitted by, or investigation of, such bidder fails to satisfy the City that such bidder is properly qualified and responsible to carry out the obligations of the contract and to complete the work contemplated therein.

If the space provided in this form to answer any question is not large enough, the contractor shall add additional sheets or space.

1. How many years has your organization been in business as a contractor under your present name?

2. Have you ever failed to complete any work awarded to you? If so, when, where, and why?

3. Has any officer or partner of your organization ever failed to complete a municipal contract handled in his own name? If so, when, where, and why?

CITY OF ALLENTOWN

PURCHASING OFFICE

435 HAMILTON STREET

ALLENTOWN, PA 18101

QUOTE NO PAGE 3

4. Has any officer or partner of your organization been in business under any other corporate organization or partnership which failed to complete a municipal contract? If so, when, where, and why?

5. Have liens or lawsuits of any kind been filed against any of your contracts? Give full details.

6. If a corporation, give the date and the state in which you are incorporated.

7. List Surety Companies and Bonding Companies which have heretofore bonded you within the last

5 years. Give name and address of company and name and amount of contract and amount of bond for the same.

8. List all contracts which you are now performing, or for which you have signed contracts but not started work. (Give names and amounts of contracts and owners).

CITY OF ALLENTOWN

PURCHASING OFFICE

435 HAMILTON STREET

ALLENTOWN, PA 18101

QUOTE NO. PAGE 4

9. State all your banking connections and give banking references:

10. The work, if awarded to you, will have the personal supervision of whom?

WORK EXPERIENCE

PURCHASING OFFICE

435 HAMILTON STREET

ALLENTOWN, PA 18101

QUOTE NO.

BEGIN WITH THE MOST RECENTLY COMPLETED PROJECT

TYPE OF WORK:

JOB TITLE:

DATE:

OWNER

COMPLETED:

CONTRACT

ADMINISTRATOR:

DESCRIPTION:

OWNER

COMPLETED:

CONTRACT

OWNER

COMPLETED:

CONTRACT

OWNER

COMPLETED:

CONTRACT

PURCHASING OFFICE

435 HAMILTON STREET

ALLENTOWN, PA 18101

QUOTE NO. PAGE 6

CONTRACTOR'S CERTIFICATION

SECTION A: TO BE COMPLETED BY CONTRACTOR

NAME: ACCOUNT NO:

ADDRESS: FEDERAL ID#:

[ ] NEW APPLICATION [ ] RENEWAL

[ ] (Have you ever done business in [ ] BUSINESS LICENSES – PAID TO DATE the City of Allentown?) [ ] BUSINESS PRIVILEGE TAX – PAID TO DATE If yes, when?

SECTION B: TO BE COMPLETED BY THE REVENUE AND AUDIT BUREAU

[ ] The Revenue and Audit Bureau certifies that the contractor indicated above has paid all of his/her taxes for the current year and has no outstanding liabilities.

[ ] For bidding purposes only, no tax liability exists at this time. However, if awarded this contract, the tax liability status must be reviewed.

[ ] No tax liability exists.

Person completing this form: Date Completed:

MBE/WBE SUBCONTRACTORS AND SUPPLIER

SOLICITATION AND COMMITMENT FORM

CITY OF ALLENTOWN

PURCHASING OFFICE

435 HAMILTON STREET

ALLENTOWN, PA 18101

No subcontractor needed _______ Prime Contractor is a MBE or WBE _______

INSTRUCTION FOR COMPLETION OF THE MBE/WBE SUBCONTRACTOR AND SUPPLIER SOLICITATION AND COMMITMENT FORM

The purpose of this form is to determine whether the bidder has discriminated in the selection of subcontractors and suppliers. Bidders must solicit MBE and WBE vendor participation for any work the bidders intend to subcontract or for any supplies/materials required to perform the contract.

1. Provide the company names, address, telephone number, fax number, email address and contact person.

2. Provide subcontractors name, address, zip code, telephone number and contact person.

3. Indicate whether the firm is a certified MBE or WBE. Place an (X) in the appropriate column. If the firm is certified MBE and WBE, the bidder will receive credit for the firm as either MBE or WBE.

4. Briefly describe the specific work to be performed and/or materials to be supplied by the certified MBE or WBE. In order to count towards reaching the MPLs, bidders must solicit certified MBE’s/WBE’s in the areas which they are certified. For example, if an MBE/WBE is certified for electrical supplies and the bidder lists plumbing supplies, the bidder will not receive credit.

5. Enter the total dollar ($) amount of the quote received. If the quote was received in the form of unit prices or hourly rates, a total dollar amount must still be provided. If the subcontractor did not respond to the bidder, the bidder must indicate “No Response”. Copies of all MBE/WBE quotes must be submitted with the bid.

6. Enter acceptance or rejection of the quote.

7. If quote is rejected complete the reason for rejection of the quote.

8. The bidder must complete both pages and submit form Page M1 with its bid.

9. The bidder must include on Page M1 all solicited and unsolicited quotes received by the bidder from MBE’s and WBE’s as long as the quotes are within the scope of work.

10. The bidder’s contact with MBE/WBE subcontractors and suppliers should be a minimum of (10) days prior to the bid opening date. This will ensure that MBE/WBE’s have sufficient time to prepare a quote. Ten days is a guide. However, adequate time must be provided to all subcontractors and suppliers to respond.

If additional forms are needed, you are permitted to photocopy form.

REJECTION OF THE BID AS NOT RESPONSIVE

COMPANY NAME: FAX NUMBER:

ADDRESS: E-MAIL ADDRESS:

CONTACT PERSON:

TELEPHONE:

COMPANY NAME, ADDRESS, ZIP CODE, TEL NO. W/

AREA CODE, CONTACT PERSON’S NAME.

M B E

W B E

TYPE OF WORK TO BE

PERFORMED AND/OR MATERIAL TO

BE SUPPLIED.

TOTAL DOLLAR

AMOUNT OF

QUOTE

QUOTE

ACCEPTED

QUOTE

REJECTED

REASON FOR REJECTION

Political Contribution Disclosure Form City of Allentown Purchasing Office For Non-Competitive Bid Contracts or Financial Assistance in Excess of $2,500

Pursuant to the City’s Administrative Code Section 130.16 (H), for all non-competitive bid contracts or financial assistance in excess of

$2,500, an individual or business (including: family members with a financial interest in the business, business associates, subcontractors, contribution to a PAC which makes a candidate contribution, consultants) shall not make a contribution in excess of

$250.00 inclusive of in-kind services in the aggregate, to a candidate for any elective City office or to an elected City office incumbent during the incumbent’s term of office.

VENDOR INFORMATION

Name________________________________________________________________________________________

Address_______________________________________________________________________________________

City_____________________________________________State__________Zip____________________________

CONTRIBUTION DISCLOSURE

Contributor Name Recipient Name Date Dollar Amount

Check here if the information is continued on subsequent page (s).

SUB-CONTRACTOR/CONSULTANT IDENTIFICATION

Name Employer Address

Check here if the information is continued on subsequent page(s).

I certify that NO contributions in the aggregate total over Two Hundred Fifty ($250.00) Dollars were made to an applicable public official by me, a family member or representative. I understand that this certification applies for the length of this contract, and that breach of such contribution rules shall be cause for the void of this contract. I further understand that I will be liable for liquidated damages of 10% of the maximum payment made to me should this contract be voided due to my breach of such contribution rules.

Read and accepted by (Signature)

Printed Name

Date Title (Position)