2-RFP 3878 Required Submittals.pdf

PDF 395 KB Posted

Attached to
RFP 3878 CLOSED-CIRCUT TELEVISION PIPELINE INSPECTION AND VIDEO SERVICES
Solicitation number
RFP-WM-3878
Issued by
Riverside County, California

About this file

Written by GovTribe AI ·

This document is a compilation of exhibits and forms for a Request for Proposal (RFP) issued by Eastern Municipal Water District (EMWD), a California-based water utility. The RFP includes multiple exhibits (B through G) that outline the requirements for potential contractors, including business information, references, qualifications, insurance affidavit, and compliance documentation. The documents are specifically focused on mobile source regulations, particularly California Air Resources Board (CARB) requirements for off-road and on-road vehicles used in construction and transportation projects.

The documents require potential contractors to demonstrate compliance with various CARB regulations, including the In-Use Off-Road Diesel-Fueled Fleet Regulation, Advanced Clean Fleets, Truck and Bus Regulation, and Heavy Duty Vehicle Inspection and Maintenance Program. Contractors must provide detailed information about their business, including licensing, references, and a comprehensive compliance history. They are required to verify and maintain documentation showing that all vehicles and equipment used in the project meet specific emissions and inspection standards, with the understanding that failure to maintain compliance could result in contract termination.

View the file

Other files

File Type Posted
1-RFP 3878 Exhibit A Price Form.pdf PDF
3-RFP 3878 CCTV Pipeline Inspections and Video Services.pdf PDF

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

EXHIBIT - B

Legal Business Name:

Business Information

Date:

Address:

Street Address Suite #

City State ZIP Code

Contact:

Phone:

Length of time in business:

Length of time at current location: Federal Tax No.

California State Contractor’s License No.:

Department of Industrial Relations Registration 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:

Title:

Email

BUSINESS REFERENCES

EXHIBIT - C

Proposer Business Name: Date:

Proposer shall provide a minimum of three (3) Customer References with three (3) 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:

Address: Contact:

Project Title: Approx. Cost: $ Contact email:

Description:

Project Date: To:

Reference 2

Reference 3

Business References for

EXHIBIT - D

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.

EXHIBIT - E

QUALIFICATIONS AND EXPERIENCE

EXHIBIT - F

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

EXHIBIT - G

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 #:

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:

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

(Risk Management)

Approved: No Yes

Reviewed by (Risk Management)

(signature required)

12/23/23 C24 00059 Contractor Mobile Source Acknowledgment Form

Contractor Mobile Source Acknowledgement Form This form and supporting attachments must be completed and included in the bid proposal.

The contractor is responsible for maintaining compliance throughout the contract term and for verifying compliance certificates for any subcontractors or rented equipment used throughout the contract term.

OFF-ROAD VEHICLES [CONSTRUCTION EQUIPMENT]

IN USE OFF ROAD DIESEL REGULATION (ORD)

13 CCR 2449-2449.2 (AMENDMENTS EFFECTIVE 10/1/2023)

SIGNED STATEMENT OF ACKNOWLEDGEMENT:

I hereby certify acknowledgement that all off-road diesel-fueled construction vehicles used for this project shall be operated in accordance with California Air Resources Board (CARB) In-use Off-road Diesel-fueled Fleet Regulation [Title 13 CCR, Division 3, Chapter 9, Article 4.8, as amended, effective 10/1/23]. I understand this applies to all equipment used for the project, including equipment used by subcontractors and/or rental equipment.

I understand that it is the contractor’s responsibility to verify that the off-road equipment used for the project, including equipment used by subcontractors and/or rental equipment, meets the CARB requirements. The contractor shall obtain copies of valid Certificates indicating Compliance with the In- Use Off-Road Diesel-Fueled Fleets Regulation for the vehicles used to execute the project scope. The contractor is responsible for maintaining compliance with the In-Use Off-Road Diesel-Fueled Fleets Regulation for the contract term and for verifying compliance certificates for any subcontractors used throughout the contract term.

I understand that copies of current, valid CARB compliance certificates MUST also be included in the bid proposal for the contractor and listed subcontractors. Copies of subsequent annual certificates for the contract term shall be maintained and provided to EMWD upon request. I understand that if the subject regulation is not applicable to equipment owned by my company, I must provide a signed statement and supporting documentation in the bid proposal and provide certificates for the equipment that will be used.

APPLICABILTY STATEMENT: All equipment used for this project will be rented.

Contractor-owned equipment will be used.

Both contractor-owned and rented equipment will be used The contractor is not subject to the off-road regulation (provide reasoning below)

I understand that I must verify that all off-road equipment used for this project complies with the In-Use Off-Road Diesel Regulation.

Complete the following (if it applies): The In Use Off Road Diesel Regulation does not apply to equipment owned and operated by my company because:

The signature below certifies acknowledgement by the contractor of the requirements above

Company Name:

Signer’s Name Date:

(PLEASE PRINT)

Signature:

The contractor is responsible for maintaining compliance throughout the contract term and for verifying compliance certificates for any subcontractors or rented equipment used throughout the contract term.

ON-ROAD VEHICLES

CARB ADVANCED CLEAN FLEETS (ACF)

13 CCR 2013 – 2013.4; 13 CCR 2015 – 2015.6

CALIFORNIA AIR RESOURCES BOARD ON-ROAD VEHICLE DISCLOSURE

All on-road vehicles with a GVWR greater than 8,500 lbs. and light-duty package delivery vehicles operated in California may be subject to the California Air Resources Board Advanced Clean Fleets regulations. Such vehicles may therefore be subject to requirements to reduce emissions of air pollutants. For more information, please visit the CARB Advanced Clean Fleets webpage at https://ww2.arb.ca.gov/our-work/programs/advanced-clean-fleets

SIGNED STATEMENT OF ACKNOWLEDGEMENT:

I hereby certify acknowledgement that the contractor understands that the above CARB regulation may apply to the on-road vehicles they operate or hire and direct for this project. I understand that it is the contractor’s responsibility to verify that the on-road vehicles used for this project, including equipment used by subcontractors and/or rental equipment, meet the CARB requirements. The contractor shall be responsible for verifying compliance with the CARB Advanced Fleet Regulations for applicable vehicles they hire and operate or hire and direct the operation of for the project. The contractor is responsible for maintaining compliance for the contract term and for verifying compliance certificates for any subcontractors used throughout the contract term. The contractor shall keep supporting records and documentation to demonstrate compliance and shall provide them to EMWD upon request.

The signature below certifies acknowledgement by the contractor of the requirements above.

Company Name:

https://ww2.arb.ca.gov/our-work/programs/advanced-clean-fleets https://ww2.arb.ca.gov/our-work/programs/advanced-clean-fleets

The contractor is responsible for maintaining compliance throughout the contract term and for verifying compliance certificates for any subcontractors or rented equipment used throughout the contract term.

ON-ROAD HEAVY DUTY VEHICLES

CARB TRUCK AND BUS REGULATION

13 CCR 2025

SIGNED STATEMENT OF ACKNOWLEDGEMENT:

I hereby certify acknowledgement that all on-road heavy duty vehicles used for this project shall be in accordance with California Air Resources Board (CARB) In-Use On-road Diesel Vehicle Regulation (Truck and Bus Regulation; Title 13 CCR, Division 3, Chapter 1, Article 4.5, section 2025).

I hereby certify acknowledgement that the contractor is aware of the Truck and Bus regulation (Title 13, California Code of Regulations, Section 2025) and will verify the use of 2010 or newer engines in any diesel heavy duty truck used for this project. I understand that it is the contractor’s responsibility to verify that the on-road vehicles used for this project, including equipment used by subcontractors and/or rental equipment, meet the CARB requirements. The contractor shall be responsible for verifying compliance with the CARB Truck and Bus for applicable vehicles they hire and operate or hire and direct the operation of for the project. The contractor shall maintain compliance throughout the contract. The contractor shall keep supporting records and documentation to demonstrate compliance and shall provide them to EMWD upon request.

The signature below certifies acknowledgement by the contractor of the requirements above.

Company Name:

RFP 3846

The contractor is responsible for maintaining compliance throughout the contract term and for verifying compliance certificates for any subcontractors or rented equipment used throughout the contract term.

ON-ROAD HEAVY DUTY VEHICLES

CARB HEAVY DUTY INSPECTION AND MAINTENANCE PROGRAM

13 CCR 2195 – 2199.1

SIGNED STATEMENT OF ACKNOWLEDGEMENT:

I hereby certify acknowledgement that all on-road heavy duty vehicles used for this project shall be in accordance with California Air Resources Board (CARB) Heavy Duty Vehicle Inspection and Maintenance Program (Heavy Duty I/M Title 13 CCR, Division 3, Chapter 3.7, Section 2195-2199.)

I hereby certify acknowledgement that the contractor is aware of the Heavy-Duty Inspection and Maintenance Program requirements (Title 13 CCR, Division 3, Chapter 3.7, Section 2195-2199) and will use heavy duty vehicles with current CARB compliance certificates for this project. I understand that it is the contractor’s responsibility to verify that the on-road vehicles used for this project, including equipment used by subcontractors and/or rental equipment, meet the CARB requirements. The contractor shall be responsible for verifying compliance with the CARB Heavy Duty I/M for applicable vehicles required to operate for the project. The contractor shall maintain compliance throughout the contract. The contractor shall keep supporting records and documentation to demonstrate compliance and shall provide them to EMWD upon request.

The signature below certifies acknowledgement by the contractor of the requirements above.

Company Name:

SUBMITTAL CHECK-OFF LIST

Item Required Submittals Checklist Check

Off

1 RFP Price Form

Proposer’s Business Information

3 Proposer’s Business References

4 Additions, Deletions and/or Exceptions

5 Qualifications and Experience

6 Insurance Affidavit

CAL/OSHA Compliance History

CARB Contractor Mobile Source

8 PACP Certification

BUSINESS REFERENCES
ADDITIONS, DELETIONS AND/OR EXCEPTIONS
QUALIFICATIONS AND EXPERIENCE
INSURANCE AFFIDAVIT
CONTRACTOR’S CAL/OSHA COMPLIANCE HISTORY AND SIC CODE
Name:
Address:
Date:
City:
State:
ZIP Code:
Contact:
Phone:
Title Email:
in business:
current location:
Federal Tax No:
undefined:
undefined_2:
Names and titles of officers of the Business 1:
Names and titles of officers of the Business 2:
Names and titles of officers of the Business 3:
Yes: Off
Name_2:
Date_2:
Firm:
Phone_2:
Address_2:
Contact_2:
Title:
Description:
Project Date:
Firm_2:
Phone_3:
Address_3:
Contact_3:
Title_2:
Description_2:
Project Date_2:
Firm_3:
Phone_4:
Address_4:
Contact_4:
Title_3:
Description_3:
Project Date_3:
supplemental information 1:
supplemental information 2:
supplemental information 3:
supplemental information 4:
supplemental information 5:
supplemental information 6:
supplemental information 7:
supplemental information 8:
supplemental information 9:
supplemental information 10:
supplemental information 11:
supplemental information 12:
supplemental information 13:
1:
2:
1_2:
2_2:
3:
4:
5:
6:
7:
8:
9:
10:
11:
12:
13:
1_3:
2_3:
3_2:
4_2:
5_2:
Requirements Rev 062025 in its entirety and agree to furnish all insurance policies with:
Check here if you DO NOT accept terms and conditions as stated in the Insurance: Off
Company Name:
Mailing Address:
City State Zip Code:
Authorized Representatives Printed Name:
Date_3:
Telephone:
Email:
Date_4:
Contractors Standard Industry Code:
Contractors Name:
California State Contractors License:
Address_5:
Contact Person:
Phone No:
No: Off
Yes_2: Off
If yes to 1 or 2 please provide information specific to the incidents and actions taken to ensure that: Off
Please answer the following questions 1 Has the contractor been cited by CalOSHA 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 incidents and actions taken to ensure that there is not a repeat violation or incidents attach additional sheets if neededRow1:
Please answer the following questions 1 Has the contractor been cited by CalOSHA 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 incidents and actions taken to ensure that there is not a repeat violation or incidents attach additional sheets if neededRow2:
Please answer the following questions 1 Has the contractor been cited by CalOSHA 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 incidents and actions taken to ensure that there is not a repeat violation or incidents attach additional sheets if neededRow3:
Please answer the following questions 1 Has the contractor been cited by CalOSHA 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 incidents and actions taken to ensure that there is not a repeat violation or incidents attach additional sheets if neededRow4:
Please answer the following questions 1 Has the contractor been cited by CalOSHA 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 incidents and actions taken to ensure that there is not a repeat violation or incidents attach additional sheets if neededRow5:
Contractors Representative signature:
Date_5:
FOR EMWD USE ONLY:
Date Risk Management:
Approved No Yes:
undefined_3: Off
undefined_4: Off
Reviewed by Risk Management:
signature required:
This form and supporting attachments must be completed and included in the bid proposal The contractor is responsible for maintaining compliance throughout the contract term and for verifying compliance certificates for any subcontractors or rented equipment used throughout the contract term:
All equipment used for this project will be rented: Off
Contractorowned equipment will be used: Off
Both contractorowned and rented equipment will be used: Off
The contractor is not subject to the offroad regulation provide reasoning below: Off
Complete the following if it applies The In Use Off Road Diesel Regulation does not apply to:
equipment owned and operated by my company because 1:
equipment owned and operated by my company because 2:
Contractor Mobile Source Acknowledgement Form:
Company Name Signers Name Date PLEASE PRINT SignatureRow1:
Contractor Mobile Source Acknowledgement Form_2:
This form and supporting attachments must be completed and included in the bid proposal The contractor is responsible for maintaining compliance throughout the contract term and for verifying compliance certificates for any subcontractors or rented equipment used throughout the contract term_2:
Company Name Signers Name Date PLEASE PRINT SignatureRow1_2:
Contractor Mobile Source Acknowledgement Form_3:
This form and supporting attachments must be completed and included in the bid proposal The contractor is responsible for maintaining compliance throughout the contract term and for verifying compliance certificates for any subcontractors or rented equipment used throughout the contract term_3:
Company Name Signers Name Date PLEASE PRINT SignatureRow1_3:
Check OffRFP Price Form:
Check OffProposers Business Information:
Check OffProposers Business References:
Check OffAdditions Deletions andor Exceptions:
Check OffQualifications and Experience:
Check OffInsurance Affidavit:
Check OffCALOSHA Compliance History:
Check OffCARB Contractor Mobile Source:
Check OffPACP Certification:

File details come from the government source that posted it. Updated .