2-RFP-HH-3864 Required Submittals.pdf

RFP #3864 PRICE FORM

PROPOSER BUSINESS NAME _

Item Description Price Break Quantities Price Per Gallon 1.

Bulk 32% Hydrochloric Acid (FOB, Destination)

1 – 500 gallons $

2. 501 -1,000 gallons $

3. 1,000+ gallons $

Price(s) shall include all labor, equipment, materials, transportation, overhead, travel, profit, insurance, sales and other taxes, fuel, 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

PROPOSER’S BUSINESS INFORMATION

Busi

Legal Business ness Information

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:

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:

California State Contractor’s License No.:

Department of Industrial Relations Registration No.:

Business References f

Proposer Business Name:

or

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

Firm:

Address: Contact:

Project

Approx. Cost:

Contact email:

Description:

Project Date: To:

Reference 2

Reference 3

LIST OF SUBCONTRACTORS

Subcontractor #1 Information Legal Business

Street Address Suite #

City State ZIP Code

California State Contractor’s License No.:

Department of Industrial Relations Registration No.

Subcontract Description:

Subcontractor #2 Information

Street Address Suite #

City State ZIP Code

California State Contractor’s License No.:

Department of Industrial Relations

Subcontractor #3 Information

Street Address Suite #

City State ZIP Code

California State Contractor’s License No.:

Department of Industrial Relations

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.

QUALIFICATIONS AND EXPERIENCE

INSURANCE AFFIDAVIT

I, (Proposer/Company) have reviewed the Insurance Requirements (Rev. 05/2021) 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. 05/2021).

☐ Check here if you DO NOT accept terms and conditions as stated in the Insurance Requirements (05/2021). 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

Contractor’s Standard Industry Code:

Contractor’s Name:

California State Contractor’s License #:

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?

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

* 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)

IRAN CONTRACTING ACT CERTIFICATION

MUST BE SUBMITTED WITH BID PROPOSAL IF BID AMOUNT IS $1,000,000 OR MORE

Prior to bidding on, submitting proposal, or executing a contract or renewal for a public entity contract for goods or services of $1,000,000 or more, a Company must either: a) certify it is not on the current list of persons engaged in investment activities in Iran created by the California Department of General Services (“DGS”) pursuant to Public Contract Code section 2203(b) and is not a financial institution extending $20,000,000 or more in credit to another person, for 45 days or more, if that other person will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list of persons engages in investment activities in Iran created by DGS; or b) demonstrate it has been exempted from the certification requirement for that solicitation or contract pursuant to Public Contract Code section 2203(c) or (d).

To comply with this requirement, please insert your Company or financial institution name and Federal ID Number (if available) and complete one of the options below. Please note: California law establishes penalties for providing false certifications, including civil penalties equal to the greater of $250,000 or twice the amount of the contract for which the false certification was made, contract termination, and three-year ineligibility to bid on contracts. (Pub. Cont. Code 2205.)

OPTION #1 – CERTIFICATION

I, the official named below, certify I am duly authorized to execute this certification on behalf of the Company/financial institution identified below, and the Company/financial institution identified below is not on the current list of persons engaged in investment activities in Iran created by DGS and is not a financial institution extending twenty million dollars ($20,000,000) or more in credit to another person/Company, for 45 days or more, if that other person/Company will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list of persons engaged in investment activities in Iran created by DGS.

IRAN CONTRACTING ACT CERTIFICATION pg.01

Pursuant to the Iran Contract Act of 2010 (Public Contract Code 2200-2208), Proposers/Bidders are ineligible to bid on or submit a proposal for any contract with a public entity for goods or services of one million dollars ($1,000,0000) or more if the Company/Bidder engages in investment activities in Iran.

For bids $1,000,000 or more, bidders must certify that it is not on the list of ineligible Proposers prohibited from doing business with the State of California and shall complete the Iran Contract Act Certification attached and submit with their proposal at the time of bid. Failure to do so ay deem your bid non-responsive.

I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Company Name/Financial Institution (Printed) Federal ID Number (or n/a)

By (Authorized Signature)

Printed Name and Title of Person Signing Date Executed

OPTION #2 – EXEMPTION

Pursuant to Public Contract Code Sections 2203(c) and (d), a public entity may permit a Company/financial institution engaged in investment activities in Iran, on a case-by-case basis, to be eligible for, or to bid on, submit a proposal for, or enters into or renews, a contract for goods and services.

If you have obtained an exemption from the certification requirement under the Iran Contracting Act, please fill out the information below, and attach documentation demonstrating the exemption approval.

Company Name/Financial Institution (Printed) Federal ID Number (or n/a)

By (Authorized Signature)

Printed Name and Title of Person Signing Date Executed

IRAN CONTRACTING ACT CERTIFICATION pg.02

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)

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.

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:

Signer’s Name Date:

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

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.

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:

Signer’s Name Date:

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.

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:

Signer’s Name Date:

SUBMITTAL CHECK-OFF LIST

Item Required Submittals Checklist Check

Off

RFP Price Form

Proposer’s Business Information

Proposer’s Business References

List of Subcontractors

Additions, Deletions, and/or Exceptions

Qualifications and Experience

Insurance Affidavit

CAL/OSHA Compliance History

Iran Contracting Act Certification

Contractor’s Mobile Source Acknowledgement Form

Safety Data Sheet

NSF 60 Certification

Supplier Delivery Procedures

Other items as applicable