2-RFP4365 - Bid Forms.docx

ATTACHMENT A – REFERENCES

Please provide three (3) references for contracts of similar scope and size within the past three (3) years. These customers may be contacted by the City. Responses will be considered by the City during the proposal evaluation process.

1. Name:

Address:

City, State, Zip:__________________________________________________________ Telephone /Email:

Contact Person: Duration of Contract:

Description of Services:__________________________________________________

2. Name:

Address:

City, State, Zip:__________________________________________________________ Telephone /Email:

Contact Person: Duration of Contract:

3. Name:

Address:

City, State, Zip:__________________________________________________________ Telephone /Email:

Contact Person: Duration of Contract:

ATTACHMENT B

Affidavit of Compliance with Section 285.525-285.550 RSMo For All Services in Excess of $5,000.00

I, __________________________, am an authorized agent of _________________________ (Bidder). This business is enrolled and participates in a federal work authorization program for all employees working in connection with services provided to the City of Jefferson. This business does not knowingly employ any person that is an unauthorized alien in connection with the services being provided. Documentation of participation in a federal work authorization program (signature page of the MOU with Homeland Security) is attached to this affidavit.

Subscribed and sworn to before me this _______ day of ___________, ______.

My commission expires: ___________________

If bidder is an individual and does not have any employees of any sort, complete this section.

I, the undersigned, being at least eighteen years of age, swear upon my oath that I am either a United States citizen or am classified by the United States government as being lawfully admitted for permanent residence.

Subscribed and sworn to before me this _______ day of ___________, ______.

ATTACHMENT C – AUTHORITY TO EXECUTE

If the Proposer is a corporation, the following Authority to Execute certificate should be completed on their company letterhead:

(Company Letterhead)

I, certify that I am the secretary of the Corporation named as Proposer herein above; that , who signed the foregoing contract on behalf of the Proposer was then , of said corporation; that said bid was duly signed for and in behalf of said corporation by authority of its governing body, and is within the scope of its corporate powers.

Signed corporate seal

ATTACHMENT D – ANTI-COLLUSION STATEMENT

STATE OF _____________________________)

COUNTY OF ___________________________)

___________________________________________________________________ being first duly sworn deposes and says that he is _______________________ of _____________________________________

TITLE OF PERSON SIGNING NAME OF PROPOSER

that all statements made and facts set out in the bid for the above project are true and correct; and that the Proposer (the person, firm, association, or corporation making said bid) has not, either directly or indirectly, entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive bidding in connection with such bid of any contract which results from its acceptance.

Affiant further certifies that Proposer is not financially interested in, or financially affiliated with, any other Proposer for the above project.

(BY) _________________________________________

(BY) _________________________________________

Sworn to before me this ________ day of ________________, 2024.

Notary Public

My commission expires: ____________________________________

ATTACHMENT E – CERTIFICATION REGARDING LOBBYING

Certification for Contracts, Grants, Loans, and Cooperative Agreements

(To be submitted with each bid or offer exceeding $100,000)

The undersigned ___________________________________ certifies, to the best of his or her knowledge and belief, that:

1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for making lobbying contacts to an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form--LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.

3) The undersigned shall require that the language of this certification be included in the award documents for all subcontracts at all tiers and that all subcontractors shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

The Contractor, _________________________________, certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. A 3801, et seq., apply to this certification and disclosure, if any.

Signature of Bidder’s Authorized Official

Name and Title of Bidder's Authorized Official

Date