2025-2026 Tillamook PCT - Attachment 1 - Offerors Authorized Representative Form.pdf

2025-2026 Tillamook Pre-Commercial Thinning S-62900-00015100

ATTACHMENT 1

SIGNATURE OF OFFEROR’S AUTHORIZED REPRESENTATIVE FORM

THIS FORM MUST BE COMPLETED AND RETURNED WITH OFFER

**This form shall be signed in ink by an authorized representative of Offeror. Any alterations or erasures shall be initialed in ink by the undersigned authorized representative.**

CONTRACTOR DATA:

Offeror shall provide the information requested below, as applicable, including Offeror’s federal tax ID number. Tax information is requested pursuant to ORS 305.385 and will be used for the administration of state, federal, and local tax laws. ODF may report the information provided to the Internal Revenue Service under the name and taxpayer identification number provided.

Offeror’s Legal Name (tax filing): _______________________________________________________

Mailing Address: ___________________________________________________________________

Citizenship (if applicable): Non-resident alien [ ] Yes [ ] No

Business Designation (check one):

[ ] Corporation [ ] Professional Corporation [ ] Partnership [ ] Limited Partnership

[ ] Limited Liability Company [ ] Limited Liability Partnership [ ] Sole Proprietorship

[ ] Other ___________________________________________

Federal Tax ID: ________________________

Offeror’s Contact Information:

Authorized Representative __________________________________________________________

Phone _____________________________ Fax _____________________________

E-mail __________________________________________________

RESIDENCY INFORMATION

In determining the lowest responsible Offeror, and for the purpose of awarding a contract, Oregon law requires a public contracting agency to add a percentage increase on the Offer of a nonresident Offeror equal to the percent, if any, of the preference given to that Offeror in the state in which the Offeror resides. ORS 279A.120.

“Resident Offeror” means a Offeror that has paid unemployment taxes or income taxes in this state during the twelve (12) calendar months immediately preceding submission of the Offer, has a business address in this state and has stated in the Offer whether the Offeror is a resident Offeror. ORS 279A.120(1)(b).

A “Non-resident” Offeror means a Offeror who is not a “resident Offeror” as defined above. ORS 279A.120(1)(a).

a. Check one: Offeror is a ( ) RESIDENT Offeror ( ) NON-RESIDENT Offeror.

b. If resident Offeror, enter your Oregon business address: (physical and mailing address)

c. If a non-resident Offeror, enter state of residency:_______________________________________________

d. If a non-resident Offeror, do you or your firm receive, or are you or your firm eligible for, any preference in award of contracts with your state’s government or with other governmental bodies in your state?

CHECK ONE: ( ) YES ( ) NO

If yes, state the preference percentage: _________________%

If yes, but not a percentage of Offer price, describe the preference:

If yes, state the law or regulation that allows the preference described (legal citation):

The individual signing on behalf of Offeror hereby acknowledges, attests and certifies individually and on behalf of the Offeror that:

• He/she is a duly authorized representative of Offeror, has been authorized by Offeror to make all representations, attestations, and certifications contained in this Offer and all addenda, if any, issued, and to execute this Offer on behalf of Offeror;

• The information supplied by Offeror in this Offer is true and accurate;

• Offeror, acting through its authorized representatives, has completely read and understands all the provisions of the Solicitation, including all attachments and addenda, if any, issued;

• The Offer was prepared independently from all other Offerors, and without collusion, fraud, or other dishonesty;

• Offeror is bound by and will comply with all the provisions, requirements, specifications, and terms and conditions contained in the Offer, including all attachments and addenda, if any, issued;

• Offeror agrees to provide all services required to be provided under the Contract in accordance with specifications and requirements, and will comply in all respects with the terms of the resulting Contract upon award;

• Offeror has the available resources, including staffing if applicable, to provide the services in a reasonable timeframe to pursue ODF’s objectives;

• Offeror has not discriminated and will not discriminate against a subcontractor in awarding a subcontract because the subcontractor is a minority, women, or emerging small business enterprise certified under ORS 200.055, or against a business enterprise that is owned or controlled by or that employs a disabled veteran, as defined in ORS 408.225; and

• Offeror has a written policy and practice that meets the requirements described in HB 3060 (2017) Oregon Laws, chapter 212, of preventing sexual harassment, sexual assault and discrimination against employees who are members of a protected class.

• To the best of their other knowledge, Offeror is not in violation of any Oregon Tax Laws. For purposes of this certification, "Oregon Tax Laws" are those tax laws listed in ORS 305.380(4), namely

ORS Chapters 118, 314, 316, 317, 318, 320, 321 and 323 and Sections 10 to 20, Chapter 533, Oregon Laws 1981, as amended by Chapter 16, Oregon Laws 1982 (first special session); the elderly rental assistance program under ORS 310.630 to 310.706; and any local tax laws administered by the Oregon Department of Revenue under ORS 305.620.

Signature of Offeror’s Authorized Representative Date