2027-181_Attachments_A,_B,_D,_E.pdf

Rev. April 2025

ATTACHMENT A: RESPONDER DECLARATIONS

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

A. Response Contents. The information provided is true, correct, and reliable for purposes of evaluation for potential contract award. The submission of inaccurate or misleading information may be grounds for disqualification from the award as well as subject the Responder to suspension or debarment proceedings as well as other remedies available by law

B. Authorized Signature. This Declaration is signed by the appropriate person(s), with the authority to contractually bind the Responder, as required by applicable articles, bylaws, resolutions, minutes, and ordinances.

C. Non-Collusion Certification.

1. The Proposal has been arrived at by the Responder independently and has been submitted without collusion and without any agreement, understanding or planned common course of action with any other vendor designed to limit fair or open competition; and

2. The contents of the Response have not been communicated by the Responder or its employees or agents to any person not an employee or agent of the Responder and will not be communicated to any other individual prior to the due date and time of this Solicitation. Any evidence of collusion among Responders in any form designed to defeat competitive responses will be reported to the Minnesota Attorney General for investigation and appropriate action.

D. Organizational Conflicts of Interest. To the best of Responder’s knowledge and belief, and except as otherwise disclosed, there are no relevant facts or circumstances which could give rise to an organizational conflict of interest.

An organizational conflict of interest exists when, because of existing or planned activities or because of relationships with other persons,

1. a vendor is unable or potentially unable to render impartial assistance or advice to the State;

2. the vendor’s objectivity in performing the contract work is or might be otherwise impaired; or

3. the vendor has an unfair competitive advantage.

If after award, an organizational conflict of interest is discovered, an immediate and full disclosure in writing must be made to the State’s Chief Procurement Officer which must include a description of the action which the contractor has taken or proposes to take to avoid or mitigate such conflicts. If an organizational conflict of interest is determined to exist, the State may, at its discretion, cancel the contract. In the event the Contractor was aware of an organizational conflict of interest prior to the award of the contract and did not disclose the conflict to OSP, the State may terminate the contract for default. Organizational conflicts of interest terms apply to any subcontractors for this work.

E. Copyrighted Material Waiver. By signing its Response, the Responder certifies that it has obtained all necessary approvals for the reproduction and distribution of the contents of its response.

SIGNATURE PAGE TO FOLLOW

By signing this form, Responder acknowledges and certifies compliance with all applicable requirements indicated above.

Company Name:

Signature:

Printed Name:

Title:

Date:

Phone Number:

Email Address:

ATTACHMENT B: PRICING

1. Pricing.

A price schedule document will not be used for this solicitation. Responders must enter their bid price(s) in SWIFT at the unit line level. If a responder needs assistance with entering their proposal, they may contact the Vendor Assistance Help Desk at (651) 201-8100, option #1, and then option #1 again.

2. Alterations or Erasures. The State reserves the right to reject a response containing an alteration or erasure of any price used to determine the lowest responsible responder unless the alteration or erasure is done in a manner that is clear and authenticated by an authorized representative of the Responder. An acceptable way to make an alteration or erasure is to cross out the price, print the correction in ink adjacent to it, and have an authorized representative of the Responder initial and date that correction.

ATTACHMENT D: ADDITIONAL INFORMATION

1. Contractor’s Contact Information. Provide the contact information for the representative responsible for the management of the contract and the representative receiving purchase orders.

Vendor’s Legal Name

Address

Contact Person (Contract)

Email Address

Telephone Number

Contact Person (PO Order)

Email Address

Telephone Number

2. Prompt Pay Discount. What prompt pay discounts do you offer? Select all that apply, if “other,” specify terms in the comment section below:

□ 1% in 30

□ 2% in 30

□ 3% in 30

□ 1% in 10, Net 30

□ 2% in 10, Net 30

□ 3% in 10, Net 30

□ 5% in 10, Net 30

□ Other

□ 1% in 15, Net 30

□ 2% in 15, Net 30

□ 3% in 15, Net 30

□ 1% in 20, Net 30

□ 2% in 20, Net 30

□ 3% in 20, Net 30

□ Net 30

□ None

Comments:

ATTACHMENT E:

Kroschel WMA Parking Lot Approach and Parking Lot Construction Solicitation #: 2027-181

QUALIFICATION FORM

VERSION: ORIGINAL

This Qualification Form must be submitted with your solicitation response. A solicitation response received without this form, or with an outdated version, may be rejected. Prime contractors are responsible for checking all addenda for the final version of this form.

Each responder must answer every question and provide all information requested on this form. Failure to meet this requirement may result in the rejection of the entire solicitation response as non-responsive.

The State (or its representative) reserves the right to clarify the required qualification information submitted on this form before an award is made. The solicitation response will be rejected if qualifications are not met.

Qualification Requirements

1. Responding company has completed as a Prime Contractor, not as a subcontractor, the work for at least one (1) contract which has achieved Substantial Completion since September 2023 of similar scope of work in construction of aggregate parking lots. This contract MUST have had a value of $10,000 or greater.

Fill in the required information for your previous projects relating to Qualification Requirement #1:

*Property Owner:

Property Owner Contact Person: Contact Person’s Telephone #:

Dollar Amount of Contract: Substantial Completion Date:

Contract substantially completed under (check one):

☐ Current Company Name ☐ Previous Company Name

*Property Owner:

Property Owner Contact Person: Contact Person’s Telephone #:

Dollar Amount of Contract: Substantial Completion Date:

Contract substantially completed under (check one):

☐ Current Company Name ☐ Previous Company Name

*The term “Property Owner” means the person or entity identified as the owner of the property where the work referenced for Qualification Requirement was performed.

The State (or its representative) reserves the right to contact the references listed above for Qualification Requirement or to request the Responder to provide additional reference projects for review. The solicitation response will be rejected if the State, in its sole discretion, receives information that indicates the responder is non-responsible. Information considered includes but is not limited to: 1) project milestones (meeting substantial and final completion dates); 2) communication with project owner and subcontractors;

3) on-site supervision; 4) coordination of subcontractors; 5) violation of Minnesota prevailing wage law; and

6) nonpayment of subcontractors.

2. Has your Company been found in default or had a contract terminated for cause in the last 36 months?

It is required that your company has not had this occur.

NOTE: If this question is answered as “yes”, your solicitation response will be rejected.

☐ YES ☐NO

Certification

By signing this form, I certify the information provided is complete and accurate.

Authorized Signature: Date:

Printed Name: Telephone:

Company Name: Title: