2027-192_Attachments.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 C: RESPONDER FORM

SOLICITATION BOND

STATE OF MINNESOTA

DEPARTMENT OF ADMINISTRATION

SOLICITATION BOND TO ACCOMPANY CONSTRUCTION

AND MAINTENANCE RESPONSES

KNOW ALL MEN BY THESE PRESENTS, that we as Principal, and as Surety, are held and firmly bound unto the State of Minnesota as Obligee, in the sum of 5% of the bid amount for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, and firmly by these presents.

Dated this day of A. D. 20 .

The condition of this obligation is such that whereas the Principal has submitted the accompanying response for the articles described in Project No. 2027-192 R3 HQ Shop Localized Concrete Repair & Boiler Room Ventilation Improvements

NOW, THEREFORE, if the aforesaid Principal shall be awarded a contract upon said response, and shall within the required number of days after the notice of such award, enter into a contract with the State of Minnesota, and give bond for the faithful performance of the contract as may be required, then this obligation shall be null and void; otherwise the

Principal and Surety will pay unto the Obligee the sum of 5% of the bid amount not as a penalty, but as liquidated damages sustained by the State of Minnesota as a result of such failure.

Principal

Signature

Title

Surety

Attorney-in-fact

INDIVIDUAL AND CO-PARTNERSHIP ACKNOWLEDGMENT

STATE

COUNTY

On this day of , 20 before me personally appeared to me known to be the person(s) described in and who executed the foregoing bond, and acknowledged that he/she/they executed the same as a free act and deed.

(Notarial Seal) (Notary Signature)

LIMITED LIABILITY COMPANY ACKNOWLEDGMENT FOR PRINCIPAL

COUNTY

On this day of , 20 before me appeared and , to me personally known, who being by me duly sworn, did say that they are respectively and of , a Limited Liability Company; and that said instrument was executed on behalf of the Limited Liability Company by authority of its Management Committee; and they acknowledged said instrument to be the free act and deed of the

Limited Liability Company.

CORPORATE ACKNOWLEDGMENT FOR PRINCIPAL

COUNTY

On this day of , 20 before me appeared and , to me personally known, who being by me duly sworn, did say that they are respectively and of , a Corporation; and that said instrument was executed on behalf of the Corporation by authority of its Board of Directors;

and they acknowledged said instrument to be the free act and deed of the Corporation.

AFFIX HERE ACKNOWLEDGMENT OF CORPORATE SURETY

The form of this bond has been prescribed by the Commissioner of Administration and approved by the Attorney General of Minnesota.

Full Name of Surety Co.

Home Office Address (Street)

City, State and ZIP Code

Name of Attorney-in-fact

Name of Local Agency

Address of Local Agency (Street)

City, State and ZIP Code

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: QUALIFICATION FORM

R3 HQ Shop Localized Concrete Repair and Boiler Room Ventilation Improvements

Solicitation No.: 2027-192

QUALIFICATION FORM

VERSION: ORIGINAL

This Prime Contractor Response 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 2 contracts which have achieved Substantial Completion since September 2021 for construction of similar scope of work. Each of these contracts MUST have had a construction value of $90,000 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):

*The term “Property Owner” means the person or entity identified as the owner of the property where the work referenced for Qualification Requirement #1 was performed.

The State (or its representative) reserves the right to contact the references listed above for Qualification Requirement #1 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. Project Manager and Job Superintendent responsible for this project EACH has had at least 5 years of experience with management and construction similar in scope and value to this project. Each of these contracts must have had a construction value of $90,000 or greater.

Project Manager Name____________________________________ Present position _______________________

List below the required information for individuals who will be responsible for this project:

Years of Experience Type of Work In What Capacity

Fill in the required information for Project Manager’s previous projects relating to Qualification Requirements #1 & #2:

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

Dollar Amount of Contract: Substantial Completion Date:

Contract substantially completed under (check one):

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

Dollar Amount of Contract: Substantial Completion Date:

Contract substantially completed under (check one):

*The term “Property Owner” means the person or entity identified as the owner of the property where the work referenced for Qualification Requirement #1 was performed.

The State (or its representative) reserves the right to contact the references listed above for Qualification Requirement #2 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.

Job Superintendent Name ______________________________ Present Position ________________________

Years of Experience Type of Work In What Capacity

3. 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

4. Has your Company received from OSHA any willful or repeated safety citations for which a final order has been issued within 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: