3-Certification Addendum Acknowledgement Form.pdf
PDF 110 KB Posted
- Solicitation number
- RFB-26-192
- Issued by
- Yuma County, Arizona
About this file
This document is a Certification & Addenda Acknowledgement Form from the City of Yuma Procurement Division, dated November 6, 2024, for the Drone Light Show Services project. The solicitation (Reference #RFB-26-162) is specifically for Drone Light Show Services for America's 250th Anniversary Celebration. The document requires potential responders to check the City of Yuma's Bonfire Procurement Portal for any addenda and submit a completed form that acknowledges receipt of solicitation documents and certifies compliance with various legal and ethical requirements.
The form requires bidders to provide company contact information and includes four key certification points: non-discrimination compliance, confirmation of no improper gratuities or favors to public servants, authorization of the representative to bind the company to the contract, and acknowledgment of all addenda. Responders are instructed to upload the completed document to the Procurement Portal for the associated solicitation. The form emphasizes the bidder's responsibility to review all solicitation documents and any subsequent addenda, with a clear statement that the City will not be held responsible if a responder fails to receive or review issued addenda.
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Text version
Procurement Division
November 6, 2024
Certification & Addenda Acknowledgement Form
Solicitation addenda are posted on the City of Yuma’s Bonfire Procurement Portal identified as:
Ref #: _____________
Project: _______________________________________________________________________________
Any changes to the solicitation document will be in the form of an Addendum. It is the responsibility of the Responder to check the Yuma Procurement Portal for any addenda to the solicitation. The City will not be held responsible if a Responder fails to receive any addenda issued. Any City changes must be in writing.
Submission of Response: The undersigned representative offers and agrees to provide goods and/or services in compliance with all solicitation documents.
Offer Date: ________________________
Responder Company Name Contact Phone #
Address Printed Name
City, State, ZIP Title
Contact Email Address Signature of Person Authorized to Sign Offer
By signing above, the representative certifies:
1. The Responder company will not discriminate against any employee, or applicant for employment in violation of Federal Executive Order 11246 or A.R.S. 3101461 Et. Seq.
2. The Responder company has not given, offered to give, a loan, a gratuity, a special discount, a tip, or any favor, or service to a public servant in connection with the submitted bid.
3. The Representative signing this certification has the authority to bind the Responder to this contract.
4. The Representative’s signature confirms receipt and consideration of all information contained in any addenda.
Upload this document to the Procurement Portal for the associated solicitation.
| Ref 1: RFB-26-162 |
| Ref 2: Drone Light Show Services for America’s 250th Anniversary Celebration |
| Responder Company Name: |
| Contact Phone: |
| Address: |
| Printed Name: |
| City State ZIP: |
| Title: |
| Contact Email Address: |
| Date1_af_date: |
File details come from the government source that posted it. Updated .