3-Certification Addendum Acknowledgement Form.pdf
PDF 123 KB Posted
- Solicitation number
- RFB-26-154
- Issued by
- Yuma County, Arizona
About this file
This is a Certification and Addenda Acknowledgement Form issued by the City of Yuma's Procurement Division on November 6, 2024, for the relining of sodium hypochlorite tanks (RFB-26-154). The form serves as the official document through which prospective responders acknowledge receipt of all solicitation documents and any addenda posted on the City of Yuma's Bonfire Procurement Portal. Responders are responsible for monitoring the portal for any addenda issued, as the City disclaims responsibility for failure to receive such updates. The form requires responders to provide company name, contact information, address, authorized representative details, and signature to confirm compliance with the solicitation requirements.
By signing the Certification and Addenda Acknowledgement Form, responders certify four key commitments: non-discrimination in employment practices in accordance with Federal Executive Order 11246 and Arizona Revised Statutes 3101461 et seq.; non-provision of gifts, gratuities, special discounts, tips, or favors to public servants in connection with the bid submission; authority of the signing representative to bind the company to the contract; and receipt and consideration of all information contained in any addenda. Responders must upload the completed form to the Procurement Portal for the associated solicitation. No pricing information, contract term, or other financial details are specified in this certification document.
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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-26-154 |
| Ref 2: Relining of Sodium Hypochlorite Tanks |
| 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 .