3-Required Forms RPF 269-2026-2040-CATS BUS RADIATORS AND FUEL TANK SERVICES .docx

PROPOSAL SUBMISSION FORM

This Proposal is submitted by:

The representative signing above hereby certifies and agrees that the following information is correct:

1. In preparing its Proposal, the Company has considered all proposals submitted from qualified, potential subcontractors and suppliers, and has not engaged in or condoned prohibited discrimination.

2. For purposes of this Section, discrimination means discrimination in the solicitation, selection, or treatment of any subcontractor, vendor or supplier on the basis of race, ethnicity, gender, age or disability or any otherwise unlawful form of discrimination. Without limiting the foregoing, discrimination also includes retaliating against any person or other entity for reporting any incident of discrimination.

3. Without limiting any other provision of the solicitation for proposals on this project, it is understood and agreed that, if this certification is false, such false certification will constitute grounds for the City to reject the Proposal submitted by the Company on this Project and to terminate any contract awarded based on such Proposal.

4. As a condition of contracting with the City, the Company agrees to maintain documentation sufficient to demonstrate that it has not discriminated in its solicitation or selection of subcontractors. The Company further agrees to promptly provide to the City all information and documentation that may be requested by the City from time to time regarding the solicitation and selection of subcontractors. Failure to maintain or failure to provide such information constitutes grounds for the City to reject the Proposal submitted by the Company or terminate any contract awarded on such proposal.

5. As part of its Proposal, the Company shall provide to the City a list of all instances within the past ten years where a complaint was filed or pending against the Company in a legal or administrative proceeding alleging that the Company discriminated against its subcontractors, vendors or suppliers, and a description of the status or resolution of that complaint, including any remedial action taken.

6. The information contained in this Proposal or any part thereof, including its Exhibits, Schedules, and other documents and instruments delivered or to be delivered to the City, is true, accurate, and complete. This Proposal includes all information necessary to ensure that the statements therein do not in whole or in part mislead the City as to any material facts.

7. None of Company’s or its subcontractors’ owners, employees, directors, or contractors will be in violation of the City’s Conflict of Interest Policy for City, Secondary and Other Employment Relationships (HR 13) if a Contract is awarded to the Company.

8. It is understood by the Company that the City reserves the right to reject any and all Proposals, to make awards on all items or on any items according to the best interest of the City, to waive formalities, technicalities, to recover and resolicit this RFP.

9. This Proposal is valid for one hundred and eighty (180) calendar days from the Proposal due date.

I, the undersigned, hereby acknowledge that my company was given the opportunity to provide exceptions to the Sample Contract as provided in the RFP. As such, I have elected to do the following:

___ Include exceptions to the Sample Contract in the following section of my Proposal: _______ ___ Not include any exceptions to the Sample Contract.

I, the undersigned, hereby acknowledge that my company was given the opportunity to indicate any Trade Secret materials or Personally Identifiable Information (“PII”) as detailed in Section 1.6.3. I understand that the City is legally obligated to provide my Proposal documents, excluding any appropriately marked Trade Secret information and PII, upon request by any member of the public. As such, my company has elected as follows:

___ The following section(s) of the of the Proposal are marked as Trade Secret or PII: ________ ___ No portion of the Proposal is marked as Trade Secret or PII.

Representative (signed): ________________________________________________________

ADDENDA RECEIPT CONFIRMATION

Please acknowledge receipt of all addenda by including this form with your Proposal. All addenda will be posted to the City’s Bonfire eProcurement Portal at https://charlottenc.bonfirehub.com/ and the City’s Contract Opportunities Site at http://charlottenc.gov/DoingBusiness/Pages/ContractOpportunities.aspx.

I certify that this proposal complies with the Specifications and conditions issued by the City except as clearly marked in the attached copy.

REFERENCES

Companies shall utilize the format below to provide a minimum of three (3) to five (5) client references. The City’s preference is for references from organizations of similar size or where the Company is performing similar services to those described herein. If such references are not available, individuals or companies that can speak to the Company’s performance are adequate.

REFERENCE:

Name of Client: Main Phone:

Address:

Primary Contact:___________________________ Title:

Contact Phone:____________________ Contact E-mail: __ Service Dates:

Summary & Scope of Project:

Contract Value: $ Number of Client Employees:

REFERENCE:

Name of Client: Main Phone:

Address:

Primary Contact:___________________________ Title:

Contact Phone:____________________ Contact E-mail: __ Service Dates:

Summary & Scope of Project:

Contract Value: $ Number of Client Employees:

Name of Client: Main Phone:

Address:

Primary Contact:___________________________ Title:

Contact Phone:____________________ Contact E-mail: __ Service Dates:

Summary & Scope of Project:

Contract Value: $ Number of Client Employees:

Name of Client: Main Phone:

Address:

Primary Contact:___________________________ Title:

Contact Phone:____________________ Contact E-mail: __ Service Dates:

Summary & Scope of Project:

Contract Value: $ Number of Client Employees:

Name of Client: Main Phone:

Address:

Primary Contact:___________________________ Title:

Contact Phone:____________________ Contact E-mail: __ Service Dates:

Summary & Scope of Project:

Contract Value: $ Number of Client Employees:

Required Forms

CATS BUS RADIATOR AND FUEL TANK REPAIR SERVICES

RFP# 269-2026-2040 March 18, 2026 12

CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS

The bidder, contractor, or subcontractor, as appropriate, certifies to the best of its knowledge and belief that neither it nor any of its officers, directors, or managers who will be working under the Contract, or persons or entities holding a greater than (ten percent) 10% equity interest in it (collectively “Principals”):

1. Are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal or state department or agency in the United States;

2. Have within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state anti-trust or procurement statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

3. Are presently indicted for or otherwise criminally or civilly charged by a government entity, (federal, state or local) with commission of any of the offenses enumerated in paragraph 2 of this certification; and

4. Have within a three-year period preceding this application/proposal had one or more public transactions (federal, state or local) terminated for cause or default.

I understand that a false statement on this certification may be grounds for rejection of this proposal or termination of the award or in some instances, criminal prosecution.

· I hereby certify as stated above:

(Print Name) Signature

Title Date

· I am unable to certify to one or more the above statements. Attached is my explanation. [Check box if applicable]

(Print Name) Signature

BYRD ANTI-LOBBYING CERTIFICATION

The undersigned certifies, to the best of their knowledge and belief, that:

1. No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of and Federal contract, grant, loan, or cooperative agreement.

2. If any funds other than federal appropriated funds have been paid or will be paid to any person for making lobbying contacts to an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form—LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions [as amended by "Government wide Guidance for New Restrictions on Lobbying," 61 Fed. Reg. 1413 (1/19/96)].

3. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including all subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction by 31 U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

___________________________________ (the “Company”) certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Company understands and agrees that the provisions of 31 U.S.C. A 3801, et seq., apply to this certification and disclosure, if any.

(Print Name) Company Name

Authorized Signature Address

COMPANY’S BACKGROUND RESPONSE

Companies shall respond to the questions below as part of their response to this RFP. Additional pages may be attached as needed to present the information requested.

1. Company’s legal name.

2. Company Location (indicate corporate headquarters and location that will be providing the Services).

3. How many years has your company been in business? How long has your company been providing the Services as described in Section 3?

4. How many public sector (cities or counties) clients does your company have? How many are using the Services? Identify by name some of the clients like City (e.g., similar in size, complexity, location, type of organization).

5. List any projects or services terminated by a government entity. Please disclose the government entity that terminated and explain the reason for the termination.

6. List any litigation that your company has been involved with during the past two (2) years for Services like those in this RFP.

7. Provide an overview of the history and history of your company.

8. If your company is a subsidiary, identify the number of employees in your company or division and the revenues of proposing company or division.

9. Identify the percentage of revenue used for research and/or development by the proposing company or division.

10. Identify any certifications held by your company if you are implementing or reselling another company's products or services. Include how long the partnership or certification has been effect.

11. Describe your company’s complete corporate structure, including any parent companies, subsidiaries, affiliates and other related entities.

12. Describe the ownership structure of your company, including any significant or controlling equity holders.

13. Provide a management organization chart of your company’s overall organization, including director and officer positions and names and the reporting structure.

14. Describe the key individuals along with their qualifications, professional certifications and experience that would comprise your company’s team for providing the Services.

15. If the Proposal will be from a team composed of more than one (1) company or if any subcontractor will provide more than fifteen percent (15%) of the Services, please describe the relationship, to include the form of partnership, each team member’s role, and the experience each company will bring to the relationship that qualifies it to fulfill its role. Provide descriptions and references for the projects on which team members have previously collaborated.

16. Explain how your organization ensures that personnel performing the Services are qualified and proficient.

17. Provide information regarding the level of staffing at your organization’s facilities that will be providing the Services, as well as the level of staffing at subcontractors’ facilities, if known or applicable.

18. If your company has been the subject of a dispute or strike by organized labor within the last five (5) years, please describe the circumstances and the resolution of the dispute.

Exceptions Form The undersigned Proposer agrees to provide all Products and Services requested in the RFP for the price(s) set forth in the Pricing Sheet, all in strict conformity with the terms, conditions and specifications set forth in the RFP and the Sample Contract (including any addenda or amendments), subject only to the exceptions stated in the chart below. Exceptions representing material changes to Proposal terms are grounds for rejection of the Proposal.

RFP/Contract Section Number RFP/Contract Section Title Exception and Proposed Change to RFP and/or Sample Contract

Date:

Company:

By:

Signature:

Print name and title of signatory

Required Forms

DBE PROGRAM FORM

LIST OF SUBCONTRACTORS - FORM A – Continuation Project DBE and non-DBE Subcontractor / Supplier Utilization Commitment Federal Disadvantaged Business Opportunity Program.

Note: This MUST be submitted with your bid. Make copies as needed.

If your company failed to meet the DBE Utilization Goal for this Project, you MUST attach documentation of your company’s Good Faith Efforts with your Proposal.

Company Name: Project Name: ______________________________________________

Person Age of Firm

Description of Work

NAICS Code

NCDOT

Reporting #

Total Projected $ % of Bid Amount