3-RFP 2027-12 ATTACHMENT A.pdf

ATTACHMENT A - PROPOSAL COVER SHEET

Part I – Proposer Information and References

RFP#: 2027-12; Project Name: Gresham Pedestrian Improvements – ARTS 2020

Legal Name of Firm as provided to IRS: ______________________________________________________

DBA Name (if different than legal name): ______________________________________________________

DUNS Number: __________ Is Proposer registered as a foreign corporation in Oregon? Yes No Corporation Professional Corporation Ltd. Liability Company Partnership Limited Partnership Ltd. Liability

Partnership Sole Proprietorship Other: __________________________

State of Incorporation/Organization:

Mailing Address: _______________________________________________________________

Type name of authorized contact for this RFP:

Email address:

Telephone: Fax:

Type name of person(s) authorized to sign Contract:

MINIMUM QUALIFICATIONS

• Registered Professional Engineer per requirements of RFP section 3.3.1:

Name Registration Number

REFERENCES

Provide references for 3 clients for which Proposer has provided, in the last 3 years, similar services to those described in this RFP (please verify contact information):

1) Name of Client: Reference Contact Person Telephone: _____ email __________ Project Title:

Scheduled Contract Completion Date: ________ Actual Contract Completion Date: _________ Contract Est. Cost: ____________ Contract Actual Cost:____________ Project Delivery Method: DBB; CMGC; DB; __________________

2) Name of Client: Reference Contact Person Telephone: _____ email __________ Project Title:

Scheduled Contract Completion Date: _____________ Actual Contract Completion Date: _____________ Contract Est. Cost: ____________ Contract Actual Cost:____________ Project Delivery Method: DBB; CMGC; DB; __________________

3) Name of Client: Reference Contact Person Telephone: _____ email __________ Project Title:

Scheduled Contract Completion Date: _____________ Actual Contract Completion Date: _____________ Contract Est. Cost: ____________ Contract Actual Cost:____________ Project Delivery Method: DBB; CMGC; DB; __________________

ATTACHMENT A - PROPOSAL COVER SHEET

Part II - Proposer Certifications

By signing below, the authorized representative on behalf of Proposer certifies that:

1. Proposer agrees to and shall comply with the terms and conditions of the sample Contract associated with this RFP and all requirements, specifications and terms and conditions contained within the RFP (and all Addenda, if any).

2. All contents of the Proposal (including any other forms or documentation, if required under this RFP) and this

Proposal Cover Sheet, are truthful and accurate and have been prepared independently from all other Proposers, and without collusion, fraud, or other dishonesty. No attempt has been made or will be made by Proposer to induce any other person to submit or not submit a Proposal. Proposer understands that any statement or representation it makes, in response to this solicitation, if determined to be false or fraudulent, a misrepresentation, or inaccurate because of the omission of material information could result in a "claim" {as defined by the Oregon False Claims Act, ORS 180.750(1)}, made under the resulting Contract being a "false claim" {ORS 180.750(2)} subject to the Oregon False Claims Act, ORS 180.750 to 180.785, and to any liabilities or penalties associated with the making of a false claim under that Act.

3. Proposer has available the appropriate material, equipment, facility and personnel resources and expertise, or ability to obtain the resources and expertise, necessary to demonstrate the capability of the firm to meet all contractual responsibilities.

4. Proposer is not experiencing financial distress or having difficulty securing financing, and has sufficient cash flow to fund day-to-day operations throughout the proposed Contract period.

a. Within the last 3-year period, has your firm filed a bankruptcy action, filed for reorganization, made a general assignment of assets for the benefit of creditors, or had an action for insolvency instituted against it? YES / NO .

b. If "YES" above, indicate the filing dates, jurisdictions, type of action, ultimate resolution, and dates of judgment or dismissal, if applicable:

5. Proposer has not been notified within the last 3-year period of any delinquent Federal, State or local taxes in an amount that exceeds $3,000 for which the liability remains unsatisfied.

6. Proposer, its principals and major subcontractors (major subcontractor is defined as receiving 10% or more of the total Contract amount) have not presently, or within the last 3 years, been convicted of, indicted for, or otherwise criminally or civilly charged by a governmental entity with the commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, state, or local) Contract or subcontract; violation of federal or state antitrust statutes relating to the submission of bids or Proposals; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, or receiving stolen property.

7. Proposer has not and will not discriminate in its employment practices with regard to race, creed, age, religious affiliation, sex, disability, sexual orientation or national origin. And, pursuant to ORS 279A.110, Proposer has not and Proposer will not discriminate against a subcontractor in the awarding of a subcontract because the subcontractor is a disadvantaged business enterprise, a minority-owned business, a woman-owned business, a business that a service-disabled veteran owns or an emerging small business certified under ORS 200.055.

8. Proposer has an operating policy supporting equal employment opportunity. If proposing firm has 50 or more people, Proposer also has a formal equal opportunity program.

o Does Proposing firm have 50 or more employees? Yes, No.

o Does Proposing firm have a formal equal employment opportunity program? Yes, No

Firms of 49 people or less do not need to have a formal equal employment opportunity program, but shall have an operating policy supporting equal employment opportunity. Firms of 50 people or more shall also have a formal equal employment opportunity program.

9. Proposer’s employees and agents are not included on the list entitled “Specially Designated Nationals and Blocked Persons” maintained by the Office of Foreign Assets Control of the United States Department of the Treasury and currently found at https://www.treasury.gov/resource-center/sanctions/SDN-List/Pages/default.aspx

10. Proposer and its Principals, and any of its prospective subcontractors for this award are not presently debarred, suspended, disqualified, proposed for debarment or declared ineligible for the award of contracts by any federal agency or agency of the State of Oregon, and does not have an Active Exclusion on the System for Award Management (SAM) which is available at https://sam.gov/.

11. Proposer, acting through its authorized representative, has read and understands the RFP instructions, specifications, and terms and conditions contained within the RFP (including the sample Contract) and all Addenda, if any. The Proposal submitted is in response to the specific language contained in the RFP, and Proposer has made no assumptions based upon either (a) verbal or written statements not contained in the RFP, or (b) a previously issued RFP, if any.

Signature: Date:

(President or Authorized Representative of Proposer)

Print Name:__________________________________ Title:__________________________________ https://www.treasury.gov/resource-center/sanctions/SDN-List/Pages/default.aspx https://sam.gov/

ATTACHMENT A - PROPOSAL COVER SHEET