4-607802-25 RFP Attachment 1 - Affidavit Pertaining to Preference of Eligibility.pdf

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RFP NO. 607802-25

CLARK COUNTY REHABILITATION CENTER

RFP ATTACHMENT 1

AFFIDAVIT PERTAINING TO PREFERENCE ELIGIBILITY

ALL BIDDERS SUBMITTING A CERTIFICATE OF ELIGIBILITY MUST SUBMIT THIS FORM VIA NGEM AT THE TIME

OF BID SUBMITTAL, OR HAND DELIVER OR EMAIL TO COUNTYPURCHASING@CLARKCOUNTYNV.GOV

WITHIN TWO (2) HOURS AFTER COMPLETION OF THE CLOSING OF THE BIDS TO BE ELIGIBLE TO RECEIVE A PREFERENCE IN BIDDING. A BIDDER THAT FAILS TO SUBMIT THE AFFIDAVIT WITHIN THE REQUIRED TIME

REPRESENTS THAT THEY WILL FOREGO RECEIVING THE PREFERENCE.

I, ____________________________ (“Affiant”), on behalf of the ________________________ (“Contractor”), swear and affirm that in order to be in compliance with NRS 338.147, and NRS 338.0117, and be eligible to receive a preference in bidding for Project No. 607802-25, Project Name Clark County Rehabilitation Center (“Project”); certify that for the duration of the Project, collectively, and not on any specific day;

(a) At least 50 percent of the workers employed on the Project including, without limitation, any employees of the

Bidder, and of any Subcontractor engaged on the Project, will hold a valid driver’s license or identification card issued by the State of Nevada Department of Motor Vehicles (“DMV”);

(b) All vehicles used primarily for the Project will be:

(1) Registered and partially apportioned to Nevada pursuant to the International Registration Plan, as adopted by the DMV pursuant to NRS 707.826; or

(2) Registered in the State of Nevada;

(c) If applying to receive a preference in bidding pursuant to subsection 3 of NRS 338.1727 or subsection 2 of NRS

408.3886, at least 50 percent of the design professionals working on the Project, including, without limitation, employees of the design-build team, and of any subcontractor or consultant engaged in the design of the Project, will have a valid driver’s license or identification card issued by the DMV;

(d) The Contractor, Applicant or Design-Build Team, and any Subcontractor engaged on the Project will maintain and make available for the inspection within this State his or her records concerning payroll relating to the Project.

Upon submission of the State Contractors’ Board certificate of eligibility to receive a preference in bidding on public works and this Affidavit, Contractor, Applicant, or Designated-Build Team recognizes and accepts that if a contract is awarded as a result of receiving a preference in bidding, failure to comply with the requirements herein, including all record keeping obligations detailed in the General Conditions, entitles Clark County to a penalty as defined by statute.

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By: ____________________________________________ ____ Title: ___________________________

Printed Name of Affiant

Signature of Affiant: _______________________________ Date:

Signed and sworn to (or affirmed) before me on this _______ day of _____________________, 20_______, by____________________________ (name of Affiant)

State of ________________________)

ss) Notary Signature

County of: ) STAMP AND SEAL

Proof of Authorization to Sign Affidavit

The person must establish his/her actual authority to act on behalf of the business organization. The individual must be the person indicated in the table below and provide written documentation clearly indicating the person’s position within that business organization. If the individual signing the Affidavit is an employee of the business organization, written documentation on organization letterhead must be provided; clearly indicating the person’s authority to act on behalf of the business organization. The authorized person identified in the table must sign the written documentation.

If the individual making application for the business organization is not one of the persons identified in the table or an authorized employee, a valid power of attorney executed by an authorized person on behalf of the business organization must be provided. The power of attorney must be made not more than 90 calendar days before the Affidavit is signed.

BUSINESS ENTITY PERSON WHO HAS AUTHORITY TO COMPLETE

AFFIDAVIT

Sole Proprietorship Name of Sole Proprietor

Partnership Name of Partner

Corporation

1. Director, if Authorized

2. Executive Officer (as indicated in the Article of Incorporation)

Limited Liability Company

1. Member, if Member-Managed LLC

2. Manager, if Manager-Managed LLC

CLARK COUNTY REHABILITATION CENTER