4-Attachment D-2 - Conditions of Award Non-Federal.pdf

ATTACHMENT D-2: CONDITIONS OF AWARD

City of Detroit Office of Contracting and Procurement

Any contract/purchase order resulting from this solicitation shall include the forms indicated below. Contractor shall complete the required forms and return them, along with the required documentation in the checklist. The clearances and documents below are required for award.

☐ 1. City of Detroit Consolidated Affidavits (must be notarized)

1. Hiring policy compliance

2. Slavery era records and insurance, and prison industry and immigration detention system records and interests disclosure

3. Covenant of equal opportunity

4. Statement of political contributions and expenditures

5. Signature & Acknowledgment

☐ 2. Sample Employment Application

Attach a copy of a sample employment application

☐ 3. Certificate of Insurance

Attach COI in compliance with coverages required in model agreement

☐ 4. Income and Revenue Tax Clearance

Approved clearances are not required to submit a response to the RFP but will be required of the successful respondent prior to City Council approval. See instructions below.

Attach evidence showing you have submitted or received clearances.

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CONSOLIDATED AFFIDAVITS

The following attestations must be provided to the City of Detroit as part of the contract approval process. Please fill out required information, attach required supplemental documents and have it notarized before submitting.

I. HIRING POLICY COMPLIANCE

I , being duly sworn, state that I am the of

, and that I have reviewed the hiring policies of this employer, I affirm that these policies are in compliance with the requirements of Chapter 17, Article V, Division 6 of the 2019 Detroit City Code, being Sections 17-5-261 through 17-5-266 thereof. I further affirm that this employer will not inquire or consider the criminal convictions of applicants for employment needed to fulfill the terms of any City contract that may result from the competitive procedure in connection with which this affidavit is submitted, until such times as the employer interviews the applicant or determines that the applicant is qualified.

In support of this affidavit, I HAVE ATTACHED A COPY OF THE EMPLOYMENT APPLICATION that will be used to hire employees needed to fulfill the terms of any City contract that may result from the competitive procedure in connection with which this affidavit is submitted.

II. SLAVERY ERA RECORDS AND INSURANCE, AND PRISON INDUSTRY AND

IMMIGRATION DETENTION SYSTEM RECORDS AND INTERESTS DISCLOSURE

1. Name of Contractor:

2. Address of Contractor:

3. Name of Predecessor Entities (ifany):

4. Prior Affidavit Submission? No Yes, on:

(Date of prior submission)

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5. Contractor was established in (year) and did not exist during the slavery era in the United States, is not a successor in interest to any entity that existed during such time, and therefore has no relevant records to search, or any pertinent information to disclose.

OR

Contractor has searched its records and those of any predecessor entity, and has found no record that Contractor or any predecessor(s) made any investments in, or derived profits from, the slave industry or slave holder insurance policies.

OR

Contractor has found records that Contractor or its predecessor(s) made investments in, or derived profits from, the slave industry or slave holder insurance policies. The nature of the investment, profits, or insurance policies, including the names of any slaves or slave holders, is disclosed in the attached document(s).

6. Contractor has searched its records and those of any and all predecessor entities, and has found no record that indicate Contractor or its predecessor(s) have used inmate labor, or have derived income directly from, or have had any investments in, the construction, operations, services or activities of prisons.

OR

Contractor has found records that indicate Contractor or its predecessor(s) have used inmate labor, or have derived income directly from, or have had any investments in, the construction, operations, services or activities of prisons. The nature of the use of inmate labor, profits, or investments is disclosed in the attached document(s).

7. Contractor has searched its records and those of any and all predecessor entities, and has found no record that indicates Contractor or its predecessor(s) have derived any income directly from, or have had any investments in, the construction, operations, services, or activities of facilities in the United States that are used for the detention of persons who are not citizens or nationals of the United States.

OR

Contractor has found records that indicate Contractor or its predecessor(s) have derived any income directly from, or have had any investments in, the construction, operations, services, or activities of facilities in the United States that are used for the detention of persons who are not citizens or nationals of the United States. The nature of the profits or investments is disclosed in the attached document(s).

I declare that the representations made in this Affidavit are accurate to the best of my knowledge and are based upon a diligent search of records in the Contractor’s possession or knowledge, and that all documentation attached to this Affidavit reflects full disclosure of all records that are required to be disclosed to the City of Detroit. I also acknowledge that any failure to conduct a diligent search, or to make a full and complete disclosure, shall render this contract voidable by the City of Detroit.

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I, , being a duly authorized representative of , (hereinafter “Contractor”), am hereby authorized to enter into a Covenant of Equal Opportunity, (hereinafter “Covenant”) with the City of Detroit, (“hereinafter” City); obligating the Contractor and all sub-contractors, not to discriminate against any employee or application for employment, training, education, or apprenticeship connected directly or indirectly with the performance of the contract, with respect to his/her hire, promotion, job, assignment, tenure, terms, conditions, or privileges of employment because of race, color, religious beliefs, public benefit status, national origin, age, marital status, disability, sex, sexual orientation, or gender identity or expression; except as otherwise exempted under Section 23-2-6 of the 2019 Detroit City Code.

Contractor will ensure that the City of Detroit Human Rights Department shall receive notification of all potential sub-contractors and a copy of their Covenant prior to the commencement of work on any City of Detroit contract. Contractor further agrees that the City of Detroit reserves the right to require additional information prior to, during, and at any time until after the Covenant is fully executed.

Furthermore, Contractor agrees that this Covenant is valid for the life of the contract and/or for a specified period of time as indicated below and that a breach of this Covenant shall be deemed a material breach of contract and be subject to damages pursuant to Section 23-4-11(e) of the 2019 Detroit City Code.

RFQ/PO No.: (if applicable)

Duration of Covenant to

III. COVENANT OF EQUAL OPPORTUNITY

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City Charter Sec. 4-122: For purposes of conflicts of interest, the City shall require in all of its contractual agreements, including, but not limited to, leases, service and equipment agreements and including contract renewals, that the contractor provide a statement listing all political contributions and expenditures (“Statement of Political Contributions and Expenditures”), as defined by the Michigan Campaign Finance Act, MCL 169.201, et seq., made by the contractor, its affiliates, subsidiaries, principals, officers, owners, directors, agents or assigns to elective city officials within the previous four (4) years. Individuals shall also list any contributions or expenditures from their spouses.”

Instructions: In accordance with Sec. 4-122 of the 2012 Detroit City Charter, please provide the following information. If additional space is needed, please enter “see additional sheet(s)” on the last row and attach additional sheets.

In Column A, enter the name of the person or company that made the contribution or expenditure. If there were no political contributions or expenditures made, enter NONE.

In Column B, enter the relationship of the donor to the contractor or vendor, that is, contractor, affiliate, subsidiary, principal, officer, owner, director, agent, assignee, or spouse of any of the foregoing who are individuals.

In Column C, enter the name of the recipient, an elective city official which under Charter § 3-107, includes only the Mayor, the City Clerk, and members of the City Council and the Board of Police Commissioners.

In Column D, enter the amount of the contribution or expenditure, as defined in the Michigan Campaign Finance Act, 1976 PA 388, MCL 169.204 and MCL 169.206.

In Column E, enter the date of the contribution or expenditure. This statement must include all contributions and expenditures within the previous four years.

A B C D E

Donor Relationship to Contractor/ Vendor

Recipient

Amount of Contribution or Expenditure

Date

IV. STATEMENT OF POLITICAL CONTRIBUTIONS AND EXPENDITURES

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Except as set forth above, I certify that no contributions or expenditures were made to elective city officials within the previous four (4) years by the contractor, its affiliates, subsidiaries, principals, officers, owners, directors, agents, assigns, and, if any of the foregoing are individuals, their spouses.

V. SIGNATURES AND ACKNOWLEDGEMENT:

I understand that the information provided in this consolidated affidavit will be relied upon by the City of Detroit in awarding the proposed bid, solicitation, contract, or lease. I swear or affirm that I have read this document, that I the authority to provide these disclosures and to bind the Contractor, and that the information provided herein is accurate. I have attached all required supplemental documents.

Sign name:

Print name:

Title:

STATE OF

MICHIGAN

COUNTY

Sworn and subscribed to before me on ,20 , by , Date Name the of .

Title Contractor

Sign:

Print:

Notary Public, County, Michigan

Acting in County

My Commission Expires:

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Please note the following additional requirements for award:

Sample Employment Application

Attach a copy of your organization’s sample employment application

City of Detroit Treasury Clearance

Approved clearances are not required to submit a response to the RFP but will be required of the successful respondent prior to City Council approval. See instructions below on page 8.

Please note that Clearance takes a minimum of 10 days after application is submitted.

Certificate of Insurance

Attach Certificate of Insurance in compliance with the coverage requirements in the model Agreement.

Insurance providers must be registered in DIFS with the State of Michigan.

https://difs.state.mi.us/locators

If your organization does not have employees, please request the worker’s compensation waiver form. If your organization does carry auto insurance and does not own automobiles, please request the owned auto waiver form if applicable.

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To apply for City of Detroit Treasury Clearance, click the link below and follow the instructions.

https://detroitmi.gov/departments/office-chief-financial-officer/ocfo-divisions/office-treasury/treasury-clearances

Scroll down to the business clearance form link:

Click the link and complete the Smartsheet form:

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Make sure to complete step 2 (Docusign form) after you submit the Smartsheet form:

Step 2: Complete and sign Docusign form

If you need assistance, reach out to cityofdetroitclearances@detroitmi.gov with your Applicant ID, found in the automated email from Smartsheet after successful submission of your application.

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CERTIFICATE OF INSURANCE