5-02. Bid Signature Sheet-Affidavit.pdf

Electrical Supplies, On-Call Bid #028.26.B3

THE HOWARD COUNTY PUBLIC SCHOOL SYSTEM

BID #028.26.B3

BID SIGNATURE SHEET/AFFIVADIT

Date: Owner: Board of Education of Howard County Maryland

10910 Clarksville Pike Ellicott City, MD 21042 Tel (410) 313-6723

Contractor:

The undersigned hereby submits a bid price to furnish and deliver the items as set forth in Bid #028.26.B3. The entire bid document including The General Provisions, Terms and Conditions, Specifications, any addenda, drawings, and the bid price will be part of any resulting contract.

PRICE

Having received clarification on all matters upon which any doubt arose, the undersigned proposes to furnish and deliver the requested items for the guaranteed pricing noted below:

PRODUCTS DISCOUNT:

The HCPSS is looking for a percentage discount “Off List” price for all bidders products.

Minimum Discount Off (%) [Minimum Range] ______________

Maximum Discount Off (%) [Maximum Range] ______________

NOTE: All costs are to be all inclusive. The costs of all labor, material, equipment, supervision, mileage, clean up, waste disposal, overhead, and profit are to be included. Travel time shall be borne by the Contractor.

COMPANY INFORMATION

Name of company Years in business

Street Address

City State Zip

Telephone # Fax #

This section to be completed on Bonfire

CONTACT FOR INSIDE CONTRACT ADMINISTRATION

In the event your firm receives a contract as a result of this Invitation for Bid, please designate an inside person whom we may contact during the period of the contract for prompt contract administration showing:

Name Title

Address Phone

Fax e-mail Cell

ADDENDA

Receipt of the following addenda is acknowledged:

Addendum No. Dated_______________ Addendum No. ______ Dated___________

Addendum No. Dated_______________ Addendum No. ______ Dated___________

Addendum No. Dated_______________ Addendum No. ______ Dated___________

AFFIDAVIT

Special Instructions: An authorized representative of the bidder shall complete the following affidavit in accordance with these bid documents and insert answer to paragraphs 1 and 3.

Statutory Affidavit and Non-Collusion Certification

I, _________________________________________, being duly sworn, depose and state:

1. I am the _______________________________________ (officer) and duly authorized

Representative of the firm named _________________________________________ whose address is _____________________________________ and that I possess the authority to make this affidavit and certification on behalf of myself and the firm for which I am acting.

2. Except as described in Paragraph 3 below, neither I, nor to the best of my knowledge, the above firm, nor any of its officers, directors, or partners, employees, agents, or employees of agents who are directly involved in obtaining or performing contracts with any public bodies has:

(a.) Been convicted of bribery, attempted bribery, or conspiracy to bribe, under the laws of any state of the federal government;

(b.) Been convicted under the laws of the state, another state, or the United States of: a criminal offense incident to obtaining, attempting to obtain, or performing a public or private contract;

or fraud, embezzlement, theft, forgery, falsification or destruction of records, or receiving stolen property;

(c.) Been convicted of a criminal violation of an antitrust statute of the State of Maryland, another state, or the United States;

(d.) Been convicted of a violation of the Racketeer Influenced and Corrupt Organization Act, or the Mail Fraud Act, for acts in connection with the submission of bids or proposals for a public or private contract;

(e.) Been convicted of any felony offenses connected with obtaining, holding, or maintaining a minority business enterprise certification, as prohibited by Section 14-308 of the State Finance and Procurement Article;

(f.) Been convicted of conspiracy to commit any act or omission that would constitute grounds for conviction under any of the laws or statutes described in Paragraph (a) through (e) above; or

(g.) Been found civilly liable under an antitrust statute of this State, another state, or the United States for acts or omissions in connection with the submission of bids or proposals for a public or private contract.

3. The only conviction, plea, or admission by any officer, director, partner, or employee of this firm to involvement in any of the conduct described in Paragraph 2 above is as follows:

If none, write "None" below. If involvement, list the date, count, or charge, official or administrative body, the individuals, their position with the firm and the sentence or disposition of the charge.

(you may attach an explanation as necessary)

4. I/we hereby propose to furnish and deliver supplies, equipment, or services, in accordance with specifications and stipulations contained herein, and at the prices quoted. I/we certify that this bid is made without any previous understanding, agreement, or connection with any person, firm, or corporation making a bid for the same supplies, materials, or equipment and is in all respects fair and without collusion or fraud.

5. I/we certify that this bid is made without having contacted any employee within The Howard County

Public School System unless such contacts were previously authorized by the Purchasing Officer.

6. I affirm that this firm will not knowingly enter into a contract with a public body under which a person or business debarred or suspended under Maryland State Finance and Procurement Title 16, subtitle 3, Annotated Code of Maryland, as amended, will provide, directly or indirectly, supplies, services, architectural services, construction-related services, leases of real property, or construction.

7. I affirm that this proposal or bid to the Board of Education of Howard County Maryland is genuine and not collusive or a sham; that said bidder has not colluded, conspired, connived and agreed, directly or indirectly, with any bidder or person to put in a sham bid or to refrain from bidding and is not in any manner, directly or indirectly, sought by agreement of collusion or communication or conference, with any person to fix the bid prices of the affidavit or any other bidder, or to fix any overhead, profit or cost element of said bid price, or that if any bidder, or to secure an advantage against the Board of Education of Howard County Maryland or any other person interested in the proposed contract; and that all statements in the proposal or bid are true. I acknowledge that, if the representations set forth in this affidavit are not true and correct, the Board of Education of

Howard County Maryland may terminate any contract awarded and take any other appropriate action.

8. I affirm that this firm will not knowingly employ an individual to work at a school if the individual is a

Registered Sexual Offender, pursuant to section 11-722 ( C ) of the Criminal Procedure Article of the Annotate Code of Maryland. A firm or person who violates this section is guilty of a misdemeanor and on conviction is subject to imprisonment not exceeding 5 years or a fine not exceeding $5,000 or both.

The statements contained in this affidavit shall be incorporated into the awarded contract as material provisions and shall be effective throughout the life of the contract. The firm has a continuing obligation through the life of the contract to submit a revised affidavit should the firm discover information, or events occur, which render the contents of this affidavit erroneous or incomplete or which would result in the firm providing a different response. The firm’s failure to submit a revised affidavit within three (3) working days of either its awareness of any error, change of circumstances, incompleteness, etc., or request by the owner shall constitute breach of contract. Upon submission of a revised affidavit, the owner has the right to take such actions as may be necessary, in the judgment of the owner, to maintain and enforce the provisions of the affidavit, including termination of the contract.

I DO SOLEMINLY DECLARE AND AFFIRM under the penalties of penalties that the contents of these affidavits (Statutory and Non-Collusion) are true and correct, that I am executing this Affidavit in compliance with Section 16-311 of the State Finance and Procurement Article, Annotated Code of Maryland, and the Non-Collusion Certification in compliance with requirements of the Board of Education of Howard County Maryland, and that I am executing and submitting this Form of Proposal on behalf of and with full authority by the bidder named below.

(Signature of Bidder) (Date)

(Print Name of Bidder) (Title of Bidder)

SUBSCRIBED AND SWORN to before me on this _________ day of ________________, 20____.

NOTARY PUBLIC

Name_______________________________________ Seal:

My Commission Expires_________________________

(Legal Name of Company)

(Address)

(City) (State) (Zip)

(Telephone) (Fax)

(E-mail address)

Contractor's License Number # _________________________________________________

We are/I am licensed to do business in the State of Maryland as a:

( ) Corporation ( ) Partnership ( ) Individual ( ) Other eMaryland Marketplace Advantage (eMMA) Vendor No.