6-Exhibit A - Required Forms and Certifications.docx
DOCX document 28 KB Posted
- Solicitation number
- 950-05-26-005
- Issued by
- El Paso County, Texas
About this file
This is an Exhibit A Required Forms and Certifications document for the University Medical Center of El Paso (a division of El Paso County Hospital District) in Texas for the General Contractor West Ambulatory Surgery Center project. The RFP seeks to select a Construction Manager at Risk to provide preconstruction services for a new 30,000 square foot Ambulatory Surgery Center located at the intersection of Resler Drive and Canyon Creek on the West side of El Paso, Texas. The facility will include 4 Operating Rooms, 2 Endoscopy Rooms, and 2 Future Technology Rooms. Proposals are due on June 22, 2026 at 2:00 PM Mountain Time. The preconstruction services shall encompass cost estimating, constructability review, phasing analysis, procurement planning, and development of a Guaranteed Maximum Price for future consideration at the appropriate design milestone. The selected Construction Manager at Risk will support design and pricing development, with potential for a subsequent construction phase agreement if the project budget, Guaranteed Maximum Price, and negotiated terms can be successfully aligned.
This exhibit outlines the required submission checklist and certification requirements for proposers, including completion of Exhibits A through C, firm qualifications documentation, project team information, project understanding and approach, preliminary schedule, references, and any exceptions or clarifications. Required certifications and forms include addenda acknowledgement, non-collusion affidavit, conflict of interest disclosure, debarment/suspension certification, and W-9 or vendor registration forms as applicable. Proposers must certify that all submitted information is true and correct and that all required forms are complete. The project is funded through University Medical Center's bond-funded capital program, and the owner makes no commitment through this solicitation to award construction phase services.
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Other files
| File | Type | Posted |
|---|---|---|
| 3-Exhibit B - Submission Form - Acknowledgement.docx | DOCX document | |
| 5-Exhibit G Teams Meeting Information.docx | DOCX document | |
| 7-Exhibit E - ASC West Site Constraints.docx | DOCX document | |
| 8-Exhibit F - A133-2019 UMC Form.docx | DOCX document | |
| 4-Exhibit C - Fee Proposal and Pricing Components.docx | DOCX document | |
| 2-950-05-26-005 General Contractor West Ambulatory Surgery Center.docx | DOCX document | |
| 1-Exhibit D - Prevailing Wage Rate Requirements.docx | DOCX document |
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Text version
EXHIBIT A
REQUIRED FORMS AND CERTIFICATIONS
RFP Title: UMC EL Paso County Hospital District – General Contractor West Ambulatory Surgery Center RFP Number: 950-05-26-005 Proposal Due Date: 06/22/2026 (2:00 PM MT)
Proposer shall complete this attachment and include all required forms and certifications identified below, as applicable to this procurement and as included in the RFP package or issued by addendum.
1. Submission Checklist Check each item included with proposal submission.
Proposal Forms and Submittals ☐ Exhibit A – Required Forms and Certifications ☐ Exhibit B – Proposal Submission Form / Acknowledgement ☐ Exhibit C - CMAR Fee Proposal Form and Pricing Components ☐ Cover Letter ☐ Firm Qualifications and Relevant Project Experience ☐ Proposed Project Team and Key Personnel ☐ Project Understanding and Approach ☐ Preliminary Schedule or Schedule Narrative ☐ References ☐ Exceptions and Clarifications (if any)
Required Certifications / Forms (if applicable) ☐ Addenda Acknowledgement completed ☐ Non Collusion Affidavit (if required) ☐ Conflict of Interest Disclosure (if required) ☐ Debarment / Suspension Certification (if required) ☐ W-9 or vendor registration form (if required at proposal stage) ☐ Other: __________________________________________ ☐ Other: __________________________________________
2. Addenda Acknowledgement (if not completed in Attachment A) Proposer acknowledges receipt of the following addenda (if any):
- Addendum No. _____ dated ______________
- Addendum No. _____ dated ______________
- Addendum No. _____ dated ______________
- Addendum No. _____ dated ______________ (If no addenda were issued, write None.)
3. Proposer Certification By signing below, Proposer certifies that the information submitted with this proposal is true and correct to the best of Proposer's knowledge and that all required forms included in this Attachment C are complete, if applicable.
Proposer Legal Name: ____________________________________________________________ Authorized Representative Name (print): __________________________________________ Title: __________________________________________________________________________ Signature: ______________________________________________________________________ Date: ___________________________________________________________________________
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