6-RFP EXHIBIT B - Statement of Assurances Certifications.pdf

EXHIBIT B

River Well #1 Renewal Project, Solicitation No. 26-3256

Statement of Assurances & Certifications (Must be signed and included with Proposal)

We Hereby Certify to comply with Title VI of the Civil Rights Act of 1964, with Section V of the Rehabilitation Act of 1973, and with all applicable requirements of federal and state civil rights and rehabilitation statues, rules and regulations. We Certify also that we shall comply with the Americans with Disabilities Act of 1990, as amended by the ADA Amendments Act (ADAAA) of 2008 and any subsequent amendments (42 U.S.C. § 12101, et seq.) (Pub L No. 101-336), ORS 659A, and all regulations and administrative rules established pursuant to those laws. We Certify, in the performance of any contract issued from any proposal related to these documents, we will in all respects adhere to the City of Bend’s policy of non-discrimination.

We Certify that we have not and shall not discriminate against a subcontractor in awarding a subcontract because the subcontractor is a minority, women or emerging small business enterprise certified under ORS 200.055 or a business enterprise that is owned or controlled by or that employs a disabled veteran, as defined in ORS 408.225.

We Certify that we, and our subcontractors, if any, and all employers working under this agreement are subject employers under the Oregon Workers' Compensation Law, and shall comply with ORS 656.017, which requires them to provide Workers’ Compensation coverage for all of their subject workers, unless such employers are exempt under the law.

We Certify that we:

ACCEPT all the terms and conditions contained herein, including the sample contract, and in the event of a forthcoming agreement containing these same terms and conditions, we would agree without exception.

DO NOT ACCEPT all the terms and conditions contained herein. Any exception to these terms should be attached to this Exhibit.

We Certify, under penalty of perjury, that the proposer has complied with the tax laws of this state or a political subdivision of this state, including but not limited to ORS 305.620, and ORS chapters 316, 317 and 318.

We Certify that we ARE ARE NOT (mark one) a “Resident Bidder” as defined by ORS 279A.120. As defined in ORS 279A.120, “Resident Bidder” means a bidder that has paid unemployment taxes or income taxes in this state in the twelve calendar months immediately preceding submission of the bid, has a business address in this state, and has stated in the bid whether the bidder is a “Resident Bidder”.

We Certify that we have reviewed the City’s Public Contracts Conflict of Interest Policy (Administrative Policy No. FIN-0102) and that Proposer’s Firm and its subcontractors DO / DO NOT have any Organizational Conflict of Interest, prior work on this project, and/or Individual Conflict of https://www.bendoregon.gov/home/showpublisheddocument/64520/638997627607030000 https://www.bendoregon.gov/home/showpublisheddocument/64520/638997627607030000

Interest (applicable to any individual identified in the Proposal). (If Proposer checks “DO”, explain the conflict or prior work and why the conflict or prior work does not exclude Proposer from proposing on this project under the City’s policy).

If not a Resident Bidder as defined in ORS 279A.120, please indicate state of residence:

ADDENDA: We Certify that we received the following Addenda:

#_____ dated: __________ #_____ dated: __________ #_____ dated: __________

#_____ dated: __________ #_____ dated: __________ #_____ dated: __________

Proposer Legal Name:

Street Address:

City, State, Zip Code:

Phone Number:

Email Address:

Signature of authorized representative

Name and Title of authorized representative:

Exceptions to the above Certifications. The Contractor will cross out those items they cannot certify to and then list the reasons for the exception (use additional pages if necessary):