A-269(5)_18658_RFP_Attachments_FINAL.pdf

Rev. April 2025

ATTACHMENT A: RESPONDER DECLARATIONS

The undersigned certifies, to the best of his or her knowledge and belief, that:

A. Response Contents. The information provided is true, correct, and reliable for purposes of evaluation for potential contract award. The submission of inaccurate or misleading information may be grounds for disqualification from the award as well as subject the Responder to suspension or debarment proceedings as well as other remedies available by law

B. Authorized Signature. This Declaration is signed by the appropriate person(s), with the authority to contractually bind the Responder, as required by applicable articles, bylaws, resolutions, minutes, and ordinances.

C. Non-Collusion Certification.

1. The Proposal has been arrived at by the Responder independently and has been submitted without collusion and without any agreement, understanding or planned common course of action with any other vendor designed to limit fair or open competition; and

2. The contents of the Response have not been communicated by the Responder or its employees or agents to any person not an employee or agent of the Responder and will not be communicated to any other individual prior to the due date and time of this Solicitation. Any evidence of collusion among Responders in any form designed to defeat competitive responses will be reported to the Minnesota Attorney General for investigation and appropriate action.

D. Organizational Conflicts of Interest. To the best of Responder’s knowledge and belief, and except as otherwise disclosed, there are no relevant facts or circumstances which could give rise to an organizational conflict of interest.

An organizational conflict of interest exists when, because of existing or planned activities or because of relationships with other persons,

1. a vendor is unable or potentially unable to render impartial assistance or advice to the State;

2. the vendor’s objectivity in performing the contract work is or might be otherwise impaired; or

3. the vendor has an unfair competitive advantage.

If after award, an organizational conflict of interest is discovered, an immediate and full disclosure in writing must be made to the State’s Chief Procurement Officer which must include a description of the action which the contractor has taken or proposes to take to avoid or mitigate such conflicts. If an organizational conflict of interest is determined to exist, the State may, at its discretion, cancel the contract. In the event the Contractor was aware of an organizational conflict of interest prior to the award of the contract and did not disclose the conflict to OSP, the State may terminate the contract for default. Organizational conflicts of interest terms apply to any subcontractors for this work.

E. Certification Regarding Lobbying. For State of Minnesota Contracts and Grants over $100,000, the undersigned certifies, to the best of his or her knowledge and belief that:

1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, Disclosure Form to Report Lobbying in accordance with its instructions.

3. The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into and is a prerequisite for making or entering into this transaction imposed by 31 U.S.C. 1352.

Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

F. Copyrighted Material Waiver. By signing its Response, the Responder certifies that it has obtained all necessary approvals for the reproduction and distribution of the contents of its response.

G. Diverse Spend Reporting. The Sample Contract contains a clause for Diverse Spend Reporting. When this clause applies, Contractor will be required to register in a free portal to report diverse spend.

Please see Diverse Spend Reporting Frequently Asked Questions for additional information.

By signing this form, Responder acknowledges and certifies compliance with all applicable requirements indicated above.

Company Name:

Signature:

Printed Name:

Title:

Date:

Phone Number:

Email Address:

https://osp.admin.mn.gov/sites/osp/files/2022-11/viva_diverse_spend_reporting_faq.pdf

ATTACHMENT B: EXCEPTIONS TO STATE’S TERMS AND CONDITIONS

The State presumes a responder agrees to the terms and conditions of this solicitation unless a responder takes specific exception to one or more of the conditions on this form.

The State reserves the right to reject, negotiate, or accept any exception listed to the State’s terms and conditions (including those found in the attached Sample Contract).

INSTRUCTIONS: A responder must explicitly list all exceptions to State’s terms and conditions, if any (including those found in the attached Sample Contract). Reference the clause number and page number of the State's term and condition for each of a responder’s exceptions. If no exceptions exist, state "NONE" specifically on the form below.

Whether or not exceptions are taken, the Responder must sign and date this form and submit it as part of their response. (Add additional pages if necessary.)

Clause and Page Number Suggested Change to Clause Explanation or Justification

By signing this form, I acknowledge that the above-named responder accepts, without qualification, all terms and conditions stated in this solicitation (including the sample contract) except those clearly outlined as exceptions above.

This acknowledgement includes acceptance of the section of the Sample Contract, Exhibit A, titled “Contractor’s Documents.”

Signature:

Printed Name:

Title:

Date:

ATTACHMENT C: COST DETAIL

1. Cost Proposal. Responder must review Attachment C: Cost Detail along with Exhibit D of the Sample Contract for all pricing requirements associated with the Cost Proposal.

A separate price proposal document will not be used for this solicitation; instead, responders are required to enter the total cost of their proposal directly into SWIFT at the unit line level. Responders who need assistance with entering their cost information may contact the Vendor Assistance Help Desk at (651) 201-8100, option #1, and then option #1 again.

If a responder is not offering the exact product listed within SWIFT, an approval-equals pricing submission may be provided within SWIFT; however, no pricing will be considered without the required documentation, including applicable OEM or authorized distributor or representative letters, as well as complete product specification documents sufficient for review.

2. Installation Services. Installation services are not included with this Contract.

3. Catalogs and Price Literature.

Responders may submit copies of all applicable catalogs, on-line catalog addresses, or price lists used for pricing purposes with their response. Do not submit marketing material with your response unless otherwise requested.

All price lists proposed must meet accessibility requirements per the Minnesota IT Services, Office of Accessibility website: https://mn.gov/mnit/programs/accessibility/

4. Alterations or Erasures. The State reserves the right to reject a response containing an alteration or erasure of any price used to determine the lowest responsible responder unless the alteration or erasure is done in a manner that is clear and authenticated by an authorized representative of the Responder. An acceptable way to make an alteration or erasure is to cross out the price, print the correction in ink adjacent to it, and have an authorized representative of the Responder initial and date that correction.

https://mn.gov/mnit/programs/accessibility/

ATTACHMENT D: WORKFORCE AND EQUAL PAY DECLARATION PAGE

This form is required for all businesses executing government contracts under the following:

Select one:

☐ Businesses executing a contract with State or Metropolitan agencies in excess of $100,000 (Workforce Certificate) and if applicable $500,000 (Equal Pay Certificate)

☐ Businesses executing a contract with University of Minnesota for general obligation bond funded capital projects in excess of $100,000 (Workforce Certificate) and if applicable $500,000 (Equal Pay Certificate)

☐ Businesses executing a contract with Political Subdivisions for general obligation bond funded capital projects in excess of $250,000 (Workforce Certificate) and if applicable $1,000,000 (Equal Pay Certificate)

Select all that apply:

We are a Certificate holder:

☐ Workforce Certificate under the name: _________________________________________________________ ☐ Equal Pay Certificate under the name: __________________________________________________________

We are applying/have applied for the following certificate(s):

☐ Workforce Certificate Application date (MM/DD/YYYY): ____________________ ☐ Equal Pay Certificate Application date (MM/DD/YYYY): ____________________

We have not applied for one or both certificates:

☐ Our Company does not yet have a Workforce Certificate or Equal Pay Certificate. We acknowledge that a

Workforce and, if applicable, Equal Pay Certificate, or approved exemption by MDHR is required before a contract can be executed.

We are Exempt:

☐ We attest to MDHR that we have not employed 40 or more employees on a single day during the prior 12 months in Minnesota or the state in where we have our primary place of business. MDHR may request the names of our employees during the previous 12 months, the date of separation, if applicable, and the current employment status and count.

Business Information

Vendor/Supplier ID Business Name Name of Contracting Agency

Authorized Signatory Name Title Date

Signature Email Phone

For assistance with this form, email the Minnesota Department of Human Rights Compliance.MDHR@state.mn.us https://mn.gov/mdhr/certificates/workforce-certificate/ https://mn.gov/mdhr/certificates/equalpay/ https://mn.gov/mdhr/certificates/workforce-certificate/ https://mn.gov/mdhr/certificates/equalpay/ https://mn.gov/mdhr/certificates/workforce-certificate/ https://mn.gov/mdhr/certificates/equalpay/

ATTACHMENT E: ADDITIONAL INFORMATION

1. Contractor’s Contact Information. Provide the contact information for the representative responsible for the management of the contract and the representative receiving purchase orders.

Vendor’s Legal Name

Address

Contact Person (Contract)

Title

Email Address

Telephone Number

Contact Person (PO Order)

Title

Email Address

Telephone Number

2. Prompt Pay Discount. What prompt pay discounts do you offer? Select all that apply:

□ 1% in 30

□ 2% in 30

□ 3% in 30

□ 1% in 10, Net 30

□ 2% in 10, Net 30

□ 3% in 10, Net 30

□ 5% in 10, Net 30

□ 1% in 15, Net 30

□ 2% in 15, Net 30

□ 3% in 15, Net 30

□ 1% in 20, Net 30

□ 2% in 20, Net 30

□ 3% in 20, Net 30

□ Net 30

3. Desired Delivery Date. The desired delivery date is on or before December 30, 2026. Responders must confirm whether they can meet this requirement. In addition to providing a specific estimated delivery date, responders must also state the estimated number of calendar days ARO required for delivery.

☐ Yes, my company is capable of delivering the requested products by ________________.

Estimated delivery time: _______ calendar days ARO.

☐ No, my company cannot deliver by December 30, 2026. The earliest my company can deliver is ____________.

Estimated delivery time: _______ calendar days ARO.

Responders may describe options for consolidating shipments or using standard rather than expedited transportation when doing so would reduce packaging, cost, or transportation impacts without preventing the ordering entity from meeting its operational needs.

Optional explanation: ____________________________________________________________________________

4. Original Equipment Manufacturer (OEM) or Authorized Distributor/Dealer (AD). Responders must confirm that they are an OEM, Authorized Representative or Distributor as defined in MN Rules 1230.0150 and if you are submitting an offer on behalf of the Original Equipment Manufacturer (OEM), your company must either:

Rev. 9.01.2021

• Be listed on the OEM’s website as an authorized distributor or an authorized manufacturer’s representative, or

• You must provide a letter from the OEM, on the OEM letterhead, stating the Responder is authorized to sell the specific product listed in the Solicitation, or the OEM’s full line of products, and that all OEM equipment warranties are applicable. (This requirement may be met by attaching the OEM letter to the Solicitation response.)

Pursuant to MN Rules 1230.0150, responses from brokers will not be accepted.

Select the below option below that pertains:

☐ Our Company is manufacturing the products to be sold under this contract. Our company is the OEM.

☐ Our Company does NOT manufacture the products to be sold under this contract. Our company is an Authorized Distributor for the supplies offered in our response.

☐ Our Company does NOT manufacture the products to be sold under this contract. Our company is an Authorized Representative for the supplies offered in our response.

☐ Our Company does NOT manufacture the products to be sold under this contract. Our company is a Broker for the supplies offered in our response.

5. Sample Invoice and Quote. Did you submit a sample invoice and quote with your response that complies with the requirements listed in Exhibit D, Supplement 1? Mark either yes or no below.

Yes ______ No ______

6. Additional Equipment, Parts or Accessories. Responders may enter below additional equipment, parts, and accessories that are required for the function, warranty or performance that were not included under the solicitation.

SKU Description Price

7. Warranty. Responders must indicate whether they can fully meet the warranty requirements as stated in the Sample Contract and Exhibits, Exhibit C: Specifications, Duties, and Scope of Work. Mark either yes or no to each item below.

7.1 Do you offer an OEM 1-year warranty covering the MobiChair® floating beach wheelchair?

Yes ______ No ______

7.2 Do you offer an offer OEM 2-year warranty covering the Mobi-Mat® AFX RecPath™ roll-out accessible pathway?

Yes ______ No ______

7.3 Do you offer an offer OEM 1-year warranty covering the Mobi-Tool™?

Yes ______ No ______

8. Products. Do the products offered meet all the specifications listed in the Exhibit C: Specifications, Duties, and Scope of Work? Mark either yes or no below.

Rev. 9.01.2021

Yes ______ No ______

Sustainability. Answer the following questions about product, warranty, delivery, and technical requirements:

9. End of Life Management. Describe available take-back, repair, refurbishment, reuse, and recycling options for each product offered and major components. For each option, identify the organization receiving the material, eligible products and conditions, geographic availability, transportation arrangements, customer costs, minimum quantities, and anticipated management method. Clearly identify any product or component for which no practical reuse or recycling pathway is available.

10. Packaging. Identify the primary packaging materials used for each product, including approximate quantities or weights when available. State whether each material is commonly reusable or recyclable in Minnesota. Confirm whether expanded polystyrene, plastic foam, plastic film, and unnecessary individual packaging will be avoided.

Explain any exceptions and identify opportunities for consolidated or reusable packaging.

11. Prohibited Substances. Disclose whether any offered product, component, coating, fabric treatment, surface treatment, or packaging contains intentionally added PFAS. The response must address the wheelchair fabric, mat material, wheels, armrests, straps, coatings, adhesives, accessories, and packaging. Provide a manufacturer or importer attestation supporting the response. Identify any intentionally added antimicrobial treatment and its purpose.

12. Spare Parts and Product Support. Identify the replacement parts available for each product, their current prices, whether installation can be performed by the customer, and the period for which parts are expected to remain available. Indicate whether parts will remain available for at least 10 years after delivery. Describe the process of notifying customers of discontinuation and providing compatible alternatives.

13. Recycled Content. For each product containing recycled material, provide the recycled-content percentage by weight, the postconsumer recycled-content percentage, the components to which the claim applies, and documentation supporting the claim. Identify all components excluded from the calculation.