All Forms.pdf

This form must be returned with your response.

In signing Proposals, we certify that we have not, either directly or indirectly, entered into any agreement or participated in any collusion or otherwise taken any action in restraint of free competition; that no attempt has been made to induce any other person or firm to submit or not to submit Proposals, that Proposals have been independently arrived at, without collusion with any other Proposers, competitor or potential competitor; that Proposals have not been knowingly disclosed prior to the opening of Proposals to any other Proposers or competitor;

that the above statement is accurate under penalty of perjury.

The undersigned, submitting this Proposal, herby agrees with all the terms, conditions, and specifications required by the City in this Request for Proposal, declares that the attached Proposal and pricing is in conformity therewith, and attests to the truthfulness of all submissions in response to this solicitation.

Proposers shall provide the information requested below. Include the legal name of the Proposers and signature of the person(s) legally authorized to bind the Proposers to a contract.

COMPANY NAME

SIGNATURE DATE

PRINT NAME OF PERSON SIGNING

J:/Finance/RFP/Form A Signature Affidavit.doc

Form A: Signature Affidavit

RFP #: 18‐PD10

Proposers hereby acknowledge the receipt and/or submittal of the following forms:

Forms

Initial to Acknowledge

SUBMITTAL

Initial to Acknowledge

RECEIPT

Description of Services/Commodities N/A

Form A: Signature Affidavit

Form B: Receipt of Forms and Submittal Checklist

Form C: Vendor Profile

Form D: References

Form E: Insurance Requirements

Form F: Fee Proposal in separate sealed envelope

Appendix A: Standard Terms & Conditions N/A

Addendum #

Addendum #

Addendum #

VENDOR NAME

J:/Finance/RFP/Form B ReceiptofFormsandSubmittalChecklist.doc

Form B: Receipt of Forms and Submittal Checklist

RFP #: 18-PD10

COMPANY INFORMATION

Company Name (Make sure to use your complete, legal company name.)

FEIN (If FEIN is not applicable, SSN collected upon award.)

Contact Name (Able to answer questions about proposal.) Title

Telephone Number Fax Number

Email

Address City State Zip

ORDERS/BILLING CONTACT

Address where City purchase orders/contracts are to be mailed and person the department contacts concerning orders and billing.

Contact Title

Telephone Number Fax Number

Email

Address City State Zip

Form C: Vendor Profile/Qualifications

LOCAL VENDOR STATUS

The City of Sun Prairie has included a local vendor preference granting a scoring preference to local suppliers. Only suppliers within the City of Sun Prairie limits as of the bid’s due date will receive preference.

CHECK ONLY ONE:

Yes, we are a local vendor.

No, we are not a local vendor.

CORPORATION INFORMATION

If applicant is a corporation, please complete both columns:

Names of Corporate Officers Names of Corporate Directors

LICENSES AND PROFESSIONAL REGISTRATION

List names of each key person of the firm. If a requested service requires a licensed/registered practitioner, you will be required to provide a copy of such license/registration before work can begin.

Name

Capacity

(Owner, Partner, Etc.)

Current Licenses/Registrations (Include Certificate # if applicable)

License/Registration

Expiration Date

CONFLICT OF INTEREST

A conflict of interest may exist where an employee or close relative/family member has a connection to your business, and a third party may consider that this relationship may compromise the competitive process. Does any employee of your company have a possible conflict of interest with this process? Yes No If yes, please specify the following:

Employee Name: __________________________ Employee Phone Number: _______________

Employee’s Relationship: _________________________

PRIOR WORK

Has your organization ever performed work for the City of Sun Prairie? Yes No If yes, please specify scope of work:

WORK EXPERIENCE

List contracts for similar services or materials that have been completed within the last five years.

Project Location Type of Service Total Amount of Contract

Completion Date

Name/Phone of Owner or Other References

KEY PROJECT PERSONNEL INFORMATION

Provide the requested information for key personnel who would be assigned to work on contracts awarded or who would, at a minimum, supervise such work.

Name and Title Primary Responsibilities

Years of Experience

Education (Degrees, Certificates)

Other Relevant Experience and/or Qualifications

JUDGEMENTS AND CLAIMS

Are there any judgements, claims or suits pending our outstanding against you or your organization?

Yes No

If yes, please explain:

DISPUTES REGARDING LIENS

Has any owner or higher‐tier contractor with whom you r business has had a contract ever disputed a claim of lien filed by you or your organization? Yes No

RECEIVERSHIP

Have you or your organization filed for bankruptcy, receivership, or reorganization within the last five years?

Yes No

LEGAL INFRACTIONS

Have you or your organization been cited and/or fined for failure to comply with federal or state regulations and/or statues in the past two years? Yes No

Information provided in this application may be audited by the City of Sun Prairie.

Provision of information on Form C does not relieve your company from providing the same or additional information as requested in a response to a request for proposal.

Submittal of Form C does not guarantee qualification. Qualification will be given only if your company meets all statutory, regulatory or City requirements, including those not listed on this application. Qualification does not guarantee your company any business.

Your company must update significant information changes in writing within 30 days.

Significant changes include, but are not limited to: change of legal status, TIN, ownership, name, address, as well as loss of licensure or registration, filing of bankruptcy, or suspension by any federal, state, or local government agency.

Failure to provide accurate and reliable information required by this form may, in accordance with any and all applicable laws, result in penalties including, but not limited to, suspension or debarment from doing business with the City of Sun Prairie and termination of contracts.

Reference # 1 – Client Information

Company Name

Contact Name

Address City State Zip

Telephone Number Fax Number

Email

Contract Period Year Completed Total Cost

Description of the Performed Work

Reference # 2 – Client Information

Contact Name

Address City State Zip

Telephone Number Fax Number

Email

Contract Period Year Completed Total Cost

Description of the Performed Work

Form D: References

Reference # 3 – Client Information

Contact Name

Address City State Zip

Telephone Number Fax Number

Email

Reference # 4 – Client Information

Contact Name

Address City State Zip

Telephone Number Fax Number

Email

Reference # 5 – Client Information

Contact Name

Address City State Zip

Telephone Number Fax Number

Email

Reference # 6 – Client Information

Contact Name

Address City State Zip

Telephone Number Fax Number

Email

J:/Finance/RFP/Form D References.doc

Insurance coverage shall be in place prior to commencing work and shall remain in force until the entire project is completed or the length of time that is specified in the contract.

INDEMNIFICATION – Professional Services

To the fullest extent allowable by law, Consultant hereby indemnifies and shall defend and hold harmless City of Sun Prairie, its elected and appointed officials, officers, employees, or authorized representatives or volunteers and each of them from and against any and all suits, actions, legal or administrative proceedings, claims, demands, damages, liabilities, interest, attorneys’ fees, costs, and expenses of whatsoever kind or nature whether arising before, during, or after completion of the work hereunder and in any manner directly or indirectly caused, occasioned, or contributed to in whole or in part or claimed to be caused, occasioned, or contributed to in whole or in part, by reason of any act, omission, fault, or negligence, whether active or passive, of Consultant or of anyone acting under its direction or control or on its behalf in connection with or incident to the performance of this Agreement regardless if liability without fault is sought to be imposed on City of Sun Prairie. Consultant’s aforesaid indemnity and hold harmless agreement shall not be applicable to any liability caused by the sole fault, sole negligence, or willful misconduct of the City of Sun Prairie, or City of Sun Prairie’s representatives. This indemnity provision shall survive the termination or expiration of this Agreement.

In any and all claims against the City of Sun Prairie, or any of its directors, officers, employees, or authorized representatives or volunteers by an employee of the Consultant, any subcontractor, or anyone for whose acts any of them may be liable, the indemnification obligation under this paragraph shall not be limited in any way by any limitation on the amount or type of damages, compensation, or benefits payable by or for the Consultant or any subcontractor under Worker’s Compensation Acts, Disability Benefit Acts, or other employee benefit acts.

No provision of this Indemnification clause shall give rise to any duties not otherwise provided for by this Agreement or by operation of law. No provision of this Indemnity clause shall be construed to negate, abridge, or otherwise reduce and other right or obligation of indemnity that would otherwise exist as to the City of Sun Prairie under this or any other contract. This clause is to be read in conjunction with all other indemnity provisions contained in this Agreement. Any conflict or ambiguity arising between any indemnity provisions in this Agreement shall be construed in favor of indemnified parties except when such interpretation would violate the laws of the state in which the job site is located.

Consultant shall reimburse City of Sun Prairie, or any of its directors, officers, employees, or authorized representatives or volunteers, for any and all legal expenses and costs incurred by

Form E: Professional Services Insurance and Indemnification Requirements each of them in connection therewith or in enforcing the indemnity herein provided. Consultant’s obligation to indemnify shall not be restricted to insurance proceeds, if any, received by the City of Sun Prairie, or any of its directors, officers, employees, or authorized representatives or volunteers.

GENERAL CONDITIONS – Professional Services

Laws, Regulations and Permits – The Consultant shall give all notices required by law and comply with all laws, ordinances, rules and regulations pertaining to the project. The Consultant shall also be liable for all violations of the law in connection with the project. If the Consultant performs any work knowing it to be contrary to such laws, ordinances, rules or regulations, the Consultant shall bear all costs arising therefrom.

Safety & Security – The Consultant shall execute and maintain his/her work so as to avoid injury or damage to any person or property. The Consultant shall comply with the requirements of the specifications relating to safety measures applicable in particular operations or kinds of work.

In carrying out his/her work, the Consultant shall at all times exercise all necessary precautions for the safety of employees appropriate to the nature of the work and the conditions under which the work is to be performed, and be in compliance with all applicable federal, state and local statutory and regulatory requirements including Wisconsin labor Code and the U.S. Department of Transportation Omnibus transportation Employee Testing Act.

INSURANCE REQUIREMENTS – Professional Services

Unless otherwise specified in this Agreement, the Consultant shall, at its sole expense, maintain in effect at all times during the performance of the Work, insurance coverage with limits not less than those set forth below with insurers and under forms of policies set forth below.

Worker’s Compensation and Employers Liability Insurance – The Consultant shall cover or insure under the applicable Wisconsin labor laws relating to worker’s compensation insurance, all of their employees in accordance with the law in the State of Wisconsin. The Consultant shall provide statutory covers for work related injuries and employer’s liability insurance with limits of $1,000,00 each accident, $1,000,000 disease policy limit, and $1,000,000 disease each employee.

Commercial General Liability and Automobile Liability Insurance – The Consultant shall provide and maintain the following commercial general liability and automobile liability insurance:

Coverage – Coverage for commercial general liability and automobile liability insurance shall be at least as broad as the following:

1. Insurance Services Office (ISO) Commercial General Liability Coverage (Occurrence Form CG 0001)

2. Insurance Services Office (ISO) Business Auto Coverage (Form CA 0001), covering Symbol 1 (any vehicle).

Limits – The Consultant shall maintain limits no less than the following:

1. General Liability – One million dollars ($1,000,000) per occurrence ($2,000,000 general aggregate if applicable) for bodily injury, personal injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to the project/location (with the ISO CG 2503, or ISO CG 2504 endorsement provided to the City of Sun Prairie) or the general aggregate including product-completed operations aggregate limit shall be twice the required occurrence limit.

2. Automobile Liability – One million dollars ($1,000,000) for bodily injury and property damage per occurrence limit covering all vehicles to be used in relationship to the Agreement.

3. Umbrella Liability – Five million dollars ($5,000,000) for bodily injury, personal injury and property damage per occurrence in excess of coverage carried for Employers’ Liability, Commercial General Liability and Automobile Liability as described above.

4. Professional Liability – One million dollars ($1,000,000) per claim and annual aggregate.

Required Provisions – The general liability and automotive liability policies are to contain or be endorsed to contain the following provisions:

1. The City of Sun Prairie, its elected and appointed officials, officers, employees or authorized representatives or volunteers are to be given additional insured status (via ISO endorsement CG 2010, CG 2033 for general liability coverage) as respects: liability arising out of activities performed by or on behalf of the Consultant; products and completed operations of the Consultant; premises occupied or used by the Consultant; and vehicles owned, leased, hired or borrowed by the Consultant. The coverage shall contain no special limitations on the scope of protection afforded to the City of Sun Prairie, its elected and appointed officials, officers, employees or authorized representatives or volunteers.

2. For any claims related to this project, the Consultant’s insurance shall be primary insurance as respects the City of Sun Prairie, its elected and appointed officials, officers, employees or authorized representatives or volunteers. Any insurance, self-insurance, or other coverage maintained by the City of Sun Prairie, its directors, officers, employees, or authorized representatives or volunteers shall not contribute to it.

3. Any failure to comply with reporting or other provisions of the policies including breaches of warranties shall not affect coverage provided to the City of Sun Prairie, its elected and appointed officials, officers, employees or authorized representatives or volunteers.

4. The Consultant’s insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer’s liability.

5. Each insurance policy required by this agreement shall state, or be endorsed to state, that coverage shall not be canceled by the insurance carrier or the Consultant, except after sixty ((60) days) (10 days for non-payment of premium) prior written notice by U.S. mail has been given to the City of Sun Prairie.

6. Such liability insurance shall indemnify the City of Sun Prairie against loss from liability imposed by law upon, or assumed under contract by, the Consultant for damages on account of such bodily injury (including death), property damage, personal injury, completed operations, and products liability.

The Consultant shall, upon demand of the City of Sun Prairie, deliver to the City of Sun Prairie such policy or policies of insurance and the receipts for payment of premiums thereon.

Deductibles and Self-Insured Retentions – Any deductible or self-insured retention must be declared to and approved by the City of Sun Prairie. At the option of the City of Sun Prairie, the insurer shall either reduce or eliminate such deductibles or self-insured retentions.

Evidences of Insurance – Prior to execution of the agreement, the Contractor shall file with the City of Sun Prairie Finance Department, a certificate of insurance (Acord Form 25-S) signed by the insurer’s representative evidencing the coverage required by this agreement. In addition Form CG 20 10 11 85 covers all bases OR Form CG 20 10 10 01 for ongoing work exposure AND Form CG 20 37 10 01 for products-completed operations exposure. Contractor will also provide form CG 28 04 10 93, Earlier Notice of Cancellation with 30 days’ notice.

Sub-Contractors – In the event that the Consultant employs other contractors (sub-contractors) as part of the work covered by this agreement, it shall be the Consultant’s responsibility to require and confirm that each sub-contractor meets the minimum insurance requirements specified above.

J:/Finance/RFP/Form E Professional Services Insurance and Indemnification.doc

Prepare the Fee Proposal to include the following:

1. All Inclusive – Covers all direct and indirect necessary expenses for each section.

2. Not to Exceed – The actual fees shall not exceed the amount specified on each line of the fee proposal.

a. Crossing Guard Hourly Pay Rate (to employee): $________________________

b. Crossing Guard Hourly Bill Rate (to city): $ _______________________

c. Any Other Potential Billable Costs: $ ________________________

The bill rates quoted above shall include the following:

a. All required payroll taxes, workers compensation, and liability insurance costs.

b. Administrative overhead and profit margin.

3. Will Vendor accept credit card for payment with no additional fees?

________ Yes _______ No

4. Will Vendor accept payment via Electronic Funds Transfer (EFT)?

5. Will Vendor allow Piggybacking of this contract to other government agencies?

The above fees shall be compensation for all the services provided pursuant to this agreement. The cost for project deliverables shall be included as part of the costs above. This fee includes all necessary meetings with the City Council and such Committees, Boards, and Commissions as required. All costs incurred by the contractors and all sub-contractors are included herein.

Form F: Fee Proposal

Any additional services over and above the services described in this agreement shall be provided only when authorized in writing by the City’s designated representative.

For additional services, provide the hourly rate for all staff positions (ie – Engineer Technician, Project Engineer, etc.) that may be designated for this project and any overhead rates that would apply:

The undersigned, submitting this Proposal, herby agrees with all the terms, conditions, and specifications required by the City in this Request for Proposal, declares that the pricing is in conformity therewith, and attests to the truthfulness of all submissions in response to this solicitation.

Proposers shall provide the information requested below. Include the legal name of the Proposers and signature of the person(s) legally authorized to bind the Proposers to a contract.

COMPANY NAME

SIGNATURE DATE

PRINT NAME OF PERSON SIGNING