Appendix A - Proposal Forms - RFP27-02.pdf

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APPENDIX A

TOWN OF HERNDON

RFP 27-02 - Stormwater Management Services

This set of attachments and Appendices shall be included in your proposal as SECTION 4 –

PROPOSAL FORMS.

Proposals without these forms will be rejected.

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SIGNATURE SHEET

RFP 27-02 - Stormwater Management Services

(Submit with Proposal)

My signature certifies that the proposal as submitted complies with all Terms and Conditions as set forth in this Request for Proposal.

Company Name:_____________________________________________________

Address:________________________________________________________________

If a Corporation, list State where incorporated: _______________________________

State Corporation Commission ID Number: __________________________________

Signature: ____________________________________________________________

Name (type or print):____________________________________________________

Official Title: _________________________________________________________

Federal Tax ID Number: ________________________________________________

Date: _____________________ Telephone Number: ________________________

Email Address: _____________________________________________

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ATTACHMENT A

REFERENCES

QUALIFICATIONS OF OFFEROR: Offeror must have the capability and capacity in all respects to fully satisfy the contractual requirements.

Indicate the length of time you have been in business providing this type of service and/or product.

years, months.

Provide a list of at least three (3) similar accounts, that your firm has provided similar goods and/or services to in the past five (5) years.

1. Company Name:

Contact:

Phone Number:

Email address: _______________________________________________________ ____

Project Title_____________________________________________________________

Project Dates: Beginning: End:

2. Company Name:

Contact:

Phone Number:

Email address: _______________________________________________________ ____

Project Title_____________________________________________________________

Project Dates: Beginning: End:

3. Company Name:

Contact:

Phone Number:

Email address: _______________________________________________________ ____

Project Title_____________________________________________________________

Project Dates: Beginning: End:

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ATTACHMENT B

PROPRIETARY INFORMATION IDENTIFICATION

Name of Firm/Offeror: _______________________________________________________

Trade secrets or proprietary information submitted by an offeror shall not be subject to public disclosure under the Virginia Freedom of Information Act; however, the offeror must invoke the protections of § 2.2- 4342F of the Code of Virginia, in writing, either before or at the time the data or other material is submitted.

The written notice must specifically identify the data or materials to be protected including the section of the proposal in which it is contained and the page numbers, and state reasons why protection is necessary.

The proprietary or trade secret material submitted must be identified by some distinct method such as highlighting or underlining and must indicate only the specific words, figures or paragraphs that constitute trade secrets or proprietary information. In addition, a summary of proprietary information shall be submitted on this form. The classification of an entire proposal document, line item prices, and/or total proposal prices as proprietary or trade secrets is not acceptable. If the proposal contains proprietary and confidential information, the Offeror shall also submit a second, redacted version of the proposal (01 copy). Upload the redacted version on Section 11, questionnaire, question 8.

Section Title: Page #s: Reason for Withholding from Disclosure

I certify the accuracy of this information.

Signed: ______________________________Title: _______________________ Date: _____________

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ATTACHMENT C

EXCEPTIONS TO RFP

Name of Firm/Offeror: ____________________________________________________

Unless stated in this portion of the proposal, all Offerors will be considered to have accepted all the terms of the Request for Proposal (RFP), including all ‘must’s,’ shall’s’, and ‘should’s,’ and any amendments as issued, without exception.

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ATTACHMENT D

BUSINESS, PROFESSIONAL AND OCCUPATIONAL LICENSE

All firms located or operating in the Town of Herndon must obtain a Business, Professional and Occupational License (BPOL) as required in the Municipal Code, Article VII and local license tax authorized, Code of Virginia, § 58.1-3700 et seq. A BPOL license is not required to submit a proposal for this solicitation. If notified of award, a BPOL license will be required before execution of the contract.

In order for the Department of Tax Administration to determine BPOL requirement prior to contract award, it is necessary to provide the following information:

• If you currently have a Town of Herndon business license, please submit a copy with your proposal.

• Do you have an office in: Virginia □ yes □ no

Town of Herndon □ yes □ no

• Date business began/will begin work in the Town of Herndon

Provide a description of the business activity that will take place in the Town of Herndon:

Authorized Signature Date

Please return this form and a copy of current Town of Herndon business license in proposal. Contract award may not be made if omitted.

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ATTACHMENT E

TOWN OF HERNDON, VIRGINIA

CONTRACTOR CERTIFICATION FORM

By signing this certification, the undersigned Contractor:

(1) verifies that it, he, or she does not and will not during the performance of this contract violate or suffer the violation of (i) the provisions of the Federal Immigration Reform and Control Act of 1986, as amended and §40.1-11.1, Code of Virginia, which prohibit the employment of illegal aliens and (ii) the provisions of Federal and State employment and wage hour laws; and

(2) shall include and enforce the preceding language contained in (1) in every subcontract issued under this contract and shall require the subcontractor to do the same; and

(3) agrees to undertake for each of its employees working on this contract the Federal I-9 employment eligibility verification process, or federal Employment Eligibility Verification (E-Verify) Program, or both; and the Contractor’s agrees to update this assurance for new employees for the duration of the contract; and

(4) agrees to provide Town access to any public documentation that relates to verifying the employee’s legal eligibility for employment in the United States in those cases where the Town harbors a reasonable suspicion that employees of Contractor or Contractor’s subcontractor working on this contract may be not legally eligible for employment in the United States.

Contractor Name __________________________________________________

Authorized Contract Signature________________________________________

Print Authorized Contract Signature___________________________________

Title of Authorized Signature_________________________________________

Date____________________________________________________

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ATTACHMENT F

State Corporation Commission Form

State Corporation Commission Form Virginia State Corporation Commission (SCC) registration information.

The offeror:

______________________ is a corporation or other business entity with the following SCC identification number: ______________________

-OR-

____________________ is not a corporation, limited liability company, limited partnership, registered limited liability partnership, or business trust

-OR-

___________________ is an out-of-state business entity that does not regularly and continuously maintain as part of its ordinary and customary business any employees, agents, offices, facilities, or inventories in Virginia (not counting any employees or agents in Virginia who merely solicit orders that require acceptance outside Virginia before they become contracts, and not counting any incidental presence of the offeror in Virginia that is needed in order to assemble, maintain, and repair goods in accordance with the contracts by which such goods were sold and shipped into Virginia from offerors out-of-state location)

-OR-

_____________________ is an out-of-state business entity that is including with this offer an opinion of legal counsel which accurately and completely discloses the undersigned offerors current contacts with Virginia and describes why those contacts do not constitute the transaction of business in Virginia within the meaning of § 13.1-757 or other similar provisions in Titles 13.1 or 50 of the Code of Virginia.

**NOTE** >> Check in the following space if you have not completed any of the foregoing options but currently have pending before the SCC an application for authority to transact business in the Commonwealth of Virginia and wish to be considered for a waiver to allow you to submit the SCC identification number after the due date for proposals (the Commonwealth reserves the right to determine in its sole discretion whether to allow such waiver): __________