Appendix B-DOH Bid submittal.doc

APPENDIX B

IFB Number DOH24-039P - BID SUBMITTAL DOCUMENT

SUBMITTAL INSTRUCTIONS

The bidder must properly complete and submit all sections of this Bid Submittal Document as their Bid by the Bid Due Date and Time.

The Bid must include all completed sections of this Bid Submittal Document as listed below:

1. Bidder Acknowledgements

2. Bidder Information

3. Subcontractor Information

4. References

5. Bid Pricing

Bidder will submit their complete Bid in accordance with Section 3, Bid Submittals, of the ITB document.

BIDDER ACKNOWLEDGEMENTS

DOH24-039P

Having carefully examined all requirements and terms and conditions identified in this Invitation for Bid (IFB), the undersigned, as Bidder, declares to that I/we have examined all of the Solicitation Documents and that I/we will contract with the Washington State Department of Health (DOH) to do everything necessary for fulfillment of DOH24-039P for the Ultra High Performance Liquid Chromatography (UHPLC) instrument, and the resulting Purchase Order or Contract, at the prices and on the terms and conditions contained herein.

I/We certify, under penalty of perjury, that this is not a sham or collusive Bid, nor made in the interest or on behalf of any person not herein named. I/We have not directly or indirectly induced or solicited any Bidder on the above work, or suppliers to put in a sham Bid, nor any other person or corporation to refrain from Bidding. I/We have not in any manner sought by collusion to secure an advantage over any other Bidders.

I/We agree that our Bid constitutes an offer to DOH, which shall be binding for sixty (60) Calendar Days from the Bid Due Date. If our Bid is accepted, we agree to sign the Contract form and furnish evidence of insurance required herein within ten (10) Calendar Days after receipt from DOH of written notice of award of Contract.

I/We certify that we are, at the time of submitting this Bid and shall remain throughout the period of the Contract, registered, and licensed by the state of Washington to perform the type of work required (if applicable) under the Solicitation Documents. We further certify that we are skilled and regularly engaged in the general class and type of work called for in the Solicitation Documents.

I/We further agree, if our Bid is accepted and a Contract is awarded by DOH, to plan and prosecute the work with such diligence that the work and portions thereof shall be completed and ready for use within the period set forth.

I/We acknowledge receipt of addenda numbers through and have been taken into account as part of our Bid.

The following information is accurate to the best of our knowledge. Any required documentation has been attached separately. We understand that failure to complete this form in its entirety may deem our Proposal “Non-Responsive”. If our business is not required to have one of the required items, we have attached a letter explaining why.

The signatory below represents that he/she has the authority to bind the company named below to the Bid submitted and any Contract awarded as a result of this Solicitation. The authorized signatory acknowledges having read and understood the entire Solicitation and agrees to comply with the terms and conditions of the Solicitation in submitting and fulfilling the offer made in its Bid. By submitting this Bid, Bidder hereby offers to furnish materials, supplies, services and/or equipment in compliance with all terms, conditions, and specifications contained in this Solicitation.

“I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct”:

Bidder Signature:

Date:

Print Name and Title

Location or Place Executed: (City, State)

Bidder INFORMATION

1. Bidder Profile:

Bidder must provide the following:

Firm Name

DBA Name (if applicable)

Street Address

City, State, Zip Code

Federal Tax ID Number

WA State UBI Number

DUNS or UEI Number

2. Bidder Authorized Representative:

Bidder must designate an Authorized Representative who will be the principal point of contact for the Procurement Coordinator for the duration of this IFB process. Bidder’s Authorized Representative will serve as the focal point for business matters and administrative activities.

Representative Name:

Street Address

City, State, Zip Code

Telephone Number

Email Address

3. Certified DBE and SBE Status:

Department of Health gathers applicable Minority-, Women-, Veterans-, Disadvantaged-, and Small-Business Enterprise information for reporting purposes. Bidder is instructed to check the applicable boxes and enter associated certification numbers, as applicable, below:

FORMCHECKBOX

Not Applicable

FORMCHECKBOX

Certified as:__________________________ Certification #:

FORMCHECKBOX

Certified as:__________________________ Certification #:

4. Statement of Prior Contract Termination:

Bidder must disclose below if the Bidder’s firm and/or any proposed subcontractors have had a contract terminated for either cause or convenience in the last five (5) years. If a contract was terminated for cause or convenience during this timeframe, submit full details of the termination including but not limited to, the reason for termination, the other party’s contact information (name, address, email address, and telephone number), and the Bidder’s position on the matter. The Department of Health will evaluate the information and may, at its sole discretion, reject the Response based on the risk to the Agency. If not applicable, Bidder is instructed to enter “NA” in the box below.

CERTIFIED INSTALLER, MAINTENANCE,

AND OEM SERVICE PROVIDERS INFORMATION

Bidder will be required to perform all work under this Contract/Purchase Order using his/her own employees carried on payroll or by using certified providers. Where certified providers are used in the performance of the Contract, Proposer will indicate as required with the Response. The Bidder will be held responsible for all work performed or not performed by the certified provider(s). S

If revisions are required in the subcontract assignment, new parties are to be proposed in advance of assignment, in writing to the Department of Health Procurement Coordinator.

If applicable, Bidder will identify below all subcontractors who will perform services in fulfillment of requirements, including their name, the nature of services to be performed, address, telephone number, email address, federal tax identification number (TIN), Washington State Unified Business Identifier (UBI), and any disadvantaged certification status:

Name:

Name:

Services:

Services:

Address:

Address:

Telephone

Telephone:

Email:

Email:

Fed ID:

Fed ID:

UBI:

UBI:

Certified ________

Certified ________

Name:

Name:

Services:

Services:

Address:

Address:

Telephone

Telephone:

Email:

Email:

Fed ID:

Fed ID:

UBI:

UBI:

Certified ________

Certified ________

REFERENCES

Bidder must provide a minimum of three (3) references for which the Bidder has provided goods and/or services similar to those described in this Solicitation. References must not be from an individual, company or organization with any special interest, financial or otherwise, to the Bidder.

Reference 1

Reference 2

Company Name:

Company Name:

Type of Organization:*

Type of Organization:*

Contact Name:

Contact Name:

Job Title:

Job Title:

Street Address:

Street Address:

City, State, Zip:

City, State, Zip:

Telephone:

Telephone:

Email:

Email:

Brief Reference Project Description:

Brief Reference Project Description:

Reference 3

Reference 4

Company Name:

Company Name:

Type of Organization:*

Type of Organization:*

Contact Name:

Contact Name:

Job Title:

Job Title:

Street Address:

Street Address:

City, State, Zip:

City, State, Zip:

Telephone:

Telephone:

Email:

Email:

Brief Reference Project Description:

Brief Reference Project Description:

*Type of Organization – Municipality, Public Agency, Etc.

BID PRICING

Instructions to Bidder: Complete Tables 1 and 2 below by entering the pricing information and lead time information as specified in each table. DO NOT ADD SECTIONS TO THE TABLE.

Do not include retail state and local sales tax in the bid pricing below. Appropriate state and local sales tax at the time of order shall be applied to the invoice. Do include all other business taxes in the bid pricing below.

Table 1: Bid Pricing

A. DESCRIPTION

(unit price x total qty needed)

B. DESCRIPTION

(unit price x total qty needed)

Training

1 Year Maintenance and Service Agreement

Lead Time

C. Additional Items

TOTAL BID PRICE

Sum of Total Price of Items 1-5 above

Table 2: Estimated Lead Time:

Bidder is instructed to provide the estimated lead time for receipt of all bid items (1-10) listed in Table 1 above:

The Department of Health has the right to contract based on the total Bid or a portion thereof. The Department of Health has the right to correct obvious mathematical errors. The price shall be shown clearly in figures. The Bid amount shall include applicable taxes (excluding sales tax). Bidders are warned against making erasures or alterations of any kind, and Bids which contain omissions, erasures or irregularities of any kind may be rejected. Any qualification, addition, limitation, or provision attached to a Bid may render the Bid non-responsive.

I/We, the Bidder, propose to perform the work under the terms and conditions contained herein for the Total Bid Price price set forth above.

Signature of Bidder

Firm/Company Name

ITB Submittal Document

DOH24-039P