Attachment 1 - Bid Submission Form.docx
DOCX document 26 KB Posted
- Attached to
- Streetlight Replacement Project
- Solicitation number
- 61899
- Issued by
- Fairfax County, Falls Church City, Virginia
About this file
The provided document is a Bid Submission Form for a state and local streetlight replacement project in Fairfax County and Falls Church City, Virginia. The project involves the replacement of 45 gas-powered streetlights with LED streetlights in the Historic District of the City of Fairfax. This is the second phase of a multi-year project, with the first phase already completed in 2023. The City will not guarantee any amount of business to the awarded bidder beyond the initial phase. The bid submission form requires bidders to provide business identification, warranty information, qualifications, licenses, and certifications related to potential conflicts of interest, collusion, and addendum receipt.
The bid does not specify pricing terms, set-asides, or incumbent information. It indicates that the project will be funded through the City of Fairfax's future Capital Improvement Plan (CIP) budgets, but the exact funding sources and amounts are not provided. The bid submission form also includes a provision for bidders to identify any trade secrets or proprietary information that they wish to protect from public disclosure.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 2 - Price Document 3.18.24.xlsx | XLSX spreadsheet | |
| Attachment 3 - Product Version Configurations.pdf | ||
| IFB 61899 - Streetlight Replacement Project.pdf |
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Text version
BID SUBMISSION FORM
Business Identification
BUSINESS NAME:
ADDRESS:
CONTACT PERSON:
TITLE:
TELEPHONE NO.:
EMAIL ADDRESS:
REMITTANCE ADDRESS:
| PROMPT PAYMENT DISCOUNT: |
| ___% FOR PAYMENT WITHIN____ DAYS; NET___DAYS |
BUSINESS ORGANIZED UNDER THE STATE LAWS OF:
PRINCIPAL BUSINESS LOCATION:
STATE CORPORATION COMMISSION IDENTIFICATION NO.:
DUNS NUMBER:
Warranty Information Provide the manufacturer’s standard warranty period:
Business Classifications Corporation
Partnership
Sole Proprietor
Minority Owned
Small Business
Non Profit
Woman Owned
Ownership Disclosure Names and address of all persons having an ownership interest of 5% or more in the business:
1.
2.
3.
Qualifications Type of work performed by this business:
Number of years this business has been in operation:
| Number of employees: |
| Full time: |
| Part Time: |
| Business License: |
| Type: |
| Issued: |
| Contractor’s License: |
| Type: |
| Class: |
| 1. |
| Issued: |
| Expires: |
| Has the business ever defaulted or failed to complete any public body contract: |
| No: |
Yes- Explain:
| Is the entity or any of its principals currently debarred, disqualified or suspended from submitting responses to the City, or any other state, local or federal entities? |
| No: |
Yes:
TRADE SECRETS OR PROPRIETARY INFORMATION:
Trade secrets or proprietary information submitted by the Bidder in connection with a procurement transaction shall not be subject to public disclosure under the Virginia Freedom of Information Act. However, the Bidder must identify the data and materials that need such protection prior to the submission of such data and material, and state the reasons why protection is necessary. Please mark one:
[ ] Yes, the Bid I have submitted does contain trade secrets and/or proprietary information.
[ ] No, the Bid I have submitted does not contain any trade secrets and/or proprietary information.
If Yes, Bidder must clearly identify below the exact data or other materials to be protected and list all applicable page numbers of the Bid containing such data or materials:STATE THE SPECIFIC REASON(S) WHY PROTECTION IS NECESSARY:
Use additional attachments if necessary
NOTE: If the Bidder fails to identify the data or other materials to be protected and fails to state the reasons why such protection is necessary in the space provided above, then the Bidder has not invoked protection accordingly, effectively making the Bid open for public inspection consistent with applicable law.
Conflict of Interests
| This solicitation is subject to the provisions of Section 2.2-3100 et. Seq., Virginia Code Annotated, the State and Local Government Conflict of Interests Act. The business is aware of information bearing on the existence of any potential organizational conflict of interest. |
| YES |
NO
Collusion:
| I certify that this bid is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a bid for the same goods and services and is in all respects fair and without collusion or fraud. I understand collusive bidding is a violation of the State and Federal law and may result in fines, prison sentences, and civil damage awards. |
| YES |
NO
ADDENDUM RECEIVED:
The undersigned warrants that it has received the following Addendum/Addenda for the Solicitation (Show date of Addendum).
| AMENDMENT NO. |
| DATE |
| INITIAL |
[Add more as needed]
Addenda issued during the bidding period will be incorporated into the Contract Documents.
Authorized Signature By signing this quote Business certifies, acknowledges, understands, and agrees to be bound by the conditions set forth in this Solicitation.
| Authorized Signature: |
| Date: |
| Name (Printed): |
| Title: |
| Email Address: |
| Telephone Number: |
File details come from the government source that posted it. Updated .