Attachment 1 - Representations and Certifications.pdf

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Attached to
ITB - EMERGENCY PROPERTY DAMAGE RESPONSE
Solicitation number
00002636
Issued by
Oregon

About this file

This is a Representations and Certifications form submitted with bids for ITB 00002636, an Emergency Property Damage Response contract opportunity issued by the City of Portland, Oregon. The form requires bidders to provide essential organizational and identification information, including the offer date, offeror name, business address, authorized representative details, and contact information. Bidders must declare their business structure (sole proprietorship, partnership, corporate entity, government entity, or other), identify any common parent company ownership, and specify their local representative for the Portland area. Additionally, all offerors must state their City of Portland Business License Tax Account number, State of Oregon Registry Number, and Federal Taxpayer Identification Number.

A critical requirement of this form is that all bidders must certify their resident status in Oregon. As defined in ORS 279A.120, a resident bidder must have paid unemployment or income taxes in Oregon during the twelve calendar months immediately preceding bid submission, maintain a business address in Oregon, and declare resident bidder status in the bid submission. This certification directly impacts bidder eligibility and may influence evaluation criteria, as Oregon prioritizes resident contractors. The form must be completed and submitted with all bids, making it a mandatory component of the bidding process for this emergency property damage response contract.

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City Project 133244 Page 13 of 17 Emergency Property Damage Response

ATTACHMENT 1

REPRESENTATIONS, CERTIFICATIONS, AND ACKNOWLEDGMENTS

ITB 00002636

[This form must be submitted with bid]

OFFER DATE

OFFEROR NAME

OFFEROR DOING BUSINESS AS

OFFEROR ADDRESS

AUTHORIZED REPRESENTATIVE NAME

AUTHORIZED REPRESENTATIVE TITLE

AUTHORIZED REPRESENTATIVE PHONE

AUTHORIZED REPRESENTATIVE EMAIL

AUTHORIZED REPRESENTATIVE MAILING

ADDRESS

AUTHORIZED REPRESENTATIVE SIGNATURE

NAME OF LOCAL REPRESENTATIVE

LOCAL REPRESENTATIVE PHONE

LOCAL REPRESENTATIVE EMAIL

CITY OF PORTLAND BUSINESS LICENSE TAX

ACCOUNT #

STATE OF OREGON REGISTRY NUMBER

FEDERAL TAXPAYER IDENTIFICATION NUMBER

(TIN)

TYPE OF ORGANIZATION Sole proprietorship;

Partnership;

Corporate entity (not tax-exempt);

Corporate entity (tax-exempt);

Government entity (Federal, State, or local);

Other:

COMMON PARENT Offeror is not owned or controlled by a common parent Name and TIN of common parent:

Name:

TIN:

RESIDENT BIDDER

All Offerors must state whether or not they are an Oregon resident Bidder as defined in ORS 279A.120, a resident Offeror is one who has paid unemployment taxes or income taxes in the State during the twelve (12) calendar months immediately preceding bid submission, has a business address in Oregon, and has stated in their bid to be a resident bidder.

Offeror is a Resident Bidder Offeror is not a Resident Bidder State of Residence:

OFFER DATE:
OFFEROR NAME:
OFFEROR DOING BUSINESS AS:
OFFEROR ADDRESS:
AUTHORIZED REPRESENTATIVE NAME:
AUTHORIZED REPRESENTATIVE TITLE:
AUTHORIZED REPRESENTATIVE PHONE:
AUTHORIZED REPRESENTATIVE EMAIL:
AUTHORIZED REPRESENTATIVE MAILING ADDRESS:
AUTHORIZED REPRESENTATIVE SIGNATURE:
NAME OF LOCAL REPRESENTATIVE:
LOCAL REPRESENTATIVE PHONE:
LOCAL REPRESENTATIVE EMAIL:
CITY OF PORTLAND BUSINESS LICENSE TAX ACCOUNT:
STATE OF OREGON REGISTRY NUMBER:
FEDERAL TAXPAYER IDENTIFICATION NUMBER TIN:
TYPE OF ORGANIZATION:
Sole proprietorship: Off
Partnership: Off
Corporate entity not taxexempt: Off
Corporate entity taxexempt: Off
Government entity Federal State or local: Off
Other: Off
COMMON PARENT:
Offeror is not owned or controlled by a common parent: Off
Name and TIN of common parent: Off
Offeror is a Resident Bidder: Off
Offeror is not a Resident Bidder: Off
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