Attachment 1 - Representations and Certifications.pdf
PDF 141 KB Posted
- 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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Text version
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 |
| Text2: |
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