Attachment 2-3 ITB Bid Submission Cover Sheet.docx

ATTACHMENT 2

Bid Submission Cover Sheet

PROJECT INFORMATION

ITB NUMBER:

PROJECT NAME:

BIDDER INFORMATION

Company Name:

Address:

Tax ID:

Alaska Business License #:

CONTACT INFORMATION

Provide contact information for the individual that can be contacted for clarification regarding this bid:

Name

Title

Address

Email

Telephone

Procurement Officer Note: REVISE OR DELETE AS REQUIRED.

ADDENDA ACKNOWLEDGEMENT

The bidder acknowledges receipt of the following amendments and has incorporated the requirements of such amendments into their bid. Failure to identify and sign for all amendments may subject the bidder to disqualification. The bidder must list all amendments (by number), then initial and date to confirm that you have received and incorporated them into your bid (add more rows as necessary).

CERTIFICATIONS

* Failure to answer or answering “False” may be grounds for disqualification. For any “False” responses, provide clarification (up to 250 word maximum for each “False” clarification) below (add rows as necessary).

CONFLICT OF INTEREST STATEMENT

Indicate below whether or not the firm or any individuals that will work on the contract has a possible conflict of interest (e.g., currently employed by the State of Alaska or formerly employed by the State of Alaska within the past two years) and, if so, the nature of that conflict. The procurement officer reserves the right to consider a bid non-responsive and reject it or cancel the award if any interest disclosed from any source could either give the appearance of a conflict or cause speculation as to the objectivity services to be provided by the bidder.

* Failure to answer may be grounds for disqualification.

If “Yes”, please provide additional information regarding the nature of that conflict:

FEDERAL REQUIREMENTS

Indicate below all known federal requirements that apply to the bid, it’s evaluation, or the resulting contract:

ALASKA PREFERENCES

If you wish to claim any Alaska Preferences, please complete the Alaska Bidder Preference Certification Form that follows the below signature section.

SIGNATURE

This bid must be signed by a company officer empowered to bind the company.

Printed Name

Title

Date

Signature

Attachment 3

ALASKA BIDDER PREFERENCE CERTIFICATION FORM

AS 36.30.321 (A) / AS 36.30.990 (2)

Solicitation Number

Project Description

Business Name

Alaska Business License Number

A signed copy of this form must be included with your bid or proposal no later than the deadline set for receipt of bids or proposals.

If you are submitting a bid or proposal as a JOINT VENTURE, all members of the joint venture must complete and submit this form before the deadline set for receipt of bids or proposals. AS 36.30.990(2)(E) If the procuring agency is unable to verify a response, the preference may not be applied. Knowingly or intentionally making false or misleading statements on this form, whether it succeeds in deceiving or misleading, constitutes misrepresentation per AS 36.30.687 and may result in criminal penalties.

SIGNATURE

By signature below, I certify under penalty of law that I am an authorized representative of the above entity and all information on this form is true and correct to the best of my knowledge.

Printed Name:

Title:

Date:

Signature:

To qualify for and claim the Alaska Bidder Preference you must answer YES to all questions in the Alaska Bidder Preference Question section below:

Alaska Bidder Preference Questions

If the answer to question 3 is YES, complete the following:

Physical Place of Business Address

City

Zip Code

“Place of business” is defined as a location at which normal business activities are conducted, services are rendered, or goods are made, stored, or processed; a post office box, mail drop, telephone, or answering service does not, by itself, constitute a place of business per 2 AAC 12.990(b)(3).

Per AS 16.05.415(a) per 2AAC 12.990(b)(7), the bidder or offeror, or at least one employee of the bidder or offeror must be a resident of the state?

Per AS 36.30.990(2)(D), is your business:

If yes, enter the current Alaska Corporate Entity Number:

Indicate below how your business is organized:

If the answer to question 2 above is YES, please identify each member by name:

If the answer to question 3 above is YES, please identify each partner by name:

Alaska Veterans Preference Questions:

To qualify for and claim the Alaska Veteran Preference, you must answer YES to the below questions as well as answer YES to all the questions in the Alaska Veteran Preference section above.

Per AS36.30.321(F), is your business:

Per AS36.30.321(F)(3), an “Alaska veteran” is defined as an individual who:

A. Served in the:

a. Armed forces of the United States, including a reserve unit of the United States armed forces ; or

b. Alaska Territorial Guard, The Alaska Army National Guard, the Alaska Air Nations Guards, or the Alaska Naval Militia; and, B. Was separated from services under a condition that was not dishonorable.

Alaska Military Skills Program Preference Questions To qualify for and claim the Alaska Military Skills Program Preference, you must answer YES to the below questions as well as answer YES to all the questions in the Alaska Bidder Preference section above.

Per 36.30.321(l), does your business:

during the last 180 days before a the person separates or retires from the service?

□ Yes □ No

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