Attachment 2 - Bid Submission Form.docx
DOCX document 26 KB Posted
- Solicitation number
- 64397
- Issued by
- Fairfax County, Fairfax City, Virginia
About this file
This document is a Bid Submission Form for a streetlight installation project in the Fairfax City Historic District in Virginia. The project involves the installation of new LED streetlights to replace the existing aging gas-powered lamp system in order to improve illumination throughout the Historic District. The City is seeking bids from qualified firms with at least 5 years of experience installing streetlights in municipal rights-of-way, and requires references for 3 similar projects completed within the last 12 months in the Greater DC Area. Bids must include specific information about the bidding company, including ownership, qualifications, and any potential conflicts of interest or proprietary information.
The project is being led by the City of Fairfax and Fairfax County in Virginia. Pricing terms, set-asides, and funding sources are not explicitly stated in the document. However, the document indicates that the new LED streetlights will replace the existing gas-powered lamps, which suggests this is a replacement/upgrade project rather than new construction. The successful bidder will be responsible for the complete installation of the new streetlights in the Fairfax City Historic District.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 4 - IFB 64397 Pricing Schedule.xlsx | XLSX spreadsheet | |
| Attachment 3 - Product Configurations & Phase 2 Map.pdf | ||
| Attachment 1 - IFB 64397.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:
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 and References 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: |
| List at least three state, county, or federal agencies or commercial references that the business contracted with in the last twelve (12) months within the Greater DC Area for a comparable procurement (include contacts and telephone numbers): |
| A) |
B)
C)
| 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: |
MANDATORY MINIMUM REQUIREMENTS:
Please mark a yes/no answer to all questions below and provide required documentation. Bids submitted without complete answers shall be considered nonresponsive.
Does your firm have at least five (5) years of experience (as the same corporate entity) installing streetlights in the municipal rights-of-way??
Does your firm have a detailed description and client point of contact for three (3) reference project completed in the last twelve (12) months within the Greater DC Area installing streetlights in the municipal rights-of-way?
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