Attachment 2, Questionnaire (Q-48OP).xlsx

Instructions

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Summary

Question Set 1: Company Profile

Legal Business Name

Number of Years in Business

DBA

Federal Employer ID

Principal Place of Business Address (Corporate Office)

Refueling Station Location Address (if different)

Does your company have more than one station location within the Globe USD boundary? If yes, include details.

Website address

Name of Authorized Contact for Offer

Authorized Contact Telephone

Authorized Contact Email Address

Type of Business

Is the company incorporated in the State of Arizona?

Name and Title of Each Principal, Owner, Officer, Major Stockholder (more than 3% or whose annual income from dividends, including the value of stock dividends, from the corporation exceeds five percent of the total annual income for such officer or employee and any other payments made to him/her by the corporation exceeds five percent of his/her total annual income):

Does your firm use or have you used in the past five years, any other business name, FEIN, or DBA other than provided herein? If yes, provide all related details.

Is there any potential conflict of interest or relationship between the Offeror and any District employee, official or Governing Board member who functions or has responsibilities in the review, approval, undertaking or carrying out of the project or purchase? *If Yes, all relevant details must be included on the Conformance and Disclosure Statements Attachment.

A judgment or conviction for any business related conduct constituting a crime under federal, state or local government law including, but not limited to, fraud, extortion, bribery, racketeering, price-fixing, or bid collusion or any crime related to truthfulness and/or business conduct?

A criminal investigation or indictment for any business related conduct constituting a crime under federal, state or local government law including, but not limited to, fraud, extortion, bribery, racketeering, price-fixing or bid collusion or any crime related to truthfulness and/or business conduct?

An unsatisfied judgment, injunction or lien for any business related conduct obtained by any federal, state or local government agency including, but not limited to judgments based on taxes owed and fines and penalties assessed by any federal, state or local government agency?

An investigation for a civil or criminal violation for any business related conduct by any federal, state or local agency?

A grant of immunity for any business related conduct constituting a crime under federal, state, or local governmental law including, but not limited to, fraud, extortion, bribery, racketeering, price- fixing, bid collusion or any crime related to truthfulness and/or business conduct?

A federal, state or local government contract suspension or termination for cause prior to the completion of the term of a contract?

A federal, state or local government suspension or debarment from the contracting process?

A federal, state or local government denial of lease or contract award for non-responsibility?

An administrative proceeding or civil action seeking specific performance or restitution in connection with any federal, state or local contract or lease?

A federal state or local determination of willful violation of any public works or labor law or regulation?

A sanction imposed as a result of judicial or administrative proceedings relative to any business or professional license?

An Occupational Safety and Health Act citation and notification of Penalty containing a violation classified as serious or willful?

Question Set 2: Experience of Firm

Is the vendor in good standing with its primary financial institution? Offeror should provide evidence of financial stability and capability to fund all costs associated with providing the requested materials/services requested in this solicitation.

Does the vendor lack the financial resources necessary to fulfill the requirements of the proposed contract in any way? If yes, attach a letter of explanation.

During the past three years, has the vendor failed to file returns or pay any applicable federal, state or local government taxes? *If yes, identify the taxing jurisdiction, type of tax, liability year(s) and tax liability amount the company failed to file/pay and the current status of the liability.

Has the Offeror filed (or had filed against it) any bankruptcy or insolvency proceeding, whether voluntary or involuntary, or undergone the appointment of a receiver, trustee, or assignee for the benefit of creditors in the past ten (10) years? If yes, provide an explanation with all relevant details.

Does your firm accept a Purchase Order (PO)?

Is your firm capable to provide the products needed to service and administer the contract Scope of Work in a timely and professional manner?

How many trucks are available? What type(s)? Are maintenance records available if requested?

Briefly describe your firm's fleet refueling management and operational capacity.

Does your firm intend to use subcontractors for the performance of this work? If yes, provide the name(s) and address location for each proposed subcontractor.

Based on refueling station location(s) offered, how many other accounts do you provide similar goods and services to in Gila County? List the customer name and location such as ABC School, Globe or XYZ Company, San Carlos.

What is the mixture of school district/public entity clients compared to commercial businesses and general Public? Ex.) 25% schools/public, 25% commercial and 50% general. Provide an overview of your experience with similar contracts, preferably contracts with other local governmental agencies.

Have there been any citations or complaints against the firm from any regulatory agency within the past five (5) years, such as ADEQ? If yes, provide details.

List three (3) client references similar to this Scope of Work. Include Name, Point of Contact with their phone and email address. References should be public entities, such as schools, counties, cities, towns or states, and related to similar scope of services provided. The district may, at its sole discretion, contact additional clients not presented as references. Additional sheets may be included within the Proposal Package.

Will the firm provide a Certificate of Insurance (COI) with the required coverages, as outlined in the Special Terms and Conditions with the District listed as an Additional Insured?

Does the firm require any additional agreement, such as user, sales or maintenance agreement? If yes, a copy must be provided.

Describe how the firm ensures fully licensed and/or certified staff to carry, transport, and deliver bulk fuels, and similar products, in accordance with federal, state, and local regulations.

Does the firm conduct Background Clearance (Registered Sex Offender)?

Does the firm conduct fingerprint clearances?

Does the firm conduct drug-free screening?

Question Set 3: Method of Approach

Does the firm warrant that: 1) fuels shall be refined to meet the appropriate federal, state, and local standards for process and final product specifications and applications; 2) all fuels shall be guaranteed against any damage to equipment resulting from the proper use of the product; and 3) the shelf life shall be a maximum of one (1) year?

Does the firm warrant that all gasoline will be reformulated unleaded 87-octane regular gasoline and shall comply with the most recent American Society for Testing and Materials" ASTM" D4814 or latest edition standard specifications for automotive gasoline?

Does the firm warrant that all gasoline fuel shall conform to the ASTM D439-8 I Standard Specifications for the State of Arizona and any ASTM revision thereafter?

Does the firm agree that all fuels shall be blended for climatic conditions and local requirements at the delivery site, i.e. summer/winter blends?

Does the firm warrant that all diesel fuel shall conform to ASTM 0975-81 Stand Specification for Number 2 diesel fuel for the State of Arizona and any ASTM revision thereafter?

Does the firm agree that the diesel fuel shall be all purpose ultra-low sulfur diesel (ULSD) fuel oil intended for use in all types of diesel engines under all normal conditions of service?

Does the firm warrant that the diesel fuel shall comply with ASTM D-975, Grade No. 1-D S15- A special- purpose, light middle distillate fuel for use in diesel engine applications requiring a fuel with 15 ppm sulfur (maximum) and higher volatility than that provided by Grade No. 2-D SIS fuel, with a Cetane rating of 45. Cetane rating will be computed using the ASTM D-976 method?

Using the above standard, a required octane rating of 45 has a tolerance, but with this tolerance, it may not be lower than 40 Cetane. The calculated Cetane method will be used to determine Cetane rating of fuel delivered. Please refer to ASTM D-976, latest edition, and confirm the test method to ensure Cetane rating of 45 is being delivered. Also confirm that no Cetane enriching additives shall be used. Only ultra-low sulfur No. 2 diesel fuel with sulfur content of 0.0015% or less will be accepted. The same applies, except it shall contain red dye for use in the District's school buses and any other exempt use class vehicles.

Does the firm warrant that all similar products shall meet the appropriate federal, state, and local standards for their intended specification, application, and use. This shall include but is not limited to diesel and/or automotive engines under all normal conditions of service for similar products such as: 15W-40 CJ-4 heavy duty motor oil, Dextron III Mercon automatic transmission fluid, drum cleaning solvent, motor oil I0W-30, antifreeze (Ethylene glycol), and non-water-based cleaning solvents?

Describe your company's typical fuel delivery procedure noting the Scope of Work requirements. Include the response time from order placement to confirmed delivery at the District's designated location (455 N. Willow Street).

An authorized representative from the District will place a delivered fuel order that will indicate the quantity requested, type of fuel, and expected delivery date. Although the District makes no guarantee of any specific gallon amount per order, GUSD will make every possible effort to ensure that orders placed constitute a full or nearly-full load. The district shall not pay any split order charge, 'Stand-by” charge, fuel surcharge, environmental fee charges or any other related fee. Minimum orders shall be identified in the proposal or otherwise will not be applicable.

The vendor shall supply the District with a most current copy of the weekly OPIS Report when the order is being placed for Delivered Fuel. The OPIS Report shall be sent to the District representative weekly when orders are placed during the entire term of the contract. If the OPIS Report is not published for any given week or not provided to the District in a timely manner, the previous week's report will be used in determining the weekly price. Prices quoted must be rounded off to the nearest four decimal places, e.g. $2.9905. No tax shall be included in the base price of fuel.

Vendor shall coordinate fuel deliveries with the District. Deliveries shall be F.O.B. and include the time needed for unloading fuel with a minimum of one (1) hour.

Deliveries shall be made between Monday and Friday, between the hours of 7:30 AM and 3:30 PM Local Arizona Time.

The vendor’s delivery driver shall call at least one (1) hour prior to delivery in order to ensure that an authorized District representative is available to receive a delivery. All deliveries must be signed for as received by a District representative.

A copy of the bill of landing shall be provided to the District at or prior to the delivery. If vendor is unable to provide a copy of the bill or landing for every delivery made, then vendor shall provide the District with a current copy of a license with the Arizona Department of Weights and Measures, and a certification of calibration from a registered agency for each metered pump from which vendor is able to obtain product.

A delivery ticket which specifies the contract vendor’s name, address, type of fuel, grade of fuel and dip stick reading prior to unloading and following unloading shall be provided at the time of each delivery.

The vendor shall notify the District for late deliveries. The District may reject late deliveries and will not be responsible for the cost for late deliveries.

The vendor shall ensure all delivery vehicles and drivers be fully licensed and/or certified to carry, transport, and deliver bulk fuels, and similar products, in accordance with federal, state, and local regulations. All vehicles will be appropriately marked when transporting fuel with placards or similar visual sign.

The vendor shall be responsible for cleanup of all spills incurred during delivery and unloading at the District site, and shall be in accordance with federal, state, and local environmental laws and ordnances. An internal management plan for spill prevention, control and clean up available for district review and feedback is desired.

Is the refueling station(s) accessible at a strategic location for refueling of District buses, fleet vehicles, and heavy equipment? Is a minimum of one (1) refueling station located within GUSD's geographic boundaries?

Is the refueling station(s) operational and open 24 hours a day, seven (7) days per week and accessible to all District fleet vehicles?

Does the refueling station(s) provide product that meets these basic requirements: Regular unleaded gasoline with a minimum anti-knock Octane rating of 87; Diesel fuel with Cetane rating range of 40 to 45 with no Cetane enriching additives; and Diesel fuel with Cetane rating range of 40 to 45 with no Cetane enriching additives but contains Red Dye.

Is a fuel card/fleet card method of payment provided?

Is the minimum reporting data available, e.g. drive or GUSD staff name, vehicle number, mileage, type of product, unit cost, amount of fuel dispensed, and extended cost?

Describe in detail the restristriction capabilities of the cards and card lock system available. Are the following able to be restricted such as the merchant category, the merchandize code, the amount of the sale, and number of times per day?

Describe in detail electronic alerts for unusual usages as setup in the restrictions or any other anti-fraudulent reporting and notifications offered.

Does the card program provide for Online Reconciliation within 24 hours? If no, describe how can usage be monitored and statements paid in a timely fashion.

Describe the card replacement process, including costs, if any, and the turnaround time to receive it after written notification from the District.

Question Set 4: Cost

A discount percentage (%) or differential shall be offered and shall be firm for the contract term.

All fuel pricing shall be firm and based on the Oil Price Information Service (OPIS) benchmark using a rack location(s) in Arizona.

Vendor shall use the current posted overall OPIS rack price for each delivery.

Gasoline and diesel products shall use the Thursday Average for the following week deliveries.

Question Set 5: Affirmation Statement

Authorized contact hereby states and certifies that the information given for this Questionnaire is true, accurate and complete. It is further acknowledged that the District will rely upon the information contained herein and within the overall response to determine responsiveness and responsibility of the Offeror for contract award. The District may, at its discretion, verify the truth and accuracy of all statements made herein by any means which it may choose.

Response Options (hidden)

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