Attachment 3 Alaska Bidder Cert. Form - Optional.pdf

STATE OF ALASKA – INVITATION TO BID (ITB) ITB 2027-1000-0077

AS-NEEDED BROCHURES FOR ALASKA STATE PARKS

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ATTACHMENT 3

ALASKA BIDDER PREFERENCE CERTIFICATION FORM

AS 36.30.321 (A) / AS 36.30.990 (2)

ALASKA PREFERENCES

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

Solicitation Number ITB 2027-1000-0077

Project Title As-Needed Brochures for Alaska State Parks

Business Name

Alaska Business License Number

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

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:

Alaska Bidder Preference: Do you believe your firm qualifies for the Alaska Bidder Preference?

☐ Yes ☐ No

Alaska Veterans Preference: Do you believe your firm qualifies for the Alaska Veteran Preference?

☐ Yes ☐ No

Alaska Military Skills Program Preference: Do you believe your firm qualifies for the Alaska Military Skills Program Preference?

☐ Yes ☐ No

To qualify for and claim the Alaska Bidder Preference you must answer YES to questions 1-7 and YES to one of the questions 8-11 in the Alaska Bidder Preference Question section below:

http://www.akleg.gov/basis/statutes.asp#36.30.687

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Alaska Bidder Preference Questions

Does your business hold a current Alaska business license per AS 36.30.990(2)(A)?

☐ Yes ☐ No

Is your business submitting a bid under the name appearing on the Alaska Business license identified above? Per AS36.30.990 (2)(B)?

☐ Yes ☐ No

Has your business maintained a place of business within the state staffed by the bidder or an employee of the bidder for a period of six months immediately preceding the date of the bid per AS 36.30.990 (2)(C)?

☐ Yes ☐ No

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).

Do you certify the Place of Business identified above meets this definition? ☐ Yes ☐ No

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

Do you certify the bidder, or at least one employee of the bidder is physically present in the state with the intent to remain in Alaska indefinitely and to make a home in the state per AS 16.05.415(a)(2)?

☐ Yes ☐ No

Do you certify the resident(s) used to meet this requirement has maintained a domicile in Alaska for the 12 months immediately preceding the deadline set for receipt of bids per AS 16.05.415(a)(2)?

☐ Yes ☐ No

Do you certify the resident(s) used to meet this requirement is only claiming residency in Alaska per AS 16.05.415(a)(3)?

☐ Yes ☐ No

Do you certify the resident used to meet this requirement is not obtaining benefits under a claim of residency in another state, territory, or country per As

16.05.415 (a)(4)?

☐ Yes ☐ No

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

8 Incorporated or qualified to do business under the laws of the state? ☐ Yes ☐ No

If yes, enter the current Alaska Corporate Entity Number:

http://www.akleg.gov/basis/aac.asp#2.12.990 http://www.akleg.gov/basis/aac.asp#2.12.990

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Indicate below how your business is organized:

Alaska Veterans Preference Questions:

To qualify for and claim the Alaska Veteran Preference, you must indicate how your business is organized by answering questions 12-15 below as well as answering YES to questions 1-7 in the Alaska Bidder Preference section above. Per AS 36.30.321(F), is your business:

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

12 A sole proprietorship owned by an Alaska veteran? ☐ Yes ☐ No

A partnership under AS32.06 or AS32.11 and a majority of the members are Alaska veterans?

☐ Yes ☐ No

A limited liability company organized under AS10.50 and a majority of the members are Alaska veterans?

☐ Yes ☐ No

A corporation that is wholly owned by individuals, and a majority of the individuals are Alaska veterans?

☐ Yes ☐ No

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.

Do you certify the individual(s) indicated in items 12-15 above meet this definition and can provide documentation of their service and discharge in necessary?

☐ Yes ☐ No

Is your business a Sole Proprietorship and the Proprietor is a resident of the state?

☐ Yes ☐ No

Is your business a Limited Liability Corporation organized under AS 10.50 and ALL members are residents of the state?

☐ Yes ☐ No

If the answer to question 10 above is YES, please identify each member by name:

Is your business a partnership under former AS32.05, AS32.06, or AS32.11 and all partners are residents of the state?

If the answer to question 11 above is YES, please identify each partner by name:

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Alaska Military Skills Program Preference Questions To qualify for and claim the Alaska Military Skills Program Preference, you must answer YES to question 17 or 18 below, YES to question 19 below, as well as answer YES to questions 1-7 in the Alaska Bidder Preference section above.

Per 36.30.321(l), does your business:

Employ at least one person who is enrolled in, or within the past two years, graduated from, a United States Department of Defense SkillBridge or United States Army career skills program that offers civilian work experience through specific industry training, pre-apprenticeships, registered apprenticeships, or internships during the last 180 days before a service member separates or retires from the service; or during the last 180 days before a person separates or retires from the service?

☐ Yes ☐ No

Have an active partnership with an entity that employs an apprentice through a program described in item 17 above?

☐ Yes ☐ No

Have proof of an employee’s graduation or enrollment in a qualified program as described in 17 or 18 above?