Attachment 5 to ITB 2025-1000-0200 - Bid Submission Cover Sheet.pdf

STATE OF ALASKA – INVITATION TO BID (ITB) ITB 2025-1000-0200

AS-NEEDED SILVICULTURE SERVICES NEAR HAINES, ALASKA

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ATTACHMENT 5

BID SUBMISSION COVER SHEET

Solicitation Number ITB 2025-1000-0200

Solicitation Title As-Needed Silviculture Services Near Haines, Alaska

Business Name

Business Address

City, State, Zip Code

Alaska Business License Number

Alaska Vendor Number (if known)

Printed Name

Title

Email Address

Telephone Number

ADDENDUM ACKNOWLEDGEMENT

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

Number Initials & Date

Number Initials & Date

Number Initials & Date

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CERTIFICATIONS

No Criteria Response* 1 The bidder certifies they comply with the laws of the State of Alaska. ☐ Yes ☐ No

The bidder is presently engaged in the business of providing the products and/or services required in this ITB.

☐ Yes ☐ No

The bidder confirms that it has the financial strength to provide and/or perform and maintain the services required under this ITB.

☐ Yes ☐ No

The bidder accepts the terms and conditions set out in the ITB and agrees not to restrict the rights of the state.

☐ Yes ☐ No

The bidder confirms that they can obtain and maintain all necessary insurance as required on this project.

☐ Yes ☐ No

The bidder certifies that all services provided under this contract by the contractor and all subcontractors shall be performed in the United States.

☐ Yes ☐ No

The bidder is not established and headquartered or incorporated and headquartered, in a country recognized as Tier 3 in the most recent United States Department of State’s Trafficking in Persons Report.

☐ Yes ☐ No

The bidder complies with the American with Disabilities Act of 1990 and the regulations issued thereunder by the federal government.

☐ Yes ☐ No

The bidder complies with the Equal Employment Opportunity Act and the regulations issued thereunder by the federal government.

☐ Yes ☐ No

The bidder complies with the applicable portion of the Federal Civil Rights Act of 1964.

☐ Yes ☐ No

The bidder can provide (if requested) financial records for the organization for the past three years.

☐ Yes ☐ No

The bidder has not had any contracts terminated for cause by the State of Alaska (within the past three years).

☐ Yes ☐ No

The bidder certifies that it is not currently debarred, suspended, proposed for debarment, or declared ineligible for award by any public or federal entity.

☐ Yes ☐ No

The bidder certifies that they will not support or participate in a boycott of Israel. Failure to comply with this requirement may cause the state to reject the bid as non-responsive or cancel the contract.

☐ Yes ☐ No

The bidder certifies that they do not have any governmental or regulatory action against their organization that might have a bearing on their ability to provide products and/or services to the State.

☐ Yes ☐ No

The bidder certifies, within the last five years, they have not been convicted or had judgment rendered against them for: fraud, embezzlement, theft, forgery, bribery, falsification or destruction of records, false statements, or tax evasion.

☐ Yes ☐ No

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The bidder does not have any judgments, claims, arbitrations or suits pending/outstanding against your company in which an adverse outcome would be material to the company.

☐ Yes ☐ No

The bidder is not (now or in the past) been involved in bankruptcy or reorganized proceeding.

☐ Yes ☐ No

The bidder confirms their bid will remain valid and open for at least 90 days.

☐ Yes ☐ No

The bidder certifies they meet the minimum prior experience requirements outlined in Sec. 1.04 Prior Experience.

☐ Yes ☐ No

* Failure to answer or answering “No” may be grounds for disqualification. For any “No” responses, provide clarification (up to 250 word maximum for each “False” clarification) below (add rows as necessary).

No Clarification

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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.

Does the bidder, or any individuals that will work on this contract, have a possible conflict of interest?

☐ Yes ☐ No

* 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, its evaluation, or the resulting contract: