Attachment A Proposer Certification Form~3.pdf

RFP 10.7.26.1 Attachment A

ATTACHMENT A

PROPOSERS CERTIFICATIONS AND REPRESENTATIONS

RFP 10.7.26.1

REQUEST FOR PROPOSALS FOR

PLAYGROUND DESIGN AND INSTALLATION

The undersigned offers and agrees to provide playground design and installation services, some work at existing playground, and other projects on an as needed basis to David Douglas School District, in accordance with Request for Proposals No. 10.7.26.1 and its Proposal.

The undersigned further certifies that he/she has read, understands, and agrees to abide by all terms and conditions of this Request for Proposals if awarded the contract for these services. The District reserves the right to award contracts by project, and may make award to one or more qualified firms.

The required form of contract is attached as Attachment C. See Contract and Work Performance for further description. The undersigned acknowledges that the information provided in the proposal is truthful, accurate and complete, and that the firm is bound by all information, data, certifications, disclosures and attachments submitted. The undersigned also acknowledges that if awarded the contract, the RFP documents, and all terms and conditions stated therein, and all information, data, certifications, disclosures and addendum shall be incorporated as part of the Contract.

NO REIMBURSEMENT FOR PROPOSAL

Proposers responding to this RFP do so solely at their own expense. The District will not be responsible or reimburse Proposers for any costs incurred in the preparation and presentation of their proposals or for any related expenses or consequential damages of any kind.

ADDITIONAL REPRESENTATIONS

1. The undersigned certifies the proposal is offered by an independent contractor as defined in ORS

670.600.

2. The proposer acknowledges that the person that signs this certification is fully authorized to sign on behalf of the Proposer listed and to fully bind the Proposer to all conditions and provisions thereof.

3. The proposer, if an individual, is of lawful age; is the only one interested in this proposal; and that no person, firm, or corporation, other than that named, has any interest in the proposal or in the proposed contract.

4. The proposal, if submitted by a joint venture is in the name of the joint venture and all parties have examined this RFP including all requirements and contract terms and conditions thereof, and, if successful, the joint venture shall execute a contract, which incorporates the stated requirements, proposal response and terms and conditions.

5. By submitting a response, the proposer certifies that no relationship exists between the proposer and the District that interferes with fair competition or is a Conflict of Interest, and no relationship exists between the proposer and another person or firm that constitutes a Conflict of Interest.

6. The proposer has examined all parts of this RFP, including all requirements and contract terms and conditions thereof, and, if successful, the proposer shall execute a contract, which incorporates the stated requirements, proposal response and terms and conditions.

7. The proposer fully understands and submits its proposal with specific knowledge that in the event the proposer’s proposal is accepted and receives all necessary approvals, the proposal will be incorporated into a contract containing general terms and conditions as provided in the RFP.

8. The undersigned understands any false statement may disqualify this proposal from further consideration or be cause for contract termination.

9. The proposer certifies that Proposer has complied or will comply with all requirements of local, state, and national laws, and that no legal requirements has been or will be violated in making or accepting this RFP.

10. The proposer agrees to comply with Oregon tax law in accordance with ORS 305.385.

11. PROPOSAL PRICING

The Undersigned hereby proposes to furnish to the District all materials, services, and labor necessary to perform all work for the District in strict accordance with the terms, conditions, and requirements as specified in the Request for Proposal.

Undersigned agrees to honor this price for 90 days from date of signature below.

12. PROPOSAL SECURITY Required Not Required $

The undersigned agrees that the proposal security accompanying this proposal is left in escrow with the Owner, that the amount thereof is the measure of liquidated damages which the Owner will sustain as a result of the failure of the undersigned to execute and deliver the above-named Contract and performance and payment bond; and that if the undersigned defaults in either executing the Contract or providing a performance and payment bond within ten (10) days after forms are provided to him/her, then the proposal security may become the property of the Owner at the Owner's option; but if this proposal is not accepted within forty-five (45) days of the submission date, or if the undersigned executes and timely delivers said Contract and performance and payment bond, the proposal security shall be returned.

13. CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY

MATTERS – The Proposer certifies to the best of its knowledge and belief that neither it nor any of its principles:

a. Are presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from submitting bids or proposals by any federal, state or local entity, department or agency;

b. Have within a five-year period preceding the date of this certification been convicted of fraud or any other criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) contract, embezzlement, theft, forgery, bribery falsification or destruction of records, making false statements, or receiving stolen property;

c. Are presently indicted for or otherwise criminally charged with commission of any of the offenses enumerated in paragraph 2. Of this certification;

d. Have, within a five-year period preceding the date of this certification had a judgement entered against proposer or its principals arising out of the performance of a public or private contract;

e. Have pending in any state or federal court any litigation in which there is a claim against proposer or any of its principals arising out of the performance of a public or private contract; and

f. Have within a five-year period preceding the date of this certification had one or more public contracts (federal, state, or local) terminated for any reason related to contract performance.

14. PERFORMANCE BOND Required Not Required The undersigned agrees, if awarded a Contract, to execute and deliver to the District, within ten (10) days after the receipt of Notice of Intent to Award the Contract, a satisfactory performance and payment bond in an amount equal to one hundred percent (100%) of the Contract Amount. In addition, Certificates of Insurance for the coverages specified in the Proposal Document must be submitted at the same time. A Performance Bond may be required but will be project specific.

15. PAYMENT BOND Required Not Required The undersigned agrees, if awarded a Contract, to execute and deliver to the District, within ten (10) days after the receipt of Notice of Intent to Award the Contract, a satisfactory payment bond in an amount equal to one hundred percent (100%) of the Contract Amount.

16. CERTIFICATION OF NON-DISCRIMINATION

The undersigned Proposer certifies that he or she has not discriminated and will not discriminate against any minority, women, or emerging small business enterprise or a business enterprise that is owned or controlled by or that employs a disabled veteran in obtaining any required subcontract. (ORS 279A.110)

The Proposer certifies that it does not discriminate against any employee or applicant for employment because of race, color, religion, sex, national origin, handicap, financial ability, age or other non-job-related factors as per ORS Chapter 659 and 42 USC §2000e. Proposer further certifies that Proposer has not and will not discriminate against a subcontractor in awarding a subcontract because the subcontractor is a minority, women, or emerging small business enterprise certified under ORS 200.055.

17. STATE OF OREGON OFFICE OF MINORITY, WOMEN & EMERGING SMALL BUSINESS

(OMWESB) CERTIFICATION

If your firm is currently certified by OMWESB in any of these categories, please indicate that certification. Minority Business Enterprise (MBE) Women Business Enterprise (WBE)

Emerging Small Business (ESB)

18. ACKNOWLEGEMENT OF RECEIPT OF ADDENDA

Addenda through received.

(If addenda were issued, completion of this line is REQUIRED AND SIGNED COPIES ARE TO

BE INCLUDED IN THE PROPOSAL SUBMISSION.)

19. RESIDENT BIDDER STATUS: YES NO

A resident bidder is defined in ORS 279A.120 as a bidder that has paid unemployment taxes or income taxes in Oregon during the 12 calendar months immediately preceding submission of the bid, has a business address in this state and has stated in the bid that they are a resident bidder.

The undersigned bidder must check the appropriate box above as to their bidder status.

PROPOSER'S SIGNATURE AND IDENTIFICATION

The undersigned hereby certifies to the truth and accuracy of all statements, answers and data contained in this proposal and application, and hereby authorizes the District to make any necessary examinations or inquiries in order to make a determination as to the qualifications and responsibility of the proposer. The undersigned has examined all parts of this RFP and understands that it is completely discretionary with the Selection Committee whether to accept, reject, or negotiate its proposal submitted pursuant thereto.

I hereby certify that this Proposal is genuine and that I have not entered into collusion with any other vendor(s) or any other person(s).

Please print or type all information requested below (except where signature is required) and attach Proposal Security (if required) to this form:

Name of Proprietor, Partnership, or Corporation Signature of Proprietor, Partner, or Corporate Officer:

Firm Name Signature

Street Address Name of Signatory

Mailing Address Title

City, State, and Zip Code Date Signed

Phone Number

E-mail Address Employer ID Number State of Incorporation Business Designation:

Individual Partnership Joint Venture Sole Proprietorship

Corporation Other

If a Joint Venture, attach verification that all parties to the joint venture accept the terms, and agree to perform services under this contract. The attached page must contain signatures of all parties to the joint venture.