Attachment_A_-_RFP_Submittal_Forms_to_Complete.pdf

CERTIFICATION OF PROPOSER

THIS FORM MUST BE PRINTED OUT, COMPLETED, AND UPLOADED BACK INTO OPENGOV

RFP

(Number and Name Entered Above)

I/We (Insert Company Name) agree to provide the goods and services as stipulated in this RFP at pricing indicated in our submitted Proposal. I/We further agree that the below undersigned is authorized by the (Insert Company Name) to contractually bind the company for the specified contract term. All exceptions (if applicable) are attached as an addendum to Proposal. I understand that the City may not accept requested exceptions to the RFP and contract. I/We further agree that, if awarded the contract, we will abide by the terms and conditions of the contract and not materially modify such terms without express written consent of the City.

Print Contact Name:

Contact Signature:

Authorized Contact Title:

Contact Email Address:

Contact Telephone:

Proposer’s (Company) Address:

City, State and ZIP Code:

California Secretary of State No.:

Milpitas Business License No.:

CSLB License No. (if applicable):

DIR Registration No. (if applicable):

https://bizfileonline.sos.ca.gov/search/business https://www.milpitas.gov/241/Business-License-Center

NON-COLLUSION DECLARATION

RFP

(Number and Name Entered Above)

The undersigned declares:

I am the of , the party making the foregoing Proposal.

This Proposal is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The Proposal is genuine and not collusive or a sham. The Proposer has not directly or indirectly induced or solicited any other proposer to put in a false or sham Proposal, and has not directly or indirectly colluded, conspired, connived, or agreed with any proposer or anyone else to put in a sham Proposal, or that anyone shall refrain from submitting a proposal response. The Proposer has not, in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the proposal price of the Proposer or any other proposer, or to fix any overhead, profit, or cost element of the proposal price, or that of any other proposer, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract. All statements contained in the Proposal are true. The Proposer has not, directly or indirectly, submitted its proposal price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham Proposal and has not paid, and will not pay, any person or entity for such purpose.

Any person executing this declaration on behalf of a Proposer that is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the Proposer.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on [date], at [city], [state].

Name of Proposer:

Signature:

Name:

Title:

PROPOSER'S STATEMENT REGARDING INSURANCE COVERAGE

PROPOSER HEREBY CERTIFIES that Proposer has reviewed and understands the insurance coverage requirements specified in this RFP. Should Proposer be awarded the contract for this RFP, Proposer further certifies that the Proposer shall meet the specified requirements for insurance, including insurance coverage of the subcontractors, and agrees to name the City as an additional insured, as well as meet all other insurance provisions set forth in this RFP.

Name of Proposer (Person, Firm, or Corporation)

Signature of Proposer's Authorized Representative

Name and Title of Authorized Representative

Date of Signing

WORKER'S COMPENSATION INSURANCE CERTIFICATION

Proposer shall execute the following form as required by the California Labor Code, Sections 1860 and 1861:

I am aware of the provisions of Section 3700 of the Labor Code, which require every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract.

Name of Proposer (Person, Firm, or Corporation)

Signature of Proposer's Authorized Representative

NONDISCRIMINATORY EMPLOYMENT CERTIFICATE

Certificate Generally Consistent with a policy of nondiscrimination in employment on contracts of the City and in furtherance of the provisions of Sections 1735 and 1777.6 of the California Labor Code, a "contractor's obligation for nondiscriminatory employment certificate" as hereinafter set forth shall be attached and incorporated by reference as an indispensable and integral term of all RFP specifications and contracts of the City for the construction, repair, or improvement of public works.

Contents of Certificate The Proposer's obligation for nondiscriminatory employment is as follows:

If awarded the contract, and in providing the goods and services under the contract, Proposer agrees as follows:

1. Proposer will not discriminate against any employee or applicant for employment because of race, creed, color, national origin, ancestry, sexual orientation, political affiliation or beliefs, sex, age, physical handicap, medical condition, marital status, or pregnancy (as those terms are defined by the California Fair Employment and Housing Act -- Government Code Section 12900-12996), except where such discrimination is based on a bona fide occupational qualification.

2. Proposer will take positive action or ensure that applicants are employed and that employees are treated during employment without regard to their race, creed, color, national origin, ancestry, sexual orientation, political affiliation or beliefs, sex, age, physical handicap, medical condition, marital status, or pregnancy (as those terms are defined by the California Fair Employment and Housing Act -- Government Code Section 12900-12996), except where such discrimination is based on a bona fide occupational qualification. Such action shall include, but not be limited to, the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising, layoff or termination, rates of pay or other forms of compensation, and selection for training, including apprenticeship. Proposer agrees to post in conspicuous places, accessible by employees and applicants for employment, notices setting forth provisions of this nondiscrimination clause.

3. Proposer will, in all solicitations or advertisements for employees placed by or on behalf of the Proposer, state that all qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, sexual orientation, political affiliation or beliefs, sex, age, physical handicap, medical condition, marital status, or pregnancy (as those terms are defined by the California Fair Employment and Housing Act -- Government Code Section 12900-12996), except where such discrimination is based on a bona fide occupational qualification.

4. Proposer will send to each labor union or representative of workers, with which Proposer has a collective bargaining agreement or other contract or understanding, a notice advising the said labor union or workers' representative of the Proposer's commitments under this provision and shall post copies of the notice in conspicuous places available to employees and applicants for employment.

5. Proposer will permit access to the Proposer's records of employment, employment advertisements, application forms, and other pertinent data and records by the City, the Fair Employment Practices Commission, or any other appropriate Agency of the State designated by the City for the purposes of investigation to ascertain compliance with Proposer's obligation for nondiscriminatory employment provisions of the Agreement or Fair Employment Practices statute.

6. A finding of willful violation of the nondiscriminatory employment practices article of this contract or of the Fair Employment Practices Act shall be regarded by the City as a basis for determining that Proposer is a "disqualified Proposer" for being "non-responsible" for any future solicitations or contracts for which the Proposer may submit responses.

7. The City shall deem a finding of willful violation of the Fair Employment Practices Act to have occurred upon receipt of written notice from the Fair Employment Practices Commission that it has investigated and determined that the Proposer has violated the Fair Employment Practices Act and has issued an order under Labor Code Section 1426 or obtained an injunction under Labor Code Section 1429.

8. Upon receipt of any such written notice, the City shall notify Proposer that unless it demonstrates to the satisfaction of the City within a stated period that the violation has been corrected, Proposer shall be declared a "disqualified Proposer" until such time as Proposer can demonstrate that it has implemented remedial measures, satisfactory to the City, to eliminate the discriminatory employment practices which constituted the violation found by the Fair Employment Practices Commission.

9. Upon receipt from any person of a complaint of alleged discrimination under any City contract, the City shall ascertain whether probable cause for such complaint exists. If probable cause for the complaint is found, City staff shall request the City Council to hold a public hearing to determine the existence of a discriminatory practice in violation of the contract resulting from this solicitation.

10. In addition to any other remedy or action provided by law or the terms of this contract, Proposer agrees that, should the City Council determine after a public hearing duly noticed to the Proposer that the Proposer has not complied with the nondiscriminatory employment practices provisions of this contract or has willfully violated such provisions, the City may, without liability of any kind, terminate, cancel, or suspend this contract, in whole or in part. In addition, upon such determination, Proposer shall forfeit a penalty of Twenty- Five Dollars and Zero Cents ($25.00) to City for each calendar day, or portion thereof, for each person who was denied employment as a result of such noncompliance. Such monies shall be recovered from the Proposer. The City may deduct any such penalties from any monies due to the Proposer from the City.

11. Proposer certifies to the City that it has met or will meet the following standards for positive compliance, which shall be evaluated in each case by the City:

a. Proposer shall notify all supervisors and other personnel officers in writing of the content of the nondiscrimination provision and their responsibilities under it.

b. Proposer shall notify all sources of employee referrals (including unions, employment agencies, advertisements, and the Department of Employment) of the content of the nondiscrimination provision.

c. Proposer shall file a basic compliance report as required by the City. Willfully false statements made in such reports shall be punishable as provided by law. The compliance report shall also specify the sources of the workforce and who has the responsibility for determining whom to hire or whether or not to hire.

d. Proposer shall notify the City of opposition to the nondiscrimination provision by individuals, firms, or organizations during the period of this contract.

12. Nothing contained in this Nondiscriminatory Employment Certificate shall be construed in any manner to prevent the City from pursuing any other remedies that may be available at law.

13. Proposer certifies to the City that the Proposer will comply with the following requirements with regard to all subcontractors and suppliers:

a. Proposer will include applicable provisions of this Nondiscriminatory Employment Certificate in all subcontracts and in any supply contract to be performed within the State of California, so that such provisions will be equally binding upon each subcontractor and each supplier.

b. Proposer will take such action with respect to any subcontract or purchase order as the City may direct as a means of enforcing such provisions including sanctions for noncompliance, provided, however, that in the event the Proposer becomes involved in, or is threatened with, litigations with a subcontractor or supplier as a result of such direction by the City, Proposer may request the City to enter into such litigation to protect the interests of the City.

Proposer

Signature of Proposer’s Authorized Representative

WAGE THEFT CERTIFICATION

Proposer certifies subject to penalty for perjury that the option checked below relating to the Proposer and its subcontractors’ status in regard to wage theft is true and correct:

Neither Proposer nor any of its subcontractors have been found by a final court order or administrative action of an investigatory government agency to have violated federal, state, or local wage and hour laws, including, but not limited to, the federal Fair Labor Standards Act, the California Labor Code, and the Milpitas Minimum Wage Ordinance, within the past five (5) years from the solicitation submission deadline.

Proposer or its subcontractors have been found by a final court order or administrative action of an investigatory government agency to have violated federal, state, or local wage and hour laws, including, but not limited to, the federal Fair Labor Standards Act, the California Labor Code, and the Milpitas Minimum Wage Ordinance, within the past five (5) years from the solicitation submission deadline. For each violation, Proposer shall provide a copy of (i) the final court order and/or final administrative decision/action; and (ii) documents demonstrating either that the order/decision/action has been fully satisfied, or if the order/decision/action has not been fully satisfied, documents evidencing a payment or other alternative plan has been approved by the court/government agency to satisfy the order/decision/action and proof that the Proposer or its subcontractors are in compliance with that plan as of the solicitation submission deadline.

Printed Name:

Firm Name:

Date:

REFERENCES

Proposer:

(Legal Name of Entity Submitting Proposal)

List three references for work of a similar nature to that specified for this solicitation performed within the last three years.

1.

Name of Agency Agency Address

Contact Name Contact Title

Contact Telephone Contact Email Address

Contract Period Contract Amount

Description of Services Performed

2.

3.

I hereby certify that the Proposer performed the work listed above.

Signature of Proposer Name Date

RFP AND/OR AGREEMENT EXCEPTIONS

Proposer hereby agrees that the goods and services provided will meet all the requirements of this RFP including, without limitation, all attachments and exhibits and, in particular, the document attached as Attachment B (“Agreement”) which is incorporated herein by this reference, unless deviations from them are clearly indicated in the Proposer’s Proposal submittal. Any exceptions taken to the RFP or Agreement must be submitted as an attachment to the Proposal, entitled “Exceptions to RFP and Contract,” and must be signed by Proposer’s authorized representative.

In the event Proposer takes exception to any provision in the RFP or Agreement, those exceptions must be set forth with specificity. An explanation must be made for each item to which an exception is taken, giving in detail the extent of the exception, the reason for which it is taken, and the suggested change. Any such exception taken to the RFP or Agreement may serve as a basis for rejection of the Proposal as nonresponsive. UNDER

NO CIRCUMSTANCES WILL THE CITY CONSIDER GENERAL STATEMENTS OF EXCEPTION OR

RESERVATION OF RIGHTS TO PROPOSE EXCEPTIONS AFTER PROPOSAL SUBMISSION. ANY SUCH

STATEMENTS, RESERVATIONS OF RIGHTS, OR GENERIC RESPONSES MAY LEAD TO THE

PROPOSAL BEING DEEMED NONRESPONSIVE AND REJECTED WITHOUT FURTHER

CONSIDERATION. FURTHERMORE, THE CITY WILL NOT ACCEPT ADDITIONAL EXCEPTIONS AFTER

THE FACT. ALL REQUESTED EXCEPTIONS MUST BE SUBMITTED WITH YOUR PROPOSAL

RESPONSE.

Failure to comply with the requirements of this provision shall serve as a waiver of the Proposer’s right to challenge or otherwise take exception to any terms of the RFP or the Agreement.

� Proposer does not take any exception to any part or provision in the RFP or Agreement and waives its right to propose exceptions to the RFP or Agreement following submission of its proposal.

� Proposer does take exception to specific provisions in the RFP or Agreement and has attached hereto a list of each exception taken with reference to the specific section or provision it takes exception to, the proposed revised language, and the basis for the exception. Proposer acknowledges and agrees that it has not submitted any general or generic statements of exception or reservation of rights to propose exceptions after Proposal submission, which will be rejected by the City and may lead to rejection of the Proposal as nonresponsive. Proposer further acknowledges and agrees its failure to include exceptions in the form required by this RFP shall constitute a waiver of its right to propose exceptions to the RFP or Agreement following submission of its Proposal.

Printed Name:

Firm Name:

Date: