Attachment C - Proposer Info and Certification~1.pdf

RFP 4056 - CMGC SERVICES FOR CITY HALL DEFERRED MAINTENANCE & QUAD REDESIGN Att C

Springfield Request for Proposals – Proposer Identification & Certification Sheet Page 1 of 2

ATTACHMENT C — PROPOSER INFORMATION

AND CERTIFICATION SHEET

Legal Name of Proposer:

Address: City, State, Zip:

State of Incorporation: Entity Type:

Contact Name: Telephone: Email:

Oregon Business Registry Number (if required):

Any individual signing below hereby certifies they are an authorized representative of Proposer and that:

1. Proposer understands and accepts the requirements of this RFP. By submitting a Proposal, Proposeragrees to be bound by the Contract terms and conditions in Attachment A and as modified by anyAddenda, except for those terms and conditions that Agency has reserved for negotiation, asidentified in the RFP.

2. Proposer acknowledges receipt of any and all Addenda to this RFP.

3. Proposal is a Firm Offer for 180 days following the Closing.

4. If awarded a Contract, Proposer agrees to perform the scope of work and meet the performancestandards set forth in the final negotiated scope of work of the Contract..

5. I have knowledge regarding Proposer’s payment of taxes and by signing below I hereby certify that, tothe best of my knowledge, Proposer is not in violation of any tax laws of the state or a politicalsubdivision of the state, including, without limitation, ORS 305.620 and ORS chapters 316, 317 and318.

6. Proposer and Proposer’s employees, agents, and subcontractors are not included on:

A. The “Specially Designated Nationals and Blocked Persons” list maintained by the Office ofForeign Assets Control of the United States Department of the Treasury found at:https://www.treasury.gov/ofac/downloads/sdnlist.pdf., or B. The government wide exclusions lists in the System for Award Management found at:

https://www.sam.gov/

7. Proposer certifies that, to the best of its knowledge, there exists no actual or potential conflictbetween the business or economic interests of Proposer, its employees, or its agents, on the one hand,and the business or economic interests of the State, on the other hand, arising out of, or relating in anyway to, the subject matter of the RFP. If any changes occur with respect to Proposer’s status regardingconflict of interest, Proposer shall promptly notify the State in writing.

8. Proposer certifies that all contents of the Proposal (including any other forms or documentation, ifrequired under this RFP) and this Proposal Identification & Certification Sheet are truthful and

RFP 4056 - CMGC SERVICES FOR CITY HALL DEFERRED MAINTENANCE & QUAD REDESIGN Att C

Springfield Request for Proposals – Proposer Identification & Certification Sheet Page 2 of 2 accurate and have been prepared independently from all other Proposers, and without collusion, fraud, or other dishonesty.

9. Proposer understands that any statement or representation it makes, in response to this RFP, if determined to be false or fraudulent, a misrepresentation, or inaccurate because of the omission of material information could result in a "claim" made under Contract being a "false claim" subject to the Oregon False Claims Act, ORS 180.750 to 180.785, and to any liabilities or penalties associated with the making of a false claim under that Act. (“Claim” and “false claim” have the meanings provided in ORS 180.750.)

10. Proposer acknowledges these certifications are in addition to any certifications required in the Contract and Statement of Work in Attachment A at the time of Contract execution. Authorized Signature Date (Printed Name and Title)