Attachment C - Proposer Information Sheet.pdf

ATTACHMENT C

PROPOSER INFORMATION SHEET

REQUEST FOR PROPOSALS

SHEVLIN PARK FUELS MANAGEMENT SERVICES

FIRM/COMPANY NAME:

STREET ADDRESS:

CITY, STATE, ZIP CODE:

WEBSITE:

PRIMARY CONTACT NAME:

PRIMARY CONTACT TITLE:

PRIMARY CONTACT TELEPHONE:

PRIMARY CONTACT EMAIL:

Name and title of the primary individual authorized to represent the Proposer in any negotiations and sign any contracts that may result:

NAME: TITLE:

Proposer, pursuant to ORS 279A.120(1), (check one) is ☐ / is not ☐ a resident Proposer. If not, indicate state of residency: .

Proposer currently has, or prior to executing a contract if awarded will be able to obtain, insurance coverage meeting or exceeding the insurance requirements of the attached Sample Contract, (check one) yes ☐ / no ☐.

1. Proposer hereby certifies that Proposer has read, understands, and agrees to comply with all terms and conditions of this Solicitation and the resulting contract.

2. Proposer acknowledges receipt of all Addenda issued under this Solicitation, if any.

3. Proposer hereby certifies that Proposer has complied or will comply with all requirements of local, state, and federal laws, and that no legal requirements have been or will be violated in making or accepting this

Solicitation.

4. Proposer hereby certifies that it has not discriminated and will not discriminate, in violation of ORS

279A.110, against any disadvantaged business enterprise, a minority-owned business, a woman-owned business, a business that a service-disable veteran owns or an emerging small business that is certified under ORS 200.055 in obtaining any required subcontract.

5. Affirmative Action Program. The District is an equal employment opportunity employer and values diversity in its work force. The District requires its consultants and contractors to have an operating policy as an equal employment opportunity employer. Firms of 50 people or less do not need to have a formal equal employment opportunity program, but shall have an operating policy supporting equal employment opportunity. Proposer shall answer the following questions by selecting yes or no.

REQUEST FOR PROPOSALS

SHEVLIN PARK FUELS MANAGEMENT SERVICES

☐Yes ☐No Does your Firm have more than 50 employees?

☐Yes ☐No Does your Firm have a formal equal employment opportunity program?

6. Proposer agrees to comply with Oregon tax laws in accordance with ORS 305.385.

7. Proposer hereby certifies that no conflict of interest, as defined below, exists which precludes an impartial

Proposal from being submitted by Proposer and that if such conflict should arise, Proposer will immediately notify the District.

a. No officer, employee, or agent of the Proposer has any personal financial interest, direct or indirect, in the operation of Bend Park and Recreation District or its affiliates.

8. Proposer hereby certifies the price(s) and amount(s) of this Proposal shall be arrived at independently and without consultation, communication or agreement with any other consultant, contractor, Proposer or potential Proposer.

9. Proposer hereby certifies that neither the price(s) nor the amount(s) of this Proposal, and neither the approximate price(s) nor approximate amount(s) of this Proposal, shall be disclosed to any other firm or person who is a Proposer or potential Proposer, and they will not be publicly disclosed before contract award.

10. Proposer hereby certifies no attempt has been made or will be made to induce any firm or person to refrain from Proposing on this Solicitation or to submit any noncompetitive Proposal or other complementary

Proposal.

11. Proposer hereby certifies that it’s Proposal is made in good faith and not pursuant to any agreement or discussion with, or inducement from, any firm or person to submit a complementary or other noncompetitive Proposal.

12. Proposer agrees that if awarded the contract, Proposer shall be authorized to do business in the State of

Oregon at the time of the award.

13. District shall not be liable for any claims or be subject to any defenses asserted by Proposer based upon, resulting from, or related to, Proposer’s failure to comprehend all requirements of this Solicitation.

14. District shall not be liable for any expenses incurred by Proposer in both preparing and submitting its

Proposal, or in participating in the Proposal evaluation/selection or contract negotiation progress, if any.

15. The signatory of this Proposer Information Sheet is a duly authorized representative of the Proposer, has been authorized by Proposer to make all representations, attestations, and certifications contained in this

Proposal document, Solicitation, and all Addenda, if any, issued, and to execute this Proposal document on behalf of Proposer.

16. By signature below, the undersigned Authorized Representative hereby certifies on behalf of Proposer that all contents of this Proposer Information Sheet and the submitted Proposal are truthful, complete and accurate. Failure to provide information required by this Solicitation may ultimately result in rejection of the

Proposal.

PROPOSER SIGNATURE

Signature Title

Name (please print) Date

Email Phone