Attachments A-C.pdf

ATTACHMENT A: Designation of Confidential and Proprietary Information

Community Engagement Toolkit and Guidebook RFP 1312A-022-01 Page A-1 of 1

____This firm is NOT designating any information as proprietary and confidential under Sect 19.36(5) of Wisconsin State

Statute or under the Wisconsin Open Records law.

____This firm IS designating the below information as propriety and confidential under Sect 19.36(5) of Wisconsin State

Statute or under the Wisconsin Open Records law. (If checked, please complete all portions below.)

The attached material submitted in response to this Proposal includes propriety and confidential information which qualifies as a trade secret, as provided in Sect 19.36(5), Wisconsin State Statutes, or is otherwise material that can be kept confidential under the Wisconsin Open Records law. As such, we ask that certain pages, as indicated below, of this proposal response be treated as confidential material and not be released without our written approval.

Prices always become public information when proposals are opened; therefore, they cannot be designated as confidential.

Section Page Number Topic

Attach additional sheets, if necessary.

Other information cannot be kept confidential unless it is a trade secret. Trade secret is defined in Sect. 134(90)(1)(c) Wis.

State Statutes as: “information, including formula, pattern, compilation, program, device, method technique or process to which all of the following apply:

1. The information derives independent economic value, actual or potential, from not being generally known to, and not being readily ascertainable by proper means by, other persons who can obtain economic value from its disclosure or use.

2. The information is the subject of efforts to maintain its secrecy that are reasonable under the circumstances.

In the event the Designation of Confidential of this information is challenged, the undersigned hereby agrees to provide legal counsel or other necessary assistance to defend the Designation of Confidentiality.

Failure to include this form in the proposal response may mean that all information provided as part of the proposal response will be open to examination or copying. East Central Wisconsin Regional Planning Commission considers other marking of confidential in the proposal document to be insufficient. The undersigned agrees to hold East Central

Wisconsin Regional Planning Commission harmless for any damages arising out of the release of any material unless they are specifically identified above.

Signature Date

Name (type or print)

ATTACHMENT B: Bid Opportunity List

Page B-1 of 2

49 Code of Federal Regulations Part 26.11 requires the Wisconsin Department of Transportation to develop and maintain a "bid opportunity list." The list is intended to show all firms that are participating, or attempting to participate, on DOT-assisted contracts. The list must include all firms that bid on prime contracts or bid or quote sub-contracts and materials and supplies on DOT-assisted projects, including DBEs and non-DBEs. For consulting companies, this list must include all sub-consultants contacting you and expressing an interest in teaming with you on a specific DOT-assisted project.

Vendors must complete and submit this form with all bids and/or proposals.

Vendors MUST complete and submit this form with all bids and/or proposals. Note that there are two sections to this attachment: one for the Prime Contractor; and one for Subcontractors and Sub-consultants, which consists of two parts.

Please review this attachment thoroughly as sections 1 and 2 MUST both be completed.

Section 1: Prime Contractor/Consultant Bidding on this Project (Proposer)

Name of Bidder:

Bidder Contact Information (address, phone, email):

DBE Status:

Age of Firm:

Type of Work:

Annual Gross Receipts:

Annual Gross Receipts (please selection one):

[ ] Less than $500,000

[ ] $500,000 - $999,999.99

[ ] $1 million - $1,999,999.99

[ ] $2 million - $4,999,999.99

[ ] $5 million and above

Section 2: Subcontractors and Sub-consultants

Prime Contractor to complete “Name of Bidder” and “Bidder’s Contact Information”, plus any information available in the remaining categories. Please complete one for each subcontractor/sub-consultant contacting you and expressing an interest in teaming with you on this project. For multiple sub-contractors, you may attach as many additional pages

ATTACHMENT B: Bid Opportunity List

Page B-2 of 2 necessary. Section 2A MUST be completed by all Prime Contractors bidding on this project to indicate interest from potential subcontractors/sub-consultants.

Section 2A: Subconsultant/Sub-contractor

☐Prime Consultant’s firm was contacted by subcontractor/sub-consultant expressing interest in teaming on this project

(please continue to section 2B)

☐Prime Consultant’s firm was NOT contacted by subcontractor/sub-consultant expressing interest in teaming on this project (no need to continue on to Section 2B)

Section 2B: Subcontractor/Sub-consultant Contact Information

Name of Subcontractor/Sub-consultant:

Subcontractor/Sub-consultant Contact Information (address, phone, email):

DBE Status:

Age of Firm:

Type of Work:

Annual Gross Receipts:

Annual Gross Receipts (please selection one):

[ ] Less than $500,000

[ ] $500,000 - $999,999.99

[ ] $1 million - $1,999,999.99

[ ] $2 million - $4,999,999.99

[ ] $5 million and above

ATTACHMENT C: Assurance of Eligibility and Compliance

Page C-1 of 2

Part 1: Proposer’s Assurance of Eligibility and Compliance

In submitting this proposal, the Proposer agrees, to the best of its knowledge, that the following eligibility criteria have been met. Failure to indicate Proposer’s ability to comply with any of the following will disqualify a Proposer from consideration. Indicating ability to comply to the following provisions does not automatically guarantee Proposer will be granted the Contract, as the assurance only indicates

Proper’s eligibility to be considered.

By signing below, the Proposer, to the best of his/her/their knowledge, assures the following eligibility conditions are met:

• Proposer’s firm is registered in sam.gov and is eligible to work on federal contracts in the United

States

• Proposer meets the following minimum insurance requirements and is able to provide certificates of insurance upon Contract execution:

1. Comprehensive General Liability - $1,000,000 combined single limits per

Occurrence;

2. Auto Liability - $300,000 combined single limits per occurrence; and

3. Worker’s Compensation – coverage satisfying statutory provisions of Chapter

102, Wis. Stats.; not less than $100,000 employer’s liability.

In addition, “hold harmless” provisions will be contained in the Contract with the successful proposer.

• Ability to comply with the Contract’s terms and provisions and all applicable statutes, laws, and regulations as outlined in the Request for Proposals on pages 10-16.

Signature_________________________________________

Name and Title _______________________ Date__________________________

ATTACHMENT C: Assurance of Eligibility and Compliance

Page C-2 of 2

Part 2: Notice of Intent to Sub-Contract

If selected to enter into Contract with ECWRPC, the Proposer (please check one):

☐will be engaging with sub-contractors to fulfill the terms of the Contract

☐will not be engaging with sub-contractors to fulfill the terms of the Contract

If the Proposer will be engaging with sub-contractors to fulfill the terms of the Contract, please complete the following section by checking the applicable boxes below.

☐The sub-contractor(s) has/have been identified in the attached proposal.

☐ If awarded the Contract, Proposer agrees to execute a signed Contract between Proposer and sub-contractor(s) as outlined on Page 11 of the RFP.

☐ If awarded the Contract, Proposer agrees to send a signed copy of the executed Contract between

Proposer and sub-contractor(s) to ECWRPC as outlined on Page 11 of the RFP.

Signature______________________________________________

Name and Title _______________________ Date__________________________