Attachments.pdf

PROPOSAL FORM & GENERAL INFORMATION

The Proposer makes the following statements and representations as part of the proposal:

CORPORATE HEAD OFFICES

PROPOSER NAME:

PROPOSER ADDRESS:

TELEPHONE: FAX NUMBER:

LOCAL OFFICES

(To be used For All Legal And Contractual Correspondence)

PROPOSER NAME:

PROPOSER ADDRESS:

TELEPHONE: FAX NUMBER:

FIRM INFORMATION

1) Federal Taxpayer ID Number (or Social Security Number if not a Corporation)

2) How long has the Proposer been in business? Under which names?

EXCEPTIONS & RESIDENCY

1) Are there exceptions to the work scope or specifications in this proposal (circle one)?

YES NO

Exceptions to any of the specifications or requirements shall be noted in writing, and attached to this Proposal Form when submitted. By taking exceptions and clearly stating them in writing on a separate sheet of paper headed Exceptions and showing the solicitation number and the Proposer’s Name, and by offering alternates to replace the excepted requirements with clear pricing options corresponding to each exception taken, the Proposer may still compete in the solicitation. The College shall be the sole judge of the acceptability of any exceptions. In the absence of exceptions, the proposal shall be for all professional services precisely as specified.

2) Is the Proposer an Oregon resident (circle one)?

YES NO

Oregon Resident, per ORS 279.029, means a Proposer that has paid unemployment taxes or income taxes in this state during the 12 calendar months immediately preceding submission of the proposal, has a business address in this state, and has stated on this form that the Proposer is an “Oregon resident”.

ADDENDA ACKNOWLEDGEMENT

The Proposer hereby acknowledges receipt of the following Addenda related to the subject solicitation documents (circle all received):

/ NONE / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 /

CERTIFICATIONS

Non-Collusion

The undersigned Proposer hereby certifies that it, its officers, partners, owners, agents, representatives, employees, and parties in interest, including the affiant, has not in any way colluded, conspired, connived, or agreed, directly or indirectly, with any other Proposer, potential Proposer, firm or person, in connection with this solicitation, to submit a collusive or sham bid, to refrain from bidding, to manipulate or ascertain the price(s) of other Proposers or potential Proposers, or to secure through any unlawful act an advantage over other Proposers or the college.

The prices submitted herein have been arrived at in an entirely independent and lawful manner by the Proposer without consultation with other Proposers or potential Proposers or foreknowledge of the prices to be submitted in response to this solicitation by other Proposers or potential Proposers on the part of the Proposer, its officers, partners, owners, agents, representatives, employees or parties in interest, including the affiant.

Conflict Of Interest

The undersigned Proposer and each person signing on behalf of the Proposer certifies, and in the case of a sole proprietorship, partnership, or corporation, each party thereto certifies as to its own organization, under penalty of perjury, that to the best of their knowledge and belief, no member of the Mt. Hood Community College Board of Education or college officer, employee, or person, whose salary is payable in whole or in part by Mt. Hood Community College, has a direct or indirect financial interest in the award of this Proposal, or in the services to which this Proposal relates, or in any of the profits, real or potential, thereof.

SIGNATURE BLOCK

Company Name:

Signer’s Mailing Address:

Signer’s City/State/Zip:

Signer’s Telephone Number:

Signer’s Facsimile Number:

Signer's Name (Printed):

Signer's Title:

Signature:

Date: