AttI_FinalSubmissionForm.pdf

OEBB EAP RFP

OregonBuys Bid Number S-44300-00008777 Attachment I

Attachment I Final Submission Form

Legal Name of Proposer:

Authorized Signatory (full name and title):

Address: City, State, Zip:

State of Incorporation: Entity Type:

Contact Name: Telephone: Email:

Oregon Business Registry Number (if required):

Part A: Mandatory Minimum Requirements By execution of this checklist, I, as the authorized representative of [Proposer], hereby certify that I have read, understand, and agree to the Mandatory Minimum Requirements below, and further certify to the truthfulness, completeness, and accuracy of the responses to the Mandatory Minimum Requirements.

Proposer Signature By: ___________________________________ Date:________________________ (Authorized Signatory)

Mandatory Minimum Requirements Checklist

Proposer agrees its Proposal is a Firm Offer and to be bound by this Proposal from the date of submission through September 30, 2024. Proposer agrees that during negotiations, OEBB may request clarification or correction of the Proposal for the purpose of evaluation.

Amendments or clarifications will not affect the remainder of the Proposal, but only that portion so amended or clarified.

If selected as an Apparent Successful Proposer (ASP), Proposer agrees to, in good faith, negotiate a Contract with OEBB by or closely around May 8, 2024.

Proposer is currently licensed to do business in the State of Oregon or will be by the expected Contract execution date of June 5, 2024.

Proposer’s Proposal is in compliance with Oregon law and the Proposer satisfies all insurance licensure requirements related to financial solvency, capital holdings, and applicable licensure types for the financial arrangements included in its Proposal.

Proposer has completed, obtained and performed all other registrations, filings, approvals, authorizations, consents or examinations required by any government or governmental authority for its acts contemplated by this Proposal and resulting Contract.

Proposer consents to OEBB investigating the references submitted by Proposer as well as those current or former customers not disclosed by Proposer and to discuss subject matter such as the Proposer’s past performance, its compliance with certain specifications and contractual obligations, its payment history regarding suppliers, subcontractors, and workers, and any other information that may be helpful in choosing an ASP.

Proposer has fully responded to all items in Attachments A and B, including providing any necessary or requested supplemental documents or information.

Proposer has fully responded to all items included in Attachment C, Sample Group Benefits Contract, including confirming acceptance of all terms or provisions that are deemed non-negotiable under this RFP.

Proposer agrees to fully complete, sign, and submit an Attachment D, Disclosure Exemption Affidavit with its claimed disclosure exemptions by February 20, 2024 and agrees to do so consistent with the instructions OEBB or its Consultant will provide by February 2, 2024.

Proposer has fully completed, signed, and submitted an Attachment F.

Proposer has fully completed, signed, and submitted an Attachment G.

Proposer has fully completed, signed, and submitted an Attachment H.

Part B: Proposer Representations and Warranties By execution of this checklist, I, as the authorized representative of [Proposer], hereby certify that I have read, understand, and agree to the Representations and Warranties below, and further certify to the truthfulness, completeness, and accuracy of such Representations and Warranties.

(Authorized Signatory)

Representations and Warranties Checklist

Attachment I

� I (the person completing this Attachment I) am duly authorized to submit this Proposal and to bind Proposer to each of the terms and provisions hereof.

Proposer possesses the established qualifications to satisfactorily perform Work of the type and size included in this RFP, including compliance with all laws, rules, and regulations applicable to the performance of Proposer’s obligations hereunder.

Proposer has the skill and knowledge possessed by well-informed members of its industry, trade or profession and Proposer will apply that skill and knowledge with care and diligence to perform the work in any resulting Contract in a professional manner and in accordance with the highest standards prevalent in Proposer’s industry, trade or profession.

Proposer prepared its response to this RFP independently from all other Proposers, unless otherwise permitted by this RFP concerning subcontractors and collaborators, and without collusion, fraud, or other dishonesty.

Proposer attests that no attempt has been made or shall be made by the Proposer to induce any other person or organization to submit or not submit a Proposal to this RFP.

Proposer attests that it has submitted its Proposal in response to the specific language contained in the RFP and all Addenda to this RFP, and Proposer has made no assumptions based upon either (a) verbal or written statements not contained in the RFP, or (b) any previously-issued RFP, if any.

Proposer agrees that the representations and warranties set forth in this Attachment I are in addition to, and not in lieu of, any other warranties provided.

Part C: Certifications

As the authorized representative of [Proposer], I hereby certify and swear under penalty of perjury to the best of my knowledge all of the following:

No Sexual Harassment. Proposer has a written policy and practice that meets the requirements, described in ORS 279A.112, of preventing sexual harassment, sexual assault and discrimination against employees who are members of a protected class. Proposer agrees, as a material term of the potential future Contract, to maintain the policy and practice in force during the entire Contract term.

No Wage Discrimination. Proposer complies with ORS 652.220 and does not unlawfully discriminate against any of Contractor’s employees in the payment of wages or other compensation for work of comparable character on the basis of an employee’s membership in a Protected Class. Contractor’s continuing compliance will constitute a material element of the future potential Contract and a failure to comply constitutes a default entitling OEBB to terminate the Contract for cause. Proposer may not prohibit any of its employees from discussing the employee’s rate of wage, salary, benefits, or other compensation with another employee or another person. Proposer may not retaliate against an employee who discusses the employee’s rate of wage, salary, benefits, or other compensation with another employee or another person.

No Discrimination/COBID. Proposer has not discriminated against and will not discriminate against minority, women or emerging small business enterprises certified under ORS 200.055 or against a business enterprise that is owned or controlled by or that employs a disabled veteran as defined in ORS 408.225 in obtaining any required subcontracts, and that Proposer is not in violation of any nondiscrimination laws.

Taxes. (a) Proposer is not subject to backup withholding because (i) Proposer is exempt from backup withholding, (ii) Proposer has not been notified by the IRS that it is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified Proposer that it is no longer subject to backup withholding; (b) the undersigned is authorized to act on behalf of Proposer, the undersigned has authority and knowledge regarding Proposer's payment of taxes, and to the best of their knowledge, Proposer is not in violation of any Oregon tax laws, including, without limitation, those tax laws listed in ORS 305.380(4), namely ORS Chapters 118, 314, 316, 317, 318, 320, 321 and 323 and Sections 10 to 20, Chapter 533, Oregon Laws 1981, as amended by Chapter 16, Oregon Laws 1982 (first special session); the elderly rental assistance program under ORS 310.657; and any local taxes administered by the Oregon Department of Revenue under ORS 305.620; (c) Proposer is an independent contractor as defined in ORS 670.600; and (d) the supplied Proposer tax identification numbers are true and accurate.

Proposer does not discriminate in its employment practices with regard to race, creed, age, religious affiliation, gender, disability, sexual orientation, national origin. When awarding subcontracts, Proposer does not discriminate against any business certified under ORS

200.055 as a disadvantaged business enterprise, a minority-owned business, a woman-owned business, a business that a service-disabled veteran owns or an emerging small business. If applicable, Proposer has a written policy and practice, that meets the requirements described in ORS 279A.112 (formerly HB 3060), of preventing sexual harassment, sexual assault and discrimination against employees who are members of a protected class.

Attachment I

Proposer is not engaged in the provision of broadband Internet access service, or if at any time Proposer is engaged in or may engage in the provision of broadband Internet access service Proposer is in compliance with Oregon Laws 2018, Chapter 88 (HB 4155) and applicable Public Utility Commission rules and will remain in compliance throughout the term of the future potential Contract.

Proposer and its employees, agents, and subcontractors are not included on:

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

https://www.sam.gov/portal/

Proposer certifies that, to the best of its knowledge, there exists no actual or potential conflict between the business or economic interests of Offeror, 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 any way to, the subject matter of the RFP. If any changes occur with respect to Proposer’s status regarding conflict of interest, Proposer shall promptly notify OEBB in writing.

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" {as defined by the Oregon False Claims Act, ORS 180.750(1)}, made under resulting Contract being a "false claim" {ORS 180.750(2)} 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.

� Proposer acknowledges these certifications are in addition to any certifications required in the Sample Contract in Attachment C at the time of Contract execution.

(Authorized Signatory) https://www.treasury.gov/ofac/downloads/sdnlist.pdf https://www.sam.gov/portal/