Bid Form and Bidder Certificiation.pdf

1 | P a g e

APPENDIX A: BID FORM AND BIDDER CERTIFICATION

SECTION 1 - BIDDER INFORMATION

Information Response

Legal Name of Bidder

DBA Name (if applicable)

Business Address

City, State, Zip

Remittance Address (if different)

Telephone Number

Email Address

Federal Tax ID (EIN)

SCC Registration Number or Exemption

Authorized Representative

Title

Authorized Representative Email

Authorized Representative Phone Number

SECTION 2- PRICING SCHEDULE

The bidder shall propose pricing for initial and contract terms and all four renewal options. The Bidder certifies that all prices submitted in response to this solicitation shall remain firm and irrevocable for a period of ninety (90) calendar days following the Bid due date, unless otherwise specified in the solicitation. The Bidder further agrees that its Bid shall remain valid and available for acceptance by Arlington Public Schools during this period.

BUSINESS AND MANAGEMENT SERVICES

2110 Washington Boulevard • Arlington, VA 22204 • Phone: (703) 228-7652

Arlington Public Schools

2 | P a g e

Item No. Description Unit of

Measure Unit Price Quantity / Estimated Qty. Extended Price

Year One

Speech Language Pathologist Services

Hour $_______ ** Up to 2080 Hours annually $_______

Year Two

Speech Language Pathologist Services

Hour $_______ ** Up to 2080 Hours annually $_______

Year Three

Speech Language Pathologist Services

Hour $_______ ** Up to 2080 Hours annually $_______

Year Four

Speech Language Pathologist Services

Hour $_______ ** Up to 2080 Hours annually $_______

Year Five

Speech Language Pathologist Services

Hour $_______ ** Up to 2080 Hours annually $_______

PRICE CERTIFICATION

The Bidder certifies that pricing submitted in response to this solicitation:

• Includes all labor, materials, equipment, travel, overhead, profit, insurance, and all other costs necessary to perform the work unless otherwise expressly stated in the solicitation.

• Does not include Virginia sales tax or any tax from which Arlington Public Schools is exempt.

• Is true, complete, and accurate to the best of the Bidder's knowledge.

SECTION 3 - PAST PERFORMANCE REFERENCES

The Bidder shall complete this section and provide the required Past Performance references to demonstrate compliance with the minimum qualifications, experience, and performance requirements of this solicitation. The Bidder shall provide at least one (1) reference for the firm and each proposed Speech-Language Pathologist evidencing successful performance of services of similar size, scope, and complexity, preferably for K-12 school divisions, public bodies, governmental agencies, or nonprofit organizations.

Reference #1

Client Organization: _______________________________________________

Contract Number (if applicable): ____________________________________

Contract Title: _____________________________________________________

Description of Services: ____________________________________________

Contract Value: $__________________________________________________

Contract Term: From _____________ To _____________

Number of SLPs Provided: ___________________________________________

3 | P a g e

Primary Contact Person: ____________________________________________

Title: ___________________________________________________________

Telephone: _______________________________________________________

Email: ___________________________________________________________

Reference #2

Client Organization: _______________________________________________

Contract Number (if applicable): ____________________________________

Number of SLPs Provided: ___________________________________________

Primary Contact Person: ____________________________________________

Title: ___________________________________________________________

Telephone: _______________________________________________________

Email: ___________________________________________________________

Reference #3

Client Organization: _______________________________________________

Contract Number (if applicable): ____________________________________

Number of SLPs Provided: ___________________________________________

Primary Contact Person: ____________________________________________

Title: ___________________________________________________________

Telephone: _______________________________________________________

Email: ___________________________________________________________

4 | P a g e

SECTION 4 - BIDDER CERTIFICATIONS

By signing this Bid Form, the Bidder certifies that:

General Certification

☐ The Bidder has examined the solicitation and all addenda and agrees to perform the work in accordance with the solicitation requirements.

☐ The Bidder is legally authorized to conduct business in the Commonwealth of Virginia.

☐ The Bidder possesses the experience, capability, personnel, licenses, and resources necessary to perform the required services.

Non-Collusion Certification

☐ The Bidder certifies that this bid is made without collusion, fraud, or other improper conduct and that no agreement has been made with any competitor regarding pricing, terms, or conditions of this solicitation.

Conflict of Interest / Ethics Certification

☐ The Bidder certifies compliance with all applicable ethics in public contracting requirements and certifies that no prohibited conflict of interest exists.

Non-Discrimination Certification

☐ The Bidder certifies that it does not discriminate against any employee, applicant, student, or participant on the basis of any classification protected by applicable federal, state, or local law and will comply with all applicable equal employment opportunity requirements.

Drug-Free Workplace Certification

☐ The Bidder certifies that it maintains a drug-free workplace and will comply with all applicable drug-free workplace requirements.

Immigration Reform Certification

☐ The Bidder certifies that it does not knowingly employ unauthorized aliens and complies with applicable federal and state immigration laws.

Debarment Certification

☐ The Bidder certifies that neither the Bidder nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in any federal, state, or local governmental procurement program.

Virginia Business Authorization Certification

☐ The Bidder certifies that it is authorized to transact business in the Commonwealth of Virginia as required by applicable law.

5 | P a g e

Responsibility Certification

☐ The Bidder certifies that all information submitted with this bid is true, accurate, and complete and understands that APS may verify any information submitted.

SECTION 5 - REQUIRED DOCUMENTS CHECKLIST

The following must be checked and copies uploaded as part of the bid submissions

Required Attachment Included

APPENDIX 1: Bid Form & Bidder Certification ☐

Resume(s) of Proposed Personnel ☐

Required Licenses and Certifications ☐

SDUPA ☐

SCC Registration Information or Exemption ☐

Criminal Convictions Certification ☐

References Supporting Experience ☐

Nondisclosure Certification ☐

Arlington County Business Licenses ☐

Signed Addenda/Addendum ☐

SECTION 6- SIGNATURE

The undersigned certifies that he/she is authorized to bind the Bidder and that all information contained in this Bid Form is true and correct.

Authorized Representative (Print Name)

Title

Signature

Date