Bid Package - Royal Oak High School Window Replacement pages 16-20.pdf

ROYAL OAK SCHOOL DISTRICT Business Office Page 16 Royal Oak High School – Window Replacement - Bid

Please state your warranty: _____________________________________________

State any prompt payment terms: __________% ___________days.

Do you conduct background checks on your employees? Yes No

Are you on the Excluded Parties List, which excludes you from receiving Federal Contracts or certain sub contracts, pursuant to the provisions of 31 U.S.C. 6101, note E.O. 12549, E.O. 12689, 48 C.F.R. 9.404? Yes No Unknown

Provide your DUNS number, if you have one: ____________________________

At least three (3) references with contact person:

Company: __________________ Contact: __________________ Phone: __________

Company: __________________ Contact: __________________ Phone:___________

Company: __________________ Contact: __________________ Phone:___________

Page 17 Royal Oak High School – Window Replacement - Bid

CONSTRUCTION BID DISCLOSURE STATEMENT – FAMILIAL RELATIONSHIP

Pursuant to MCL 380.1267, a sworn and notarized statement disclosing any familial relationship that exists between the owner or any employee of the bidder and any member of the Royal Oak Schools Board or the Royal Oak Schools Superintendent must be accompanied with the bid. Bids without this disclosure statement will not be accepted.

The members of the Royal Oak Schools Board are Deborah Anderson, Gary Briggs, Marty Cardamone, Jeff Brinker, Carrie Beerer, Allison Sykes, and Maryanne VanHaitsma

The Royal Oak Schools Superintendent is Mary Beth Fitzpatrick

€ The Following are the familial relationships:

€ There are none.

STATE OF MICHIGAN )

) ss

COUNTY OF_____________)

The undersigned, authorized representative of bidder (insert name) does hereby acknowledge that bidder has read the foregoing disclosure statement and the statements herein contained are true.

Signature of Bidder Representative

Print Name

Title

Subscribed and sworn to before me this _____day of ___________________, Notary Public, ______________County, Michigan My commission expires: ____/____/________

Page 18 Royal Oak High School – Window Replacement - Bid

AFFIDAVIT OF COMPLIANCE – IRAN ECONOMIC SANCTIONS ACT

Michigan Public Act No. 517 of 2012

The undersigned, the owner or authorized officer of the below named contractor (the “Contractor”), pursuant to the compliance certification requirement provided in the Royal Oak Schools (the “School District”) Request For Proposals For Royal Oak High School – Window Replacement (the “RFP”), hereby certifies, represents and warrants that the Contractor (including its officers, directors and employees) is not an “Iran linked business” within the meaning of the Iran Economic Sanctions Act, Michigan Public Act No. 517 of 2012 (the “Act”), and that in the event Contractor is awarded a contract as a result of the aforementioned RFP, the Contractor will not become an “Iran linked business” at any time during the course of performing the Work or any services under the contract.

The Contractor further acknowledges that any person who is found to have submitted a false certification is responsible for a civil penalty of not more than $250,000.00 or 2 times the amount of the contract or proposed contract for which the false certification was made, whichever is greater, the cost of the School District’s investigation, and reasonable attorney fees, in addition to the fine. Moreover, any person who submitted a false certification shall be ineligible to bid on a request for proposal for three (3) years from the date the it is determined that the person has submitted the false certification.

CONTRACTOR:

Name of Contractor

By:

Its:

Date:

STATE OF )

)ss.

COUNTY OF ____________ )

This instrument was acknowledged before me on the _____ day of ________________, 20 , by __________________________.

, Notary Public

______________ County, __________

My Commission Expires:___________

Acting in the County of :___________

8850374.1 31354/151790