Bid S-58100-00017037 RFQ AttD Proposer Information and Certification Sheet.pdf

RFQ Bid S-58100-00017037 AttD– Early Literacy Provider List Att D

DAS Procurement Services, Version 1.0 – August 16, 2021 Page 1 of 3

ATTACHMENT D — RESPONDER INFORMATION AND

CERTIFICATION SHEET

Legal Name of Responder

Address: City, State, Zip:

State of Incorporation: Entity Type:

Contact Name: Telephone: Email:

Oregon Business Registry Number (if required):

Number of years providing facilitation services in the field of education for school districts, Education Service Districts or other senior level administrative positions in the field of education: _____________________________________

Any individual signing below hereby certifies they are an authorized representative of Responder and that:

1. Responder understands and accepts the requirements of this REQUEST FOR QUALIFICATIONS. By submitting a Proposal, Responder agrees to be bound by the Contract terms and conditions in Attachment A and as modified by any Amendment, except for those terms and conditions that Agency has reserved for negotiation, as identified in the REQUEST FOR QUALIFICATIONS.

2. Responder acknowledges receipt of any and all Amendments to this REQUEST FOR

QUALIFICATIONS.

3. Proposal is a Firm Offer for 180 days following the Opening.

4. If awarded a Contract, Responder agrees to perform the scope of work and meet the performance standards set forth in the final negotiated scope of work of the Contract.

5. I have knowledge regarding Responder’s payment of taxes and by signing below. I hereby certify that, to the best of my knowledge, Responder is not in violation of any tax laws of the state or a political subdivision of the state, including, without limitation, ORS 305.620 and ORS chapters 316, 317 and 318.

6. Responder does not discriminate in its employment practices with regard to race, creed, age, religious affiliation, gender, disability, sexual orientation, national origin. When awarding subcontracts, Responder 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 owned or an emerging small business. If applicable, Responder has, or will have prior to contract execution, 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. Agency may not enter into a contract with an anticipated contract price of $150,000 or more with a Responder that does not certify it has such a policy and practice. See https://www.oregon.gov/DAS/Procurement/Pages/hb3060.aspx for additional information and sample policy template.

https://www.oregon.gov/DAS/Procurement/Pages/hb3060.aspx

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7. Responder complies with ORS 652.220 and does not unlawfully discriminate against any of Responder’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. “Protected class” means a group of persons distinguished by race, color, religion, sex, sexual orientation, national origin, marital status, veteran status, disability or age.

Contractor’s continuing compliance constitutes a material element of this Contract and a failure to comply constitutes a breach that entitles Agency to terminate this Contract for cause.

Contractor may not prohibit any of Contractor’s employees from discussing the employee’s rate of wage, salary, benefits, or other compensation with another employee or another person. Contractor 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.

8. Responder is not engaged in the provision of broadband Internet access service, or if at any time Responder is engaged in or may engage in the provision of broadband Internet access service Responder 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 Contract.

9. Responder and Responder’s 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

B. the government wide exclusions lists in the System for Award Management found at:

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

10. Responder certifies that, to the best of its knowledge, there exists no actual or potential conflict between the business or economic interests of Responder, 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 REQUEST FOR QUALIFICATIONS. If any changes occur with respect to Responder’s status regarding conflict of interest, Responder shall promptly notify the State in writing.

11. Responder certifies that all contents of the Proposal (including any other forms or documentation, if required under this REQUEST FOR QUALIFICATIONS) and this Proposal Certification Sheet are truthful and accurate and have been prepared independently from all other Responders, and without collusion, fraud, or other dishonesty.

12. Responder understands that any statement or representation it makes, in response to this REQUEST FOR QUALIFICATIONS, 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 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.

13. Responder acknowledges these certifications are in addition to any certifications required in the Contract and Statement of Work in Attachment A at the time of Contract execution.

https://www.treasury.gov/ofac/downloads/sdnlist.pdf https://www.sam.gov/portal/

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Authorized Signature Date

(Printed Name and Title)