BPM004422 Solicitation Attachments - REQUIRED OFFEROR FORMS.docx

Attachment 12: Pricing Sheet

RFP Solicitation No. BPM004422 Statewide Environmental Laboratory Services Arizona Department of Environmental Quality (ADEQ) 1110 W. Washington Street Phoenix, AZ 85007

SUBMISSION OF OFFER: Undersigned hereby offers and agrees to furnish Statewide Environmental Laboratory Services materials and services in compliance with all terms, conditions, specifications and amendments in the Solicitation indicated above and any written exceptions in Offer indicated by the latest dated version below:

Initial Offer:

Revised Offers:

Best and Final Offer:

Offeror company name

Signature of person authorized to sign Offer

Address

Printed name and title

City | State | ZIP

Contact name and title

Federal tax identifier (EIN or SSN)

Attachment 1: Offer and Acceptance Form

Statewide Environmental Laboratory Services Arizona Department of Environmental Quality (ADEQ)

1 Solicitation Attachments CERTIFICATION: By signature in the above, Offeror certifies that it:

1. will not discriminate against any employee or applicant for employment in violation of Federal Executive Order 11246, [Arizona] State Executive Order 2009-9 or A.R.S. § 41-1461 through 1465;

2. has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with the submitted offer. Failure to provide a valid signature affirming the stipulations required by this clause will result in rejection of the Offer. Signing the Offer with a false statement will void the Offer, any resulting contract, and may be subject to legal penalties under law;

3. complies with A.R.S. § 41-3532 when offering electronics or information technology products, services, or maintenance; and

4. is not debarred from, or otherwise prohibited from participating in any contract awarded by federal, state, or local government.

ACCEPTANCE OF OFFER: State hereby accepts the initial Offer, Revised Offer, or Best and Final Offer identified by the latest date and number at the top of this form (the Accepted Offer). Offeror is now bound (as Contractor) to carry out the Work under the attached Contract, of which the Accepted Offer forms a part. Contractor is cautioned not to commence any billable work or to provide any material or perform any service under the Contract until Contractor receives the applicable Order or written notice to proceed from the Procurement Officer.

Award Date:

Ana Machiche Date Procurement Officer Signature

Louis Anaya, MPA, C.P.M., CPPB Date Chief Procurement Officer Signature

Please note that if any of the following apply to this Solicitation, Contract, or Contractor, then the Offeror shall select the “Exempt Solicitation, Contract, or Contractor” option below:

· The Solicitation or Contract has an estimated value of less than $100,000;

· Contractor is a sole proprietorship;

· Contractor has fewer than ten (10) employees; OR

· Contractor is a non-profit organization.

Pursuant to A.R.S. §35-393.01, public entities are prohibited from entering into contracts “unless the contract includes a written certification that the company is not currently engaged in, and agrees for the duration of the contract to not engage in, a boycott of goods or services from Israel.”

Under A.R.S. § 35-393:

1. "Boycott" means engaging in a refusal to deal, terminating business activities or performing other actions that are intended to limit commercial relations with entities doing business in Israel or in territories controlled by Israel, if those actions are taken either:

(a) Based in part on the fact that the entity does business in Israel or in territories controlled by Israel.

(b) In a manner that discriminates on the basis of nationality, national origin or religion and that is not based on a valid business reason.

2. "Company" means an organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, limited liability company or other entity or business association, including a wholly owned subsidiary, majority-owned subsidiary, parent company or affiliate, that engages in for-profit activity and that has ten or more full-time employees.

5. "Public entity" means this State, a political subdivision of this State or an agency, board, commission or department of this State or a political subdivision of this State.

The certification below does not include boycotts prohibited by 50 United States Code Section 4842 or a regulation issued pursuant to that section. See A.R.S. § 35-393.03.

In compliance with A.R.S. § 35-393 et seq., all offerors must select one of the following:

☐The Company submitting this Offer does not participate in, and agrees not to participate in during the term of the contract, a boycott of Israel in accordance with A.R.S. § 35-393 et seq. I understand that my entire response will become a public record in accordance with A.A.C. R2-7-C317.

☐The Company submitting this Offer does participate in a boycott of Israel as described in A.R.S. § 35-393 et seq.

☐Exempt Solicitation, Contract, or Contractor.

Indicate which of the following statements applies to this Contract:

· Solicitation or Contract has an estimated value of less than $100,000;

· Contractor is a sole proprietorship;

· Contractor has fewer than ten (10) employees; and/or

· Contractor is a non-profit organization.

Company Name

Signature of Person Authorized to Sign

Address

Printed Name

Title

Attachment 2: Boycott of Israel Disclosure

Statewide Environmental Laboratory Services Arizona Department of Environmental Quality (ADEQ)

All materials submitted as part of a response to a solicitation are subject to Arizona public records law and will be disclosed if there is an appropriate public records request at the time of or after the award of the contract. Recognizing there may be materials included in a solicitation response that are proprietary or a trade secret, a process is set out in A.A.C. R2-7-103 (copy attached) that will allow qualifying materials to be designated as confidential and excluded from disclosure. For purposes of this process the definition of “trade secret” will be the same as that set out in A.A.C. R2-7-101(52).

Complete this form and return it with your Offer along with the appropriate supporting information to assist the State in making its determination as to whether any of the materials submitted as part of your Offer should be designated confidential because the material is proprietary or a trade secret and therefore not subject to disclosure.

STATE WILL NOT CONSIDER ANY MATERIAL IN YOUR OFFER “CONFIDENTIAL” UNLESS DESIGNATED ON THIS FORM.

Check one of the following – if neither is checked, State will assume that as equivalent to “DOES NOT”:

This response DOES NOT contain proprietary or trade secret information. I understand that my entire response will become public record in accordance with A.A.C. R2-7-C317.

1. Is a formula, pattern, compilation, program, device, method, technique or process, AND

2. Derives independent economic value, actual or potential, from not being generally known to, and not being readily ascertainable by proper means by, other persons who can obtain economic value from its disclosure or use; AND

3. Is the subject of efforts by myself or my organization that are reasonable under the circumstances to maintain its secrecy.

NOTE: Failure to attach an explanation may result in a determination that the information does not meet the statutory trade secret definition. All information that does not meet the definition of trade secret as defined by A.A.C. R2-7-101(52) will become public in accordance with A.A.C. R2-7-C317. State may make its own determination on materials in accordance with A.A.C. R2-7-103.

If State agrees with Offeror’s designation of trade secret or confidentiality and the determination is challenged, the undersigned hereby agrees to cooperate and support the defense of the determination with all interested parties, including legal counsel or other necessary assistance.

By submitting this response, Offeror agrees that the entire Offer, including confidential, trade secret and proprietary information may be shared with an evaluation committee and technical advisors during the evaluation process. Offeror agrees to indemnify and hold State, its agents and employees, harmless from any claims or causes of action relating to State’s withholding of information based upon reliance on the above representations, including the payment of all costs and attorney fees incurred by State in defending such an action.

Offeror Company Name

Signature of Authorized Person

Address

Printed Name

Title

Attachment 3: Confidential Information

Statewide Environmental Laboratory Services Arizona Department of Environmental Quality (ADEQ)

A.A.C. R2-7-103 [Confidential Information] as was current at time of Solicitation issuance

Attachment 3 Supplement: Confidential Information Designation FOR REFERENCE ONLY

Statewide Environmental Laboratory Services Arizona Department of Environmental Quality (ADEQ)

Attachment 4: Conformance Statements

Statewide Environmental Laboratory Services Arizona Department of Environmental Quality (ADEQ)

If taking exceptions, the Attachment Supplements must be uploaded as a separate word doc. file titled “Attachment Supplement -”

STATE WILL NOT CONSIDER ANY EXCEPTIONS UNLESS DESIGNATED ON THIS FORM.

READ PARAGRAPH 6.8 OF THE INSTRUCTIONS TO OFFERORS BEFORE TAKING ANY EXCEPTIONS – TAKING EXCEPTIONS CAN BE GROUNDS FOR STATE REJECTING OR DOWN-GRADING YOUR OFFER IN EVALUATION.

CONFORMANCE TO THE INSTRUCTIONS TO OFFERORS

Check one of the following – if neither is checked, State will assume that as equivalent to “YES”:

CONFORMANCE TO SCOPE OF WORK AND PRICING

Check one of the following – if neither is checked, State will assume that as equivalent to “YES”:

NO – Offeror acknowledges that it has read and understands the Scope of Work Document and the Pricing Document of the Solicitation Documents and attests that its Offer complies with both EXCEPT FOR the exceptions listed in Attachment Supplement 2.

CONFORMANCE TO THE CONTRACT TERMS AND CONDITIONS

Check one of the following – if neither is checked, State will assume that as equivalent to “YES”:

NO – Offeror acknowledges that it has read and understand the Special Terms and Conditions and the Uniform Terms and Conditions, along with their respective Exhibits and Appendices 2 of the Solicitation Documents and attests that its Offer complies with both EXCEPT FOR the exceptions listed in Attachment Supplement 3.

Exceptions to Instructions – Attachment Supplement 1

Special Instructions to Offerors

X Rationale:

x

x

x

Uniform Instructions to Offerors

x

x

Company Name

Signature of Person Authorized to Sign

Attachment 4 Supplement: Exceptions

Statewide Environmental Laboratory Services Arizona Department of Environmental Quality (ADEQ)

Exceptions to Scope of Work and Pricing – Attachment Supplement 2

Scope of Work

x

x

x

Pricing Document

x

x

Company Name

Signature of Person Authorized to Sign

Exceptions to Contract Terms & Conditions – Attachment Supplement 3

Special Terms & Conditions

X Rationale:

x

X Rationale:

x

X Rationale:

x

Uniform Terms & Conditions

Rationale:

x

x

Company Name

Signature of Person Authorized to Sign

Attachment 4 Supplement: Exceptions

Statewide Environmental Laboratory Services Arizona Department of Environmental Quality (ADEQ)

Answer all questions thoroughly in the spaces provided. Complete this form in full for each one of the Key Personnel proposed to be involved in carrying out the Work. Duplicate as needed. Insert or attach a separate resume if desired, but any attached resumes are supplemental to this form and do not substitute for this form. If there are more than three (3) Key Personnel, please utilize the same form for each additional Personnel.

What primary functions will be assigned?

x

Describe person’s experience in performing services like those that are to be assigned.

Also state the person’s related experience with large local, state or federal government agencies.

x

What primary functions will be assigned?

x

Describe person’s experience in performing services like those that are to be assigned.

Also state the person’s related experience with large local, state or federal government agencies.

x

What primary functions will be assigned?

x

Describe person’s experience in performing services like those that are to be assigned.

Also state the person’s related experience with large local, state or federal government agencies.

x

Attachment 5: Key Personnel

Statewide Environmental Laboratory Services Arizona Department of Environmental Quality (ADEQ)

The Offeror shall provide a Letter of Insurability from the Insurance Company as a proof that the Offeror currently possesses the required insurance as stated in the Section 6.2 of Special Terms and Conditions or the Offeror is able to obtain the required Minimum Scope and Limits of Insurance should a contract be awarded to them.

The Letter of Insurability (and any additional letters) should be clearly marked as:

Attachment - Supplement Insurance NOTE: If Awarded a Contract, The Offeror shall provide a Certificate of Insurance (e.g. ACORD forms) and associated policy endorsement(s) prior to beginning service(s) under the Contract.

Attachment 6: Letter of Insurability

Statewide Environmental Laboratory Services Arizona Department of Environmental Quality (ADEQ)

STATE MAY DETERMINE YOUR PROPOSAL IS NON-RESPONSIVE IF YOU DO NOT ANSWER ALL QUESTIONS FULLY.

Firm Name

Year established

Principal address (street, city, state)

Entity type:

Structure:

Branch or Division:

Parent:

Years of experience providing goods similar in type and quantity as required by this Solicitation.

Years of experience performing services similar in size and scope as required by this Solicitation.

Years the organization has conducted business in Arizona.

Contract Representatives to Contact

1.

2.

3.

Licenses/Certifications

4.

5.

6.

7.

8.

Capacity

9.

10.

11.

12.

Attachment 7: Organization Profile

Statewide Environmental Laboratory Services Arizona Department of Environmental Quality (ADEQ)

13.

Check “NO” if you WILL NOT subcontract any portion of the Work and will therefore be carrying out all of the Work with your own personnel.

If you WILL subcontract any portion of the Work, check “YES” below and list name(s) of persons or companies you propose to use as subcontractors.

1. Fill in the information for every significant subcontractor – indicate the type of work the subcontractor will perform under the Contract, and their approximate percentage of the total Contract work.

2. Provide copies of relevant certifications each one possesses in the Attachment Supplements section.

3. Provide description of quality assurance methods and quality control measures that you will use to ensure that Subcontractor work meets the Contract requirements.

4. State may demand additional information about proposed subcontractors as a precondition of award.

Attachment 8: Proposed Subcontractors

Statewide Environmental Laboratory Services Arizona Department of Environmental Quality (ADEQ)

STATE MAY DETERMINE YOUR PROPOSAL IS NON-RESPONSIVE IF YOU DO NOT ANSWER ALL QUESTIONS FULLY.

The Offeror shall provide a narrative response to each question that demonstrates their understanding of the Scope of Work requirements and describes their company’s overall method of approach for providing the services stated in this solicitation. If there is a question that is not applicable to the services required by the Scope of Work, Offeror may mark it N/A.

Experience and Capacity Questions:

Question 1: Company Profile The Offeror must include a narrative description of its organization. The narrative must include the following:

1.16 Include a table that specifies the current status of any proficiency testing and the status of any corrective actions by method.

Offeror Response:

Click here to enter your response.

Question 2: Offeror to fill in the blanks on the following question:

Courier Service and bottle delivery is free of charge within ______________ miles from Laboratory with ___________ business day(s) notice.

Question 3:

Is courier service available beyond the free courier service mileage, the Agency would be billed for this service and would have to be mutually agreed upon by the Agency and the Laboratory?

Offeror Response:

Click here to enter your response.

Question 4: Proposed Project Members and Organization Utilize Attachment 5 to identify Key Personnel to be utilized to perform services within a resultant contract.

Question 5: Subcontractors Utilize Attachment 8 to identify Proposed Subcontractors to be utilized to perform services within a resultant contract.

Attachment 9: Experience and Capacity Questionnaire

Statewide Environmental Laboratory Services Arizona Department of Environmental Quality (ADEQ)

The State intends to conduct reference checks for accounts referenced provided by Offerors. It may, at its sole discretion, contact additional clients not presented as references. Offerors shall provide at least three (3) client references for assignments that replicate or mirror the requirements of this RFP. All assignments shall be for assignments received and completed within the last five (5) years.

Event Scope and deliverables, include number of resources engaged in project, timeline of project (major milestones)

List job positions provided and technologies utilized to supplement services.

x

Event Scope and deliverables, include number of resources engaged in project, timeline of project (major milestones)

List job positions provided and technologies utilized to supplement services.

x

Event Scope and deliverables, include number of resources engaged in project, timeline of project (major milestones)

List job positions provided and technologies utilized to supplement services.

x

Attachment 10: Experience References

Statewide Environmental Laboratory Services Arizona Department of Environmental Quality (ADEQ)

Question 1: Describe the Offeror’s review process for quality assurance and timely submittal of result reports to the State Agency as per the scope of work TATs.

Question 2: Describe the laboratory’s electronic reporting capabilities, including reports and electronic data deliverables.

Attachment 11: Method of Approach

Statewide Environmental Laboratory Services Arizona Department of Environmental Quality (ADEQ)

Pricing Sheet pricing:

Offeror shall complete and submit attached EXCEL document titled “BPM004422 Pricing Sheet” for commonly-requested analytes that the Offeror and it’s proposed Subcontractor(s) are certified/licensed by ADHS to provide with the following items:

· Method(s);

· Type (Total, dissolved, etc.);

· Method reporting limits (MRLs);

· Method detection limits (MDLs);

· Unit Cost (14 calendar day TAT);

· Rush Unit Cost;

· Rush Unit TATs (Offeror to specify number of calendar days);

· If Specialty Test and will be over 14 calendar day TAT, Offeror to specify how many days TAT and;

· Lab location performing analysis.

If Offer is not certified/licensed to provide or elects to not provide the test specified, type in “No Bid”

Additionally, the Offeror shall add additional lab analyses that it is licensed/certified for and elects to provide, with Methods, Type, MRLs, Unit Cost, Rush Unit Cost, Rush Unit TATs and Lab Location Performing the analysis to the end of the list of specified tests at the bottom of each worksheet on the “Pricing Sheet”.

Note: There is an EXCEL workbook with eight (8) worksheets on Attachment 4 “Pricing Sheet” to be completed. Worksheets are for services to be separated by the following categories:

· General;

· Surface – Ground Water;

· Drinking Water;

· Air;

· Waste;

· Pharmaceutical;

· Fish and;

· Pesticides Under “General” worksheet, Offeror shall stipulate kit assembly charges, if any, on the Pricing Sheet.

In addition under “General” worksheet, Offeror shall fill-in the blanks for Courier services.

· Indicate whether organization will offer a prompt payment discount, please complete one or more that will apply:

· DISCOUNT WILL BE ____% IF PAYMENT ISSUANCE DATE TO CONTRACTOR IS WITHIN SEVEN (7) CALENDAR DAYS FROM ADEQ’S RECEIPT OF INVOICE.

· DISCOUNT WILL BE ____% IF PAYMENT ISSUANCE DATE TO CONTRACTOR IS WITHIN SEVEN (10) CALENDAR DAYS FROM ADEQ’S RECEIPT OF INVOICE.

· DISCOUNT WILL BE ____% IF PAYMENT ISSUANCE DATE TO CONTRACTOR IS WITHIN ___ ( ) CALENDAR DAYS FROM ADEQ’S RECEIPT OF INVOICE.

On this page Offeror to include a one (1) paragraph (4 sentences maximum) description as to how Offeror derived the proposed rates.

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