BPM006201 Offer and Acceptance.pdf

Procurement

ATTACHMENT

OFFER AND ACCEPTANCE

Solicitation No: BPM006201 Available online at https://app.az.gov

Rev 09/2022

OFFER

TO THE STATE OF ARIZONA:

The undersigned hereby offers and agrees to perform in compliance with all terms, conditions, specifications and amendments of this solicitation and any written exceptions in the offer. Signature also acknowledges receipt of all pages indicated in the Table of Contents.

Offeror (Company) Name Signature of Person Authorized to Sign Offer

Address Printed Name Date

City State Zip Title

Email Address Phone Number

Company Email Address Fax Number

By signature in the Offer section above, the Offeror certifies that the submission of the Offer did not involve collusion or other anticompetitive practices.

ACCEPTANCE OF OFFER (FOR DEPARTMENT USE ONLY)

The Contractor is now bound to perform based upon Contract Number _________________________________including all terms, conditions, specifications, amendments, etc., and the Contractor's offer as accepted by the state.

The Contractor is hereby cautioned not to commence any billable work or provide any material, service or construction under this contract until contractor receives a purchase order document.

State of Arizona

Effective this day of 20

Procurement Officer Awarded Date

Aqua-Serv Engineers, Inc

13560 Colombard Court

Fontana Ca 92337 tminamyer@aqua-serv.com tminamyer@aqua-serv.com

Tim Minamyer 6-06-2024

Account Manager

951-703-5130

951-681-9698 https://app.az.gov/

Rev. 08/2023

Risk Management

ADOT PROCUREMENT CONTRACT INSURANCE CHECKLIST

Instructions: This checklist is a tool provided to assist in expediting the review of the required insurance documents as outlined in the Special Terms and Conditions of your contract. This checklist is intended to clearly outline the required insurance documents that need to be added to your contract before orders can be placed. It is recommended that you provide this checklist and a copy of your ADOT contract to your insurance broker or agent. After your insurance broker or agent provides the required items identified below, check the box in the “Included” column for each document. Once this is completed, forward this checklist and the required documents to the Procurement Officer as indicated in your award letter.

Required Description of Insurance Requirement Included

Certificate of Insurance

Certificate of Insurance to include:

• Certificate Holder to read: The State of Arizona/ADOT, 206 S. 17th Ave, Phoenix, AZ 85007

• Description of Operations: Must state that the insurance applies to any and all work performed for or on behalf of the State of Arizona/ADOT

General Liability ☒ Additional Insured Endorsement for Ongoing Operations ☐ ☐ Additional Insured Endorsement for Completed Operations (Construction only) ☐ ☒ Waiver of Subrogation Endorsement or Policy Verbiage ☒ ☒ Primary and Noncontributory Endorsement ☒

Auto Liability ☒ Additional Insured Endorsement ☒ ☒ Waiver of Subrogation Endorsement ☒ ☐ Coverage provided for hazardous material transportation (if applicable) ☐

Worker’s Compensation ☒ Waiver of Subrogation Endorsement ☒

Professional Liability (if applicable) ☐ Policy limit meets contract requirements ☐

Contractor’s Pollution Liability (if applicable) ☐ Includes coverage for pollution losses arising out of completed operations ☐ ☐ Additional Insured Endorsement ☐ ☐ Waiver of Subrogation Endorsement ☐ ☐ Primary and Noncontributory Endorsement ☐

Professional Environmental Liability (if applicable) ☐ Policy limit meets contract requirements ☐

Other Required Insurance (if applicable) ☐ Technology Errors and Omissions (no endorsements required) ☐ ☐ Network Security (Cyber) and Privacy Liability (additional insured, waiver of subrogation, primary and noncontributory endorsements are required) ☐

☐ Media Liability Coverage (no endorsements required) ☐ ☐ Commercial Crime Policy or Blanket Fidelity Bond (loss payee endorsement is required) ☐ ☐ Aviation/Aircraft Liability (endorsements to be determined by ADOT Risk as applicable) ☐ ☐ Installation Floater (additional insured, loss payee, waiver of subrogation, primary and noncontributory endorsements are required) ☐

☐ Builder’s Risk (additional insured, loss payee, and waiver of subrogation endorsements are required) ☐

☐ Other:__________________________________ ☐