BUS BID ATTACHMENTS.pdf

REQUIRED ATTACHMENTS

The bid must include each completed and signed a3achment.

REQUIRED PROPOSAL FORMS

ATTACHMENT A

PROPOSER’S OFFER AND GUARANTEES

By execution below, the Proposer hereby offers to furnish the items as described herein. The Proposer also certifies that it can and will provide and make available, at a minimum, the items set forth in this solicitation.

PAYMENT REMITTANCE

FIRM’S NAME AND ADDRESS ADDRESS

Name: Name:

Address: Address:

P.O. Box or Suite No. P.O. Box or Suite No.

City

City

State

State Zip Zip

Contact Person:

Telephone No. Fax No. E-Mail Address:

FEDERAL EMPLOYER I.D. NUMBER: SOCIAL SECURITY NUMBER: (If Federal I.D.

is not applicable)

Payment Terms: Age of Firm:

Disadvantaged Business Enterprise:

( ) Yes ( ) No

If yes, certified by which agency?

( ) Female ( )

Male ( ) Black ( ) Hispanic ( ) Asian American ( ) Indian/Alaskan Native ( ) Other ( ) Not Applicable Annual Gross Receipts: ( ) less than $500,000 ( ) $500,000 to $1 million ( ) $1 million to $5 million ( ) greater than $5 million

Contractor’s License Type:

Contractor’s License Number:

License Expiration Date:

Signature of Con

Name and Title of tractor's Contractor's Authorized

ATTACHMENT B

PRE-AWARD MANUFACTURER'S CERTIFICATION

That Name of Proposal hereby certifies that the ___________________________________________________

MANUFACTURER

vehicle(s) offered by this Proposal have been designed, manufactured, assembled, tested and found suitable for intended purpose as specified in the Proposal documents, and as such the vehicle(s) do comply fully with the MDOT's specifications.

Name of Firm

Address

City State Zip elephone T

Authorized Person Name and Title (Type or Print)

Signature of Authorized Person

Date

ATTACHMENT C

STATEMENT OF ELIGIBILITY

REGARDING DEBARMENT AND SUSPENSION

That Name of Proposal

Hereby certifies that neither it nor its “principals" [as defined at 49 C.F.R. Part 29.105(p)] is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction be any Federal department or agency.

This contract is a covered transaction for purposes of 49 CFR Part 29. As such, the contractor is required to verify that none of the contractor, its principals, as defined at 49 CFR 29.995, or affiliates, as defined at 49 CFR 29.905, are excluded or disqualified as defined at 49 CFR 29.940 and 29.945. The contractor is required to comply with 49 CFR 29, Subpart C and must include the requirement to comply with 49 CFR 29, Subpart C in any lower tier covered transaction it enters into.

By signing and submitting its Proposal or proposal, the Proposal or proposer certifies as follows:

The certification in this clause is a material representation of fact relied upon by the Mississippi Department of Transportation. If it is later determined that the Proposal or proposer knowingly rendered an erroneous certification, in addition to remedies available to MDOT, the Federal Government may pursue available remedies, including but not limited to suspension and/or debarment. The Proposal or proposer agrees to comply with the requirements of 49 CFR 29, Subpart C, while this offer is valid and throughout the period of any contract that may arise from this offer. The Proposal or proposer further agrees to include a provision requiring such compliance in its lower tier covered transactions.

City State Zip Telephone

Signature of Authorized Person Date

ATTACHMENT D

DISADVANTAGED BUSINESS ENTERPRISE

CERTIFICATION FOR TRANSIT VEHICLE MANUFACTURERS

The Proposal hereby certifies that it has complied with the requirements of 49 CFR Section 26. If it is a transit vehicle manufacturer, the Proposal certifies that it has complied with the requirements of 49 CFR Section 26 by submitting an annual DBE goal to the Federal Transit Administration (FTA).

The goal has either been approved or not disapproved by FTA.

The Proposal, if a non-manufacturer supplier, hereby certifies that the manufacturer of the transit vehicle to be supplied has complied with the requirements of 49 CFR Section 26.

Telephone

ATTACHMENT E

FEDERAL MOTOR VEHICLE

SAFETY STANDARD CERTIFICATION

That ___________________________________________________________________

Hereby certifies that the vehicle offered in this Proposal comply with the Federal Motor Vehicle Safety Standard (FMVSS) as established by the Department of Transportation and with requirements of the laws of the State of Mississippi, all as are in effect at the time of delivery of the vehicles as to including lighting equipment, as well as all warning, operating and safety devices.

The Proposal shall submit 1) manufacturer’s FMVSS self-certification sticker information that the vehicle being Proposal complies with the relevant FMVSS or 2) manufacturer’s certified statement that the contracted buses will not be subject to FMVSS regulations.

ATTACHMENT F

AMERICAN WITH DISABILITIES ACT (ADA)

VEHICLE ACCESSIBILITY CERTIFICATION

That _______________________________________________________ hereby certifies that the ___________________________________________vehicle(s)

Manufacturer offered by this Proposal have been designed, manufactured, assembled, tested, and found suitable for the transportation of disabled person and that such vehicle(s) are in compliance with the U.S. DOT and FTA regulations concerning accessibility specification, including but not limited to CFR 49 Part 38.

ATTACHMENT G

CIVIL RIGHTS

CERTIFICATION FOR TRANSIT VEHICLE MANUFACTURERS

The Proposal, if a transit vehicle manufacturer, hereby certifies that it will comply with the regulations of the U.S. Department of Transportation as stated in 49 CFR Part 19, Section 21, as amended (Title VI) which will be incorporated by reference and made a part of all contracts.

or

The Proposal, if a non-manufacturer supplier, hereby certifies that the manufacturer of the transit vehicle to be supplied will comply with the above referenced requirement of 49 CFR Part 19, Section 21, as amended per (Title VI).

ATTACHMENT H

BUY AMERICA CERTIFICATE

(Rolling Stock)

This procurement is subject to the Federal Transit Administration Buy America Requirements.

A Buy America Certificate, as per attached format, must be completed and submitted with the Proposal. A Proposal which does not include the certificate will be considered non- responsive.

A waiver from the Buy America Provision may be sought by MDOT if grounds for the waiver exist.

The Proposal hereby certifies that it will comply with the requirements of 49 U.S.C. Section 5323(j)(2)(C), Section 165(b)(3) of the Surface Transportation Assistance Act of 1982, as amended, and the regulations in 49 CFR 661.11:

Or

The Proposal hereby certifies that it cannot comply with the requirements of 49 U.S.C.

Section 5323(j)(2)(C), 49 C.F.R. 661.11, Section 165(b)(3) of the Surface Transportation Act of 1982, as amended, but may qualify for an exception to the requirement pursuant to 49 Section (j)(2)(A) or (i)(2)(B), or (j)(2)(D), or section 165(b)(2) or (b)(4) of the Surface Transportation Assistance Act, as amended, and regulations in 49 CFR 661.7.

Date

Signature of Authorized Person

ATTACHMENT I

SERVICE AND PARTS

The Proposal shall state below the representatives responsible for assisting the MDOT and the contractor operating the vehicle to ensure that adequate parts and authorized service locations are available to the greatest extent practical throughout the State.

The Proposal agrees to furnish along with each Proposal, a complete list of the location of the nearest distribution center, which shall furnish a complete supply of parts and components for the repair and maintenance of the vehicle supplied. The Proposal shall state below or by separate attachment, its policy on transportation charges for parts other than those covered by warranty.

Location of nearest Technical Service Representative to Procuring Agency:

Location of nearest Parts Distribution Center to Procuring Agency:

Policy for delivery of parts and components to be purchased for service and maintenance:

Regular Method of Shipment:

Cost to Procuring Agency:

Proposal must also supply a list of recommended parts to be stocked ad their price lists.

ATTACHMENT J

CERTIFICATION REGARDING DRUG-FREE

WORKPLACE REQUIREMENTS

That_______________________________________________________ hereby certifies that it will comply with Federal Transit Administration regulations regarding Drug – Free Workplace Requirements.

ATTACHMENT K

CERTIFICATION OF RESTRICTIONS ON LOBBYING

(This Certification is required to be completed and returned by the contractor with the Proposal. Failure to return this certification with the Proposal will result in a determination that the Proposal is nonresponsive or unacceptable.)

The undersigned certifies, to the best of his or her knowledge or belief, that:

1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress in connection with this application, an officer or employee of Congress, or an employee of a grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.

3. The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, sub- grants, and contracts under grants, loans, and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

The Contractor, certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. 3801, et seq., apply to this certification and disclosure, if any.

These instruments executed this _________ day of _________________, __20_______

By_________________________________________________ (Signature of Contractor’s Authorized Official)

(Printed/Typed Name of Contractor’s Authorized Official) (Title of Contractor’s Authorized Official)

ATTACHMENT L

MANUFACTURER’S CERTIFICATION

FOR BUS TESTING PROGRAM

(49 CFR PART 665)

In accordance with 49 CFR Part 665, Bus Testing Program, _________________________________, hereby certifies that the ___________________________________________________ Manufacturer’s Name and Model Number vehicle(s) will comply with 49 U.S.C. 5323(c) and will meet the following conditions before a contract is awarded for any new bus purchase by the Mississippi Department of Transportation.

1. A model of the bus has been tested at the Pennsylvania Institute Bus Testing Facility (Altoona Testing Center); and

2. The Mississippi Department of Transportation will receive a copy of the Test Report on the bus model being Proposal, no later than sixty (60) days after the Proposal opening date.

The undersigned understands that misrepresenting the testing status of a vehicle acquired with Federal financial assistance may subject the undersigned to civil penalties as outlined in the Department of Transportation's regulation on Program Fraud Civil Remedies, 49 CFR Part 31. In addition, the undersigned understands that FTA may suspend or debar a manufacturer under the procedures in 49 CFR Part 29.

ATTACHMENT M

MANUFACTURER’S CERTIFICATION OF

ROLLING STOCK MINIMUM SERVICE LIFE

That _______________________________________________________ tested and is in compliance with the Federal Transit Administration’s requirements and regulations concerning rolling stock minimum service life requirements. The bus that is being Proposal has a minimum service life of years and/or an accumulation of ________________ miles.

ATTACHMENT N

MANUFACTURER’S CERTIFICATION OF

COMPLIANCE WITH THE CLEAN AIR ACT

That __________________________________________________ tested and has been found to be in compliance with all applicable standards, orders or regulations issued pursuant to the Clean Air Act, as amended, 42 U.S.C. §§ 7401 et seq and the National Environmental Policy Act.

ATTACHMENT O

CERTIFICATION OF COMPLIANCE WITH

AMERICANS WITH DISABILITIES ACT OF 1990

That ______________________________________________ hereby certifies that it will comply with all regulations and requirements of the Americans with Disabilities Act f 1990.

ATTACHMENT P

CERTIFICATION OF COMPLIANCE WITH FEDERAL TRANSIT ACT

AND

FIXING AMERICA’S SURFACE TRANSPORTATION ACT (FAST ACT)

That ___________________________________ hereby certifies that it will comply with all regulations and requirements of the Federal Transit Act, as amended; and the Fixing America’s Surface Transportation Act of December 4, 2015, as amended.

ATTACHMENT Q

CERTIFICATION OF PROGRAM FRAUD AND FALSE OR FRAUDULENT

STATEMENTS OR RELATED ACTS

(This Certification is required to be completed and returned by the contractor with the Proposal. Failure to return this certification with the Proposal will result in a determination that the Proposal is nonresponsive or unacceptable.)

The undersigned certifies, to the best of his or her knowledge or belief, that:

(l) The Proposal acknowledges that the provisions of the Program Fraud Civil Remedies Act of 1986, as amended, 31 U.S.C. §§3801 et seq. and U. S. DOT regulations, "Program Fraud Civil Remedies," 49C.F.R. Part 31, apply to its actions pertaining to this Project. Upon execution of this Contract Agreement, the Proposal certifies or affirms the truthfulness and accuracy of any statement it has made, it makes, it may make, or cause to be made, pertaining to the contract or the FTA assisted project for which this contract work is being performed. In addition to other penalties that may be applicable, the Proposal further acknowledges that if it makes, or causes to be made, a false, fictitious, or fraudulent claim, statement, submission, or certification, the Federal Government serves the right to impose the penalties of the Program Fraud Civil Remedies Act of 1986 on the Proposal to the extent the Federal Government deems appropriate.

(2) The Proposal also acknowledges that if it makes, or causes to be made, a false, fictitious, or fraudulent claim, statement, submission, or certification to the MOOT or the Federal Government under a contract connected with a project that is financed in whole or in part with Federal assistance originally awarded by FTA under the authority of 49 U.S.C. §5307, the Government reserves the right to impose the penalties of 18 U.S.C. §1001 and 49 U.S.C. §5307(n)(l) on the Proposal, to the extent the Federal Government deems appropriate.

(3) The Proposal agrees to include the above two clauses in each subcontract financed in whole or in part with Federal assistance provided by FTA. It is further agreed that the clauses shall not be modified, except to identify the subcontractor who will be subject to the provisions.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 3801, Title 31, United States Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

The Contractor, __________________________________________, certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any.

These instruments executed this _________ day of __________________________, __20_______

By_____________________________________________________________ (Signature of Contractor’s Authorized Official)

(Printed/typed Name of Contractor’s Authorized Official)

(Title of Contractor’s Authorized Official)

ATTACHMENT R

TERMINATION OF CONTRACT

That ____________________________________________ hereby certifies that it will comply with 49 CFR Part 18 and FTA Circular 4220.1F in regarding the Termination of this or any contract if deemed necessary by the Contracting Agency.