Capital IFB Required Forms_02-05-26.pdf

HOWARD COUNTY, MARYLAND

Office of Procurement and Contract Administration

AFFIDAVIT

Must be completed, signed by an officer of the company (President, CEO, Vice President, etc.)

Contractor

Address

I, , the undersigned, of the above named

(Print Signer's Name) (Title)

Contractor does declare and affirm this day of , , that I hold the aforementioned office

(Month) (Year) in the above named Contractor and I affirm the following:

AFFIDAVIT I

The Contractor, his Agent, servants and/or employees, have not in any way colluded with anyone for and on behalf of the Contractor or themselves, to obtain information that would give the Contractor an unfair advantage over others, nor have they colluded with anyone for and on behalf of the Contractor, or themselves, to gain any favoritism in the award of the contract herein.

AFFIDAVIT II

No officer or employee of Howard County, whether elected or appointed, has in any manner whatsoever, any interest in or has received prior hereto or will receive subsequent hereto any benefit, monetary or material, or consideration from the profits or emoluments of this contract, job, work or service for the County, and that no officer or employee has accepted or received or will receive in the future a service or thing of value, directly or indirectly, upon more favorable terms than those granted to the public generally, nor has any such officer or employee of the County received or will receive, directly or indirectly, any part of any fee, commission or other compensation paid or payable to the County in connection with this contract, job, work, or service for the

County, excepting, however, the receipt of dividends on corporation stock.

AFFIDAVIT III

Neither I, nor the Contractor, nor any officer, director, or partners, or any of its employees who are directly involved in obtaining contracts with Howard County have been convicted of bribery, attempted bribery, or conspiracy to bribe under the laws of any state, or of the federal government for acts of omissions committed after July 1, 1977.

AFFIDAVIT IV

Neither I, nor the Contractor, nor any of our agents, partners, or employees who are directly involved in obtaining contracts with

Howard County have been convicted within the past 12 months of discrimination against any employee or applicant for employment, nor have we engaged in unlawful employment practices as set forth in Section 12.200 of the Howard County Code, or Subtitle 6 of

Title 20 of the State Government Article, Annotated Code of Maryland or, of Sections 703 and 704 of Title VII of the Civil Rights

Act of 1964 as amended.

AFFIDAVIT V

The Contractor:

i. Is not currently identified on the list created by the Maryland State Board of Public Works as a person engaging in investment activities in Iran as described in Section 17-702 of the Maryland State Finance and Procurement

Article ; or

ii. Is not currently engaging in investment activities in Iran as described in Section 17-702 of the Maryland State

Finance and Procurement Article.

If the person is unable to make the certification, it will provide the County, a detailed description of the Contractor’s investment activities in Iran.

AFFIDAVIT VI

If applicable, the Contractor has complied with Sections 14-101 through 14-108 of the Election Law Article of the Annotated Code of Maryland, which requires that every person that enters into, during any 24 month period, one or more contracts, leases, or other agreements with the State, a county, or an incorporated municipality, or their agencies, involving a cumulative consideration of at least $200,000 or more, shall file with the State Administrative Board of Election Laws a statement disclosing contributions to a candidate, or a series of such contributions, in a cumulative amount in excess of $500 made during the reporting period to a candidate for elective office in any primary or general election.

I do solemnly declare and affirm under the penalties of perjury that the contents of the foregoing affidavits are true and correct to the best of my knowledge, information and belief.

Signature

Printed Name

Title Rev. 01/29/2020

CONTRACTOR INFORMATION

SOLICITATION NO.:

SOLICITATION TITLE:

The undersigned agrees to furnish and deliver the above goods and/or services in accordance with the specifications issued for same, and subject to all terms, conditions, and requirements in the solicitation, and in the various bid documents:

COMPANY NAME:

FEDERAL TAX IDENTIFICATION NO./SOCIAL SECURITY NO.:

ADDRESS:

(Street) (City) (State) (Zip)

TELEPHONE: FAX:

EMAIL ADDRESS:

REPRESENTATIVE’S NAME:

TITLE:

If applicable, for Agreements, provide the name and title of the person with legal authority to sign on behalf of the

Contractor. If the title of the individual is not “President” or “Vice President”, provide verification of the signatory authority with your submittal.

NAME OF COMPANY SIGNATORY (Printed):

TITLE OF COMPANY SIGNATORY (Printed):

Howard County prefers to email Purchase Orders when possible, please provide an EMAIL ADDRESS FOR

RECEIPT OF PURCHASE ORDERS:

Does the company have a written non-discrimination policy (i.e.: race, creed, religion, handicap, color, sex, national origin, age, occupation, marital status, political opinion, sexual orientation, gender identity/expression, personal appearance, familial status, source of income)? YES NO

The County reserves the right to request such documentation, if desired, at a later date.

Howard County is exempt from all local, state, and federal taxes, and prices stipulated by the Contractor are considered maximum and are not subject to any increase due to any taxes, or any other reason. The County’s tax-exempt status ho wever is NON-TRANSFERABLE. Prices stipulated by the Contractor are considered maximum and are not subject to any increase due to any taxes, or any other reason. Contractor’s bid price shall be inclusive of any fees or taxes responsible by the Contractor.

Delivery Time After Receipt of Order:

If applicable, this delivery time will be considered in determining the award.

Delivery Terms: F.O.B. Destination, Inside Delivery.

The company accepts Visa cards: Yes No

Contractors are not permitted to charge the County any additional fees over and above their bid prices to process payments on procurements cards.

Payment Terms: (The payment terms shall be considered net 30 days unless otherwise indicated.)

Howard County, Maryland Page 1 of 1 Office of Procurement

Via eProcurement System

Revised 9/15/2023

VETERAN-OWNED BUSINESS ENTERPRISE PROGRAM FORM

Complete this form and return it with your response to the solicitation

Complete Part 1 below if: Prime Contractor is certified in the Veteran Small Business Certification (VetCert) Program as a Veteran-owned Small Business by the US Small Business Administration (SBA)

Complete Part 2 below if: Prime Contractor is proposing to subcontract with a business that is certified in the Veteran Small Business Certification (VetCert) Program as a Veteran-owned Small Business by the US Small Business Administration (SBA)

Complete Part 3 below if: Prime Contractor proposes NO Veteran-Owned Business Enterprise participation

Check as applicable

1. □ Veteran-Owned Business Enterprise Certification:

Prime Contractor is certified in the Veteran Small Business Certification (VetCert) Program as a Veteran-owned Small Business by the US Small Business Administration (SBA)

2. □ Veteran-Owned Business Enterprise Subcontract Participation:

Prime Contractor proposes to subcontract with a business that is certified in the Veteran Small Business Certification (VetCert) Program as a Veteran-owned Small Business by the US Small Business Administration (SBA) as described below:

Name(s) of VOBE Subcontractor(s): ______________________________________________________________ Description of Work: __________________________________________________________________________ Percentage of Participation: __________ %

3. □ NO Veteran-Owned Business Enterprise Subcontract Participation Proposed.

Name of company: ___________________________________________________________________________ Printed name: _______________________________________________Title: ____________________________ Authorized signature: _________________________________________Date: ____________________________ Email: _____________________________________________________ Phone: ___________________________

In accordance with Section 4.130 of the Howard County Code, it is the policy of Howard County Government to encourage increased participation by Veteran-Owned Business Enterprises in the procurement of all goods and services through all solicitations by the County. The Veteran-Owned Business Enterprise (VOBE) program includes an overall aspirational goal of 1% of the County’s total dollar value of procurement contracts to be made directly or indirectly with Veteran-Owned Business Enterprises. Participation may be either on a direct basis in response to this solicitation or on a subcontractor basis.

For the purposes of the Veteran-Owned Business Enterprise Program, a Veteran-Owned Business Enterprise (VOBE) is defined as a business enterprise that is certified in the Veteran Small Business Certification (VetCert) Program as a Veteran-owned Small Business by the US Small Business Administration (SBA). To search the database of certified veteran-owned businesses please visit https://veterans.certify.sba.gov https://veterans.certify.sba.gov/

EQUAL BUSINESS OPPORTUNITY PARTICIPATION

NOTICE TO PRIME CONTRACTORS

15% SUBCONTRACTING GOAL ON CONTRACTS

VALUED AT $50,000 OR MORE

Howard County Code Section 4.122 established an Equal Business Opportunity program to foster overall equity and fairness to all citizens in relation to business enterprises conducting business with the County.

If a contract is $50,000 or more, the Prime Contractor shall make a good faith effort to comply with the Howard County Equal Business Opportunity (EBO) program’s 15% subcontracting goal. The Prime Contractor shall make a good faith effort to obtain minority subcontractor participation even if the Prime Contractor has the capability to complete the work with its own workforce. Certified MBE/WBE/DBE prime contractors can count 100% of the work they self-perform on contracts with EBO subcontracting goals. The subcontracting goal percentage may vary if the contract is funded by a federal or state agency.

Prime Contractors should submit the following completed Equal Business Opportunity Subcontractor Participation Form with the bid. Identify subcontractors prior to submitting the proposal. After contract award, changes in subcontractors require the written approval of the EBO Coordinator.

Possible areas of obtaining subcontracting participation include, but are not limited to, flagging services, hauling, copying and printing, and the purchase of materials used in performing the contract.

Contractors may use minority, women or disabled business enterprises certified by Howard County, Maryland; the Maryland Department of Transportation; the City of Baltimore, Maryland; or another certifying entity in order to satisfy the 15% subcontracting goal. The website addresses for lists of minority businesses are:

Procurement & Contract Administration | Howard County Maryland DOT - Vendor Management System

City of Baltimore - Diversity Management System

Contractors should submit a completed Equal Business Opportunity Subcontractor Participation Form with the bid identifying each certified EBO firm they intend to use on the contract. However, if the EBO Subcontractor Participation Form is not submitted with the bid, the County may request EBO subcontractor participation of the successful contractor.

Contractors failing to achieve the Equal Business Opportunity Program goal following a good faith effort to obtain participation must complete the Equal Business Opportunity Program Request for Subcontracting Waiver and provide documentation of its good faith attempts to obtain EBO participation.

The County will determine if the efforts made satisfy a good faith attempt. A waiver will only be considered in rare contracts after a determination that the Contractor has made a good faith effort and thoroughly documented the efforts. Contractors should submit the Equal Business Opportunity Program Request for Subcontracting Waiver with the bid. However, if the request for waiver form is not submitted with the bid, the County may obtain the request for waiver of the successful contractor.

If the County exercises its option to renew the contract, it is expected that the EBO subcontracting goal will be met for each subsequent contract year when the contract amount is $50,000.00 or more.

Questions relating to the EBO program shall be directed to the EBO Coordinator 410-313-6370.

PRIME CONTRACTORS’ COMPLIANCE OF EBO SUBCONTRACTOR PARTICIPATION

Prime Contractors that are awarded County contracts shall maintain adequate records of EBO participation on County contracts. The County may require that prime contractors report whether or not they met the proposed EBO subcontracting goal, so that the County can track compliance of EBO participation on County contracts.

Revised 02/05/2026

Revised 02/05/2026 Buyer Initial:

HOWARD COUNTY, MARYLAND

EQUAL BUSINESS OPPORTUNITY (EBO)

SUBCONTRACTOR PARTICIPATION FORM

COUNTY USE ONLY

EBO APPROVAL

SIGNATURE (VENDOR OFFICIAL) TITLE DATE

PRINTED NAME EMAIL

INSTRUCTIONS FOR COMPLETING THIS FORM

Complete the section below identifying each certified EBO firm (Minority (MBE), Woman (WBE), and Disabled (DBE) Business Enterprises) you intend to use on this project. Attach additional sheets if more than two (2) subcontractors.

This form represents the contractor’s commitment to utilize the named EBO firms at the percentages indicated should the contract be awarded to the contractor. This form should accompany your bid or proposal.

*EBO Types: AA (African American), ASA (Asian American), HIS (Hispanic American), NA (Native American), FEM (Female), DIS (Disabled)

PRIME CONTRACTOR SHOULD LIST ALL EBO SUBCONTRACTORS / SUBCONSULTANTS / SUPPLIERS

CONTRACT TITLE:

SOLICITATION # CAPITAL PROJECT # CONTRACT / PO #

TERM: RENEWAL # AMOUNT $

PRIME CONTRACTOR NAME:

ADDRESS: PHONE:

EBO STATUS (Y/N): *EBO TYPE: CERTIFICATION # CERTIFYING AGENCY:

SUBCONTRACTOR NAME:

ADDRESS: PHONE:

EMAIL: CONTACT REPRESENTATIVE:

*EBO TYPE (Check One) □ AA □ ASA □ HIS □ NA □ FEM □ DIS

CERTIFYING AGENCY: CERTIFICATION # EBO PARTICIPATION %

DESCRIPTION OF WORK: EBO PARTICIPATION $

SUBCONTRACTOR NAME:

ADDRESS: PHONE:

EMAIL: CONTACT REPRESENTATIVE:

*EBO TYPE (Check One) □ AA □ ASA □ HIS □ NA □ FEM □ DIS

CERTIFYING AGENCY: CERTIFICATION # EBO PARTICIPATION %

DESCRIPTION OF WORK: EBO PARTICIPATION $

Information on Howard County, Maryland’s Living Wage Requirement

Basics of the Howard County Living Wage Legislation

In 2007, the Howard County Council passed legislation requiring a minimum “living wage” for employees of certain contractors and subcontractors of Howard County. A Contractor that is defined as a “Covered Employer” under Howard

County Code Section 4.122A shall pay each employee an hourly rate sufficient to at least equal 125% of the federal poverty guidelines for a family of four individuals calculated on the basis of a 40-hour work week for 52 weeks.

Howard County Code Sec. 4.122A applies to service contracts estimated to be over $100,000.00 per year. The code does not apply to commodities contracts, contractors who employ fewer than 5 employees during the contract term, public entities, non-profit organizations, or contracts awarded under emergency, or expedited procedures. Other contractors may also be exempt; see the complete list of exemptions in Section 1 on the front of this form.

The living wage requirements do not apply to an employee:

• who performs no measurable work related to any contract with the County

• who participates in a government-operated or government-sponsored program that restricts the earnings of or wages paid to employees to a level below the wage required under the law

• who participates for not longer than 120 days in a calendar year in a government-operated or government-sponsored summer youth employment program

• for whom a different wage rate is expressly set in a collective bargaining agreement, or

• for whom a higher wage is required by a federal, state, or County law.

This form serves as written certification to the County of your firm’s intent to comply with the County’s wage requirements during this term and any subsequent renewals. A Covered Employer shall not subdivide a contract; pay an employee through a third party; or treat an employee as a subcontractor or independent Contractor to avoid the imposition of any requirement under this law. Failure to comply with this requirement at any time during the initial term and subsequent renewals may be sufficient cause for termination for default. A violation of this law is a Class A civil offense;

in addition to a fine, the County may suspend or debar the violator under Howard County Code Sec. 4.117.

Current Living Wage Rate in Howard County

As of January 15, 2026, the Living Wage Rate is $19.83 per hour.

How the Living Wage Rate is Calculated

The Howard County Living Wage Rate is calculated by taking 125% of the Federal Poverty Guideline for a family of 4, then using this amount to determine the hourly rate based on 40 hours/week. On January 15, 2026, the Federal HHS

Poverty Guideline was published as $33,000 for a family of 4 (see https://aspe.hhs.gov/poverty-guidelines).

125% of $33,000 = $41,250.00 $41,250.00 ÷ 52 weeks ÷ 40 hrs/week = $19.83 per hour

This hourly rate must be paid to employees (full-time or part-time) during the time the employees actually provide services to the County. The current Living Wage remains in effect until new federal poverty guidelines are published, which is usually the following January. If there is a change, the Office of Procurement and Contract Administration will attempt to notify all current contractors via email using the email address provided on this form. The current rate is posted on our website at https://www.howardcountymd.gov/procurement-contract-administration. It is the contractor’s responsibility to ascertain the current rate.

Since the rate is subject to change annually, you must ensure that your bid pricing is sufficient to cover the cost of any increases during the term of the contract, including subsequent renewals. All prices shall take the current wage rate, and subsequent increases in the wage rate, if any, into account and there shall be no unit price adjustment for future wage rate increases during the initial term of this agreement and any subsequent renewals thereof. Future wage rate increases are hereby defined as any new rates approved by the County that take effect after and supersede the rate shown in this solicitation.

If you have questions about the Living Wage Requirement or how to complete this form, please contact the

Office of Procurement and Contract Administration at purchasing@howardcountymd.gov or 410-313-6370.

https://www.howardcountymd.gov/procurement-contract-administration mailto:purchasing@howardcountymd.gov

Howard County, Maryland Wage Rate Requirements for Service Contracts

Exemption Status Subtitle 1, Howard County Code Section 4.122A(b)(2)

Prime Sub-

Contr. Contr.

□ □ Contractor or Subcontractor employs fewer than 5 employees at any time during the contract term.

□ □ Contractor or Subcontractor received less than $100,000 from the County in the most recent 12-month period prior to the start date, and will be entitled to receive less than $100,000 from the County within the next 12-month period.

□ □ Contractor or Subcontractor is a nonprofit organization that has qualified for an exemption from federal income taxes under Section 501(c)(3) of the Internal Revenue Code.

□ □ Contractor or Subcontractor is expressly precluded from complying with Howard County Code Sec. 4.122A by the terms of any federal, state, or County law, federal or state contract or grant, and the contract falls within that preclusion.

□ □ Contractor or Subcontractor is a public entity.

□ □ Contractor or Subcontractor participates in a contract awarded under Howard County Code Secs. 4.111

(Emergency), or 4.112 (Expedited).

□ □ Contractor or Subcontractor is a regulated public utility.

□ □ Contract was awarded under a cooperative procurement with another government or organization of governments.

Check here □ if none of the above statements are applicable to your company or the Subcontractor, then continue to Section 2.

I do hereby certify that I have read and understand the provisions of Section 4.122A of the Howard County Code, that I am an authorized representative of the Contractor named below, and that:

□ As a “covered employer,” the Contractor and all Subcontractors will comply with the County’s Wage Rate Requirements for Service Contracts (Howard County Code Sec. 4.122A) and will pay all employees not exempt under the wage requirements, and who perform direct measurable work for the County, the applicable wage requirements at the time the work is performed. The Contractor will keep the records necessary to show compliance and will submit such records to the

Purchasing Agent on request of the Purchasing Agent; and will publicize the requirements of this law to any employees who may be covered by the law. The Contractor’s proposed pricing is sufficient to meet the current living wage rate requirements during the initial term of the agreement and any increases applicable to subsequent renewals.

□ If health insurance is provided to employees, the per employee hourly cost of the premium for health insurance to an employee who provides services to the County that appears in the bid or proposal is correct.

Contractor Name ______________________________ Vendor Federal ID Number __________________

Address ______________________________________ Phone Number _____________________________

_____________________________________________ Email Address _____________________________

Authorized Signature ___________________________ Date _____________________________________

Print Name of Signatory ________________________ Title of Signatory __________________________

To be completed by the

Buyer

Contract Title: Buyer’s

Initials:

Contract #: Contract Term:

Capital Project No: Renewal #:

rev 01-26-2026

Check all that apply, then continue to Section 2. If none of these statements apply to your company or the Subcontractor, check the last box in this section and continue to Section 2.

Section 1:

Exemptions

Section 2:

Certifications

• If you checked any exemptions in Section 1, skip this section and continue to Section 3.

• If you did not check any exemptions in Section 1, check each box in Section 2 that applies to your company, then complete Section 3 below.

Section 3:

Contact Information

Provide your contact information in the space below, then sign and date this form and submit it with your bid.