Combi Oven_Child Nutrition_NMS_SY25-26.docx

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Combi Oven NMS
Solicitation number
2025 NMS OVEN SY 25-26
Issued by
St. Louis County, Missouri

About this file

This is a bid document from the Hazelwood School District in Florissant, Missouri, soliciting bids for the purchase and replacement of combi ovens at North Middle School. The district is seeking two Alto-Shaam Model 7-20E PRO Prodigi Pro Combi Ovens/Steamers, with a mandatory pre-bid meeting scheduled for Friday, August 15, 2025, at 9:00 a.m. at the school location. Bid proposals are due Monday, August 25, 2025, by 11:00 a.m. CDT through the district's Bidnet online submission system. The ovens come with various specifications including Wi-Fi enabled controls, multiple cooking modes, warranty options, and additional accessories like shelves and fry baskets.

The bid includes detailed requirements for MBE/WBE (Minority and Women Business Enterprise) participation, with goals of 25% for MBEs and 5% for WBEs. Vendors must be certified by specified agencies and complete required forms including HSD Form A (Subcontractor Utilization Form) and HSD Form B (Subcontractor Solicitation Form). The district requires E-Verify documentation and OSHA safety training for workers. Installation will be handled by a local Alto-Shaam Authorized Service Agent, with the winning dealer responsible for removing existing equipment and verifying electrical specifications. The bid emphasizes compliance with USDA non-discrimination guidelines and Buy American provisions for food service equipment.

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File Type Posted
Agreement for Contracted Services_05.08.25.docx DOCX document
HSD FORM B MBE-WBE SUB SOLICITATION.docx DOCX document
E VERIFY.pdf PDF
HSD Form A - Subcontractor .doc DOC document

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Hazelwood School District Combi Oven Replacement & Purchase

Due:

Monday, August 25, 2025 Time: 11:00 a.m. CDT

January 10, 2024

Combi Oven- Child Nutrition – North Middle School The Hazelwood School District is seeking bids to purchase and replace the oven at North Middle School.

There will be a mandatory pre-bid meeting held at Hazelwood North Middle School, located at 4420 Vaile Lane, Florissant MO 63034. The prebid meeting will take place Friday, August 15, 2025 at 9:00 a.m. Please have a business card available to give to the district representative.

Any questions regarding the specifications are to be directed to Danielle Thomas, Director of Purchasing and Supplier Diversity no later than Tuesday, August 19, 2025 at 12:00 p.m. through the Vendor Registry online question submission process via the district’s website at https://www.hazelwoodschools.org/Page/2238. Only these inquiries will be answered. Any items requiring clarification will be distributed to all known vendors.

Interested parties should submit their bid proposals through Bidnet via the district’s website at https://www.hazelwoodschools.org/Page/2238 on or before Monday, August 25, 2025 not later than 11:00 a.m.

Sealed bids shall contain the following non-amended forms:

Bid Forms including:

· HSD Form A – MBE/WBE Subcontractor Utilization Form

· HSD Form B - MBE/WBE Subcontractor Solicitation Form

· Bid Form – Labor Agreement Responses must be submitted on or before the date and time listed above through the district’s Bidnet online bid submission via the district’s website at https://www.hazelwoodschools.org/Page/2238. The Hazelwood School District is not responsible for late or incorrect deliveries. The Hazelwood School District reserves the right to accept or reject any and all bids. Once the Hazelwood School District has awarded the Bid, the Bid Submission will represent as the contractual agreement unless otherwise communicated.

BID SPECIFICATIONS

1.Furnish the commercial combi ovens as described in the specifications below.
2.All shipping and handling fees must be included in the bid submission.
3.Shipping instructions will be provided upon award of the bid.

USDA Non-discrimination Statement: In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form,(AD3027) found online at:

http://www.ascr.usda.gov/complaint filing cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992.

Submit your completed form or letter to USDA by:

(1)Mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250- 9410;
(2)Fax: (202) 690-7442; or (3) email: program.intake@usda.gov. This institution is an equal opportunity provider.

Hazelwood School District-North Middle School 4420 Vaile Avenue Florissant, MO 63034

ITEM 1 - COMBI OVEN, ELECTRIC (2 REQ'D)

Alto-Shaam Model 7-20E PRO Prodigi™ Pro Combi Oven/Steamer, electric, boiler-free, countertop, capacity (7) 18" x 26" full size sheet or (16) 12" x 20" full size hotel pan (GN 1/1), Wi-Fi enabled control with steam/convection/combi cooking modes, removable "T" style temperature probe, (2) power levels, programmable cool-down, SafeVent™ steam venting, (5) cleaning levels, triple-pane door, high efficiency LED lighting, (2) side racks with (8) non-tilt support rails, door hinged right, stainless steel construction, adjustable stainless steel legs, EcoSmart®, cULus, UL EPH Classified, CE, IPX5, ENERGY STAR®, EAC, city-wide COA for New York City

2 eaNOTE: Subject to Manufacturer’s Terms & Conditions. See Documents Section
2 eaOne year parts and labor warranty, standard
2 eaAlto-Shaam Certified Chef provides complimentary support and training on all Alto-Shaam combi ovens
2 eaK-12 Extended Warranty (K-12 operators only): Extends the warranty to 2 years parts and labor. (NET)
2 eaK-12 Extended Warranty (K-12 operators only): Extends the warranty to 3 years parts and labor. (NET)
2 eaIt is the sole responsibility of the owner/operator/purchaser of this equipment to verify that the incoming water supply is comprehensively tested and, if required, provide a means of water treatment that would meet the compliance requirements with the manufacturers water quality standards published on the product spec sheet. Non-compliance with these minimum standards will potentially damage this equipment and/or components and VOID the original equipment manufacturers warranty
2 eaECO
2 ea208-240v/50/60/3-ph/45.7-52.7 amps, 16.4-21.9 kW, No cord or plug
2 ktModel 5021527 Installation Kit, for electric combi ovens, CPVC, rated up to 80.0 amps, per oven ((NET) NO FURTHER DISCOUNTS APPLY)
2 eaNote: Please refer to Installation Program brochure for kit contents 2 eaWifi, standard
2 ea3 Additional shelves (SH-22584, for 6 total) FREE PROMO
2 ea3 Fry baskets for frying or steaming (BS-26730) FREE PROMO 2 eaStacked
1 eaModel 5031207 Reverse Osmosis System, 10 gallon hydropneumatic storage tank, up to 175 gpd production, operates at line pressure (non-electric), particulate & chlorine reduction prefilter, mineral-addition cartridge, post‐filter for chloramine reduction, full system bypass valve and valve-in-head system shut off, includes hose, tubing & fittings for installation, compact wall-mount processor with remote storage tank provides installation flexibility, Include manifold (Y-Fitting) for stacked oven connection (For Stacked Application) ((NET) NO FURTHER DISCOUNTS APPLY)
2 eaNOTE: Prodigi Factory Authorized Installation Program (above) MUST be selected for RO field install option to become available
2 eaRemovable "T" style temperature probe, standard
4 eaModel CE-46991 Alto-Shaam, Concentrated Oven Cleaner, Quantity 50 tablets per container (75 gram tablet size). (Replaces CTP/CTC cleaner, CE-36354)
4 eaModel CE-27889 Scale Free™ deliming product, 4 lb. bottle, citrus-based, non-corrosive 1 eaModel 5016707 Stacking Hardware, 7-20E or 7-20G over 7-20G
1 eaModel 5017391 Mobile Stacking Base, for 7-20 or 10-20 model ovens
1 eaModel INSTALLATION ***Installation to be handled by the local Alto Shaam Authorized Service Agent, with a site survey being required by all bidding dealers, Installation pricing to be priced as separate line item***

***Installer/Dealer will be responsible for removal of any existing equipment deemed by the school district*** ***Winning Dealer must verify all ovens voltages before ordering equipment***

***Installer must consult with District Electrician prior to beginning project***

***Free/Unlimited Culinary Training***

Terms and Conditions

A. PROFESSIONALISM: The District reserves the right to remove any individual employed by the Vendor from the District’s property who may not be conducting him/herself in a professional manner or who may not be dressed properly, if it is in the best interest of the District.

B. HACCP REQUIREMENTS: The District expects a Hazard Analysis Critical Control Point (HACCP) plan to be in place by potential vendors and their manufacturers. Prior to awarding the bid, the District may require documentation.

C. STANDARDS OF IDENTITY: All products must meet the Buy American provision in 7 CFR 210.21(d)requirements. Products must be processed in the U.S. and contains over 51% of its agricultural food component, by weight or volume, from the U.S. Documentation must be available upon request. All products must conform to U.S. minimum standards of identity as authorized by the Food, Drug and Cosmetic Act and the supporting regulations in 21 CFR.

Failure to comply places the Proposer in violation of the contract with the District as well as Federal law.

D. Termination for Cause: Except as may be otherwise provided by this document, the awarded contract maybe terminated in whole or in part by either party to the awarded contract in the event of failure by the other party to fulfill its obligations under the awarded contract through no fault of the terminating party; provided that no such termination may be implemented unless and until the other party is given:

a. at least thirty (30) days written notice (delivered by certified mail, return receipt requested) of intent to terminate, and

b. an opportunity for consultation with the terminating party, followed by a reasonable opportunity, of not more than ten (10) business days or such other reasonable amount of time as may be required under the circumstances, to rectify the defects in products or performance, prior to termination.

E. Termination for Convenience: The SFA may terminate an award prior to the expiration of the term, without cause and without penalty, upon thirty (30) days written notice to the selected Vendor.

F. Debarment and Suspension Certification:

(https://www.fsa.usda.gov/Internet/FSA_File/ad1047.doc) The Vendor certifies that neither the Vendor or its principals; the sub-recipients or their principals; or the subcontractors or their principals are suspended, debarred, proposed for debarment, voluntarily excluded from covered transactions, or otherwise disqualified by any federal department or agency from doing business with the Federal government pursuant to Executive Orders 12549 and 12689. The Vendor specifically covenants that neither the Vendor nor its principals; the subcontractors or their principals; norm the sub-recipients or their principals are included on the Excluded Parties List System ("EPLS") maintained by the General Services Administration ("GSA"). By responding to this solicitation the Vendor is certifying they are in “Good Standing”.

G. Byrd Anti-Lobbying (https://forms.sc.egov.usda.gov/efcommon/eFileServices/eFormsAdmin/SF- LLL_9707V01.pdf)

The Byrd Anti-Lobbying Amendment requires a lobbying certification to be obtained for procurement contracts of more than $100,000. Any vendor whose contract award is for more than $100,000 must complete a Certification Regarding Lobbying form. The SFA must keep this signed certification statement on file with a copy of the vendor’s contract.

H. DELIVERY LOCATION: After award, all deliveries shall be made and all services provided to the location specified by the Child Nutrition Department.

I. STANDARD CONDITIONS OF BID: Delivery charge to be INCLUDED in price quotations. Substitutions to be approved by Child Nutrition Services Office prior to delivery. Substitution without prior approval is cause for disqualification of entire Bid. Bid quantities will be met as nearly as possible based on budgetary guidelines and student participation. All factors including service, accuracy, price and other amenities will be considered when evaluating the bids. Hazelwood Child Nutrition Services will perform a cost or price analysis wherein independent estimates are created prior to issuing the request for proposal.

Hazelwood School District Child Nutrition Services reserves the right to reject any or all bids based solely on Hazelwood Child Nutrition Services evaluation and to waive any technicalities. This does not obligate Hazelwood Child

Nutrition Services to pay any costs incurred by vendors related to submission of proposals in response to this request for bids. Hazelwood Child Nutrition Services may wish to visit Supplier’s facilities, warehouse(s), or other facilities and may use the visitation as a basis for accepting or rejecting proposals.

Supplier(s) shall, upon request and at no charge, accompany Hazelwood Child Nutrition Services personnel.

Hazelwood Child Nutrition Services shall have the right to reject any or all products furnished, which in its sole opinion, are not in strict conformity with the requirements of the bid specifications.

J. PRICES: All bids shall be deemed final, and no bid shall be subject to correction or amendment for error or miscalculation. All bid prices shall be quoted as ‘delivered’ prices to each Hazelwood Child Nutrition Services

BID RESPONSE SHEET

TOTAL PROPOSED BID COST OF COMBI OVEN PURCHASE: $

COMPANY NAME ADDRESS CITY/ZIP

PHONE FAX

E-MAIL FEDERAL TAX ID

X DATE: SIGNATURE

PRINT NAME

AGREEMENT FOR CONTRACTED SERVICES

Hazelwood School District

Contractor:

Address:

City: , State: , Zip:

Telephone Number:

Contractor’s Tax identification Number (or Social Security Number):

Note:

The successful contractor will be required to enter into a contract with the Owner per the bid specifications and bid submission.

1. Scope of Services: CONTRACTOR, in exchange for the compensation paid by DISTRICT under this contract, agrees to provide the following services:

2. Term of Contract: The term of this contract commences on theday of
,, and terminates on theday of,.

3. Compensation: DISTRICT will pay for the services provided by CONTRACTOR under this contract an amount not to exceed $ per .

4. Execution of Contract: This contract is not effective until fully executed by both parties.

Contractor’s SignatureDate
Subscribed and sworn to before me on thisday of,2023.

Notary Public My Commission Expires:

District’s Signature Date

HAZELWOOD SCHOOL DISTRICT 15955 NEW HALLS FERRY ROAD FLORISSANT, MISSOURI 63031

BID FORM

Name Title

The undersigned hereby certifies to the Board that % of its workmen and % of the workmen of all of its contractors for the Project have satisfactorily completed an apprenticeship program developed and operated in accordance with the Policy Recommendation, as that term is defined in the Specifications. Inaccurate certifications shall constitute cause for termination of any contract with the Board and the Board may then require, whether or not included in the contract, indemnification for any costs incurred by the Board in connection with the termination.

The undersigned hereby certifies to the Board that it (is) (is not) already bound by a collective bargaining agreement with the St. Louis Building and Construction Trades Council, AFL- CIO, and its affiliated Local Unions. If not already bound, the undersigned hereby certifies that it (will) (will not) enter into such an agreement for this Project. Inaccurate certifications shall constitute cause for termination of any contract with the Board and the Board may then require, whether or not included in the contract, indemnification for any costs incurred by the Board in connection with the termination.

The undersigned hereby proposes to complete the work shown and specified and delivered to the Board no later than the agreed upon schedule. In addition to the information requested herein, attach a current and complete form, the American Institute of Architects, Contractor’s Qualification Statement, AIA Document A305, and a copy of the bidding contractor’s current Business License. The Board, in the interest of a standardization and ultimate economy reserves the right to require a substitution for Subcontractors, materials and equipment proposed by the bidder.

One of the following must be checked:

( ) The undersigned is bound by an agreement.

If bound, please indicate what union your agreement is with:

If not bound:

( )The undersigned will enter into an agreement for this project.
( )The undersigned will not enter into an agreement for this project.

Bidder Signature: Date:

Bidder Name & Title:

Company Name: Federal I.D. No.:

Official Address: City, State, Zip:

Phone: Corporate Seal:

SUPPLIER DIVERSITY

The Hazelwood School District has established a Supplier Diversity Program to provide opportunities for the meaningful participation of Minority Business Enterprises (MBEs) and Women Business Enterprises (WBEs) in purchases made by the District. To this end the District has set goals for participation on all construction projects of 25% for MBEs and 5% for WBEs. The Supplier Diversity Program also encourages its business partners to strive for a workforce goal of twenty five percent (25%) minority and five percent (5%) women. The District may reject any and all bids that do not meet its program goals.

Upon request and verification of need by the Hazelwood School District, the District will pay MBE/WBE contractors every two weeks for labor cost upon presentation of required documentation.

The Hazelwood School District Supplier Diversity Program can be downloaded from the district’s website at www.hazelwoodschools.org; on the left side of the home page click on “Bids and Proposals,” then go to the section labeled “Documentation.” The entire program including forms A and B are located within the Supplier Diversity document.

The District will accept, as prospective MBE/WBE participants for these projects, only those MBE/WBE firms which have been certified by one or more of the following agencies on or before the date of the bid opening:

1. City of St. Louis (St. Louis Development Corporation/Airport Authority)

2. St. Louis Minority Supplier Development Council (SLMSDC)

3. Missouri Regional Certification Committee (MRCC)

4. State Certifications, e.g., the State of Missouri and other states

5. National Minority Supplier Development Council (NMSDC)

6. Women Business Enterprise National Council (WBENC) and its affiliates In the case of a manufacturer, the District will also accept MBE/WBE certification by any state division of purchasing or the National Minority Supplier Development Council and its affiliates.

The School District reserves the right to reject any and all Bids, to waive informalities therein to determine the lowest and best bid, and to approve the Bond. No Bid may be withdrawn for a period of 60 days subsequent to the specified time for receipt of bids.

HAZELWOOD SCHOOL DISTRICT

Supplier Diversity Program

SUBCONTRACTOR UTILIZATION FORM

Project Name:

Prime Contractor:

If I am awarded this bid I will subcontract with the following MBE/WBE firms:

Work or TradeMBE/WBE Firm NameSubcontract Amount
to be Subcontractedor Joint Venture(MBE)(WBE)

SUBTOTALS: $ $ MBE/WBE SUBCONTRACTS TOTAL $

TOTAL BID: _ TOTAL MBE % TOTAL WBE % _

NOTE: A MBE or WBE Subcontractor may be included as a Joint Venture with a Non-Certified MBE/WBE on Form “A”. However, only the portion of work to be managed and performed by the Certified MBE/WBE may be counted towards the goal.

HSD FORM A

Project Name:

HAZELWOOD SCHOOLDISTRICT

Supplier Diversity Program

MBE/WBE SUBCONTRACTOR SOLICITATION REPORT

Prime Contractor:

I have contacted the following minority and women business enterprises and will not subcontract with them due to the reasons cited below: (Attach additional pages as necessary) Firm Name and Contact Person Mailing Address Reason not utilized

HSD FORM B

Additional Information E-Verify Section 285.530, RSMo, requires businesses that contract with districts for services that may exceed $5,000 to provide affidavits affirming that the businesses use E-Verify and do not employ illegal workers in connection with the contract.

OSHA Training §292.675, RSMo., requires contractors and subcontractors to provide a ten (10) hour OSHA construction safety program for on-site workers of public works projects. If employees/workers/laborers of the contractor or subcontractor have already completed the training program, they must have documentation of completing the program. They do not need to retake this training.

Client References Bidders must supply at least three (3) client references for completed work in the last 1-2 years. Please provide the organizations name, address, phone, contact person, project description and contract amount.

BUSINESS ENTITY CERTIFICATION, ENROLLMENT DOCUMENTATION, AND AFFIDAVIT OF WORK AUTHORIZATION

BUSINESS ENTITY CERTIFICATION:

The Proposer must certify their current business status by completing either Box A or Box B or Box C on this Exhibit.

BOX A: To be completed by a non-business entity as defined below.

BOX B: To be completed by a business entity who has not yet completed and submitted documentation pertaining to the federal work authorization program as described at www.e- verify.gov/.

BOX C: To be completed by a business entity who has current work authorization documentation on file with a Missouri state agency including Division of Purchasing and Materials Management.

Business entity, as defined in section 285.525, RSMo, pertaining to section 285.530, RSMo, is any person or group of persons performing or engaging in any activity, enterprise, profession, or occupation for gain, benefit, advantage, or livelihood. The term “business entity” shall include but not be limited to self- employed individuals, partnerships, corporations, contractors, and subcontractors. The term “business entity” shall include any business entity that possesses a business permit, license, or tax certificate issued by the state, any business entity that is exempt by law from obtaining such a business permit, and any business entity that is operating unlawfully without such a business permit. The term “business entity” shall not include a self-employed individual with no employees or entities utilizing the services of direct sellers as defined in subdivision (17) of subsection 12 of section 288.034, RSMo.

Note: Regarding governmental entities, business entity includes Missouri schools, Missouri universities (other than stated in Box C), out of state agencies, out of state schools, out of state universities, and political subdivisions. A business entity does not include Missouri state agencies and federal government entities.

BOX A – CURRENTLY NOT A BUSINESS ENTITY

I certify that (Company/Individual Name) DOES NOT CURRENTLY MEET the definition of a business entity, as defined in section 285.525, RSMo pertaining to section 285.530, RSMo as stated above, because: (check the applicable business status that applies below)

· I am a self-employed individual with no employees; OR

· The company that I represent employs the services of direct sellers as defined in subdivision (17) of subsection 12 of section 288.034, RSMo.

I certify that I am not an alien unlawfully present in the United States and if (Company/Individual Name) is awarded a contract for the services requested herein under (RFP/RFQ Number) and if the business status changes during the life of the contract to become a business entity as defined in section 285.525, RSMo, pertaining to section 285.530, RSMo, then, prior to the performance of any services as a business entity, (Company/Individual Name) agrees to complete Box B, comply with the requirements stated in Box B and provide Rockwood School District with all documentation required in Box B of this document.

Authorized Representative’s Name (Please Print)

Authorized Representative’s Signature

Company Name (if applicable) Date

(Complete the following if you DO NOT have the E-Verify documentation and a current Affidavit of Work Authorization already on file with the State of Missouri. If completing Box B, do not complete Box C.)

BOX B – CURRENT BUSINESS ENTITY STATUS

I certify that (Business Entity Name) MEETS the definition of a business entity as defined in section 285.525, RSMo, pertaining to section 285.530.

Authorized Business Entity Representative’s Name (Please Print)

Authorized Business Entity Representative’s Signature

Business Entity Name Date

E-Mail Address

As a business entity, the consultant/contractor must perform/provide each of the following. The consultant/contractor should check each to verify completion/submission of all of the following:

· Enroll and participate in the E-Verify federal work authorization program (Website: www.e-verify.gov; Phone: 888-464-4218; Email: e-verify@dhs.gov) with respect to the employees hired after enrollment in the program who are proposed to work in connection with the services required herein; AND

· Provide documentation affirming said company’s/individual’s enrollment and participation in the E-Verify federal work authorization program. Documentation shall include EITHER the E-Verify Employment Eligibility Verification page listing the consultant’s/contractor’s name and company ID OR a page from the E-Verify Memorandum of Understanding (MOU) listing the consultant’s/contractor’s name and the MOU signature page completed and signed, at minimum, by the consultant/contractor and the Department of Homeland Security – Verification Division. If the signature page of the MOU lists the consultant’s/contractor’s name and company ID, then no additional pages of the MOU must be submitted; AND

· Submit a completed, notarized Affidavit of Work Authorization provided on the next page of this document.

AFFIDAVIT OF WORK AUTHORIZATION:

The consultant/contractor who meets the section 285.525, RSMo, definition of a business entity must complete and return the following Affidavit of Work Authorization.

Comes now(Name of Business Entity Authorized Representative) as(Position/Title) first being duly sworn on my oath, affirm(Business Entity Name) is enrolled and will continue to participate in the E-Verify federal work authorization program with respect to employees hired after enrollment in the program who are proposed to work in connection with the services related to contract(s) with the State of Missouri for the duration of the contract(s), if awarded in accordance with subsection 2 of section 285.530, RSMo. I also affirm that
(Business Entity Name) does not and will not knowingly employ a person who is an unauthorized alien in connection with the contracted services provided under the contract(s) for the duration of the contract(s), if awarded.

In Affirmation thereof, the facts stated above are true and correct. (The undersigned understands that false statements made in this filing are subject to the penalties provided under section 575.040, RSMo.)

Authorized Representative’s Signature Printed Name

Title Date

E-Mail Address E-Verify Company ID Number

Subscribed and sworn to before me thisof. I am
(DAY)(MONTH, YEAR)
commissioned as a notary public within the County of, State of

(NAME OF COUNTY)

, and my commission expires on.
(NAME OF STATE)(DATE)

Signature of Notary Date

(Complete the following if you have the E-Verify documentation and a current Affidavit of Work Authorization already on file with the State of Missouri. If completing Box C, do not complete Box B.)

BOX C – AFFIDAVIT ON FILE - CURRENT BUSINESS ENTITY STATUS

I certify that (Business Entity Name) MEETS the definition of a business entity as defined in section 285.525, RSMo, pertaining to section 285.530, RSMo, and have enrolled and currently participates in the E-Verify federal work authorization program with respect to the employees hired after enrollment in the program who are proposed to work in connection with the services related to contract(s) with the State of Missouri. We have previously provided documentation to a Missouri state agency or public university that affirms enrollment and participation in the E-Verify federal work authorization program. The documentation that was previously provided included the following.

· The E-Verify Employment Eligibility Verification page OR a page from the E-Verify Memorandum of Understanding (MOU) listing the consultant’s/contractor’s name and the MOU signature page completed and signed by the consultant/contractor and the Department of Homeland Security – Verification Division

· A current, notarized Affidavit of Work Authorization (must be completed, signed, and notarized within the past twelve months).

Name of Missouri State Agency or Public University* to Which Previous E-Verify Documentation Submitted:

(*Public University includes the following five schools under chapter 34, RSMo: Harris-Stowe State University – St. Louis; Missouri Southern State University – Joplin; Missouri Western State University – St. Joseph; Northwest Missouri State University – Maryville; Southeast Missouri State University – Cape Girardeau.)

Date of Previous E-Verify Documentation Submission:

Previous RFP/RFQ Number for Which Previous E-Verify Documentation Submitted:

(if known)

Authorized Business EntityAuthorized Business Entity
Representative’s Name (Please Print)Representative’s Signature

E-Verify MOU Company ID Number E-Mail Address

Business Entity Name Date

FOR STATE USE ONLY

Documentation Verification Completed By:

Buyer Date

BID SUBMITTALS

As a reminder, please verify that all submittals for this bid are included with your response:

Check List

1. Bid Response Sheet

2. Agreement for Contracted Services

3. HSD FORM A – MBE/WBE Subcontractor Utilization Form

4. HSD FORM B – MBE/WBE Subcontractor Solicitation Form

5. E-Verify Affidavits image2.jpeg image3.png image4.jpeg image1.jpeg

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