J.2 through J.9 Attachments.pdf

ATTACHMENT J.2

ANTI-COLLUSION STATEMENT

TO ALL BIDDERS/OFFERORS:

TIDS STATEMENT MUST BE EXECUTED AND RETIJRNED WITH BID/PROPOSAL

DOCUMENTS.

In the preparation and submission of this bid/proposal on behalfof _ (name of vendor), we did not either directly or indirectly enter into any combination or arrangement with any person, firm or corporation, or enter into any agreement, participate in any collusion, or otherwise take any action in the restraint of free competition in violation of the Sherman Anti-Trust Act, 15 USCS, Sections I et seq.

The undersigned vendor hereby certifies that this agreement, or any claims resulting therefrom, is not the result of, or affected by, any act of collusion with, or any act of, another person or persons, firm or corporation engaged in the same Line of business or commerce; and that no person acting for, or employed by the D.C. Courts has an interest in, or is concerned with this proposal; and that no persons, finn or corporation, other than the undersigned, have or are interested in this proposal.

BY: _

COMPANY

BUSINESS ADDRESS

Subscribed and sworn before me this __ day of , 20__, in

City and State

Notary Public

ATIACHMENT J.3

ETHICS IN PUBLIC CONTRACTING

A. To achieve the purpose of this section, all employees and persons doing business with the Court shall be required to observe the ethical standards prescribed herein. The Executive Officer shall make available and disseminate to every person doing business with the Court, and to every Court managerial employee with procurement responsibilities, the requirements of this section.

B. It shall be a breach of ethical standards for any employee to participate directly or indirectly in a procurement when the employee knows that the employee or any member of the employee's immediate family has a financial interest pertaining to the procurement. When a Coon employee knows that he or she has an actual or potential conflict of interest, or when the Executive Officer has determined that an actual conflict of interest exists, such employee shall be disqualified from the procurement involved.

C. It shall be a breach of ethical standards for person to offer, give, or agree to give any employee or former employee, or for any employee to solicit, demand, accept, or agree to accept from anther person, a gratuity or an offer of employment in connection with any decision, approval, disapproval, recommendation, preparation of any pan of procurement.

D. It shall be a breach of ethical standards for any payment, gratuity, or offer of employment to be made by or on behalf of a subcontractor under a contract to the prime contractor, or higher tier subcontractor, as an inducement for the award of a subcontract or order.

E. It shall be a breach of ethical standards for any employee, former employee or any other person knowingly to use confidential information for actual or anticipated personal gain. No employee or officer of the Coon shall serve on the board of directors or other governing body (whether or not compensated) of any contractor with whom the Court has a current contractual relationship if the individual's responsibilities with the Court entail the lening or management of the contract.

BY:

ATTACHMENT J.4

NON DISCRIMINATION

Employment discrimination by contractor is prohibited.

Every contract over $10.000.00 shall include or incorporate by reference the following provisions:

1. During the performance of this contract, the Contractor agrees as follows:

a. The Contractor will not discriminate against any employee or applicant for employment because of race, religion, color, sex, or national origin, except where religion, sex, or national origin is a bona fide occupational qualification reasonably necessary to the normal operation of the Contractor. The Contractor agrees to post in conspicuous places. available to employees and applicants for employment, notices setting forth the provisions of this nondiscrimination clause.

b. The Contractor, in all solicitations or advenisements for employees placed by or on behalf of the Contractor. will state that such Contractor is an equal opportunity employer.

c. Notices, advertisements, and solicitations placed in accordance with federal law, rule, or regulation shall be deemed sufficient for the purpose of meeting the requirements of this section.

2. The Contractor will include the provisions of the foregoing paragraphs, a, b, and c in every subcontract or purchase order of over $10,000.00, so that the provisions will be binding upon each subcontract or vendor.

BY:

ATIACHMEl''T J.S

CERTIFICATION OF ELIGffiILITY

PROJECT NAME: _

________________________, being duly sworn, or under penalty of perjury under the laws of the United States, certifies that, except as noted below, (the company) or any person associated therewith in the capacity of (owner, partner, director, officer, principal investigator. project director. manager, auditor, or any position involving the administration of federal funds) is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility under any Federal, District or State statutes; has not been suspended, debarred voluntarily excluded or determined ineligible by any Federal, District, or Stage agency within the past three (3) years; does not have a proposed debarment pending; and has not been indicted, convicted; or has a Civil judgment rendered against it by a Court of competent jurisdiction in any matter involving fraud or official misconduct within the past three (3) years.

Exceptions will not necessarily result in denial of award, but will be considered in determining bidder responsibility. For any exception noted, indicate below to whom it applies, initiatingagency, and dates of action. Providing false information may result in criminal prosecution or administrative sanctions.

Contractor

Date President or Authorized Official

Title

The penalties for making false statements are prescribed in the Program Fraud Civil Remedies Act of 1986 (Public Law 99-509,31 U.S.C. 3801-3812).

Subscribed and sworn before me this day of , 20__, in

City and State

Notary Seal Notary Public

ATTCHMENT J.6

TAX CERTIFICATION AFFIDAVIT

For all bids/offers over 100,000.00, the following affidavit is required:

_____________, 20

I hereby certify that:

1. 1 have complied with the applicable tax law fillings and licensing requirements of the District of Columbia.

2. The following inf~rmation is true and correct concerning the payment of my tax liability:

3. If not current, as checked in Item 2, I am in compliance with a payment agreement with the Department of Finance and Revenue 0 Yes 0 No, and/or the Deparnnent of Employment Services 0 Yes 0 No.

4. My tax nwnbers are as follows:

D.C. Employer Tax ID No.: _ Unemployment Insurance Account No.: _ D-U-N-S No.:

The D.C. Courts is hereby authorized to verify the above information with appropriate Government authorities. Penalty of making false statements is a fine of not more than $1,000.00, imprisonment for not more than one (1) year or both, as prescribed in D.C. Code Sec. 22-2514. Penalty for false swearing is a fine of not more than $2,500.00, imprisonment for not more than three (3) years, or both, as prescribed in D.C. Code Sec. 22-2513.

Signature of Person Authorized to Sign Title This Document

Typed or Printed Name

Name of Organization _

Notary: Subscribed and sworn before me this _day of , 20 at at __-:-:- _

Month and Year City and State

Attachment J.7

CERTIFICAnON REGARDING A DRUG-FREE WORKPLACE

A. Definition as used in this provision:

"Controlled substance" means a controlled substance as defined in Schedules I through V of Section 202 of the Controlled Substance Act (21 U.S.c. 812) and as further defined in the regulation at 21 CPR 1308.11 - 1308.15.

"Conviction" means a finding ofguilt (including a plea of nolo contenders) or imposition of sentence, or both, by any judicial body charged with the responsibility to determine violations of the Federal or State criminal drug statutes.

"Drug free workplace" means a site for the performance ofwork done in connections with a specific contract at which employees of the Contractor are prohibited from engaging in the unlawful manufacture, distribution, dispensing, possession or use ofa controlled substance.

"Employee" means an employee of a Contractor directed engaged in the performance of work under a D.C. Courts contract.

"Individual" means a bidder/otTeror that has no more than one employee including the bidder/otTeror.

B. By submission of its bid/offer, the bidder/offeror, if other than an individual who is making a bid/otTer that equals or exceeds $25,000.00, certifies and agrees that with respect to all employees of the bidder/otTeror to be employed under a contract resulting from this solicitation will:

(1) Publish a statement notifying such employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the Contractor's work place and specifying the actions that will be taken against employees for violation of each prohibition:

(2) Establish a drug-free awareness program to inform such employees about:

programs: and

(iv) The penalties that may be imposed upon employees for drug abuse violations in the workplace:

(3) Provide all employees engaged in performance of the contract with a copy of the statement required by subparagraph (B), (1) of this provision;

(4) Notifying such employees in the statement required by subparagraph (b), (I) of this provision, that as a condition ofcontinued employment on the contract resulting from this solicitation, the employee will:

(i) Abide by the tenus of the statement; and

(ii) Notify the employer of any criminal drug statue conviction for violation occurring in the work place no later than five (5) days after such conviction;

(5) Notify the Contracting Officer within ten (10) days after receiving notice under subdivision (B), (4), (ii) of this provision from an employee or otherwise receiving actual notice of such conviction;

(6) Within thirty (30) days after receiving notice under subparagraph (B), (4) of this provision of a conviction, impose the following sanctions or remedial measures on any employee who isconvicted ofdrug abuse violationsoccurring inthe workplace:

(i) Take appropriatepersonnel action against such employee up to and including termination: or

(ii) Require suchemployee to satisfactorily participate in a drug abuse assistance or rehabilitation program approved for such purpose by a Federal, State, or local health, law enforcement or other appropriate agency; and

(7) Make a good faith effort to maintain a drug-free workplace through implementation of subparagraphs (B), (I) through (B), (6) of this provision.

C. By submission of its bid/offer,the bidder/offeror, ifan individual, who is makinga bid/offer of any dolIar value, certifies and agrees that the bidder/offeror will not engage in the unlawfulmanufacturedistribution,dispensing, possession or use ofa controlledsubstance in the performance of the contract resulting from this solicitation.

D. Failureofthe bidder/offeror to provide the certification required by paragraphs (B) or (C) of theses provisions, renders the bidder/offeror unqualified and ineligible for award.

E. Inaddition to other remedies available to the D.C. Courts, the certification inparagraphs (8) and (C) ofthis provision concerns a matter within the jurisdiction ofan agency ofthe United States and the making of a false, fictitious or fraudulent certification may render the maker subject to prosecution under Title 18, United States Code, Section 1001.

Concurrence:

AUTHORIZED CONTRACTOR PERSONNEL

Name:

Signature:

Title:

Date:

ATTACHMENT J. 8

DISTRICT OF COLUMBIA COURTS

RELEASE OF CLAIMS

The undersigned Contractor, pursuant to the term of Contract No. between the District of Columbia Courts herein referred to as the "Courts' and herein (Name of Contractor) referred to as the "Contractor" for (type of service):

Located at:

I. The Contractor hereby certified that there is due and payable by the Courts to the Contractor under the contract and fully approved modifications the balance of:

2. The Contractor further certified that in addition to the amount set forth in paragraph I above, there are outstanding and unsettled the following items which the Contractor claims are just and due and owing by the Courts to the Contractor:

(a) (b) (c) (d)

(Itemize claims and amounts due. If none, so state)

3. The contractor further certified that all work required under this contract including work required under all modifications has been performed in accordance with the terms thereof and that there are no unpaid claims for materials, supplies, equipment. or service.

4. Except for the amounts stated in paragraph I and 2 above, the Contractor certifies that it has received from the Courts all sums of money pursuant to the above mentioned contract and any modifications.

-2

5. That in consideration of the payment of the amount stated in paragraph I above, the Contractor does hereby release the Courts from any and all claims arising under or by virtue of this contract. Except the amount listed in paragraph 2 above, provided however, that iffor any reason the Courts does not pay in full the amount stated in paragraph I above, said deduction shall not affect the validity of this release. But the amount so deducted shall be automatically included under paragraph 2 above, as an amount which the Contractor has not released but will release upon payment thereof. The Contractor further certifies that upon receipt of the payment of the amount listed in paragraph 2 above, and any amount with may be deducted from paragraph I above, the Contractor will release the Courts from any and all claims arising out of the above contract or any modifications thereof, and will execute such further release or assurance as the Courts may request.

In WITNESS WHEREOF, the Contractor has signed and sealed this instrument this day of ,20

WITNESS: CONTRACTOR:

__________(Seal) (Print of Type)

(Signature) (Signature)

(Address) (Official Title)

ATTACHMENT J.9 Page I of2

PAST PERFORMANCE EVALUATION FORM

(Check appropriate box)

Performance Elements

Excellent Good Acceptable Poor Unacceptable

Quality of Service Timeliness of Performance Cost Control

Business Relations Customer Satisfaction

1. Name & Title of Evaluator:

2. Signature of Evaluator: _

3. Name of Organization: _

4. Telephone Number of Evaluator: _

5. State type of service received: _

6. State Contract Number, Amount and period of Performance _

7. Remarks on Excellent Performance: Provide data supporting this observation.

(Continue on separate sheet if needed)

8. Remarks on unacceptable performance: Provide data supporting this observation.

(Continue on separate sheet if needed)

• • Page 2 of 2

RAriNG GUIDeliNES

Summarize Contractor performance in each of the ratingareas. Assign each area a rating of 0 (Unacceptable). 1 (Poor), 2 (Acceptable), 3 (Good),4(Excellent), or ++ (Plus). Use the following instructions a guidance in making these evaluations.

Quality Produet/Servll:e Cost Control

TIlMIess of Performance

Business Relations

-WrttW1 budget (overt uncW target costs)

-Gunw1t, ~, Ind ~1IIings

-ReIaIIonship of negated costs to aclUIII

-Cost etIiciellCie& -O\8nge order Issue

-MeetIrUIim mIIeatones -ReIIble P lip III lINe 10 we:hnic:III dnc:tians ~ontirne.

including Wf'lIP"UP 8fId -ccnnct 8dminls1nIlion -NoliquidM.cl damegea ..-sed

-eftdve~( -a...... corr..pondence

-R8Ipalllive to conIract

.PrampI notitc8tion of conlr8d prabIems

-RNIonIbIeIc:ooperalive ·F1eJibIe ·PnHctiwI ..tI8c:IN8Wi reWlmlIIIlIled IOfuliOn$ .atecIive ....,.,.,..

disacMntIIged ~

Subcollncting IJIOl18m

O.laro Nonconfonnances .. comprises the ac:tMvwnent aI conlnICt 1'IIQUIrwnents, despite use of AQetw;y _n:es

0Uys .,.. c:ompri$ing Ihe ~of contr8d 1'IlqIftmentI. DeIpite use of AqtIN;yresources.

Raponae '" Inquirie5. ledlnicaII ~ issues is nal4lltec:tiw8nd .-ponsNe.

1, \Jrwc:ceptable

2. Poor

Nonc:onIon'nano require ma;or AQertey resources to enswe adlieYement of c:onlnIct requirernenls.

Nonconbmanc:es '-luil'8 minor Agenr:r I'8IOUl'C8S to eosure ~ of conlnIct requirernenta.

Cost ~ require major DeiayI ,.quiI'8 ITIIIjor response to irlquines. tee:hnicaII Ar;Janc:r /8IClUrC8$ to ensure /v;Itrtcy_ to ensure HNlceIeclmilllatl...1...- is ac:I1leIIement of contrac:t ae:tIiewrn8C1l of contnIct Il\8I'IIlMIY eIfecliYe md 1'8QUitements. reQUirements. respor1Ilve.

Costs issues ,.quire minor DeIaya r8qUire minor Respon&eIto Wlquiries. technical Ageney I'MOUIC8S to _1'8 1'o(JfIrCt _10.... s~ luua Is achie\Iement 01 contr8d lIChiewment 01c:ontnIct sOlMllihll efJec:tiye Ind 1'lIqUltecnents. requirements. responINe.

3. Acceptable NonconIorm8nc:es do not impect ac:hievement of contr8d requimnentll.

Coat Issu. do not impac:t ec:tlIcMrnent aI contract flQUiremenls

ResponHS to inquires, teeIYIicaI _wIcefecimiIllatniIlw __ is usUllly eIIlIclMt 8nd responsMI.

4. Good There .. no quelity problems There ... no cost issues. There _ not delays. R8IpoI.- '" 1nqulriM, -=tv1ic2 s~iauesis etfectiveand responsive.

5. Excellent