D1SPRY29SB Attachment B - Price Bid Form.docx
DOCX document 24 KB Posted
- Solicitation number
- BPM058096
- Issued by
- Maryland
About this file
This is a Price Bid Form and Small Business Affidavit (Attachment B) for Invitation for Bid D1SPRY29SB issued by the Maryland Department of Transportation State Highway Administration (MDOT SHA) for Roadside Tree Line Spraying services in District 1. The contract requires bidders to submit pricing for High Volume Herbicide Application Crew services, with labor and equipment only, totaling 170 hours of work. Bidders must complete the form in its entirety without alterations, providing only the stipulated pricing information in the designated columns for unit cost and total cost calculations.
Pricing submissions must exclude sales and use taxes, as MDOT SHA holds exemption certificates for both Maryland sales tax (Exemption Certificate Number 3000256-3) and federal excise taxes (Exemption Number 52-73-0358K). This solicitation is designated for Small Business Reserve or Preference procurement, requiring bidders to affirm their qualification as a small business under Maryland State Finance and Procurement Article § 14-501(c) and to notify the Procurement Officer within 30 days if circumstances change during contract performance. Bidders must provide their company information, authorized representative signature, and small business qualification number with the date of most recent qualification. False information or failure to meet small business qualifications may result in bid rejection, contract termination, suspension and debarment, or criminal prosecution.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment 1 - No Bid_Vendor Feedback Form.pdf | ||
| D1SPRY29SB IFB Tree Line Spraying with Herbicide.docx | DOCX document |
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Text version
PRICE FORM
& SBR AFFIDAVIT– ATTACHMENT-B D1SPRY29SB Pg 1
This form is to be completed in its entirety, is not to be altered in any way and is to contain only the price or prices stipulated on the form.
| State Highway Administration IFB No.: |
| D1SPRY29SB |
| Column A |
| Column B |
| Column C |
| Column D |
| Item / Description |
| Quantity |
(See Note a) Vendor’s Bid per Unit Total Cost ($) (Column B x C)
High Volume Herbicide Application Crew (Labor and Equipment Only)
170 Hours
TOTAL BID AMOUNT (Sum of Column D) (See Note)
NOTE:
MDOT SHA, is exempt from Maryland Sales and Use Taxes by Exemption Certificate Number 3000256-3 and from Federal Excise Taxes by Exemption Number 52-73-0358K. Do not include sales tax in bid prices.
PRICE FORM
& SBR AFFIDAVIT– ATTACHMENT-B D1SPRY29SB Pg 2
For the Contractor:
Company Name & Address
Name Address City State Zip
Phone _____________________ Fax ______________________Email ______________________________
Representing the above Company _______________________________
SIGNATURE
Print Name & Title
SOCIAL SECURITY NO. OR
FEDERAL TAX ID NO. _________________________ DATE: ___________________
Maryland Department of Transportation
SMALL BUSINESS CONTRACT AFFIDAVIT
********** PROVIDING FALSE INFORMATION **********
Anyone providing false information to the State of Maryland in connection with obtaining or attempting to obtain a contract under Small Business Reserve or Preference procurement may be subject to the following:
1. A determination by a Procurement Officer that a bidder/offeror is not responsible;
2. A determination that a contract entered into is void or voidable under § 11-204 of the State Finance and Procurement Article of the Annotated Code of Maryland;
3. Suspension and debarment under Title 16 of the State Finance and Procurement Article;
4. Criminal prosecution for procurement fraud (§ 11-205.1 of the State Finance and Procurement Article), perjury, or other crimes; and
5. Other actions permitted by law.
********** FAILURE TO MEET MINIMUM QUALIFICATIONS **********
Any Bidder or potential bidder failing to meet the qualifications of a "small business" specified in § 14-501(c) of the State Finance and Procurement Article will be ineligible to participate in a procurement designated for a Small Business Reserve under § 14-504 or Small Business Preference under § 14-206 - 207. Any person or company bidding on Small Business Reserve or Preference procurement and not qualifying as a small business under § 14-501(c) will have its bid or offer rejected on the ground that the bidder is not responsible.
I AFFIRM THAT:
| To the best of my knowledge, information, and belief, as of the date of submission of this Bid/Proposal, | ||
| (name of firm) meets the qualifications for certification as a Small Business in Maryland. I further affirm that, if for any reason during the term of the contract | (name of firm) no longer meets the qualifications of certification as a Small Business in Maryland, I will notify the Procurement Officer within 30 days. I agree that a failure to so notify the Procurement Officer of this change in circumstances may result in this contract being terminated for default. |
I DO SOLEMNLY DECLARE AND AFFIRM UNDER THE PENALTIES OF PERJURY THAT THE CONTENTS OF THIS AFFIDAVIT ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE, INFORMATION, AND BELIEF.
SMALL BUSINESS QUALIFICATION NUMBER ___________________
Date of Most Recent Qualification__________________________________
DATE:_____________
BY:_____________________________________________________________
Signature (Authorized Representative and Affidavit)
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