DO42827SB-Attachment B Price Form.docx
DOCX document 20 KB Posted
- Solicitation number
- BPM055727
- Issued by
- Dorchester County, Maryland
About this file
This is a Price Form (Attachment B) for a Small Business Contract issued by the Maryland Department of Transportation State Highway Administration (MDOT/SHA) for roadside hand mowing services in Dorchester County under IFB #DO42827SB. The contract requires a hand mowing crew consisting of four-person staff including equipment and fuel, with an estimated quantity of 32 crew days. Bidders must complete the form in its entirety without alterations, providing only the daily rate per crew in Column C and calculating the total cost in Column D by multiplying the estimated quantity by the unit price.
All bid prices must exclude sales and use taxes, as SHA is exempt from Maryland Sales and Use Taxes (Certificate Number 3000256-3) and Federal Excise Taxes (Exemption Number 52-73-0358K). The form includes a mandatory Small Business Contract Affidavit requiring bidders to affirm that their firm meets the qualifications for certification as a Small Business in Maryland under Section 14-501(c) of the State Finance and Procurement Article. Bidders must provide their Small Business Qualification Number and the date of most recent qualification. False information or failure to maintain small business status during the contract term may result in bid rejection, contract termination, debarment, or criminal prosecution. The estimated quantities are for bid evaluation purposes only and may not represent actual quantities upon contract award.
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| File | Type | Posted |
|---|---|---|
| DO42827SB IFB.docx | DOCX document |
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Text version
PRICE FORM– ATTACHMENT-B
This form and Small Business Contract Affidavit 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.
SHA IFB #: DO42827SB
This form is to be completed in its entirety and unaltered.
| Column A |
| Column B |
| Column C |
| Column D |
| Item |
| Estimated Quantity |
| Vendor’s Bid |
| Total Cost ($) |
| (See Note a) |
| Per Unit |
| (Column B x C) |
Hand Mowing Crew (4 person staff to include Equipment/fuel/etc) Daily rate per crew
| 32 Crew Days |
| $____________ |
Crew Day
TOTAL (sum of column D)
For the Contractor:
Company Name & Address
City State Zip
Representing the above Company _______________________________
SIGNATURE
Print Name & Title
SOCIAL SECURITY NO. OR
FEDERAL TAX ID NO. _________________________ DATE: ___________________
NOTE:
a) Quantities are estimated and used for bid evaluation only. They may not represent the actual quantities experienced once the contract is awarded.
b) 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 tax in bid prices
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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