DO43227SB-Attachment B Price Form.docx
DOCX document 20 KB Posted
- Solicitation number
- BPM055726
- Issued by
- Maryland
About this file
This is a price form attachment (Attachment B) for an Invitation for Bid (IFB) issued by the Maryland Department of Transportation State Highway Administration (MDOT/SHA) for roadside litter pickup services in Dorchester County under contract number DO43227SB. The solicitation requests pricing for litter pickup crew services, with each crew consisting of four staff members and including all necessary trash bags and equipment. The estimated quantity for bid evaluation purposes is 32 crew days, though this quantity may not represent actual quantities once the contract is awarded. The form requires vendors to provide a per-unit daily rate for the crew and calculate the total cost by multiplying the bid price per crew day by the estimated 32 crew days.
Bidders must submit pricing on the unaltered form provided and are prohibited from including Maryland sales and use taxes or federal excise taxes in their bid prices, as MDOT/SHA is tax-exempt. This is a Small Business Reserve or Preference procurement, and all bidders must affirm under penalty of perjury that their firm meets the qualifications for certification as a small business in Maryland as defined in the State Finance and Procurement Article. Bidders must provide their small business qualification number and the date of most recent qualification. Any bidder found to not meet small business qualifications will have their bid rejected as non-responsive, and false information provided in connection with obtaining the contract may result in debarment, contract voidation, or criminal prosecution.
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Other files
| File | Type | Posted |
|---|---|---|
| DO43227SB- Dorchester Litter- 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 #: DO43227SB
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) |
Litter Pickup crew (4 staff and all trash bags and equipment needed etc) daily rate
| 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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