DOELEC29SB - Attachment B Price Form.docx
DOCX document 24 KB Posted
- Solicitation number
- BPM054116
- Issued by
- Dorchester County, Maryland
About this file
This is a Price Form and Small Business Reserve Affidavit for Invitation for Bids (IFB) No. DOELEC29SB issued by the Maryland Department of Transportation State Highway Administration (MDOT SHA) for electrical repair services in Dorchester County. The contract scope includes labor services provided by electrical technicians and master electricians, equipment rental for scissor lifts at two working height ranges (0-20 feet and 21-35 feet), and daily trip charges. The estimated quantities are 200 hours of regular electrical technician labor, 50 hours of master electrician labor, 24 trip charges, and 5 unit days each for both scissor lift categories over the contract duration.
Bidders must submit pricing for hourly rates for technician and electrician services, per-unit trip charges, and per-unit-day rates for equipment rental, with parts and materials budgeted at $2,500.00 to be billed as incurred at retail or manufacturer's suggested retail price (MSRP). This is a Small Business Reserve procurement restricted to certified small businesses under Maryland State Finance and Procurement Article § 14-501(c); bidders must complete the affidavit affirming their small business status and commit to notifying the Procurement Officer within 30 days if their status changes during contract performance. MDOT SHA is exempt from Maryland and Federal taxes, and bidders must not include sales tax in their bid prices. False information or failure to maintain small business qualification may result in bid rejection, contract termination, suspension and debarment, or criminal prosecution.
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| File | Type | Posted |
|---|---|---|
| DOELEC29SB - Category II Procurement Invitation For Bid Template.docx | DOCX document |
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Text version
PRICE FORM
CONTRACT BID FORM & SBR AFFIDAVIT– ATTACHMENT-B
This form is to be completed in its entirety, is not to be altered in any way and is to contain only the price or prices stipulated on the form.
SHA IFB No.: DOELEC29SB
| Column A |
| Column B |
| Column C |
| Column D |
| Item / Description |
| Estimated Quantity |
| Vendor’s Bid per unit |
| Total Cost ($) |
(over contract duration)
(Column B x C)
| Electrical Technician Regular Hourly Rate |
| 200 hours |
| $ _________/Hr |
| $ ________ |
| Master Electrician Regular Hourly Rate |
| 50 hours |
| $ _________/Hr |
| $________ |
| Daily Trip Charge |
| 24 Ea |
| $ _________/Ea |
| $________ |
| Scissor Lift 0-20' Working Height |
| 5 Unit Days |
| $ _________/UD |
| $________ |
| Scissor Lift 21-35' Working Height |
| 5 Unit Days |
| $ _________/UD |
| $________ |
Parts/Materials for Repairs to be billed as incurred at Retail or MSRP (do not alter)
$2,500.00
TOTAL BID AMOUNT (Sum of Column D)
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.
For the Contractor:
Company 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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