Evidence of Responsibility Form.pdf
PDF 131 KB Posted
- Attached to
- RFP 20262020 Community Renewable Energy Project_Solar Electric and Battery Storage_Design Build
- Solicitation number
- S-KE0010-00016295
- Issued by
- Lane County, Oregon
About this file
This is an Evidence of Responsibility Form issued by the City of Eugene, Oregon for Solicitation No. 20262020, a design-build contract for the Community Renewable Energy Project involving solar photovoltaic and battery energy storage systems. The form requires bidders to demonstrate financial, material, equipment, facility, and personnel resources necessary to meet contractual obligations; maintain current required business licenses; carry adequate liability and other insurance coverage as specified in solicitation documents; and provide a satisfactory record of performance on three similar projects completed within the last five years. Bidders must disclose any criminal or civil charges, indictments, or convictions within the last three years related to public contracts, antitrust violations, embezzlement, theft, forgery, bribery, falsification of records, false statements, tax evasion, or receipt of stolen property, as well as any outstanding or pending judgments. The form also requires documentation of compliance with prevailing wage statutes and regulations, including the federal Davis-Bacon Act and Oregon Revised Statutes 279C.800-279C.870, with submission of final orders or court judgments if violations occurred within the last three years.
The Evidence of Responsibility Form mandates that bidders employing 50 or more full-time workers on contracts estimated to exceed $500,000 must possess a current, unexpired Pay Equity Certificate issued by the Department of Administrative Services. For each of the three required reference projects, bidders must provide project description, location, completion date, contract amount, project owner contact information, and detailed explanations regarding any material deficiencies in contract performance and whether the bidder remained within contract time and budget constraints. The form must be completed and signed by a duly authorized representative of the bidding firm, with signature, printed name, and date required for submission as part of the bidder's evidence of responsibility to the City of Eugene.
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Text version
EVIDENCE OF RESPONSIBILITY FORM
Solicitation No. 20262020
Prior to award of the Contract, the City will evaluate whether the apparent successful Bidder meets the applicable standards of responsibility identified in ORS 279C.375(3) and OAR 137-049-0390. In doing so, City may investigate Bidder and request information in addition to that already required in this ITB.
Failure to provide this information shall result in Bid rejection. The City may postpone the notice of intent to award the Contract after bid opening to complete its investigation and evaluation. Failure of the apparent successful Bidder to demonstrate responsibility as required under OAR 137-049-0390 shall render the Bidder non-responsible and shall constitute grounds for bid rejection, as required under OAR 137-049-0440.
Bidder may add additional pages to this form as needed to provide the required information.
Name of Bidder: _______________________________________________________________________
Primary Office Address: _______________________________________________________________________
1. Does Bidder have available the appropriate financial, material, equipment, facility, and personnel resources and expertise, or ability to obtain the resources and expertise necessary to meet all contractual responsibilities?
Yes ☐ / No ☐
2. Does Bidder hold current licenses that businesses or service professionals operating in this state must hold in order to undertake or perform the work specified in the contract?
3. Is Bidder covered by liability insurance and other insurance in amounts the contracting agency requires in the solicitation documents?
4. Within the last 3 years has the Bidder been criminally or civilly charged, indicted, or convicted in connection with:
a. Offenses related obtaining, attempting to obtain, or performing a public (federal, state, or local) contract or subcontract,
b. Violation of federal or state antitrust statutes relating to the submission of Bids or Proposals, or
c. Embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, or receiving stolen property?
If yes, indicate the jurisdiction, date of indictment, charge or judgment, and names and summary of charges below:
Does Bidder have any outstanding or pending judgments against it? Yes ☐ / No ☐
If yes, please provide an explanation:
5. Pay Equity Certificate. This certificate is required if Bidder employs 50 or more full-time workers and the resulting Contract price is estimated to exceed $500,000. Does a current authorized representative of Bidder possess an unexpired Pay Equity Certificate issued by the Department of Administrative Services?
Yes ☐ / No ☐ / Not Applicable ☐
6. Within the last 3 years has the Bidder, or any officer, partner, agent or employee of Bidder been found to have violated any state or federal prevailing wage statute or regulation (including the federal Davis-Bacon and related Acts and ORS 279C.800 – ORS 279C.870) in any Final Order of the Oregon Bureau of Labor and Industries or the United States Department of Labor, or by any court of competent jurisdiction?
Yes ☐ / No ☐
If yes, provide copies of the final order(s) or judgment in which this occurred and explain in detail:
(a) The circumstances behind any violation, including the amount(s) not paid
(b) Whether the amount(s) have now been paid
(c) The reasons for the violation
(d) All efforts undertaken to ensure that future violations will not occur
RECORD OF SATISFACTORY PERFORMANCE
Bidder must demonstrate that it has completed previous contracts of a similar nature with a satisfactory record of performance. Bidder shall provide the information below for 3 different projects completed in the last 5 years that demonstrate Bidder’s experience with projects of similar size, scope, and complexity to the Project that is the subject of this ITB. Bidder must provide contact information for the individual who can describe the quality of workmanship and service that the Bidder provided on current and past projects of similar size and complexity.
Bidder may add additional lines to this form as needed to provide the required information.
Project #1
Description of Project:
Project Location:
Project Date:
Contract Amount:
Project Owner:
Project Contact Information (Name/Phone/Email):
Did the project owner ever find that you were materially deficient in contract performance?
Yes ☐ / No ☐
If yes, (i) was the deficient performance expressly excused under the terms of the contract, or (ii) did you take appropriate corrective action? Please provide an explanation:
Did you stay within the contract time and budget to the extent the costs associated with and time available to perform a previous contract were within your control? Yes ☐ / No ☐
Project #2
Description of Project:
Project Location:
Project Date:
Contract Amount:
Project Owner:
Project Contact (Name/Phone/Email):
Did the project owner ever find that you were materially deficient in contract performance?
Yes ☐ / No ☐
If yes, (i) was the deficient performance expressly excused under the terms of the contract, or (ii) did you take
Did you stay within the contract time and budget to the extent the costs associated with and time available to perform
Project #3
Description of Project:
Project Location:
Project Date:
Contract Amount:
Project Owner:
Project Contact (Name/Phone/Email):
Did the project owner ever find that you were materially deficient in contract performance?
Yes ☐ / No ☐
If yes, (i) was the deficient performance expressly excused under the terms of the contract, or (ii) did you take
Did you stay within the contract time and budget to the extent the costs associated with and time available to perform
The undersigned is a duly authorized representative of the Bidder, has been authorized by Bidder to make all representations, attestations, and certifications contained in this Evidence of Responsibility Form.
Signature: ____________________________________________________________________________________
Printed Name: _________________________________________________________ Date: __________________
| Contract Amount: |
| Project Owner: |
| Project Contact Information (Name/Phone/Email): |
| If yes, (i) was the deficient performance expressly excused under the terms of the contract, or (ii) did you take appropriate corrective action? Please provide an explanation: |
| Did you stay within the contract time and budget to the extent the costs associated with and time available to perform a previous contract were within your control? Yes ☐ / No ☐ |
| Contract Amount: |
| Project Owner: |
| Project Contact (Name/Phone/Email): |
| If yes, (i) was the deficient performance expressly excused under the terms of the contract, or (ii) did you take appropriate corrective action? Please provide an explanation: |
| Did you stay within the contract time and budget to the extent the costs associated with and time available to perform a previous contract were within your control? Yes ☐ / No ☐ |
| Contract Amount: |
| Project Owner: |
| Project Contact (Name/Phone/Email): |
| If yes, (i) was the deficient performance expressly excused under the terms of the contract, or (ii) did you take appropriate corrective action? Please provide an explanation: |
| Did you stay within the contract time and budget to the extent the costs associated with and time available to perform a previous contract were within your control? Yes ☐ / No ☐ |
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