Exhibit 1 thru 12 Proposal Forms Vehicle Dash Cameras RFP 22-014~3.pdf

SALEM AREA MASS TRANSIT DISTRICT (SAMTD)

Vehicle Dash Cameras RFP No. 22-014

PART 3

PROPOSAL FORMS

EXHIBITS 1-14

SALEM AREA MASS TRANSIT DISTRICT EXHIBITS

The following items must be included in your proposal in order to receive consideration. Failure to complete all forms included in this package may result in your proposal being ruled nonresponsive.

Nonresponsive Proposals will not be considered for a contract award. Please sign and date each form and/or certification.

Proposer Sample Invoice (Please provide)

Proposer Financial Statements (Reserved)

Exhibit #1 – Proposal Form

Exhibit #2 – Acknowledgement of Addenda to RFP

Exhibit #3 – Non-Collusion Affidavit

Exhibit #4 – Organizational Conflict of Interest

Exhibit #5 - DBE Participation Commitment Statement

Exhibit #6 - DBE Letter of Intent

Exhibit #7 - DBE Affidavit

Exhibit #8 - DBE Unavailable Certification

Exhibit #9 - Contractor’s Representations & Warranties Certification

Exhibit #10 - Federal Debarment & Suspension Certificate

Exhibit #11 - Certification Regarding Lobbying (Reserved)

Exhibit #12 – Buy America Certification (Reserved)

Exhibit #13 – Price Proposal Form

Exhibit #14 – References

EXHIBIT #1

PROPOSAL FORM

The undersigned (“Proposer”), upon acceptance by SAMTD, agrees to furnish all labor, freight, transportation, materials, equipment, services, supplies, and other work in accordance with the Request for Proposal No. 22-014, entitled ”Vehicle Dash Cameras,” as issued on May 6, 2022.

PROPOSER: The undersigned certifies as follows:

1. That he/she has read and understands all requirements and specifications of the Request For Proposal (RFP) (including any exhibits also posted); and

2. That he/she agrees to all requirements, specifications, terms, and conditions of the Solicitation referenced above; and

3. That he/she will furnish the designated item(s) and/or service(s) as Proposed in the Proposal; and

4. That he/she certifies under penalty of perjury that Proposer is, to the best of his/her knowledge, not in violation of any Oregon tax law; and

5. That his/her company has been certified as one of the following registered business classifications:

DBE ______ MBE _______ WBE _______ ESB _______ Veteran-Owned _______

Corporation ______ Other, identify: ______________________________________________

Resident Proposer (Oregon): _____ Yes _____ No

6. Federal Tax I.D. Number: D&B (Dun’s) Number:

Firm's Name:

Firm's Address:

Contact Person E-mail

Authorized Signature Date

Telephone Number Fax Number

Name of Project Manager and Title

7. Accounts Receivable Address, if different from above:

Proposer understands and agrees that, by his/her signature, if awarded the contract for the project, he/she is entering into a contract with SAMTD that incorporates the terms and conditions of the entire Request for Proposal package.

Proposer understands that this Proposal constitutes a firm offer to SAMTD that cannot be withdrawn for one-hundred twenty (120) calendar days from the date of the deadline for receipt of Proposals. If awarded the contract, Proposer agrees to deliver to SAMTD the required insurance certificates within ten (10) calendar days of the Notice of Award.

IMPORTANT: This form must be signed below by an authorized representative of the proposing firm, to authenticate the Proposal.

Authorized Signature: Date:

Printed Name:

Title:

EXHIBIT #2

ACKNOWLEDGMENT OF ADDENDA

The following form shall be completed and included in the Proposal.

Failure to acknowledge receipt of all addenda may cause the Proposer to be considered nonresponsive to the solicitation. Acknowledged receipt of each addendum must be clearly established and included with the Proposal.

The undersigned acknowledges receipt of the following addenda to the documents:

Addendum No. Dated

Addendum No. Dated

Addendum No. Dated

Addendum No. Dated

Addendum No. Dated

Addendum No. Dated

Addendum No. Dated

Contractor Name:____________________________________________________

Signature of Authorized Representative:______________________________ ____

Printed Name:__________________________________Date:________________

Title/Position:_______________________ _______________

EXHIBIT #3

NON-COLLUSION AFFIDAVIT

I state that I am (the sole owner) (a partner) (an officer) (an agent) of ________________________, and that I am authorized to make this affidavit on behalf of my firm, and its owners, directors, and officers.

I am the person responsible in my firm for the price(s) and the amount of this offer.

I state that:

1. The price(s) and amount of this offer have been arrived at independently and without consultation, communication, or agreement with any other contractor, Proposer, or potential Proposer.

2. That neither the price(s) nor the amount of this Proposal, and neither the approximate prices(s) nor approximate amount of this Proposal, have been disclosed to any other firm or person who is a Proposer or potential Proposer, and they will not be disclosed before the Proposal opening/closing.

3. No attempt has been made or will be made to induce any firm or person to refrain from Proposing on this contract, or to submit a Proposal higher than this Proposal, or to submit any intentionally high or competitive Proposal or other form of complementary Proposal.

4. The Proposal of my firm is made in good faith and not pursuant to any agreement or discussion with, or inducement from, any firm or person to submit a complementary or other form of competitive Proposal.

5. , its affiliates, subsidiaries, officers, directors, and employees are not currently under investigation by any governmental agency and have not in the last four years been convicted of or found liable for any act prohibited by state or federal law in any jurisdiction, involving conspiracy or collusion with respect to Proposing on any public contract.

I state that understands and acknowledges that the above representations are material and important, and will be relied on by Salem Area Mass Transit District in awarding the contract(s) for which this Proposal is submitted. I understand and my firm understands that any misstatement in this affidavit is and shall be treated as fraudulent concealment from Salem Area Mass Transit District of the true facts relating to the submission of Proposals for this contract.

Signed Date _____________________________

Printed Name and Title ______________________________________________________

EXHIBIT #4

ORGANIZATIONAL CONFLICT OF INTEREST

AND AVOIDANCE / MITIGATION PLAN

This disclosure statement outlines potential organizational conflicts of interest, either real or apparent, which as a result of activities or relationships with other persons or entities, such person or entity:

1. Is unable or potentially unable to render impartial assistance or advice to Salem Area Mass Transit District; or

2. Is or might be otherwise impaired in its objectivity in performing the contract work; or

3. Has an unfair competitive advantage.

SECTION I. List potential organizational conflicts of interest. An organizational conflict of interest exists where other activities, relationships, or contracts of a contractor inhibit, affect, or prevent the contractor from rendering impartial assistance or advice to SAMTD; a contractor's objectivity in performing the contract work is or might be otherwise impaired (e.g., a contractor assisting with a design might have a financial interest in a product or system that could be utilized in implementing that design); or a contractor has an unfair competitive advantage which might be gained through its involvement in writing, or reviewing the solicitation and contract documents, including the scope or specification except as part of a general industry review.

SECTION II of this disclosure statement describes the management plan for avoiding or neutralizing the potential Organizational Conflicts of Interest as described in SECTION I of this disclosure statement. I acknowledge that Salem Area Mass Transit District may require revisions to the management plan described in SECTION II of this disclosure statement prior to approving it, and that Salem Area Mass Transit District has the right, in its sole discretion, to limit or prohibit my involvement in the Project as a result of the potential conflicts of interest described in SECTION I of this disclosure statement.

SECTION Ia – Name of Person or Firm Potentially Conflicted

SECTION Ib – Current Project Name and Scope of Work

SECTION Ic – Future Project Name and Description of Potential Conflict of Interest

SECTION II - Plan for Managing Potential Conflicts of Interest

Signed Date _____________________________

Printed Name and Title ______________________________________________________

EXHIBIT #5

DISADVANTAGED BUSINESS ENTERPRISE (DBE) PARTICIPATION

COMMITMENT STATEMENT

AGENCY GOAL: 2.49%

SAMTD hereby notifies all Proposers that it is the policy of SAMTD to ensure nondiscrimination on the basis of race, color, sex, or national origin in the award and administration of contracts.

Proposers are urged to obtain Disadvantaged Business Enterprise (DBE) participation on this project, although there is no specific DBE contract goal for this project. Proposers are encouraged to attend any pre-Proposal conferences held to better understand the project and better obtain participation of DBE contractors, as applicable.

DBE GOAL: Proposal documents for all Federal Transit Administration-funded projects must contain a DBE policy statement advising Proposers that, as required by the Federal Transit Administration, SAMTD has established an overall DBE goal, and that SAMTD is required to report its DBE participation to FTA each year. As such, SAMTD is required to request information from contractors in order to fulfill its reporting responsibilities.

The Proposer's total DBE goal is the sum of the Proposer's proposed commitment to the goals for disadvantaged and women-owned firms. Proposers will calculate single goal percentages using the Proposer's proposed total dollar amount commitment to each single goal, divided by the Proposer's total amount of Proposal dollars. Goals will be calculated to the nearest one-one hundredth (0.01) of a percent.

Proposers must indicate the total DBE goal they propose to achieve. Even if the assigned contract goals are 0 percent, Proposers must fill in all blanks related to the Proposer's contract goals.

FAILURE TO DO SO MAY RENDER THE PROPOSAL NONRESPONSIVE.

PROPOSER`S CONTRACT GOALS:

TOTAL DBE GOAL %

The Proposers shall list all DBE subcontractors and their intended function for each phase of this contract. Monetary amounts shall be included beside each subcontractor that is identified to perform work on this contract. If there is no DBE participation, please note so in the space above.

By signing this statement, the Proposer assures that Good Faith Efforts have been made to meet the goal(s) for the DBE participation specified for this contract, and accepts the DBE Policy Statement on the next page.

Contractor Name:____________________________

Signature of Authorized Representative:____________

Printed Name:_______ Date:

Title/Position:

DISADVANTAGED BUSINESS ENTERPRISE POLICY STATEMENT

DBE POLICY: It is the policy of the United States Department of Transportation (DOT) and Salem Area Mass Transit District (SAMTD) that minority business enterprises, as defined in 49 CFR 26, shall have an equal opportunity to participate in the performance of contracts financed in whole or part with federal funds under this agreement. Consequently, the DBE requirements of 49 CFR 26 and FTA 4220.1F, as amended, apply to this agreement.

DBE OBLIGATION: SAMTD or its Contractor agrees to ensure that minority business enterprises, as defined in 49 CFR 26, have an equal opportunity to participate in the performance of contracts and subcontracts financed in whole or in part with Federal funds provided under this agreement. SAMTD and its Contractor shall take all necessary and reasonable steps in accordance with 49 CFR 26 to ensure that disadvantaged business enterprises (DBE) have an equal opportunity to compete for and perform contracts. SAMTD and its Contractor shall not discriminate on the basis of race, color, national origin, or sex in the award and performance of DOT-assisted contracts.

DBE APPLICABILITY: This applies to all projects and contracts financed by the Federal Transit Administration (FTA) or through the Oregon Department of Transportation (ODOT) without regard to the funding source. Recipients and Contractors shall conform to all applicable civil rights laws, orders, and regulations, including Section 504 of the Rehabilitation Act of 1973. Recipients and their Contractors shall not discriminate on the basis of race, age, sex, color, religion, national origin, mental or physical handicap, political affiliation, or marital status in the award and performance of ODOT contracts.

DBE CERTIFICATION: SAMTD will accept current certifications by the State of Oregon Office of Minority, Women and Emerging Small Business Enterprise Program (OMWESB). If a completed application for DBE certification has been submitted to the Office of Minority, Women and Emerging Small Business Enterprise Program (OMWESB) as of Proposal opening but has not been processed, the District may count the applicant’s participation toward achieving the DBE contract specific goal, assuming that the applicant’s certification application is approved prior to contract award. The DBE directory of certified firms is available on the Internet at:

https://oregon4biz.diversitysoftware.com/FrontEnd/VendorSearchPublic.asp?XID=6787&TN=oregon 4biz

This DBE Policy Statement shall be included in all subcontracts entered into under this contract.

GOOD FAITH EFFORTS: In addition to signing the DBE Participation Commitment Statement contained in the Proposal documents, the Proposer who has not achieved the assigned goal on this project shall document the steps taken to obtain participation. Failure to document and submit good faith efforts when the Proposer has not achieved the assigned goal shall render Proposal nonresponsive. Good faith efforts may include the following:

A. Attendance at a pre-Proposal meeting, if any, scheduled by SAMTD to inform the DBEs of subcontracting opportunities in this contract work;

B. Advertising in general circulation media, trade association publications, and minority-focus media at least ten (10) days before Proposals or Proposals are due. If ten (10) days are not available, a shorter reasonable time will be acceptable;

C. Use of the Oregon Department of Consumer & Business Services Certified DBE Directory;

D. Written notification to DBEs that their interest in the contract is solicited;

E. Efforts to select portions of the work proposed to be performed to increase the likelihood of achieving the assigned goal;

F. Efforts to negotiate for specific sub-Proposals, including at a minimum:

a. The name, address, or telephone number of each DBE contacted;

b. A description of the information provided regarding the plans and specifications for the portions of the work to be performed;

c. A statement of why additional agreements were not reached;

d. Reasons for rejecting as unqualified any DBE contacted;

G. Efforts to provide assistance in obtaining any necessary bonding or insurance;

H. Efforts to use the service of banks owned and controlled by minorities or women;

I. Efforts to assist the DBE in purchasing materials and supplies; and

J. Any other affirmative action efforts

CONTRACT/SUBCONTRACT APPLICABILITY: DBE Program for Contracts Solicitation language shall require that contractors, including subcontractors, must meet all requirements of the DBE program as a matter of responsiveness.

A. Prompt Payment to Subcontractors: The prime contractor agrees to pay each subcontractor under this prime contract for satisfactory performance of its contract no later than thirty (30) days from the receipt of each payment the prime contractor receives from SAMTD. The prime contractor agrees further to return retainage payments to each subcontractor within thirty (30) days after the subcontractor’s work is satisfactorily completed. Any delay or postponement of payment from the above-referenced timeframe may occur only for good cause following written approval of SAMTD. This clause applies to both DBE and non-DBE subcontracts.

B. Contract Assurance Clause: SAMTD will ensure that the following clause is placed in every DOT-assisted contract and subcontract:

The contractor or subcontractor shall not discriminate on the basis of race, color, national origin, or sex in the performance of this contract. The contractor shall carry out applicable requirements of 49 CFR Part 26 in the award and administration of DOT-assisted contracts. Failure by the contractor to carry out these requirements is a material breach of this contract, which may result in the termination of this contract or such other remedy as the recipient deems appropriate.

EXHIBIT #6

DBE LETTER OF INTENT

(To be completed by each DBE)

To: __________________________________________________ (Name of Prime Proposer)

The undersigned intends to perform work in connection with the above project as a DBE in the following capacity (check one):

Individual Corporation Partnership Joint Venture

The Disadvantaged Business status of the undersigned is confirmed:

(a) On the reference list of Disadvantaged Business Enterprises dated ____________, or

(b) On the attached Disadvantaged Business Enterprise Identification Statement.

The undersigned is prepared to perform the following work in connection with the above project (specify in detail the particular work items or parts thereof to be performed):

The above work will not be sublet to a non-Disadvantaged Business Enterprise at any tier. The undersigned will enter into a formal agreement for the above work with you, conditioned upon your execution of an agreement with SAMTD.

Date ___________________ _______________________________________________ Name of Disadvantaged Business Enterprise

By____________________________________________

EXHIBIT #7

DBE AFFIDAVIT

(To be completed by each DBE)

STATE OF ____________________________________ (DATE ___________________)

COUNTY OF __________________________________

The undersigned being duly sworn, deposes and says that he/she is the (Sole owner, partner, president, treasurer or ________________________ of ______________________________ and certifies that since the date other duly authorized official of a corporation) (Name of DBE) of its certification by the Oregon Department of Transportation (ODOT), *UCP or other *DOT, the certification has not been revoked nor has it expired nor has there been any change in the minority status of _______________________________.

(Name of DBE)

(Signature and Title of Person Making Affidavit)

*Certified DBE’s can be found on http://www.oregon4biz.com/How-We-Can-Help/COBID/

Sworn to before me this _______________ day of ______________________, 20_____.

(Notary Public)

Affix Seal Here:

NOTE: The Proposer must attach the DBE’s most recent certification letter or document to this affidavit.

*Please list other entity __________________________________________________

EXHIBIT #8

DBE UNAVAILABLE CERTIFICATION

To be completed by Prime Contractor:

I, ______________________________, the below named agent of ___________________, certify that I have contacted the following Disadvantaged Business Enterprise to obtain a Proposal for the following work items.

Certified DBE Contractor

Work Disciplines Sought

To the best of my knowledge and belief, said Disadvantaged Business Enterprise was unavailable for work on this project, or unable to prepare a Proposal for the following reason(s):

Signature: _______________ ________________ Date: _______________________

To be completed by DBE:

_____________________________________________ was offered an opportunity to propose (Name of Disadvantaged Business Enterprise) on the above identified work on _____________________ by _________________________.

(Date) (Source)

The above statement is a true and accurate account of why I did not submit a Proposal on this project.

(Signature of Disadvantaged Business Enterprise) (Date)

EXHIBIT #9

CONTRACTOR’S REPRESENTATIONS AND WARRANTIES CERTIFICATION

(State of Oregon)

Contractor hereby represents and warrants to Salem Area Mass Transit District (SAMTD) that:

1. Contractor has the power and authority to enter into and perform this Contract.

2. This Contract, when executed and delivered, is a valid and binding obligation of Contractor, enforceable in accordance with its terms.

3. Contractor (to the best of Contractor’s knowledge, after due inquiry) has never knowingly or intentionally failed to comply with:

(i) All tax laws of this state, including but not limited to ORS 305.620 and ORS Chapters 316, 317, and 318;

(ii) Any tax provisions imposed by a political subdivision of this state that applied to Contractor, to Contractor’s property, operations, receipts, or income, or to Contractor’s performance of or compensation for any work performed by Contractor;

(iii) Any tax provisions imposed by a political subdivision of this state that applied to Contractor, or to goods, services, or property, whether tangible or intangible, provided by Contractor;

and

(iv) Any rules, regulations, charter provisions, or ordinances that implemented or enforced any of the foregoing tax laws or provisions.

4. Any goods and/or services to be provided to SAMTD, in the performance of Contractor’s obligations under this Contract, shall be provided to SAMTD free and clear of any and all restrictions on or conditions of use, transfer, modification, or assignment, and shall be free and clear of any and all liens, claims, mortgages, security interests, liabilities, charges, and encumbrances of any kind.

Contractor Name:_______________________________________________________ _

Signature of Authorized Representative:_______________________________ ________

Printed Name:_______________________________________Date:___________ _____

Title/Position:__________________________ _____________

To be included with ALL SOLICITATIONS, per SB 675, eff. 9-21-15.

EXHIBIT #10

CERTIFICATION REGARDING DEBARMENT, SUSPENSION,

INELIGIBILITY, AND VOLUNTARY EXCLUSION

This certification is made in accordance with Executive Order 12549, 49 CFR Part 29, 31 U.S.C.

§ 6101 and similar federal requirements regarding debarment, suspension, and ineligibility with respect to federally funded contracts.

This contract is a covered transaction for purposes of 49 CFR Part 29. As such, the contractor is required to verify that none of the contractor, its principals, as defined at 49 CFR 29.995, or affiliates, as defined at 49 CFR 29.905, are excluded or disqualified as defined at 49 CFR 29.940 and 29.945.

The contractor is required to comply with 49 CFR 29, Subpart C and must include the requirement to comply with 49 CFR 29, Subpart C in any lower tier (subcontractors) covered transaction it enters into.

By signing and submitting its Proposal or Proposal, the Proposer or Proposer certifies as follows:

The certification in this clause is a material representation of fact relied upon by Salem Area Mass Transit District. If it is later determined that the Proposer or Proposer knowingly rendered an erroneous certification, in addition to remedies available to Salem Area Mass Transit District, the Federal Government may pursue available remedies, including but not limited to suspension and/or debarment. The Proposer or Proposer agrees to comply with the requirements of 49 CFR 29, Subpart C while this offer is valid and throughout the period of any contract that may arise from this offer. The Proposer or Proposer further agrees to include a provision requiring such compliance in its lower-tier covered transactions (subcontractors).

If the Proposer or Proposer is unable to certify to the statement above, it shall attach an explanation and indicate that it has done so by placing an “X” in the following space ________.

Signature of the Proposer or Proposer Authorized Official

Name and Title of the Proposer or Proposer Authorized Official

Federal ID #

Dun & Bradstreet (Dun’s) ID #

Date

CERTIFICATION REGARDING DEBARMENT, SUSPENSION,

INELIGIBILITY, AND VOLUNTARY EXCLUSION

Instructions for Certification

1. By signing and submitting this Proposal or Proposal, the prospective contractor is providing the signed certification set out below:

"Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion – Lower- Tier Covered Transaction"

(1) The prospective contractor certifies, by submission of this Proposal or Proposal, that neither it nor its "principals" [as defined at 49 C.F.R. § 29.105(p)] is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency.

(2) When the prospective contractor is unable to certify to the statements in this certification, such prospective participant shall attach an explanation to this Proposal or Proposal.

2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective contractor knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, Salem Area Mass Transit District (SAMTD) may pursue available remedies, including suspension and/or debarment.

3. The prospective contractor shall provide immediate written notice to SAMTD if at any time the prospective contractor learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower-tier covered transaction," "participant," "persons," "lower-tier covered transaction," "principal," "Proposal," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549 [49 CFR Part 29].

5. The prospective contractor agrees by submitting this Proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower-tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized in writing by SAMTD.

6. The prospective contractor further agrees by submitting this Proposal that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion – Lower-Tier Covered Transaction," without modification, in all lower-tier covered transactions and in all solicitations for lower-tier covered transactions.

7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower-tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List issued by U.S. General Services Administration.

8. Nothing contained in the foregoing shall be construed to require establishment of system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower-tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to all remedies available to the Federal Government, SAMTD may pursue available remedies including suspension and/or debarment.

EXHIBIT #11

CERTIFICATION REGARDING LOBBYING

Certifications for Contracts, Grants, Loans, and Cooperative Agreements Exceeding $100,000

(RESERVED FOR THIS SOLICITATION)

EXHIBIT #12

BUY AMERICA CERTIFICATION

(To be submitted with each Bid or offer exceeding $100,000)

(RESERVED FOR THIS SOLICITATION)

EXHIBIT #13

BIDDER PRICE FORM

(ATTACHED SEPARATELY)

EXHIBIT #14

“REFERENCES”

(ATTACHED SEPARATELY)

END OF PART 3