Exhibit B - Proposer Information and Certification~1.pdf

EXHIBIT B

PROPOSER INFORMATION AND CERTIFICATION

INSURANCE AGENT OF RECORD

Template 04.28.2023

FIRM/COMPANY NAME:

STREET ADDRESS:

CITY, STATE, ZIP CODE:

PRIMARY CONTACT NAME:

PRIMARY CONTACT TITLE:

PRIMARY CONTACT TELEPHONE:

PRIMARY CONTACT EMAIL:

Proposer (check one) is ☐ / is not ☐ a resident of the State of Oregon (“resident” as defined in ORS

279A.120(1)). If not, indicate state of residency: .

Proposer (check one) yes ☐ / no ☐ holds current license(s) and/or certificate(s) as required to perform the Scope of Services.

Name and title of primary individual authorized to represent Proposer in any negotiations and sign any agreement(s) that may result from the RFP:

NAME: TITLE:

Proposer currently has, or prior to executing any agreement(s) if awarded will be able to obtain, insurance coverage meeting or exceeding the insurance requirements of the attached sample agreement, (check one) yes ☐ / no ☐.

Affirmative Action Program. The District is an equal employment opportunity employer and values diversity in its work force. The District requires its contractors to have an operating policy as an equal employment opportunity employer. Firms of 50 people or less do not need to have a formal equal employment opportunity program, but should have an operating policy supporting equal employment opportunity. Proposer shall answer the following questions (check yes or no):

yes ☐ / no ☐ Does your firm have more than 50 employees?

yes ☐ / no ☐ Does your firm have a formal equal employment opportunity program?

Proposer, by signature of its authorized representative below, hereby certifies:

a. that Proposer has read, understands, and agrees to comply with the terms and conditions of the

RFP and the resulting agreement, subject to any negotiations entered into between the District and Proposer in accordance with the RFP, if awarded;

b. that Proposer has complied, or will comply, with all requirements of local, state, and federal laws, and no legal requirements have been or will be violated in responding to the RFP or executing any agreement(s) that result;

c. that Proposer has not discriminated and will not discriminate, in violation of ORS 279A.110, against any disadvantaged business enterprise, a minority-owned business, a woman-owned business, a business that a service-disable veteran owns or an emerging small business that is certified under ORS 200.055 in obtaining any required subcontract;

d. under penalty of perjury, that Proposer is, to the best of Proposer’s knowledge, not in violation of any tax laws described in ORS 305.380;

e. that no Conflict of Interest (“Conflict of Interest” means no officer, employee, or agent of the

Proposer has any personal financial interest, direct or indirect, in the operation of Bend Park and

Recreation District or its affiliates), exists which precludes an impartial Proposal from being submitted by Proposer and that if such conflict should arise, Proposer will immediately notify the District;

f. the price(s) and/or amount(s) of this Proposal were arrived at independently and without consultation, communication, or agreement with any other consultant, Proposer, or potential

Proposer, and neither the exact nor approximate price(s) and/or amount(s) of this Proposal will be publicly disclosed before agreement award(s) or cancellation of the RFP;

g. no attempt has been made or will be made to induce any firm or person to refrain from

Proposing on the RFP or to submit any noncompetitive Proposal or other complementary

Proposal;

h. that it’s Proposal 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 noncompetitive

Proposal; and

i. that if awarded an agreement, Proposer will be authorized to do business in the State of Oregon at the time of the award.

2. Proposer acknowledges receipt of all Addenda issued under the RFP, if any.

3. The District is not be liable for any claims or subject to any defenses asserted by Proposer based upon, resulting from, or related to, Proposer’s failure to comprehend all requirements of the RFP.

4. The District is not liable for any expenses incurred by Proposer in both preparing and submitting its

Proposal or in participating in the Proposal evaluation/selection or contract negotiation process, if any.

5. The signatory of this Proposer Information and Certification is a duly authorized representative of the Proposer, has been authorized by Proposer to make all representations, attestations, and certifications contained in this Proposal document, the RFP, and all Addenda issued, if any, and to execute this Proposal document on behalf of Proposer.

By signature below, the undersigned authorized representative hereby certifies on behalf of Proposer that all contents of this Proposer Information and Certification and the submitted Proposal are truthful, complete, and accurate. Failure to provide information required by the RFP may ultimately result in rejection of the Proposal.

PROPOSER SIGNATURE

Signature Title

Name (please print) Date

– END OF EXHIBIT B –