Exhibit VIII Contractor Wksht
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- Attached to
- On-Call Geotechnical Drilling Services
- Solicitation number
- RFQ-484-08152022
- Issued by
- Georgia
About this file
This is a Contractor Information Worksheet for Request for Quotation (RFQ) 484-08152022 issued by the Georgia Department of Transportation (GDOT) for On-Call Geotechnical and Environmental Drilling Services. GDOT seeks qualified firms to provide geotechnical and environmental drilling services including bridge foundation drilling and sampling, soil survey drilling and sampling, wall foundation drilling and sampling, and environmental drilling and sampling. The solicitation establishes open agency contracts to be utilized as jobs and needs are identified by the Department. A virtual optional pre-bid meeting was held on Thursday, July 28, 2022 at 10:00 AM. The awarded contracts shall be in effect for up to five years and will include options for price increases and/or decreases during the term of the agreement at specified intervals. GDOT reserves the right to reject any or all proposals and to waive technicalities and informalities at its discretion. A restriction of communication is in effect from the advertisement date until a successful respondent is selected and the selection is announced; respondents are prohibited from communicating about the solicitation or scope with GDOT staff except for question submissions as instructed in the RFQC or as provided by existing work agreements.
The worksheet requires contractors to provide company information and certify their status regarding scrutinized company designations under Georgia Code Section 50-5-84 and related statutes. Contractors must certify whether they are scrutinized companies with business operations in Sudan, Russia, Belarus, or China. False certifications may result in civil penalties, contract termination, ineligibility to bid on state contracts for three or more years, and other available remedies. Scrutinized companies under the Russia/Belarus and China provisions are ineligible to submit responses, while Sudan-related scrutinized companies may be eligible if DOAS makes a determination that it is in the best interests of the State. Civil penalties for false certification regarding Russia/Belarus and China scrutinized company status equal the greater of $250,000 or twice the contract amount.
Text of this file
Sheet1 Contractor Information Worksheet for RFQ-484-08152022
| Contractor General Information | ||
| This spreadsheet requests basic information concerning the Contractor and may establish other requirements the Contractor must meet to be considered eligible for award. Read each question carefully and provide all requested answers. | ||
| Question # | Description | |
| 1 | Provide Company Information: | |
| Description | Response | |
| Company Name |
(Provide full legal name)
| Address 1 | ||
| Address 2 | ||
| City | ||
| State | ||
| Zip Code | ||
| Authorized Person’s Name | ||
| Telephone Number | ||
| Email Address | ||
| 2 | Is your company a scrutinized company as defined by O.C.G.A. Section 50-5-84? Please answer either a, b, or c as described below. | Response |
| SUDAN: Any Supplier that currently and/or previously, within the last three years, has had business activities or other operations outside of the United States, must certify that it is not a “scrutinized company.” A scrutinized company is a company conducting business operations in Sudan that is involved in power production activities, mineral extraction activities, oil-related activities, or the production of military equipment, but excludes a company which can demonstrate any of the following exceptions noted in O.C.G.A. Section 50-5-84. False certification hereunder may result in civil penalties, contract termination, ineligibility to bid on state contractors for three or more years, and/or any other available remedy. If the Supplier is a scrutinized company, the Supplier shall not be eligible to bid on or submit a proposal for a contract with the State Entity unless DOAS makes a determination in accordance with O.C.G.A. Section 50-5-84 that it is in the best interests of the State to permit the scrutinized company to submit a bid or proposal. Any scrutinized company desiring DOAS to make such a determination should contact both DOAS and the Issuing Officer immediately. |
Please answer either a, b or c in the response column of this worksheet to indicate your answer:
a. I certify my company is NOT a “scrutinized company.”
b. I certify my company is a “scrutinized company.”
c. I certify I have requested and received written permission from DOAS to submit a response to this Event in accordance with O.C.G.A. Section 50-5-84.
| 3 | Is your company a scrutinized company as defined by O.C.G.A. Section 50-5-84.1? Please answer either a or b as described below. | Response |
| RUSSIA/BELARUS: A scrutinized company is any sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, limited liability company, or other entity or business association, including all wholly owned subsidiaries, majority owned subsidiaries, parent companies, or affiliates of such entities or business associations, that exists for the purpose of making profit owned or operated by the Government of Belarus or the Government of Russia. The Government of Belarus means the Republic of Belarus, and the Government of Russia means the Russian Federation. A scrutinized company is ineligible to submit a response to this solicitation. False certification hereunder may result in a civil penalty in an amount that is equal to the greater of $250,000 or twice the amount of the contract for which a bid or proposal was submitted, contract termination, and any other penalties available under law, rule or policy. |
Please answer either a or b in the response column of this worksheet to indicate your answer:
a. I certify my company is NOT a “scrutinized company.”
b. I certify my company is a “scrutinized company.”
| 4 | Is your company a scrutinized company as defined by O.C.G.A. Section 50-5-84.2? Please answer either a or b as described below. | Response |
| CHINA: A scrutinized company is any sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, limited liability company, or other entity or business association, including all wholly owned subsidiaries, majority owned subsidiaries, parent companies, or affiliates of such entities or business associations, that exists for the purpose of making profit owned or operated by the Government of China. The Government of China means the People’s Republic of China led by the Chinese Communist Party. A scrutinized company is ineligible to submit a bid or proposal in response to this solicitation. False certification hereunder may result in a civil penalty in an amount that is equal to the greater of $250,000 or twice the amount of the contract for which a bid or proposal was submitted, contract termination, and any other penalties available under law, rule, regulation or policy. |
Please answer either a or b in the response column of this worksheet to indicate your answer:
a. I certify my company is NOT a “scrutinized company.”
b. I certify my company is a “scrutinized company.”
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