FAC98 Required Forms.docx

FAC98 Required Forms

The following documents are mandatory for this RFR. Failure to provide these documents may be cause for the bid to be deemed as non-responsive and may result in disqualification.

Listed below are the required forms that must be submitted with the bid response for award consideration.

Once completed, save the file with the following name “Company Name_FAC98_Required Forms” for submission.

*if saving each form separately file name should follow “Company Name_FAC98_Form Name”

1. Prompt Pay Discount Form (PPD) (mandatory requirement MUST offer PPD)

2. SDP Plan Form #1 - Plan Commitment (mandatory requirement MUST offer % commitment)

3. Business Reference Form (Business Reference Letters need to be separate attachments)

4. Bidder Current Environmentally Preferable Products / Practices Form

5. Certificate of Non-Collusion

COMMONWEALTH OF MASSACHUSETTS

Prompt Pay Discount Form (Invoice discounts for receiving fast payments) Revised 3/9/07 Bidder Name: .

Vendor Code (VCUST): .

Contract/RFR Number(s): FAC98 Floorcoverings and Accessories, Floorcovering Installation, Maintenance and Repair

Prompt Payment Discounts (PPD). All contractors/vendors doing business with the Commonwealth must provide a Prompt Payment Discount (PPD) for receiving early payments unless the Contractor/vendor can provide compelling proof that providing a prompt pay discount would be unduly burdensome. Contractors benefit from PPD by increased, usable cash flow as a result of fast and efficient payments for commodities or services rendered. Contractors who agree to accept Electronic Funds Transfer (EFT) increase the prompt pay benefit by ensuring that funds are paid directly to their designated bank accounts, thus eliminating the delay of check clearance policies and traditional mail lead time. Payments processed through the state accounting system (MMARS) can be tracked and verified through the Comptroller’s Vendor Web system using the Vendor/Customer Code assigned to you by a Commonwealth department.

The Commonwealth benefits because contractors reduce the cost of products and services through the applied discount. While Bidders/Contractors have flexibility in determining the actual % discount(s) offered to the Commonwealth, the discount(s) must be identified for 10, 15, 20 and/or 30 days for payment issuance in the column entitled “% Discount Off Proposed Price” below. The Commonwealth may use the prompt pay discounts submitted as a basis for selection and may negotiate discounts as deemed in the best interest of the Commonwealth. The requirement to offer PPD discounts may be waived by the Commonwealth on a case-by-case basis if participation in the program would be unduly burdensome, provided the specific reason for the hardship is outlined below.

All discounts offered will be taken in cases where the payment issue date is within the specified number of days listed below and in accordance with the Commonwealth’s Bill Paying Policy. Payment days will be measured from the date goods are received and accepted / performance was completed OR the date an invoice is received by the Commonwealth, whichever is later to the date the payment is issued as an EFT (preferred method) or mailed by the State Treasurer. The date of payment “issue” is the date a payment is considered “paid” not the date a payment is “received” by a Contractor.

If internal Bidder/Contractor systems require an alternate method of measuring payment issue dates, the Bidder/Contractor must note the issues below or on an attached page if necessary to be considered by the PMT. In cases where the Bidder/Contractor considers that offering a Prompt Payment Discount would be a hardship, the Bidder must clearly define the issues and reasons for said hardship. Providing volume discounts or other discounts on prices is not considered a hardship, since the PPD provides the additional benefit of early cash flow for the Contractor.

Enter the Prompt Payment Discount percentage (%) off the invoice payment, for each of the payment issue dates listed, if the payment is issued within the specified Payment Issue days. For example:

5% - 10 Days 4% - 15 Days 3% - 20 Days 2% - 30 Days If no discount is offered enter 0%

The Contractor is unable to provide a prompt payment discount due to the following hardship:

Contractor/Bidder Authorized Signature _________________________________ Date: ____________

Contractor/ Bidder Authorized Signatory Print Name and Title: __________________________________ Supplier Diversity Program (SDP) Plan Commitment SDP Plan Form #1 (To be submitted with Bid Response)

Contract/RFR Document Number: FAC98

Instructions: Completing all parts of this form is mandatory. Please read all sections of the Bid related to the SDP. Complete one form and submit with your Quote.

Important: Prime bidders that are certified as an M/WBE, M/WNPO, VBE and SDVOBE must also submit an SDP Plan Form and may not list themselves or their affiliates as SDP Partners.

Part I Bidder/Contractor Information (Required)

Part II Annual Financial Commitment (Required)

Provide a specific percentage of Bidder/Contractor sales derived from this contract to be spent with all certified SDP Partners on a Massachusetts fiscal year (July 1-June 30) basis.

Annual SDP Percentage Committed in Bid Response for Life of Contract:

Click here to enter percentage.%

Supplier Diversity Program (SDP) Resources:

· Lists of M/WBEs, M/WNPOs, VBEs and SDVOBEs certified or verified by the Supplier Diversity Office (SDO) are located at www.mass.gov/sdo.

· Additional resources to assist Prime Bidders in finding potential Certified Partners can be found at www.mass.gov/sdp.

The Operational Services Division offers trainings on compliance with the SDP Plan requirements. Registration information for upcoming trainings can be found on the Supplier Diversity Program Trainings webpage.

Business Reference Form Bidder: _______________________________________________________ RFR Name/Title: Floorcoverings and Accessories, Floorcovering Installation, Maintenance and Repair RFR Number: FAC98 The bidder must provide three (3) business references on this form and three (3) letters of references must be submitted with bid response (reference letters to be submitted as separate attachments).

Reference name:_____________________________________ Contact:

Address: _________________________________________Phone: # ( ) Fax/Internet address:

Description and date(s) of commodities and services provided:

Reference name: _______________________________________Contact:

Address: _________________________________________Phone: # ( ) Fax/Internet address:

Description and date(s) of commodities and services provided:

Reference name: ______________________________________ Contact:

Address: __________________________________________Phone: # ( ) Fax/Internet address:

Description and date(s) of commodities and services provided:

References will be contacted to confirm the bidder’s abilities and qualifications as stated in the bidder’s response. The department may deem the bidder’s response unresponsive if a reference is not obtainable from a listed reference after reasonable attempts.

Bidder Current Environmentally Preferable Products / Practices Form Bidder Company Name: _________________________________________ Date: _______________ This form is a standard evaluation tool. Questions 1- 6 apply to the operations of the Bidder (not the operations of a manufacturer or other company the bidder works with). Question 7, 8 and 9 requests additional information about environmentally preferable product offerings.

The primary purpose of this form is to encourage potential Bidders to communicate existing business practices that foster a sustainable approach to conducting their operations. This may include one that has a reduced impact on the environment or public health, such as, but not limited to, creating less waste by using less packaging; eliminating the use substances and/or materials that are considered toxic; or using alternative fuel vehicles in the delivery fleet for the purpose of reducing air pollution and greenhouse gas emissions.

The Commonwealth considers such initiatives part of the “best value” of procurement. Bidders have an opportunity to receive additional points in the evaluation phase of the RFR for the environmental initiatives they have identified. However, bidders must substantiate all answers in the space provided below or in an attachment in order to receive any additional points. If reference is made to an attached document, or a website, list the specific page and line to which information is referenced.

1. Sustainability Program/Environmental Business Practices

a) Does your company have a general corporate-wide sustainability policy? If yes, attach or provide a link to your sustainability policy AND summarize what your corporate sustainability policy directs your company to do: Click here to enter text.

b) Indicate any other types of specific corporate sustainability policies AND attach policy in order to receive credit.

☐Climate Action Plan ☐Zero Waste Policy ☐Toxics Reduction Strategy ☐Green Fleet Policy ☐Sustainable Procurement Policy or Environmentally Preferable Purchasing Policy ☐Waste Prevention and/or recycling policy/program (describe and list types of materials you recycle)

Briefly describe and list sustainable procurement practices and achievements as a result of the policies checked above: Click here to enter text.

c) Does your company publish an annual Sustainability Report listing accomplishments and future goals? If yes, please attach (or provide a link to) your latest Sustainability Report. Please describe key elements and accomplishments (such as receiving sustainability awards). Click here to enter text.

d) Please list individual steps not indicated above that your company has taken to improve the sustainability at your own operations:

☐ Uses at least 50% remanufactured toner cartridges in printers (attach total annual spend on remanufactured and Original Equipment Manufacturer cartridges) Click here to enter text.

☐ Uses Green Cleaning products (certified by UL Ecologo, GreenSeal or SaferChoice) in all cleaning or janitorial services (attach copy of scope of work with cleaning services provider and types of green products used) Click here to enter text.

☐ Purchase appliances and equipment (printers, copiers, microwaves, etc.), that are Energy Star or EPEAT certified models. (list certified products) Click here to enter text.

☐ Incorporates green building design elements into all construction and renovation projects (list green design elements and provide documentation). Click here to enter text.

☐ Owns or leases buildings certified to LEED or another green building standard? (describe) Click here to enter text.

☐ Purchases or creates renewable electricity onsite (through solar or wind systems, for example)? Describe and indicate the % of energy that is derived from renewable sources: Click here to enter text.

☐ Has received a third party energy audit (usually through the utility) and implemented recommendations (attach audit recommendations and identify what has been completed). Click here to enter text.

☐ Has received a third party waste audit and implemented recommendations (attach audit recommendations and identify what has been completed). Click here to enter text.

☐ Please list other sustainable initiatives (e.g., waste reduction programs, green building management programs, other energy efficiency programs, etc.) and provide any measurable data: Click here to enter text.

2. Packaging:

Has your company implemented any of the following environmental packaging initiatives?

☐ All packaging contains post-consumer recycled materials. List post-consumer recycled content: Click here to enter text.

☐ Packaging materials do not contain chemicals or materials of concern such as PVC (vinyl, BPA, etc.). Please describe: Click here to enter text.

3. Shipping/Transportation:

Describe in detail how your company has implemented environmentally sound shipping and transportation practices.

☐ Your company uses electric, hybrid-electric, bicycles or other alternative fuel vehicles to transport products to your retail stores or other locations. (Describe program) Click here to enter text.

☐ Your company is a US EPA SmartWay Partner. Attach partnership agreement. Click here to enter text.

☐ Has an anti-idling policy. Attach policy.

☐ Diesel vehicles are equipped with emission control devices. List device(s) here: Click here to enter text.

☐ Uses biodiesel in your vehicles. List estimated amount used in the last year: Click here to enter text.

☐ Use environmentally preferable products in its fleet program (e.g., retread tires, re-refined motor oil, low-VOC solvents, etc.). List products here: Click here to enter text.

☐ Encourages the use of public/green transit. Provide name and description of program(s): Click here to enter text.

☐ Minimizes shipping energy and environmental impacts in other ways? Please describe: Click here to enter text.

4. Training and Education Describe how your company trains staff and educates customers on the products or service that involves an environmentally preferable component. Click here to enter text.

5. Certifications Bidders should familiarize themselves with the various certifications for products and processes that are available within the industry in which they operate, with particular attention to those concerning environmental issues. Has your company or any of its manufacturers and/or subcontractors obtained any of the following product / industry certifications? In order to receive credit, please attach a copy certifications listed below:

☐ Other. Please describe: Click here to enter text.

6. Other Environmental Criteria Bidders may provide additional information about environmentally preferable practices that are not indicated and explained above (attach any appropriate documentation to substantiate claim) Click here to enter text.

7. Environmental Product Offering:

Bidders providing environmentally preferable options in the price sheet should also provide additional information about those options here. Please include a description of the product, how the product is environmentally preferable, how pricing compares to the conventional product counterpart, links to additional information, or if attaching product information, please reference names of files, and any additional information that would be helpful for reviewer: Click here to enter text.

8. Labeling:

a) Does your company adhere to the Carpet and Rug Institute’s voluntary back-of-carpet labeling system which identifies the types of fibers in the product? Click here to enter text.

b) Does your company provide a Health Product Declaration on all products? Click here to enter text.

9. Recycling Does your company have the ability to recycle carpet? Click here to enter text.

Does your company have the ability to recycle flooring? Click here to enter text.

Certificate of Non-Collusion

Contract Reference (Doc. # & Name): FAC98 Floorcoverings and Accessories, Floorcovering Installation, Maintenance and Repair

The undersigned certifies under penalties of perjury that this bid or proposal has been made and submitted in good faith and without collusion or fraud with any other person. As used in this certification, the word “person” shall mean any natural person, including consultants and independent contractors, business, partnership, corporation, union, committee, club or other organization, entity, or group of individuals.

Name of Business

Operational Services Division | One Ashburton Place, Suite 1017 | Boston, MA 02108 | 617-720-3300 | www.mass.gov/osd image1.png image2.png