FI960-21 - Att1 - Proposal Form.docx
DOCX document 32 KB Posted
- Attached to
- Large Format Scanner (FI960-21)
- Solicitation number
- S-C25102-00000952
- Issued by
- Marion County, Oregon
About this file
This document is the Proposal Form for a contract opportunity issued by Marion County, Oregon and the cities of Salem, Oregon. The contract is for the provision of a large format scanner. The Proposal Form outlines the requirements for prospective vendors to submit a bid, including providing their company information, certifying compliance with applicable laws and regulations, and acknowledging receipt of any addenda. The contract term and any renewal options are not specified.
The Proposal Form also includes a Certification Regarding Debarment, Suspension and Other Responsibility Matters, which requires vendors to disclose any prior criminal convictions, contract terminations, or pending litigation related to the performance of public contracts. Pricing terms, set-asides, funding sources, and other salient commercial details are not provided in the Proposal Form.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| FI960-21 - Exh1 - Sample Purchase Order.pdf | ||
| FI960-21 - Att2 - Trade Secret Form.docx | DOCX document | |
| FI960-21 - Att3 - Reference Form.docx | DOCX document | |
| FI960-21 - Request for Proposal.pdf | ||
| FI960-21 - Att4 - Cost Proposal Submission Form.docx | DOCX document | |
| PCS21-007RFP_Electrical and Low Voltage Svcs.pdf |
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Text version
ATTACHMENT 2 –TRADE SECRET FORM
Attachment 1. Proposal Form OFFEROR NAME: _______________________________________________________________________________________ ADDRESS: _____________________________________________________________________________________________
| TELEPHONE NUMBER: _________________ | EMAIL: ______________________ | WEB SITE: ____________________ | ||
| TAXPAYER ID NUMBER: _______________ | DATE/STATE OF INCORPORATION: _____________________________ | |||
| BUSINESS DESIGNATION: | Corporation | Sole Proprietor | Partnership | |
| S Corporation | Non-Profit | Government |
Other: __________________________________________________
CERTIFICATION/LICENSE NUMBER: __________________________________________________
The undersigned further acknowledges, attests and certifies individually and on behalf of the Proposer that:
| 1. | That this proposal is, in all respects, fair and without fraud; that it is made without collusion with any official of the county; and that the proposal is made without any collusion with any person making another proposal on this Contract. |
| 2. | Information and prices included in this proposal shall remain valid for ninety (90) days after the proposal due date or until a Contract is approved, whichever comes first. |
| 3. | The Proposer acknowledges receipt of all Addenda issued under the RFP. |
| 4. | The Proposer certifies that it does not discriminate against any employee or applicant for employment because of race, color, religion, sex, national origin, handicap, financial ability, age or other non-job-related factors as per ORS 659 and USC 42 2000e. |
| 5. | The Proposer, acting through its authorized representative, has read and understands all RFP instructions, specifications, and terms and conditions contained within the RFP and all Addenda, if any; |
| 6. | The Proposer agrees to and shall comply with, all requirements, specifications and terms and conditions contained within the RFP, including all Addenda, if any; |
| 7. | The proposal submitted is in response to the specific language contained in the RFP, and Proposer has made no assumptions based upon either (a) verbal or written statements not contained in the RFP, or (b) any previously-issued RFP, if any. |
| 8. | The Proposer agrees that if awarded the Contract, Proposer shall be authorized to do business in the State of Oregon at the time of the award; |
| 9. | The signatory of this Proposal Form 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 and all Addenda, if any, issued, and to execute this proposal document on behalf of Proposer. |
10. By signature below, the undersigned Authorized Representative hereby certifies on behalf of Proposer that all contents of this Proposal Form 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.
CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS - The Offeror certifies to the best of its knowledge and belief that neither it nor any of its principals:
| 1. | Are presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from submitting bids or proposals by any federal, state or local entity, department or agency; |
| 2. | Have within a five-year period preceding the date of this certification been convicted of fraud or any other criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) contract, embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; |
| 3. | Are presently indicted for or otherwise criminally charged with commission of any of the offenses enumerated in item number 2 of this certification; |
| 4. | Have, within a five-year period preceding the date of this certification had a judgment entered against contractor or its principals arising out of the performance of a public or private contract; |
| 5. | Have pending in any state or federal court any litigation in which there is a claim against contractor or any of its principals arising out of the performance of a public or private contract; and |
| 6. | Have within a five-year period preceding the date of this certification had one or more public contracts (federal, state, or local) terminated for any reason related to contract performance. |
Where Offeror is unable to certify to any of the statements in this certification, Offeror shall attach an explanation to their offer. The inability to certify to all of the statements may not necessarily preclude Offeror from award of a contract under this procurement.
IF THE PROPOSAL IS MADE BY A JOINT VENTURE, IT SHALL BE EXECUTED BY EACH PARTICIPANT OF THE JOINT VENTURE.
THIS OFFER SHALL BE SIGNED BY AN AUTHORIZED REPRESENTATIVE OF THE PROPOSER; ANY ALTERATIONS OR ERASURES TO THE OFFER SHALL BE INITIALED IN INK BY THE UNDERSIGNED AUTHORIZED REPRESENTATIVE.
SIGNATURE OF PROPOSER'S DULY AUTHORIZED REPRESENTATIVE FOR ALL SECTIONS:
Authorized Signature: __________________________________________________________ Print Name: __________________________________________________________________ Title: _______________________________________________________________________ Contact Person (Type or Print): ___________________________________________________ Telephone Number: (___) _____________________ Email: __________________________ The Offeror will notify the County representative on the cover page of this RFP within 30 days of any change in the information provided on this form.
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