FILLABLE ATTACHMENT A.docx

ATTACHMENT A

BID PACKAGE FORMS

· FORM A-1: BIDDER INFORMATION AND CERTIFICATIONS FORM

· FORM A-2: PRICING FORM

FORM A-1 — BIDDER INFORMATION AND CERTIFICATIONS FORM

ITB S-63400-00013289

Mongold Day-Use Area Self-Adjusting Aluminum Dock

[Note to Bidders: If additional space or lines are needed attach an additional page to the end of the form.]

Business Name: [ ]

Is Bidder authorized to transact business by the Oregon Secretary of State? Yes ☐ / No ☐

· If yes, provide business registry number or otherwise describe authorization:

Business Owner(s) Name: [ ]

Business Address: [ ]

Bidder is a: (select one)

Telephone Number: [ ]

Email Address: [ ]

Federal Employer Identification Number (“FEIN”) Number: [ ]

Unique Entity Identifier (“UEI”) Number: [ ]

Contract Authorized Representative Name: [ ]

If Bidder is a joint venture or partnership, the individual named above must be authorized to sign on its behalf and execute agreements. Additionally, upon request, Bidder shall provide a copy of the joint venture agreement or partnership agreement evidencing authority to Bid and to enter into the resulting Contract that may be awarded, together with corporate resolutions (if applicable) evidencing corporate authority to participate as a joint venture or partnership.

SUBCONTRACTORS CERTIFIED UNDER ORS 200.055

Agency promotes and applies a policy of diversity, equity, and inclusion in public contracting by engaging in efforts to increase public contracting opportunities for businesses and enterprises that the Certification Office for Business Inclusion and Diversity has certified under ORS 200.055.

Provide the company name(s) of any subcontractor certified under ORS 200.055 as a disadvantaged business enterprise, a minority-owned business, a woman-owned business, an emerging small business, or a veteran-owned business, that Bidder intends to utilize in the performance of this Contract.

Name: [ ]

Name: [ ]

Name: [ ]

Name: [ ]

Name: [ ]

RESPONSIBILITY INQUIRY

Bidder may add additional lines to this section and form as needed to provide the required information.

1. Does Bidder have available the appropriate financial, material, equipment, facility, and personnel resources and expertise, or ability to obtain the resources and expertise, necessary to demonstrate the capability of Bidder to meet all contractual responsibilities?

Yes ☐ / No ☐

2. Within the last 5 years, how many contracts of a similar nature has Bidder completed that, to the extent that the costs associated with and time available to perform the contract remained within Bidder′s control, Bidder stayed within the time and budget allotted, and there were no contract claims by any party? Number of contracts: [insert #]

How many contracts did not meet those standards? Number of contracts: [insert #]

If any contracts did not meet those standards, please provide an explanation:

Has Bidder been debarred or otherwise disqualified from bidding on contracts by any state, local, or federal agency under any state or federal law? Yes ☐ / No ☐

If yes, please provide an explanation:

3. Within the last 3 years, has Bidder had:

a. any contracts terminated for default by any government agency, or

b. any lawsuits filed against it by creditors or involving contract disputes?

Yes ☐ / No ☐

If yes, please provide an explanation: (With regard to judgments, include jurisdiction and date of final judgment or dismissal.)

4. Within the last 3 years has Bidder been criminally or civilly charged, indicted, or convicted in connection with:

a. obtaining, attempting to obtain, or performing a public (federal, state, or local) contract or subcontract,

b. violation of federal or state antitrust statutes relating to the submission of Bids or Proposals, or

c. embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, or receiving stolen property?

Yes ☐ / No ☐

If yes, indicate the jurisdiction, date of indictment, charge or judgment, and names and summary of charges below:

Does Bidder have any outstanding or pending judgments against it? Yes ☐ / No ☐

If yes, please provide an explanation:

5. Is Bidder experiencing financial distress or having difficulty securing financing?

Yes ☐ / No ☐

If yes, please provide an explanation:

6. Does Bidder have sufficient cash flow to fund day-to-day operations throughout the proposed contract period?

Yes ☐ / No ☐

If no, please provide an explanation:

Within the last 3 years, has Bidder filed a bankruptcy action, filed for reorganization, made a general assignment of assets for the benefit of creditors, or had an action for insolvency instituted against it?

Yes ☐ / No ☐

If yes, provide the filing dates, jurisdictions, type of action, ultimate resolution, and dates of judgment or dismissal, if applicable:

Does Bidder have all required licenses, insurance and/or registrations, if any, and is Bidder legally authorized to do business in the State of Oregon? Yes ☐ / No ☐

If no, please provide an explanation:

7. Pay Equity Certificate. This certificate is required if Bidder employs 50 or more full-time workers and the resulting Contract price is estimated to exceed $500,000. Does a current authorized representative of Bidder possess an unexpired Pay Equity Certificate issued by the Department of Administrative Services?

Yes ☐ / No ☐ / Not Applicable ☐

[If the certificate was provided with the Bid or Proposal submitted for a solicitation related to the prospective contract, then it is not necessary to resubmit it. Just indicate “see Bid” or “see Proposal” in the response field. Otherwise, if applicable, submit a copy of the certificate with this form.]

Does Bidder have documented diversity, equity and inclusion values and practices as required pursuant to Executive Order 22-15? Yes ☐ / No ☐

8. Within the last 3 years has the Offeror, or any officer, partner, agent or employee of Offeror been found to have violated any state or federal prevailing wage statute or regulation (including the federal Davis-Bacon and related Acts and ORS 279C.800 – ORS 279C.870) in any Final Order of the Oregon Bureau of Labor and Industries or the United States Department of Labor, or by any court of competent jurisdiction?

Yes ☐ / No ☐

If yes, provide copies of the final order(s) or judgment in which this occurred and explain in detail:

(a) The circumstances behind any violation, including the amount(s) not paid

(b) Whether the amount(s) have now been paid

(c) The reasons for the violation

(d) All efforts undertaken to ensure that future violations will not occur

Response:

RECORD OF SATISFACTORY PERFORMANCE

Bidder must demonstrate that it has completed previous contracts of a similar nature with a satisfactory record of performance. Bidder shall provide the information below for 3 different projects completed within the last 3 years that demonstrate Bidder’s experience with projects of similar size, scope, and complexity to the Project that is the subject of this ITB. Bidder must provide contact information for the individual who can describe the quality of workmanship and service that the Bidder provided on current and past projects of similar size and complexity.

Agency reserves the right to choose and investigate any contact or reference (whether or not furnished by the Bidder), and to investigate past performance with respect to its successful performance of similar projects, compliance with specifications and contractual obligations, its completion or delivery of service on schedule, and its lawful payment of suppliers, subcontractors, and employees.

Bidder may add additional lines to this form as needed to provide the required information.

Project #1

Description of Project: [ ]

Project Location: [ ]

Project Date: [ ]

Contract Amount: [ ]

Project Owner: [ ]

Project Contact: [name], [phone], [email]

Did the project owner ever find that you were materially deficient in contract performance?

Yes ☐ / No ☐

If yes, (i) was the deficient performance expressly excused under the terms of the contract, or (ii) did you take appropriate corrective action? Please provide an explanation:

Did you stay within the contract time and budget to the extent the costs associated with and time available to perform a previous contract were within your control? Yes ☐ / No ☐

Project #2

Description of Project: [ ]

Project Location: [ ]

Project Date: [ ]

Contract Amount: [ ]

Project Owner: [ ]

Project Contact: [name], [phone], [email]

Did the project owner ever find that you were materially deficient in contract performance?

Yes ☐ / No ☐

If yes, (i) was the deficient performance expressly excused under the terms of the contract, or (ii) did you take appropriate corrective action? Please provide an explanation:

Did you stay within the contract time and budget to the extent the costs associated with and time available to perform a previous contract were within your control? Yes ☐ / No ☐

Project #3

Description of Project: [ ]

Project Location: [ ]

Project Date: [ ]

Contract Amount: [ ]

Project Owner: [ ]

Project Contact: [name], [phone], [email]

Did the project owner ever find that you were materially deficient in contract performance?

Yes ☐ / No ☐

If yes, (i) was the deficient performance expressly excused under the terms of the contract, or (ii) did you take appropriate corrective action? Please provide an explanation:

Did you stay within the contract time and budget to the extent the costs associated with and time available to perform a previous contract were within your control? Yes ☐ / No ☐

CERTIFICATIONS OF BIDDER’S DULY AUTHORIZED REPRESENTATIVE

THIS BID MUST BE SIGNED BY AN AUTHORIZED REPRESENTATIVE OF THE BIDDER

The undersigned acknowledges, attests, and certifies individually and on behalf of the Bidder that:

(1) The undersigned is a duly authorized representative of the Bidder, has been authorized by Bidder to make all representations, attestations, and certifications contained in this Bid and all Addenda, if any, issued;

(2) Bidder, acting through its authorized representatives, has read and understands all Bid instructions, Specifications, Plans, terms and conditions contained in this Bid document (including all listed attachments and Addenda, if any, issued);

(3) The Bid submitted is in response to the specific language contained in the ITB, and Bidder has made no assumptions based upon either (a) verbal or written statements not contained in the ITB, or (b) any previously issued ITB, if any;

(4) The State shall not be liable for any claims or be subject to any defenses asserted by Bidder based upon, resulting from, or related to, Bidder’s failure to comprehend all requirements of the ITB;

(5) The State shall not be liable for any expenses incurred by Bidder in preparing and submitting its Bid or in participating in the Bid evaluation/selection process;

(6) The Bidder agrees to be bound by and comply with all applicable requirements of ORS 279B.200 through ORS 279B.283 and the administrative rules regarding conditions concerning hours and rate of wages for labor;

(7) The Bid was prepared independently from all other Bidders, and without collusion, fraud, or other dishonesty;

(8) Bidder is bound by and will comply with all requirements, Specifications, Plans, terms and conditions contained in this Bid (including all listed attachments and Addenda, if any, issued);

(9) Bidder will furnish the designated item(s) or service(s) in accordance with the Specifications, Plans and requirements, and will comply in all respects with the terms of the resulting Contract upon award;

(10) Bidder represents and warrants that Bidder has the power and authority to enter into and perform the Contract and that the Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms;

(11) Bidder has no undisclosed liquidated or delinquent debt owed to the State or any department or agency of the State;

(13) Bidder is, to the best of my knowledge, not in violation of any Oregon Tax Laws. For purposes of this certification, “Oregon tax laws” means (i) all tax laws of this state, including but not limited to ORS 305.380(4), ORS 305.620 and ORS chapters 316, 317, and 318; and (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; and (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;

(14) Bidder has not discriminated and will not discriminate against any disadvantaged business enterprise, minority-owned business, women-owned business, emerging small business, or veteran-owned business (as those terms are defined in ORS 200.005), in obtaining any required subcontracts;

(15) Bidder has a written policy and practice that meets the requirements described in ORS 279A.112 for preventing sexual harassment, sexual assault and discrimination against employees who are members of a “protected class”; and

(16) If awarded a Contract, Bidder agrees and acknowledges each Contractor and subcontractor will comply with the prohibition on aerosolizing, smoking or vaporizing when in a public place per ORS 433.845; and

(17) All affirmations and certifications contained within the Bid, including those in this Bidder Information and Certification Form and the Pricing Form, are true and correct.

ACKNOWLEDGMENT OF ADDENDA

(must be completed by Bidder as a matter of responsiveness)

Bidder acknowledges and agrees: (select one option) ☐ Addenda No. [insert #] to No. [insert #] have been issued for this ITB.

☐ Addenda have not been issued for this ITB.

If addenda have been issued, Bidder has received and duly considered all addenda. Bidder acknowledges and agrees to the terms of all such Addenda as those terms revise the terms, conditions, Plans and Specifications of this ITB.

SIGNATURE OF BIDDER’S DULY AUTHORIZED REPRESENTATIVE

(Legal Business Name)

FORM A-2 — PRICING FORM

ITB S-63400-00013289

Mongold Day-Use Area Self-Adjusting Aluminum Dock

PRICING SUBMITTAL INSTRUCTIONS:

Bidder shall enter pricing and other required information for all Bid Items listed in this Pricing Form. If this Pricing Form is replaced by Addendum, Bidders shall use the Addendum form to provide pricing and other required information. If the Pricing Form is only modified by Addendum, Bidders shall follow the instructions in the Addendum for making modifications to the Pricing Form. Failure to supply the required information in the Pricing Form, as modified by subsequent Addenda, may result in Bid rejection as nonresponsive.

All Work described in the Contract Documents but not specifically itemized in the Pricing below is considered incidental to the Work, and Bidder agrees to furnish all necessary plant, labor, equipment, accessories, materials, permits, and perform all incidental Work at no additional cost to the Agency. Contractor shall furnish all temporary facilities such as power, lights, heat, telephone, potable water, portable toilets, and job office as needed to perform the Work at no additional charge to the Agency. No payment shall be made unless and until complete dock components are delivered and accepted as provided in ITB Section A.1.

NOTE: Bid price is total contract price including contractor’s profit and overhead. Items not explicitly listed in the bid schedule above are considered incidental.

The undersigned understands that the State reserves the right to increase or decrease the above quantities at the same unit prices as shown or to remove items as necessary to meet budgetary constraints. The undersigned has carefully examined the Contract Documents and the site of the work, and agrees to furnish all necessary plant, labor, equipment, accessories, materials, permits, and perform all operations shown and specified in accordance with the Contract Documents for the price(s) set herein.

Bid submitted by:

(Legal Business Name)

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