IFB 126379 Bid Submission Form - Compost Collection Services.docx

IFB 126379 BID SUBMISSION FORM

Business Identification

BUSINESS NAME:

ADDRESS:

CONTACT PERSON:

TITLE:

TELEPHONE NO.:

EMAIL ADDRESS:

REMITTANCE ADDRESS:

BUSINESS ORGANIZED UNDER THE STATE LAWS OF:

PRINCIPAL BUSINESS LOCATION:

STATE CORPORATION COMMISSION IDENTIFICATION NO.:

DUNS NUMBER:

Business Classifications Corporation

Partnership

Sole Proprietor

Minority Owned

Small Business

Non Profit

Woman Owned

Ownership Disclosure Names and address of all persons having an ownership interest of 5% or more in the business:

1.

2.

3.

Qualifications and References Type of work performed by this business:

Number of years this business has been in operation:

B)

C)

Yes- Explain:

Yes:

TRADE SECRETS OR PROPRIETARY INFORMATION:

Trade secrets or proprietary information submitted by the Bidder in connection with a procurement transaction shall not be subject to public disclosure under the Virginia Freedom of Information Act. However, the Bidder must identify the data and materials that need such protection prior to the submission of such data and material, and state the reasons why protection is necessary. Please mark one:

[ ] Yes, the Bid I have submitted does contain trade secrets and/or proprietary information.

[ ] No, the Bid I have submitted does not contain any trade secrets and/or proprietary information.

If Yes, Bidder must clearly identify below the exact data or other materials to be protected and list all applicable page numbers of the Bid containing such data or materials:STATE THE SPECIFIC REASON(S) WHY PROTECTION IS NECESSARY:

Use additional attachments if necessary

NOTE: If the Bidder fails to identify the data or other materials to be protected and fails to state the reasons why such protection is necessary in the space provided above, then the Bidder has not invoked protection accordingly, effectively making the Bid open for public inspection consistent with applicable law.

Conflict of Interests

NO

Collusion:

NO

ADDENDUM RECEIVED:

The undersigned warrants that it has received the following Addendum/Addenda for the Solicitation (Show date of Addendum).

[Add more as needed]

Addenda issued during the bidding period will be incorporated into the Contract Documents.

Authorized Signature By signing this quote Business certifies, acknowledges, understands, and agrees to be bound by the conditions set forth in this Solicitation.

Price Schedule Compost Collection Services

Please provide pricing for the following:

Name of Program Manager:

Waste processing facility:

1) Name: _____________________________________________

2) Address: ___________________________________________

3) Permit #: ____________________________________________

4) Permit expiration date:_________________________________

State Corporation Commission Form Virginia State Corporation Commission (SCC) registration information. The offeror:

· is a corporation or other business entity with the following SCC identification number: ____________ -OR-

· is not a corporation, limited liability company, limited partnership, registered limited liability partnership, or business trust -OR-

· is an out-of-state business entity that does not regularly and continuously maintain as part of its ordinary and customary business any employees, agents, offices, facilities, or inventories in Virginia (not counting any employees or agents in Virginia who merely solicit orders that require acceptance outside Virginia before they become contracts, and not counting any incidental presence of the offeror in Virginia that is needed in order to assemble, maintain, and repair goods in accordance with the contracts by which such goods were sold and shipped into Virginia from offeror’s out-of-state location) -OR-

· is an out-of-state business entity that is including with this proposal an opinion of legal counsel which accurately and completely discloses the undersigned offeror’s current contacts with Virginia and describes why those contacts do not constitute the transaction of business in Virginia within the meaning of § 13.1-757 or other similar provisions in Titles 13.1 or 50 of the Code of Virginia.

**NOTE** >> Check the following box if you have not completed any of the foregoing options but currently have pending before the SCC an application for authority to transact business in the Commonwealth of Virginia and wish to be considered for a waiver to allow you to submit the SCC identification number after the due date for proposals (the City reserves the right to determine in its sole discretion whether to allow such waiver):