IFB 159208 Fillable Forms.pdf

ATTACHMENT __A___

State Corporation Commission Form

Failure to complete and return this attachment may result in your bid being deemed NON-RESPONSIVE.

Solicitation #:

Virginia State Corporation Commission (SCC) registration information.

The bidder:

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 bidder 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 bidder’s out-of-state location) -OR-is an out-of-state business entity that is including with this bid an opinion of legal counsel which accurately and completely discloses the undersigned bidder’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 bids (the Commonwealth reserves the right to determine in its sole discretion whether to allow such waiver):

SBSP-IFB PIM-40

ATTACHMENT __B___

Small Business Subcontracting Plan

IFB # ____________

It is the goal of the Commonwealth that over 42% of its purchases be made from small businesses. All potential bidders are required to include this document with their bid response in order to be considered responsive.

Small Business: "Small business (including micro)” means a business which holds a certification as such by the Virginia Department of Small Business and Supplier Diversity (DSBSD) on the due date for bids.

This shall also include DSBSD-certified women- owned and minority-owned businesses and businesses with DSBSD service disabled veteran owned status when they also hold a DSBSD certification as a small business on the bid due date. Currently, DSBSD offers small business certification and micro business designation to firms that qualify.

Certification applications are available through DSBSD online at www.SBSD.virginia.gov (Customer Service).

Bidder Name:

Preparer Name: Date:

Who will be doing the work: □ I plan to use subcontractors □ I plan to complete all work

Instructions A. If you are certified by the DSBSD as a micro/small business, complete only Section A of this form.

B. If you are not a DSBSD-certified small business, complete Section B of this form. For the bid to be considered and the bidder to be declared responsive, the bidder shall identify the portions of the contract that will be subcontracted to DSBSD-certified small business for the initial contract period in relation to the bidder’s total price for the initial contract period in Section B.

Section A If your firm is certified by the DSBSD provide your certification number and the date of certification.

Certification number: Certification Date:

Section B If the “I plan to use subcontractors box is checked,” populate the requested information below, per subcontractor to show your firm's plans for utilization of DSBSD-certified small businesses in the performance of this contract for the initial contract period in relation to the bidder’s total price for the initial contract period. Certified small businesses include but are not limited to DSBSD-certified women-owned and minority-owned businesses and businesses with DSBSD service disabled veteran-owned status that have also received the DSBSD small business certification. Include plans to utilize small businesses as part of joint ventures, partnerships, subcontractors, suppliers, etc. It is important to note that these proposed participation will be incorporated into the subsequent contract and will be a requirement of the contract. Failure to obtain the proposed participation percentages may result in breach of the contract.

SBSP-IFB PIM-40

B. Plans for Utilization of DSBSD-Certified Small Businesses for this Procurement

Subcontract #1

Company Name: SBSD Cert #:

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Value % (Initial Term): Contact Address:

Description of Work:

Subcontract #2

Company Name: SBSD Cert #:

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Value % (Initial Term): Contact Address:

Description of Work:

Subcontract #3

Company Name: SBSD Cert #:

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Value % (Initial Term): Contact Address:

Description of Work:

Subcontract #4

Company Name: SBSD Cert #:

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Value % (Initial Term): Contact Address:

Description of Work:

Subcontract #5

Company Name: SBSD Cert #:

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Value % (Initial Term): Contact Address:

Description of Work:

Administrative Services Division/Procurement

IFB #: 159208

VENDOR QUALIFICATION / EQUIPMENT

INVENTORY CERTIFICATION

All bidders responding to this IFB are required to complete equipment information for each piece of equipment listed in question #4.

Failure to complete this attachment may render the bid non-responsive.

1. Name of Business:

2. Name of Owner or Chief Executive Officer: Telephone Number:

3. How many years has the firm been in the business of performing the services called for in this IFB?

4. All equipment that will require inspection by VDOT prior to Notice of Award is listed below.

• In Column 1 place an “O” beside each piece of owned equipment. Place N/A in any block (YEAR/MAKE/MODEL/CAPACITY/ID#/VIN) that does not apply for owned equipment

• In Column 1 place an “R” beside each piece of equipment that will be rented/leased or sub-contracted

• In Column 1 place a “P” beside each piece of equipment that is to be purchased.

• For rented, subcontracted or purchased equipment no detail (Year/Make/Model/Capacity/ID#VIN) is required at time of bid submission.

• See #5 for rented/leased, sub-contracted or purchased equipment requirements.

• VDOT may inspect any equipment used in the performance of this contract at any time during the performance of this contract. Any substitutes for equipment listed below must be inspected and approved prior to being used in performance of this contract.

“O” “R” “P”

LINE # DESCRIPTION -

LOT 1

YEAR MAKE MODEL CAPACITY ID #/VIN

1 Air Track Drill 2 Track Loader, Min 85 HP

3 Track Dozer/Ripper, Approx 300 HP 4 Track Dozer/Ripper, Approx 210 HP 5 Track Dozer 6 Track Mini Excavator, Min 10,000lbs 7 Track Excavator, Min. 35,000lbs. thumb 8 Track Excavator, Min 35,000lbs Hyd 9 Track Excavator, Min 69,000lbs thumb 10 Track Excavator, Boom Min 60ft 11 Backhoe, Rubber Tire, Min 60 HP 12 Loader, Rubber Tire, Min 2 CY 13 Skid Steer Loader, Min 40 HP 14 Motorgrader, 23,000 – 25,000 lbs 15 Roller, Sheepsfoot, Dbl Drum, 8-13 ton 16 Roller, Steel Wheel, Vibratory, 8-12 ton 17 Roller, Steel Wheel, Vibratory, Trench

18 Tractor, Front Mt Loader, Rear Mt Sweep 19 Tractor, Post Auger, Approx 40-50 HP 20 Tractor/Lowboy Trailer, Min 35 ton

21 Tandem Dump Truck w/ Trailer,Min 20 22 Dump Truck, Tandem Rock

“O” “R” “P”

LINE # DESCRIPTION -

LOT 1 (continued)

YEAR MAKE MODEL CAPACITY ID # / VIN

22 Dump Truck, Tandem Rock 23 Tandem Dump Truck 24 Dump Truck, Single Axle 24 Dump Truck, Single Axle 25 Truck w/ TMA, Min 10,000 lbs empty 26 Pickup Truck w/ Amber Light 27 Water Truck, 1,500-gal, Min 2” pump 28 Pull Behind Chipper, Min 18” capacity 29 Air Compressor, 150 CFM 30 Straw Blower w/ Transport 31 Water Pump, Min 2” Pump Hose 32 Elec. Flashing Arrow Board 36 Soil Tamper, Gas, 11” Shoe 45 Rollback Truck 46 Vacuum Truck 47 Hydroseeding Truck

“P”

LINE # DESCRIPTION -

LOT 2

YEAR MAKE MODEL CAPACITY ID #/VIN

1 Pickup Truck (Foreman) 2 Backhoe with extendahoe, 4-in-1 bucket 3 Motorgrader, Min 24,000 lbs 5 Track Excavator,Min 153HP & 51,000lbs 6 Excavator, Track Backhoe,Min 35,000lbs 7 Backhoe, Min 2,000lb w/ Hyd Breaker 8 Tandem Dump Truck, Min 50,000 GVW 8 Tandem Dump Truck, Min 50,000 GVW 8 Tandem Dump Truck, Min 50,000 GVW 8 Tandem Dump Truck, Min 50,000 GVW 9 Skid Steer Loader, Min 40 HP 10 Tandem Rock Dump Truck, 50,000 GVW 10 Tandem Rock Dump Truck, 50,000 GVW 11 Steel Wheel, Vibratory Roller, Min 6 ton 12 Rubber Tire Loader,148HP, Min 2.5CYD 13 Straw Blower w/ Transport 14 Track Excavator, Min 10,000 lbs 15 Crawler Dozer, 70 HP 16 Crawler Dozer, 90 HP 17 Tractor/Lowboy Trailer, Min 35 ton 18 Water Truck, Min 3 tons, Min 1,000gal 19 Rammer Compactor, 60 stroke 22 Soil Tamper, Min 11 HP, 11” shoe 23 Elec. Flashing Arrow Board 26 Truck w/ TMA, Min 10,000 lbs empty 27 Tractor, Front Mt. Loader,Rear Mt Sweep

“P”

LINE # DESCRIPTION -

LOT 2 (continued)

YEAR MAKE MODEL CAPACITY ID #/VIN

28 Pickup Truck w/ Amber Light 29 Vibratory Roller 33 Rollback Truck 34 Vacuum Truck 37 Hydroseeder

5. Rented, leased equipment: Prior to Notice of Intent to Award VDOT shall require the bidder to provide a letter from the applicable entity on company letterhead stating the type of equipment with detailed equipment description and availability for the duration of the contract period, for any equipment intended for use to perform services of this IFB. This letter must be provided to the Contract Officer within 2 business days of request or the bidder will be deemed non-responsive.

Sub-Contracted equipment: Prior to Notice of Intent to Award VDOT shall require the bidder to complete the sub-contracting form identifying the company they intend to use for sub-contracting and listing of the equipment. This form must be provided to the Contract Officer within 2 business days of request or the bidder will be deemed non-responsive.

Future equipment purchase: Prior to Notice of Intent to Award, VDOT shall require the bidder to provide proof of purchase with detailed equipment description and confirmed delivery date for any equipment intended for use to perform services of this IFB. This proof of purchase must be provided to the Contract Officer within 2 business days of request or the bidder will be deemed non-responsive. All purchased equipment must be available by date of award.

6. Is any of the equipment listed above currently committed on any other contract (VDOT / non VDOT) contracts? ___Yes ___No

If yes, identify which equipment (year, make, model, ID/VIN), where the equipment is committed, contract number(s), name the party to the contract and location.

ATTACHMENT __D____

Solicitation #:

SUBCONTRACTOR APPROVAL REQUEST

No portion of the work (including equipment) shall be subcontracted to another firm or individual without prior written consent of Virginia Department of Transportation (herein referred to as VDOT). In the event that the contractor desires to subcontract some part of the work specified herein, the contractor shall furnish VDOT with the names, qualifications, and experience of their proposed subcontractors for agency approval. The primary contractor shall, however, remain fully liable and responsible for the work performed by its subcontractor(s) and shall assure compliance with all requirements of the contract.

List proposed subcontractor(s), including name, address, contact person, and type of work to be performed under this contract below.

FIRM INDIVIDUAL’S

NAME & ADDRESS

CONTACT PERSON AND

PHONE NUMBER

TYPE OF WORK TO BE

PERFORMED

TYPE OF EQUIPMENT PROPOSED SUBCONTRACTOR WILL PROVIDE

QUALIFICATIONS / EXPERIENCE LEVEL OF PROPOSED SUBCONTRACTOR

Please indicate which above proposed subcontractors are certified (with DSBSD) as Small, Women Owned or Minority Businesses.

Certification Number(s):

FOR VDOT USE ONLY:

The proposed subcontractor(s) listed above is/are approved and accepted under the terms and conditions of the contract requirements herein.

Signature of Authorized VDOT Representative Date Telephone Number

ATTACHMENT __E__

NORMAL AND EMERGENCY CONTACTS

Solicitation # ___________

Send Contracts To:

Bidder's Name/Title

Primary Phone Number

Bidder's Mailing Address E-mail Address

Contact Person’s Name

Cellular Telephone Number

Telephone Number - Normal Work Hours Telephone Number - After Work Hours Fax Number

E-mail Address

Contact Person’s Name

Cellular Telephone Number

Telephone Number - Normal Work Hours Telephone Number - After Work Hours Fax Number

E-mail Address

Contact Person’s Name

Cellular Telephone Number

Telephone Number - Normal Work Hours Telephone Number - After Work Hours Fax Number

E-mail Address

ATTACHMENT __F___

Solicitation # ____________

REFERENCES

Bidders should provide a list of at least 3 references where similar goods and/or services have been provided. Each reference shall include the name of the organization, the complete mailing address, the name of the contact person, the email, and the telephone/fax number.

FIRM’S NAME AND ADDRESS CONTACT PERSON EMAIL ADDRESS TELEPHONE / FAX #

IFB#

ATTACHMENT

CONTRACTOR’S CAPACITY

Whether awarded one (1) lot or multiple lots, the Contractor shall be responsible to mobilize the proper resources needed to complete the requested work. Indicate the number of lots your company has the capacity for supplying the requested services for:

Bidders must rank their lot preferences for all lots bid, i.e. 1, 2, 3 with “1” being the most preferred. In the event a bidder is the lowest responsive and responsible bidder on more than one lot, awards will be made according to the bidder’s lot preference ranking and the Contractor’s available equipment.

LOT # RANKING (ex. 1, 2, 3) Lot 1

Lot 2

ATTACHMENT G

IFB# _______________________

LAND DISTURBER (EROSION AND SEDIMENT CONTROL CONTRACTOR

CERTIFICATION (ESCCC) REQUIREMENTS: The requirement of personnel to obtain erosion and sediment control certification in accordance with the VDOT Road and Bridge Specifications, Section 107.16 (a) is satisfied by meeting one of the following:

• Hold a current VDOT Erosion and Sediment Control Certification (ESCCC)

• Hold a current* DCR Contractor Certificate. *DCR Contractor Certificates are considered current for a period of two years beyond the original expiration date.

List the name of the individual(s) with DCR certification :___________________________