IFB 160924 Attachment A-F.pdf

'-\'DOT Vlfg ru., Department

'\;V of Transportation

ATTACHMENT A

State Corporation Commission Form

Failure to tomplete and retom this attachment may relllllt in your bid being REJECTED or deemed NON-RESPONSIVI:.

160924 Solicitation#: _____ _

Virginia State Corporation Commi11ion (SCC) registration information.

The bidder: _________________ _

□ is a corporation or other business entity with the following SCC identification number: ____ _

-OR-

O is not a corporation, limited liability company, limited partnership, registered limited liability partnership, or bU8iness trust -OR-

D 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 acconiance with the contracts by which such goods were sold and shipped into Virginia from bidder's out-of-sbrte location) .OR-

□ is an out-of-state business entity that is including with this bid an opinion oflegal com1sel which accurately and completely discloses the undersigned bidder's C\D'l'CD.t contacts with Virginia and describes why those contacts do not constitute the transaction ofbusiness in Virginia within the meaning of§ 13.1-757 or other similar provisions in Titles

13.1 or 50 of the Code ofVirginia.

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

160924

B

ATTACHMENT

Solicitation #: 160924

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 YDOT 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

C

'\ 'DDT Virginia Oepartrneot '\v ofTransportat,on

ATfACIIMENT D

NORMAL AND EMERGENCY CONTACTS

SoJidtaUon # 160924

Said Cllllfrada To: Primary Phone BiAlclel"1 Namel'l'ide Nlllllber

Bfclcler'1 MalJln& E--nAddnn

Contact Penon'■ Name

Celbdar Telephone Number

Telephone Number-Normal WorkRoan Telephone Number - After WorkRoan Fu Nlllllher

E-mail Addrcls

Contact Penon'■ Name

Celbdar Telephone Number

Telephone Number-Normal WorkRoan Telephone Number - After WorkRoan FuNamber

E-mail Addrcls

Contact Penon'■ Name

Celbdar Telephone Number

Telephone Number-Normal WorkRoan Telephone Number - After WorkRoan FuNlllllher

E-mail Addrcl1

Solieltation # 160924

'\ IDOT Vlrgmln Department '\;V ofTrJOsport.atlon

ATIACHMENT E

BEEERJNCES

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

FJRM•S NAME AND ADDRESS CONTACTPBRSON EMAIL ADDRESS TELEPHONE/FAX#

4\ \ 'DOT

Vlrgmia Department

\l ofTransportal,on

.4.dmini•�tive Services Divilion/Procurement

IFB#: 160924____ _

ATTACHMENT F_

VENDOll QUALIFICATION /EQ1JIPMENT INVENTOJlY CERTlll'ICA'110N

AD b!Alclen naponcllq to 11m IFB an nqlllred to complete equipment lnformadoD for ad! pleee of equfpmem u ,,.,fled h\ tu.

l'aibn to fully eomplete dlil attachmeat may reader the bid a.on-mpoum.

VDOT II IIJlabJe to rmew abmntoryllltor otllercloaamatatloD other tblJl 60N IPedled belowllll #4 ID. order to codnn tbatthe otreNCI eqlllpment meetl tile reqalrecl �m.

1. Nllllll'JofB111imu: _____________________ _

2, Name of Owner or CbiefE:ecutive Oflicer:. __________ Telq,hone Number: _____ _

3. How many yean has the :firm been in the business of performins the services called. for in this IFB? ___ _

4. All n,quin,d ,qnipmmt la limd in tho table below and will n,quin, veri&ation prior to iamanc:e of a Notice oflntmt to Award.

• OWNED Equipment:

• In tbe :6nt eolumn. p� 111 "O" beeide each pie<:e of owned equipment.

• CompJetethe YEAR/MAKE/MODEI.JCAPACITYIID#/VIN; place N/Anmto equipmentforwbichacolamn cloeaJIOI: apply.

• Verification will be in-penon: Prior to the No&ice oflment to .Award, VDOT will evalule the owned equipment u 11peeilied in the IFB.

• RENTED/LEASED Eqlllpmmt:

• In tbe :6nt eolumn p� 111 "ll" beeide each piece of cqujpmc:m 1hat will be mited/beed

• Verlftadon will be bf nntal �t: Prior to die No&ice of intent to Award, the bidder &hall provide a siped letbir 1mm tbe applicable nmtal entity on WJ11jl6ily lettemead staling tho type of equipmenl wi1h detailod ,oquipment dl!lmption(1) and qualllity(i111) Bl well u tho availability for tho duration of tho cantract period, for any equipment intended mr UH to perfi>nn 1emc111 of this IFB. Thill latter &hall be provided to tho ColJlnct Officl!r within 2 bulrineu days of n,qUNt, or tho biddl,r will be deemed non-n,spcmnve.

• SUBCONTRACTED Equipment:

• Jn tbe :6nt column place an "S" bollidc, each pieee of equipment that will be llllhccmlracted.

• Verlftadon wlJI be bf Svbeomnetor Apprcmil Req'D•t Form Aaaclment _: Prior to the Notice of

Intmt to Award, the bidder &hall comp!m a aeparate SahCODtl8c1Dr Approval Requeat Farm for each CCHIIJNWY they intend to mbcontrut equipment from, providing detailed equipment dacripticm(•) and qmmtity(ies)'IIIIIW'"I'ype ofHquipmentProposod. Subcontractor WillProvide." Thia foan &hall be pmvidlld to tho Contract Oflicer within 2 hminess days of roqust or tho bidder will be ,,_,., .... nan-respomiw.

• FVTmlE PUllCllASE Eqalpment:

• In tbe :6nt column place a ''P" beside each pioc:e of equipment 1hat ia to be pmcliued.

• V.ultatlon will be by pn,of ofpvdwe: Prior1o Nolice oflnti::ntto Award. the bidder shall provide proof of puichaae with dewJed equipment desaiption(a) 8lld quantity(ies), a, wen u a confirmed deliv«y date :for any equipment in1cnded for u,e to perform ,ervice, of thia JFB, Tllil proof of J'llft)lwe ahall be providicd to tbe Contract Oflic:er within 2 'bulineu c1ayil of request or the bidder wiD be deemed non.-re,pouive. All pun:lwed equipment IIIIIBt be available by date of award.

Jacketed double boiler melting kettle with legible material gauge

Jacketed double boiler melting kettle with legible material gauge

Strobe Light Backup Alarm