IFB 24-001 WATER & WASTEWATER TREATMENT CHEMICALS – ALUMINUM SULFATE.pdf

Orange Water and Sewer Authority

Our community’s trusted partner for clean water and environmental protection.

IFB NO. 24-001

INVITATION FOR BID

FOR

WATER & WASTEWATER TREATMENT CHEMICALS – ALUMINUM SULFATE

Date Issued: June 3, 2024

Page i IFB 24-001 WATER & WASTEWATER TREATMENT CHEMICALS – ALUMINUM SULFATE| June 3, 2024

Table of Contents

NOTIFICATION

1 NOTICE OF INVITATION TO BID

2 TIMELINE

3 BIDDER INSTRUCTIONS

3.1 Bid Requirements

4 SELECTION PROCESS FOR BIDS FOR ALUMINUM SULFATE

5 GENERAL BID CONDITIONS

5.1 Questions and Addenda

5.2 Public Bid Opening and Late Bids

5.3 Proprietary Information

5.4 Method of Response

5.5 Withdrawal of Bids

5.6 Acceptance of Terms and Conditions

5.7 False, Incomplete or Unresponsive Statements

5.8 Clear and Concise Submission

5.9 Prime Bidder Responsibilities

5.10 Minority Business Participation

5.11 Insurance

5.11.1 General Liability Insurance

5.11.2 Automobile Liability Insurance

5.11.3 Workers' Compensation Insurance

5.12 Contract Term and Extension

5.12.1 Price Escalation

6 PROTEST PROCEDURES

6.1 Protests Received Prior to Receipt of Bids

6.2 Selection Protests

6.3 Filing Procedures

7 COSTS AND DAMAGES

Attachment A…...………Specifications Attachment B…...………Bid Form Attachment C…………...E-Verify Affadavit Attachment D…………...Certificate Regarding Conflict of Interest Attachment E…………...Iran Divestment Act Attachment F……………Companies Boycotting Israel Divestment Act Form Attachment G…………....Non-Collusion Affadavit Attachment H…………....Reference Form Attachment I………….....Response Checklist

NOTIFICATION

INVITATION FOR BID

SOLICITATION NO. 24-001

FOR

WATER & WASTEWATER TREATMENT CHEMICALS – ALUMINUM SULFATE

1 NOTICE OF INVITATION TO BID

The Orange Water and Sewer Authority (OWASA), invites sealed bids from qualified suppliers for the supply of Aluminum Sulfate, used in water and wastewater treatment processes.

To obtain a copy of the Invitation for Bid (IFB) document, suppliers shall download the document from the OWASA’S website at https://www.owasa.org/bid-opportunities/

Bids are solicited and will be received at Orange Water and Sewer Authority (OWASA), Administration Building, 400 Jones Ferry Road Carrboro, NC 27510, until 3:00 p.m., ET Thursday, June 20, 2024, for the WATER & WASTEWATER TREATMENT CHEMICALS – ALUMINUM

SULFATE SOLICITATION.

Questions regarding the IFB shall be directed to David Moore, Procurement Coordinator at dmoore@owasa.org.

OWASA reserves the right to reject any or all Bids.

2 TIMELINE

DATE

EVENTS

June 3, 2024

IFB distributed and posted to OWASA website

June10, 2024

3:00 PM ET

Inquiries must be received in writing by (e-mail only) to David Moore at dmoore@owasa.org

June13, 2024

3:00 PM ET

Responses to all questions received will be posted on the OWASA website.

June 20, 2024 3:00 PM ET Bids due at the administrative offices of OWASA

June 20, 2024 3:30 PM ET Public Bid Opening at the administrative offices of OWASA

June 27, 2024 (tentative) Notice of Intent to Award Contract Contingent upon Executive Director’s Approval

July 1, 2024 (tentative)

Contract Start Date

3 BIDDER INSTRUCTIONS

Bids shall be delivered to David Moore, Procurement Coordinator, at Orange Water and Sewer Authority (OWASA), 400 Jones Ferry Road, NC 27510. The outside of the envelope must be marked BID: 24-001 WATER & WASTEWATER TREATMENT CHEMICALS – ALUMINUM SULFATE and shall indicate the name, and address of the bidder.

OWASA reserves the right to reject any or all Bids for any reason determined by OWASA to be in its best interest, or to award the bid to the lowest responsive responsible bidder, taking into consideration quality, performance, and the time specified in the bids for the performance of the contract.

3.1 Bid Requirements

INFORMATION REQUIRED FROM THE BIDDER

See Attachment I Response Checklist.

To determine responsiveness in the chemical solicitation, the following items must be received:

Bid Submission Documents and Attachments o 3.1.1 Specifications (Attachment A) o 3.1.2 Bid Form (Attachment B) o 3.1.3 E-Verify Affidavit (Attachment C) o 3.1.4 Certificate Regarding Conflict-of-Interest (Attachment D) o 3.1.5 Iran Divestment Act Certificate (Attachment E) o 3.1.6 Companies Boycotting Israel Divestment Act Form (Attachment F) o 3.1.7 Non-Collusion Affidavit (Attachment G) o 3.1.8 Reference Form (Attachment H) o 3.1.9 Response Checklist (Attachment I) o 3.1.10 Provide Safety Data Sheets (SDS) of company’s specific product.

o 3.1.11 Provide a Certificate of Analysis (COA).

Color: Clear to amber or light green

Baume@ 60F: (30-40)

Specific Gravity @ 60F: (1.31-1.34)

Temperature in F: varies

Alumina, % AL2O3: (has to be >8) pH (neat): (1.5-2.8)

Turbidity range

FeO3 %: <0.35 o 3.1.10 Provide Delivery Lead Time for an Order.

o 3.1.11 Provide three references from chemical facilities (not finance department) previously supplied.

4 SELECTION PROCESS FOR BIDS FOR ALUMINUM SULFATE

The selection process for bids for aluminum sulfate will be conducted to identify the lowest responsive and responsible bidder taking into consideration time, quality, and performance.

The steps are as follows:

o Safety Data Sheets (SDS)-Pass/Fail o Certificate of Analysis-(COA)-Pass/Fail o Delivery Lead Time for an Order-Pass/Fail o Provide three references from chemical facilities previously supplied-Pass/Fail o Lowest responsive responsible bidder

This selection process ensures a fair, transparent, and compliant procurement of aluminum sulfate. By evaluating critical criteria on a pass/fail basis and awarding the contract to the lowest responsive and responsible bidder, we aim to secure reliable deliveries, high standards of quality and performance. Only contractors who pass all four criteria will be considered. The chosen supplier must meet all contractual obligations and ensure timely and reliable delivery of the product, contributing to the efficient operation of our services.

OWASA may waive any irregularities in any bid that does not prejudice other respondents.

OWASA reserves the right to reject any and all Bids.

5 GENERAL BID CONDITIONS

5.1 Questions and Addenda

Any changes to this IFB document will be made by written addenda issued by OWASA. Upon issuance, the addenda will be considered part of the IFB document and will prevail over inconsistent or conflicting provisions contained in earlier versions of the IFB document.

Addenda will be available for download from the OWASA website in the same manner as the IFB document. This process will be repeated each time an addendum is posted to the OWASA website.

Bidders shall acknowledge their receipt of all addenda with their submission. As with other required documentation, Bids that fail to provide a detailed listing of addenda received may be excluded from further consideration for this solicitation.

It is the desire of OWASA to provide the same information to all interested parties to ensure fairness and impartiality in the procurement process. To that end, OWASA will not respond to telephone inquiries or personal visits. Visitation by respondents or their representatives may be made to OWASA only at the pre-bid meeting, if held. All questions are to be submitted in writing. Submit written questions via e-mail to the OWASA Procurement Coordinator at dmoore@owasa.org by 3:00 pm Eastern Time on June 10, 2024. Responses to questions will be posted on the OWASA website no later than 3:00 pm Eastern Time on June 13, 2024.

Answers to questions or directives to Submitters regarding the IFB process by any OWASA employee other than Mr. Moore and verbal answers to questions are not binding on OWASA.

5.2 Public Bid Opening and Late Bids

The public bid opening for the current solicitation will be conducted on June 20, 2024, at 3:30 PM, at the main conference room of OWASA’s administration offices. All interested parties are invited to attend this transparent process. Please note that bids must be submitted by 3:00 PM on the day of the opening. Bids received after this time will not be accepted under any circumstances. This strict adherence to deadlines ensures fairness and integrity in the procurement process, allowing all participants to compete on an equal footing.

Public Bid Opening Location:

OWASA Administration Office 400 Jones Ferry Road Carrboro, NC 27510

5.3 Proprietary Information

Any reservations on the use of data contained in the proposal shall be clearly stated in writing.

OWASA will attempt to comply with a Proposer’s designation of proprietary/confidential information. However, OWASA may not be able to withhold a record (data, document, etc.) or deny access to a record requested by an individual (the public) when an obligation is imposed upon OWASA under the North Carolina Public Records Act (Act). OWASA’s determination to withhold or disclose a record will be based upon the particular circumstances involving the record in question and whether the record may be exempted from disclosure under the Act.

Records which the Proposer considers to be trade secrets and privileged or confidential must be identified by the Proposer on each page submitted.

5.4 Method of Response

Responses to this IFB shall be made according to the scope of work and instructions contained herein. Failure to adhere to instructions may be cause for rejection of any Bid.

5.5 Withdrawal of Bids

Any bid may be withdrawn any time prior to the stated bid opening date and time (closing time).

The withdrawal request must be executed by the bidder or a duly authorized representative. The mailto:dmoore@owasa.org withdrawal of the bid does not prejudice the right of the bidder to file a new bid prior to the bid closing time. No bids may be withdrawn after the bid opening date and time.

5.6 Acceptance of Terms and Conditions

Bidders understand and agree that submission of a Bid will constitute acknowledgment and acceptance of, and a willingness to comply with, all the terms, conditions, and criteria contained in this IFB, except as otherwise specified in the Bid. Any and all parts of the submitted Bids may become part of any subsequent Agreement between the selected Bidder and OWASA.

5.7 False, Incomplete or Unresponsive Statements

False, incomplete, or unresponsive statements in connection with a Bid may be sufficient cause for rejection of the Bid. The evaluation and determination of the fulfillment of the above requirement will be OWASA’S responsibility and its judgment shall be final.

5.8 Clear and Concise Submission

Bids shall provide a straightforward, concise delineation of the Bidder’s capability to satisfy the requirements of the IFB. Each Bid shall be submitted in the requested format and provide all required information. Each Bid shall be signed in ink by a duly authorized officer of the company.

5.9 Prime Bidder Responsibilities

The selected Bidder will be required to assume responsibility for all requested deliverables as indicated in Attachment A-Specifications regardless of who produces them. Further, OWASA will consider the selected Prime Bidder to be the sole point of contact with regard to contractual matters, including payment of any and all charges resulting from the contract.

5.10 Minority Business Participation

It is the policy of OWASA to provide minority businesses an equal opportunity to participate in all aspects of OWASA’s contract activities. Bidder shall comply with OWASA’s Minority Business Participation Outreach Plan and Guidelines.

5.11 Insurance

During the performance of the Contract, bidder shall maintain the minimum levels of insurance shown below and provide certificates of such coverage to Owner prior to performance. All policies must provide ten (10) days advance written notice to Owner in the event of cancellation, expiration, or alteration.

5.11.1 General Liability Insurance, with a combined single limit of $1,000,000 for each occurrence and $1,000,000 in the aggregate.

5.11.2 Automobile Liability Insurance, with a combined single limit of $1,000,000 for each person and $1,000,000 for each accident.

5.11.3 Workers' Compensation Insurance in accordance with statutory requirements and Employers' Liability Insurance, with a limit of $500,000 for each occurrence.

5.12 Contract Term and Extension

The term of this Agreement shall be for one (1) year commencing on July 1, 2024 (tentative), with the option for OWASA to extend for two (2) additional one (1) year periods upon written notice at least 15 days prior to the end of the current term. Failure to exercise these options will result in the Agreement's termination at the end of the then-current term.

5.12.1 Price Escalation

The Supplier shall notify OWASA of the Adjusted Price for each extension year no later than 60 days prior to the commencement of that extension year. The Adjusted Price shall be calculated using the Producer Price Index (PPI) for Aluminum Compounds (WPU06130209) published by the Bureau of Labor Statistics. This adjustment shall be final and binding on both parties for the duration of the extension year.

6 PROTEST PROCEDURES

6.1 Protests Received Prior to Receipt of Bids

Protests concerning the procedures of this solicitation must be submitted in writing to the OWASA Director of Finance not later than five (5) working days prior to the date set for the receipt of Bids. Upon receipt of a protest, the Director of Finance may, at his/her discretion, extend or postpone the deadline for receipt of Bids. The Director of Finance will answer the protest in writing not later than three (3) working days prior to the deadline date for receipt of Bids.

6.2 Selection Protests

Following this announcement, a bidder may file a protest regarding the recommendation. A protest of the recommendation must be in writing and must be received by the OWASA Director of Finance not later than five (5) working days after the OWASA Announcement of Notice of Intent to Award Contract. OWASA will consider all protests regarding the recommended Bidder prior to executing the contract.

6.3 Filing Procedures

Any and all protests filed with the OWASA shall:

1. Include the name and address of the protester.

2. Identify the procurement.

3. Contain a statement of the legal and factual grounds for the protest and any supporting documentation. The grounds for the protest must be fully supported.

4. Indicate the ruling or relief desired from OWASA.

Protests shall be filed with the OWASA Director of Finance, via personal delivery or courrier to 400 Jones Ferry Road Carrboro, NC 27510; The Director of Finance will respond in detail to each substantive issue raised in the protest. With regard to a properly filed protest, OWASA’s determination will be final.

7 COSTS AND DAMAGES

All costs of a protest shall be the responsibility of the protestor and undertaken at the protestor’s expense. OWASA will not be liable for damages to the Proposer filing the protest or to any participant in the protest, on any basis, expressed or implied.

IFB 24-001 WATER & WASTEWATER TREATMENT CHEMICALS – ALUMINUM SULFATE

SPECIFICATIONS Page | 1 of 2

Attachment A

SPECIFICATIONS

Anticipated activities under this engagement are identified below. Other related activities not specifically listed here may be identified during the term of the engagement. Specifications for this treatment chemical are as forth in ANSI/AWWA Standard, except as may be modified by the specific requirements herein. Supplementary Specifications used in conjunction with the AWWA Standard.

The affidavit of compliance tender document shall accompany each deliver the Liquid Aluminum Sulfate solution MUST MEET ANSI/AWWA B403-88. The product shall be aluminum sulfate which has been produced by the reaction between sulfuric acid and a mineral deposit rich in aluminum such as bauxite.

REQUIREMENTS: Liquid alum shall be delivered in tank truck quantities of approximately 4,300 gallons. Tank trucks making deliveries shall be equipped with suitable unloading devices and sufficient discharge hose to transfer the alum from the truck to OWASA’s storage tank. Trucks used to deliver liquid alum shall be used only to haul alum products. The supplier shall be responsible for cleanup of any spills resulting form the delivery of or occurring during unloading of this chemical.

IMPURITIES: The material shall be free from suspended matter and contain no turbidity visible to the naked eye and such clarity as to permit the reading of flow measuring devices without difficulty. The material shall contain not soluble minerals or organic substances capable of producing injurious effects upon public health. Specifications shall be as follows:

Chemical Needed: Aluminum Sulfate Solution, Iron Free

Al2O3 total 8.00% to 8.33% basicity 0.05% total iron as Fe2O3 0.30% maximum insoluble 0.05% maximum

ESTIMATED ANNUAL CONSUMPTION: The annual consumption of ALUMINUM SULFATE is estimated to be approximately 900 Dry Tons. This estimate is based on historical consumption data and subject to change.

REJECTION: OWASA reserves the right to analyze each truckload of liquid alum upon arrival at destination, or to have the supplier provide an analysis of the material in the shipment, and to reject such material for failure to meet one or more of the above specifications. All rejected material shall be returned to supplier at supplier's expense. OWASA may require the successful bidder to furnish a sample of the material they propose to furnish together with a representative

IFB 24-001 WATER & WASTEWATER TREATMENT CHEMICALS – ALUMINUM SULFATE

SPECIFICATIONS Page | 2 of 2 analysis sufficient to show that the product meets all provisions of these specifications, and should shipments not meet the specifications of the sample submitted, rejection may be made.

PRICING: Bid price shall be all inclusive. No additional fees will be accepted.

DELIVERY:

Delivery is expected within two weeks from the order date.

The delivery company must provide their own equipment for unloading the chemical, such as an air compressor. The connection type to the tank fill line is a 2-inch cam fitting with a 25-50 ft hose.

Delivery Locations:

Water Treatment Plant or Wastewater Treatment Plant

400 Jones Ferry Road 170 Old Mason Farm Road

Carrboro, NC 27510 Chapel Hill, NC 27517

Attn: Monica Dodson Attn: Wil Lawson

Purchase Order or Purchase Contract deliveries shall be made during normal business hours of 7:00 a.m. and 3:30 p.m EST Monday-Friday. For bulk deliveries, the supplier shall furnish the pumps, compressor and/or power required to transfer the chemical into OWASA’s bulk storage facilities and shall be responsible for cleanup of spills up to and including the unloading operations.

All deliveries are subject to acceptance inspection by OWASA, which my include a chemical analysis to ensure compliance with the specifications. Chemical vendors shall provide OWASA with a photo ID of the delivery driver along with vehicle identification such as license plate numbers, and an approximate day and time for each delivery. Driver shall possess training in the handling of the chemical delivered and proper use of the personal protection equipment and shall use proper safety equipment during the delivery of the chemical. All connections and chemical transfer equipment shall be inspected by driver before offloading is initiated. Faulty or poorly maintained equipment and/or driver inexperience in handling of chemical shall constitute grounds for rejection of delivery.

BID SHEET

To: Orange Water and Sewer Authority 400 Jones Ferry Road Carrboro, NC 27510

The undersigned, as the bidder, hereby declares that this bid is made without connection to any other person, company, or parties making a similar bid or proposal and that the bid is in all respects fair and in good faith, without collusion or fraud.

The bidder has carefully examined the specifications and instructions to bidders and hereby declares that bidder will furnish the equipment called for in the manner prescribed in the specifications and instructions to bidders for the following price:

Price Per Dry Ton($): ___________________________________ ( please do not include sales tax)

Name of Business Submitting Proposal

Signature of Authorized Representative/Title

Print Name

Address

Email Address of Representative

Attachment B

Estimated 900 Dry Tons Price__________________________ ( please do not include sales tax)

Orange Water and Sewer Authority Finance Department 400 Jones Ferry Road Carrboro, NC 27510 ap@owasa.org

Name (as reported on your income tax return)

Business Name Federal ID# or SS#

Check one of the following:

Corporation Sole Proprietorship Partnership Other

Order Address

Street

PO Box

City

State

Zip Code

Contact Person

Phone Number

Fax Number

Terms

Payment Address

Street

PO Box

City

State

Zip Code

Contact Person

Phone Number

Fax Number

Discount

E-Mail Address

Are you related to or have a professional relationship with any OWASA employee? Yes No (If you answered yes, the Relationship Vendor Form should be completed and included with this bid)

Are you a minority business enterprise? Yes No

If you answered yes, please check the appropriate box:

African-American ___Hispanic American Indian ___Female Asian American Socially and economically disadvantaged as defined in 15 U.S.C. 637

Product(s) and/or Service(s) Please list the type product(s) and/or service(s) that your company can provide:

Signature: Title: __________________________________________

Attachment B

If you are related to or have a professional relationship with any employee of Orange Water and Sewer

Authority, this form must be completed and included with this bid.

Vendor Information:

Name:

Address:

Related OWASA employee:

Relationship to employee:

We agree that our relationship will not hinder or corrupt our professional relationship with Orange Water & Sewer Authority.

Vendor Signature Date

OWASA Employee Signature Date

Orange Water and Sewer Authority is aware and understands these parties have a relationship with each other. The decision to authorize the use of this vendor was not influenced in any manner by the relationship referenced above.

Department Manager Date

Finance Officer Date

Attachment B

Orange Water and Sewer Authority Finance Department 400 Jones Ferry Road Carrboro, NC 27510

Relationship Vendor Form

E-VERIFY AFFIDAVIT

I, (the individual attesting below), being duly authorized by and on behalf of

(the entity identified as the "Employer") after first being duly sworn hereby swears or affirms as follows:

1. Employer understands that E-Verify is the federal E-Verify program operated by the United States Department of Homeland Security and other federal agencies, or any successor or equivalent program used to verify the work authorization of newly hired employees pursuant to federal law in accordance with Article 2 of Chapter 64 of the North Carolina General Statutes.

2. Employer understands that Employers Must Use E-Verify. Each employer, after hiring an employee to work in the United States, shall verify the work authorization of the employee through E-Verify in accordance with Article 2 of Chapter 64 of the North Carolina General Statutes.

3. Employer will ensure compliance with E-Verify by any subcontractors subsequently hired by Employer for specified contracts subject to E-Verify entered into with the Orange Water and Sewer Authority.

This day of , .

Signature of Affiant

Print or Type Name:

State of County of

Signed and sworn to (or affirmed) before me, this the day of , .

My Commission Expires:

Notary Public

(A ffix O fficial/N o tarial Seal)

Name of Counterparty:

Attachment C

ATTACHMENT D

1 Certification Regarding Conflict of Interest

CERTIFICATION REGARDING CONFLICT OF INTEREST

The Submitter is required to certify that performance of the work will not create any conflicts of interest or disclose any actual or potential conflicts of interest by completing and signing one of the following statements:

All Vendors should be aware of OWASA’S Code of Ethics, which prohibits OWASA Employees and Board Members from having certain relationships with persons or entities conducting (or proposing to conduct) business with OWASA and which prohibits the acceptance of gifts from Vendors. If the Vendor has an actual or potential conflict, the Vendor shall disclose any Conflict of Interest that may exist.

Conflicts of Interest (Potential or actual) will be evaluated by OWASA’S General Counsel to determine the proper course of action. Failure to comply with the provisions established above may render the vendor ineligible to participate in OWASA’S procurement process.

The Submitter hereby discloses no conflicts of interest.

DATE: ________________________________________________________________________

AUTHORIZED SIGNATURE: _______________________________________________________

TITLE: ________________________________________________________________________

SUBMITTER/COMPANY NAME: ____________________________________________________

OR

The Submitter hereby discloses the following circumstances that could give rise to a conflict of interest for the Submitter, any affiliates, any proposed subconsultants, and key personnel of any of these organizations. (Attach additional sheets as needed.)

ATTACHMENT D

2 Certification Regarding Conflict of Interest

Name of the Individual/Company to which potential conflict of interest might apply:

Nature of potential conflict of interest:

Proposed Remedy:

DATE: _______________________________________________________________________

AUTHORIZED SIGNATURE: _______________________________________________________

TITLE: _______________________________________________________________________

SUBMITTER/COMPANY NAME: ___________________________________________________

RFP Number (if applicable):

Name of Vendor or Bidder:

IRAN DIVESTMENT ACT CERTIFICATION

REQUIRED BY N.C.G.S. 143C-6A-5(a)

As of the date listed below, the vendor or bidder listed above is not listed on the Final Divestment List created by the State Treasurer pursuant to N.C.G.S. 143-6A-4.

The undersigned hereby certifies that he or she is authorized by the vendor or bidder listed above to make the foregoing statement.

Signature Date

Printed Name Title

Notes to persons signing this form:

N.C.G.S. 143C-6A-5(a) requires this certification for bids or contracts with the State of North Carolina, a North Carolina local government, or any other political subdivision of the State of North Carolina. The certification is required at the following times:

When a bid is submitted

When a contract is entered into (if the certification was not already made when the vendor made its bid)

When a contract is renewed or assigned

N.C.G.S. 143C-6A-5(b) requires that contractors with the State, a North Carolina local government, or any other political subdivision of the State of North Carolina must not utilize any subcontractor found on the State Treasurer’s Final Divestment List.

The State Treasurer’s Final Divestment List can be found on the State Treasurer’s website at the address www.nctreasurer.com/Iran and will be updated every 180 days.

http://www.nctreasurer.com/Iran dmoore Typewritten Text

ATTACHMENT E

dmoore Typewritten Text dmoore Typewritten Text dmoore Typewritten Text

Companies Boycotting Israel Divestment Act Certification Form

RFP/RFQ Number (if applicable):

Name of Contracting Party or Bidder:

COMPANIES BOYCOTTING ISRAEL DIVESTMENT ACT CERTIFICATION

REQUIRED BY N.C.G.S. §147-86.81et seq. * Pursuant to N.C.G.S. §147-86.81, any person identified as engaging in a boycott of Israel, as defined by this Act. In addition, State agencies must divest from investments in such restricted companies, determined by appearing on the Final Divestment List created by the State Treasurer pursuant to G.S.

147-86.81, is ineligible to contract with the State of North Carolina or any political subdivision of the State.

As of the date listed below, the supplier or bidder listed above is not listed on the Final Divestment List created by the State Treasurer pursuant to N.C.G.S. §147-86.81.

The undersigned hereby certifies that he or she is authorized by the contracting party or bidder listed above to make the foregoing statement.

Signature Date

Printed Name Title

N.C.G.S. §147-86.81requires this certification for bids or contracts with the State of North Carolina, a North Carolina local government, or any other political subdivision of the State of North Carolina. The certification is required at the following times:

• When a bid is submitted

• When a contract is entered into (if the certification was not already made when the vendor made its bid)

• When a contract is renewed or assigned

N.C.G.S. § 147-86.81(b) requires that contractors with the State, a North Carolina local government, or any other political subdivision of the State of North Carolina must not utilize any subcontractor found on the State Treasurer’s Final Divestment List.

The State Treasurer’s Final Divestment List can be found on the State Treasurer’s website at:

https://www.nctreasurer.com/inside-the-department/OpenGovernment/Pages/Divestment-Acts- Resources.aspx and will be updated every 180 days.

* Note: Enacted by Session Law 2017-193 as N.C.G.S. §147-86.81et seq.

Attachment F

Attachment G

NON-COLLUSION AFFIDAVIT

The prequalified bidder, being duly sworn, solemnly swears (or affirms) that neither he, nor any official, agent or employee has entered into any agreement, participated in any collusion, or otherwise taken any action which is in restraint of free competitive bidding in connection with any bid or contract, that the prequalified bidder has not been convicted of violating N.C.G.S. § 133-24 within the last three years, and that the prequalified bidder intends to do the work with its own bonafide employees or subcontractors and will not bid for the benefit of another contractor.

By submitting this non-collusion affidavit, the Contractor certifies, under penalty of perjury according to North Carolina law, their compliance with non-collusion standards. This affidavit affirms the Contractor's adherence to the required non-collusion guidelines without any exceptions.

SIGNATURE OF PREQUALIFIED BIDDER

Name of Prequalified Bidder_____________________________________________________

Print or type name

Address as Prequalified_________________________________________________________

Signature of Prequalified Bidder__________________________________________________

Print or type Signer's Name

Signature of Witness___________________________________________________________

Print or type Signer’s name

AFFIDAVIT MUST BE NOTARIZED

Subscribed and sworn to before me this the _____ day of _____________________ 20__.

Signature of Notary Public of ____________________________County State of ______________________________ My Commission Expires: ________________ NOTARY SEAL

(BIDDER TO COMPLETE AND RETURN WITH BID)

List Three (3) References from chemical facilities previously supplied

REFERENCE NO. 1 - COMPANY NAME:

ADDRESS:

CONTACT PERSON: TITLE:

E-MAIL: TELEPHONE NUMBER:

AMT. OF CONTRACT: DATE AND TYPE OF SERVICE

REFERENCE NO. 2 - COMPANY NAME:

ADDRESS:

CONTACT PERSON: TITLE:

E-MAIL: TELEPHONE NUMBER:

AMT. OF CONTRACT: DATE AND TYPE OF SERVICE

REFERENCE NO. 3 - COMPANY NAME:

ADDRESS:

CONTACT PERSON: TITLE:

E-MAIL: TELEPHONE NUMBER:

AMT. OF CONTRACT: DATE AND TYPE OF SERVICE

REFERENCE NO. 4 - COMPANY NAME:

ADDRESS:

CONTACT PERSON: TITLE:

E-MAIL: TELEPHONE NUMBER:

AMT. OF CONTRACT: DATE AND TYPE OF SERVICE

REFERENCE NO. 5 - COMPANY NAME:

ADDRESS:

CONTACT PERSON: TITLE:

E-MAIL: TELEPHONE NUMBER:

AMT. OF CONTRACT: DATE AND TYPE OF SERVICE

ATTACHMENT H

ATTACHMENT- I

IFB RESPONSE CHECKLIST

Page | 2

Bidder Response Checklist

ALL FORMS AND REQUIRED INFORMATION BELOW MUST BE COMPLETED AND

INCLUDED WHEN YOU SUBMIT YOUR BID PACKAGE:

Bidder Attachments The Bidder must complete the following table identifying all the other documents that are being attached as part of the IFB response.

Table 1 Vendor Attachment Checklist

Item # Attachment Name

Attachment Provided?

1 BID Form (Attachment B) YES NO

2 E-Verify Form (Attachment C) YES NO

3 Certificate Regarding Conflict-of-Interest Form (Attachment D)

YES NO

4 Iran Divestment Act Form (Attachment E) YES NO

5 Companies Boycotting Israel Divestment Act Form (Attachment F)

YES NO

6 Non-Collusion Form (Attachment G)

YES NO

7 Reference Form (Attachment H)

YES NO

8 Response Checklist (Attachment I) YES NO

9 Provide Safety Data Sheets (SDS) YES NO

10 Provide a Certificate of Analysis (COA) YES NO

Page | 3

Item # Attachment Name

Attachment Provided?

11 Provide Delivery Lead Time for an Order YES NO

12 Provide three references from chemical facilities (not finance department) previously supplied YES NO

7 COSTS AND DAMAGES