IFB 25-002 WASTEWATER TREATMENT CHEMICAL – ACETIC ACID.pdf

Orange Water and Sewer Authority

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

IFB NO. 25-002

INVITATION FOR BID

FOR

WASTEWATER TREATMENT CHEMICAL – ACETIC ACID

Date Issued: October 7, 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 ACETIC ACID,

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 Excess/Umbrella Liability Insurance

5.11.2 General Liability Insurance

5.11.3 General Liability Property Damage Liability

5.11.4 Automobile Liability Insurance

5.11.5 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. 25-002

FOR

WASTEWATER TREATMENT CHEMICAL – ACETIC ACID,

1 NOTICE OF INVITATION TO BID

The Orange Water and Sewer Authority (OWASA), invites sealed bids from qualified suppliers for the supply of Acetic Acid,, used in 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 Wednesday, October 23, 2024, for the WASTEWATER TREATMENT CHEMICAL – ACETIC

ACID, 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

October 7, 2024

IFB distributed and posted to OWASA website

October 14, 2024

3:00 PM ET

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

October 17, 2024

3:00 PM ET

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

October 23, 2024 3:00 PM ET Bids due at the administrative offices of OWASA

October 23, 2024 3:30 PM ET Public Bid Opening at the administrative offices of OWASA

October 28, 2024(tentative) Notice of Intent to Award Contract Contingent upon Executive Director’s Approval

November 4, 2024 (tentative)

Contract Start Date https://www.owasa.org/bid-opportunities

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: 25-002 WASTEWATER TREATMENT CHEMICAL – ACETIC ACID, 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).

Test Limits Product 20% Acetic Acid Appearance Clear, Colorless Odor Characteristic Odor (vinegary) Color (APHA) 30 Max Iron (Fe) Report Percentage value Assay (CH3COOH) 19-35% Sulfur Dioxide (SO2) Report PPM

Hydrogen Peroxide (H202)

5-60 PPM

Density Report PPM pH 2-3 o 3.1.12 Provide Delivery Lead Time for an Order.

o 3.1.13 Provide three references from facilities (not finance department) previously supplied.

Provide two copies of your bid documents with one thumb drive.

4 SELECTION PROCESS FOR BIDS FOR ACETIC ACID,

The selection process for bids for ACETIC ACID, 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 facilities previously supplied-Pass/Fail o Lowest responsive responsible bidder

This selection process ensures a fair, transparent, and compliant procurement of ACETIC ACID,. 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 October 14, 2024. Responses to questions will be posted on the OWASA website no later than 3:00 pm Eastern Time on October 17, 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 October 23, 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.

mailto:dmoore@owasa.org

5.4 Method of Response

Responses to this IFB shall be made according to the specifications 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 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 Excess/Umbrella Liability Insurance, with a limit of $4,000,000.

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

5.11.3 General Liability Property Damage Liability, with a limit of $1,000,000 for each occurrence.

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

5.11.5 Workers' Compensation Insurance in accordance with statutory requirements and Employers' Liability Insurance, with a limit of $1,000,000 for each occurrence.

5.12 Contract Term and Extension

The term of this Agreement shall be for one (1) year commencing on the Effective Date, 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 Basic Organic Chemicals (0614) 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 25-002 WASTEWATER TREATMENT CHEMICAL – ACETIC ACID

SPECIFICATIONS Page | 1 of 2

Attachment A

ACETIC ACID 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.

The Certificate of Analysis (COA) document shall accompany each delivery of the Liquid Acetic Acid solution and must meet specifications below.

Acetic Acid Specifications

Chemical Requirements:

• Product: 20% Acetic Acid

• Appearance: Clear, colorless liquid

• Odor: Characteristic vinegar-like odor

• Color (APHA): 30 Max

• Iron (Fe): Report percentage value

• Assay (CH₃COOH): 19-35%

• Sulfur Dioxide (SO₂): Report PPM

• Hydrogen Peroxide (H₂O₂): 5-60 PPM

• Estimated Annual Consumption: Approximately 2,300,000 pounds per year

Delivery Requirements:

• Estimated Annual Consumption: Approximately 2,300,000 pounds per year

• Delivery Method: Acetic Acid shall be delivered in tanker truck quantities, with a 2-inch cam fitting connection for unloading.

• Delivery Frequency: Typically weekly or biweekly shipments are expected.

• Delivery Location:

o Wastewater Treatment Plant: 170 Old Mason Farm Road, Chapel Hill, NC 27517 o Attention: Wil Lawson

Deliveries shall be made during normal business hours (7:00 a.m. to 3:30 p.m. EST, Monday through Friday). The supplier must provide unloading equipment, such as a compressor, and is responsible for cleaning up any spills that occur during unloading. All delivery equipment must be inspected by the driver before offloading begins, and all drivers must have appropriate training in handling the chemical and using personal protective equipment.

Acceptance and Rejection:

• OWASA reserves the right to analyze each shipment upon arrival and reject any material that does not meet these specifications. Any rejected material will be returned at the supplier's expense.

• A sample of the material, along with a representative analysis, may be requested to confirm compliance before bulk deliveries.

IFB 25-002 WASTEWATER TREATMENT CHEMICAL – ACETIC ACID

SPECIFICATIONS Page | 2 of 2

Pricing:

• The bid price for the Acetic Acid shall be all-inclusive, with no additional fees or surcharges.

Additional Requirements:

• Photo ID of the delivery driver, vehicle identification, and an approximate delivery day and time must be provided in advance.

• The driver shall use proper safety equipment during the delivery, and faulty equipment or inexperienced handling of chemicals will constitute grounds for delivery rejection.

BID SHEET

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

Name of Business Submitting Proposal

Signature of Authorized Representative/Title

Print Name

Address

Email Address of Representative

Attachment B

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:

Acetic Acid Price Per Pound($): ___________________________________ ( please do not include sales tax)

Estimated 2,300,000 pounds per year__________________________ ( 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 facilities (not finance department) previously supplied YES NO

7 COSTS AND DAMAGES