IFB_BPM005756_Required_Forms_CONSTRUCTION.pdf

THE STATE OF ARIZONA

GAME AND FISH DEPARTMENT

5000 W. CAREFREE HIGHWAY

Phoenix, AZ 85086-5000

(602) 942-3000 •WWW.AZGFD.GOV

Required Forms Updated 09-26-2022 BPM005756

CONSTRUCTION SOLICITATION

BPM005756

REQUIRED FORMS

Contents Offeror’s Check List 2

Offer and Acceptance Form 3

Designation of Confidential, Trade Secret & Proprietary Information 4

R2-7-103. Confidential Information 5

Boycott of Israel Disclosure 6

Forced Labor of Ethnic Uyghurs Ban 7

Attachment I – SubContractors 8

Attachment II – References 9

Attachment III – Data Sheet 10

Attachment IV – Amendment Acknowledgement 11

Attachment V – Business Information Checklist 12

NON-COLLUSION AFFIDAVIT 13

BID BOND 14

PRIOR APPROVAL REQUEST FORM 13

OFFEROR’S CHECK LIST (for

Offeror’s use only.) This is the only document does not have to be returned.

Arizona Game and Fish Department

Purchasing Office

5000 West Carefree Highway

Phoenix, Arizona 85086

Offeror’s Check List

DOCUMENT SUBMITTED*

If you have been notified that an amendment has been issued, you must re-open your offer in APP, make any required modifications, if any, and re-submit your offer. If you do not do this you have not submitted an offer in the Arizona Procurement Portal and your offer will be considered as non-responsive

☐ YES, ☐ NO,

☐ NA

Offer and Acceptance (Complete the top half of page 3, sign and upload into your offer in Arizona Procurement Portal.)

“Designation of Confidential, Trade Secret & Proprietary Information” form

Boycott of Israel Disclosure ☐ YES ☐ NO

Forced Labor of Ethnic Uyghurs Ban ☐ YES ☐ NO

Pricing has been entered in Arizona Procurement Portal’s “items” tab. ☐ YES ☐ NO

Attachment I-Subcontractors ☐ YES ☐ NO

Attachment II- References ☐ YES ☐ NO

Attachment III- Data Sheet ☐ YES ☐ NO

Attachment IV-Amendment Acknowledgement ☐ YES ☐ NO

Notarized Non-Collusion Affidavit is to be scanned and attached to your offer as an attachment in APP. ☐ YES ☐ NO

The original hard copy Notarized Non-Collusion Affidavit mailed or hand-delivered to Arizona Game and Fish Department Attn: Purchasing, 5000 W.

Carefree Highway, Phoenix, AZ 85086 prior to bid due date and time.

☐ YES ☐ NO

Bid Bond is to be scanned and attached to your offer as an attachment in APP. ☐ YES ☐ NO

The original hard copy Bid Bond mailed or hand-delivered to Arizona Game and Fish Department Attn: Purchasing, 5000 W. Carefree Highway, Phoenix, AZ 85086 prior to bid due date and time

☐ YES ☐ NO

Prior Approval Request Form Due at least 7 calendar days before bid opening.

Email request form to the IFB procurement contact ☐ YES ☐ NO

* Ensure Items above have been completed, scanned (preferably as one pdf file) and uploaded into the “Attachments” tab of your bid (quote) in Arizona Procurement Portal. Note Prior Approval Request Form is required to be turned in to the procurement officer NO LATER than 5 days before bid due date.

☐ YES ☐ NO

OFFER AND ACCEPTANCE

Arizona Game and Fish Department

Purchasing Office

Offer and Acceptance Form OFFER

TO THE STATE OF ARIZONA:

The Undersigned hereby offers and agrees to furnish the material, service or construction in compliance with all terms, conditions, specifications and amendments in the Solicitation and any written exceptions in the offer.

Company Name Signature of Person Authorized to Sign Offer

Address Printed Name

City State Zip Title

Phone:

Fax:

Contact Email Address

By signature in the Offer section above, the Offeror certifies:

1. The Offeror shall not discriminate against any employee or applicant for employment in violation of Federal Executive Order 11246, State Executive Order 2009-9 or A.R.S. §§ 41−1461 through 1465.

2. The Offeror has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with the submitted offer. Failure to provide a valid signature affirming the stipulations required by this clause shall result in rejection of the offer. Signing the offer with a false statement shall void the offer, any resulting contract and may be subject to legal remedies provided by law.

3. The Offeror certifies compliance with A.R.S.§41-3532 when offering electronics or information technology products, services or maintenance.

4. The Offeror is not debarred from, or otherwise prohibited from participating in any contract awarded by any federal, state or local government.

ACCEPTANCE OF OFFER

The Offer is hereby accepted.

The Contractor is now bound to sell the materials or services listed by the attached contract and based upon the solicitation, including all terms, conditions, specifications, amendments, etc., and the Contractor’s Offer as accepted by the State.

This Contract shall henceforth be referred to as Contract No. ____________________________________________________.

The effective date of the Contract is ____________________________________________________.

The Contractor is cautioned not to commence any billable work or to provide any material or service under this contract until Contractor receives purchase order, contact release document or Procurement’s written notice to proceed.

State of Arizona Awarded this day of

Kristen Micurescu, CPPB, as Branch Chief and not personally

Designation of Confidential, Trade Secret &

Proprietary Information

Arizona Game and Fish Department

Purchasing Office

Designation of Confidential, Trade Secret & Proprietary Information

All materials submitted as part of a response to a solicitation are subject to Arizona public records law a will be disclosed if there is an appropriate public records request at the time of or after the award of the contract. Recognizing there may be materials included in a solicitation response that is proprietary or a trade secret, a process is set out in A.A.C. R2-7-103 that will allow qualifying materials to be designated as confidential and excluded from disclosure. For purposes of this process the definition of “trade secret” will be the same as that set out in A.A.C. R2-7-101(52).

This form must be completed and returned with the response to the solicitation and any supporting information to assist the

State in making its determination as to whether any of the materials submitted as part of the solicitation response should be designated confidential because the material is proprietary or a trade secret and therefore not subject to disclosure.

All offerors must select one of the following:

My response does not contain proprietary or trade secret information. I understand that my entire response will become public record in accordance with A.A.C. R2-7-C317.

My response does contain trade secret information because it contains information that:

1. Is a formula, pattern, compilation, program, device, method, technique or process, AND

2. Derives independent economic value, actual or potential, from not being generally known to, and not being readily ascertainable by proper means by, other persons who can obtain economic value from its disclosure or use; AND

3. Is the subject of efforts by myself or my organization that are reasonable under the circumstances to maintain its secrecy.

Please note that failure to attach an explanation may result in a determination that the information does not meet the statutory trade secret definition. All information that does not meet the definition of trade secret as defined by A.A.C.

R2-7-101(52) will become public in accordance with A.A.C. R2-7-C317. The State reserves the right to make its own determination of Proposer’s trade secret materials through a written determination in accordance with A.A.C. R2-7-

103.

If the State agrees with the proposer’s designation of trade secret or confidentiality and the determination is challenged, the undersigned hereby agrees to cooperate and support the defense of the determination with all interested parties, including legal counsel or other necessary assistance.

By submitting this response, proposer agrees that the entire offer, including confidential, trade secret and proprietary information may be shared with an evaluation committee and technical advisors during the evaluation process. Proposer agrees to indemnify and hold the State, its agents and employees, harmless from any claims or causes of action relating to the State’s withholding of information based upon reliance on the above representations, including the payment of all costs and attorney fees incurred by the State in defending such an action.

Company Name Signature of Person Authorized to Sign

Address Printed Name

City State Zip Title

Designation of Confidential, Trade Secret &

Proprietary Information

Arizona Game and Fish Department

Purchasing Office

R2-7-103. Confidential Information

A. If a person wants to assert that a person's offer, specification, or protest contains a trade secret or other proprietary information, a person shall include with the submission a statement supporting this assertion. A person shall clearly designate any trade secret and other proprietary information, using the term "confidential". Contract terms and conditions, pricing, and information generally available to the public are not considered confidential information under this Section.

B. Until a final determination is made under subsection (C), an agency chief procurement officer shall not disclose information designated as confidential under subsection (A) except to those individuals deemed by an agency chief procurement officer to have a legitimate state interest.

C. Upon receipt of a submission, an agency chief procurement officer shall make one of the following written determinations:

1. The designated information is confidential and the agency chief procurement officer shall not disclose the information except to those individuals deemed by the agency chief procurement officer to have a legitimate state interest;

2. The designated information is not confidential; or

3. Additional information is required before a final confidentiality determination can be made.

D. If an agency chief procurement officer determines that information submitted is not confidential, a person who made the submission shall be notified in writing. The notice shall include a time period for requesting a review of the determination by the state procurement administrator.

E. An agency chief procurement officer may release information designated as confidential under subsection (A) if:

1. A request for review is not received by the state procurement administrator within the time period specified in the notice; or

2. The state procurement administrator, after review, makes a written determination that the designated information is not confidential

Participation in Boycott of Israel

Purchasing Office

BPM005756 Required Forms Updated 09-26-2022 SPO Form Boycott of Israel Disclosure Revision No. 1 | Revised 09-22

Boycott of Israel Disclosure Please note that if any of the following apply to this Solicitation, Contract, or Contractor, then the Offeror shall select the “Exempt

Solicitation, Contract, or Contractor” option below:

● The Solicitation or Contract has an estimated value of less than $100,000;

● Contractor is a sole proprietorship;

● Contractor has fewer than ten (10) employees; and/or

● Contractor is a non-profit organization.

Pursuant to A.R.S. § 35-393.01, public entities are prohibited from entering into contracts “unless the contract includes a written certification that the company is not currently engaged in, and agrees for the duration of the contract to not engage in, a boycott of goods or services from

Israel.”

Under A.R.S. § 35-393:

1. "Boycott" means engaging in a refusal to deal, terminating business activities or performing other actions that are intended to limit commercial relations with entities doing business in Israel or in territories controlled by Israel, if those actions are taken either:

(a) Based in part on the fact that the entity does business in Israel or in territories controlled by Israel.

(b) In a manner that discriminates on the basis of nationality, national origin or religion and that is not based on a valid business reason.

2. "Company" means an organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, limited liability company or other entity or business association, including a wholly owned subsidiary, majority-owned subsidiary, parent company or affiliate, that engages in for-profit activity and that has ten or more full-time employees.

5. "Public entity": (a) Means this State, a political subdivision of this State or an agency, board, commission or department of this State or a political subdivision of this State. (b) Includes the universities under the jurisdiction of the Arizona board of regents and community college districts as defined in section 15-1401.

The certification below does not include boycotts prohibited by 50 United States Code Section 4842 or a regulation issued pursuant to that section. See A.R.S. § 35-393.03.

In compliance with A.R.S. § 35-393 et seq., all offerors must select one of the following:

☐ The Company submitting this Offer does not participate in, and agrees not to participate in during the term of the contract, a boycott of

Israel in accordance with A.R.S. § 35-393 et seq. I understand that my entire response will become a public record in accordance with A.A.C.

R2-7-C317.

☐ The Company submitting this Offer does participate in a boycott of Israel as described in A.R.S. § 35-393 et seq.

☐ Exempt Solicitation, Contract, or Contractor.

Indicate which of the following statements applies to this Contract:

● Solicitation or Contract has an estimated value of less than $100,000;

● Contractor is a sole proprietorship;

● Contractor has fewer than ten (10) employees; and/or

● Contractor is a non-profit organization.

Company name Signature of person authorized to sign

Address Printed name and title

City State Zip Email address Phone number https://advance.lexis.com/document/?pdmfid=1000516&crid=1d22ae96-91e7-4fa9-b751-02b4d725faa3&pddocfullpath=%2Fshared%2Fdocument%2Ffe%2Furn%3AcontentItem%3A654C-M4F3-GXF6-84SC-00000-00&pdcontentcomponentid=4313&pdteaserkey=sr0&pditab=allpods&ecomp=rd-zk&earg=sr0&prid=a8f940d3-c58d-4e64-9124-f2bfdcdb31d8

Forced Labor of Ethnic Uyghurs Ban

Purchasing Office

BPM005756 Required Forms Updated 09-26-2022 SPO Form No. 205

Forced Labor of Ethnic Uyghurs Ban

Please note that if any of the following apply to the Contractor, then the Offeror shall select the “Exempt Contractor” option below:

● Contractor is a sole proprietorship;

● Contractor has fewer than ten (10) employees; OR

● Contractor is a non-profit organization.

Pursuant to A.R.S. § 35-394, the State of Arizona prohibits a public entity from entering into or renewing a contract with a company unless the contract includes written certification that the company does not use the forced labor, or any goods or services produced by the forced labor, of ethnic Uyghurs in the People's Republic of China.

Under A.R.S. § 35-394:

1. "Company" means an organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, limited liability company or other entity or business association, including a wholly owned subsidiary, majority-owned subsidiary, parent company or affiliate, that engages in for-profit activity and that has ten or more full-time employees.

2. "Public entity" means this State, a political subdivision of this State or an agency, board, commission or department of this State or a political subdivision of this State.

In compliance with A.R.S. §§ 35-394 et seq., all offerors must select one of the following:

☐ The Company submitting this Offer does not use, and agrees not to use during the term of the contract, any of the following:

● Forced labor of ethnic Uyghurs in the People’s Republic of China;

● Any goods or services produced by the forced labor of ethnic Uyghurs in the People’s Republic of China; or

● Any Contractors, Subcontractors, or suppliers that use the forced labor or any goods or services produced by the forced labor of ethnic Uyghurs in the People’s Republic of China.

☐ The Company submitting this Offer does participate in use of Forced Uyghurs Labor as described in A.R.S. § 35-394.

☐ Exempt Contractor

Indicate which of the following statements applies to the Contractor (may be more than one):

☐ Contractor is a sole proprietorship;

☐ Contractor has fewer than ten (10) employees; and/or

☐ Contractor is a non-profit organization.

Company Name Signature of person authorized to sign

Address Printed name and title

City, State, ZIP Contact email address Contact phone number

ATTACHMENT I

Purchasing Office

BPM005756 Required Forms Updated 09-26-2022

Attachment I – SubContractors

SUBCONTRACTORS

Bidder shall identify all proposed subcontractors/material suppliers that will be utilized to perform any portion of the Specifications. Additional Subcontractor(s) not listed below or on a supplemental page must receive written approval from AGFD before utilization.

Name of Subcontractor

City, State

Number of years in business

Type of business (LLC, Corporation, Sole Proprietor, etc.)

AZ Contractor’s license number

Service to be provided

Name of Subcontractor

City, State

Number of years in business

Type of business (LLC, Corporation, Sole Proprietor, etc.)

AZ Contractor’s license number

Service to be provided

ATTACHMENT II

Purchasing Office

Attachment II – References

REFERENCES

Three (3) professional references who have received services and materials supplied within the past 36 months similar to the Specifications of this Solicitation shall be listed below. References from AGFD are not to be included.

References from the western United States and Arizona are preferred. The contact person shall be someone who has responsibility for the operation of the material and/or service and shall be aware that they are being used as a reference.

Reference 1

1) Company: Contact Name:

Phone: Email:

Description of services provided:

Reference 2

2) Company: Contact Name:

Reference 3

3) Company: Contact Name:

ATTACHMENT III

Purchasing Office

DATA SHEET

Attachment III – Data Sheet

Offeror shall provide the following:

COMPANY NAME:

ADDRESS:

EMAIL ADDRESS FOR PRIMARY CONTACT:

PHONE NUMBER:

FAX NUMBER:

LICENSE NUMBER:

AZ TAX LICENSE NO:

FEDERAL EMPLOYER ID NO:

PRINCIPAL OFFICERS:

Primary Contact NAME:

TITLE:

NAME: TITLE:

ATTACHMENT IV

Purchasing Office

Attachment IV – Amendment Acknowledgement

AMENDMENT ACKNOWLEDGEMENT

Failure to return completed amendment acknowledgement sheet may result in a bid being rejected. If no amendments have been received the Contractor shall indicate “none” and return this page with their offer.

Bidder acknowledges receipt of the following addenda covering revisions to the IFB and states that the costs, if any, of such revisions have been included in the Base Bid and other prices quoted herein:

Solicitation Amendment no.: Dated:.

Solicitation Amendment no.: Dated:.

Solicitation Amendment no.: Dated:.

Solicitation Amendment no.: Dated:.

Note: If no addenda have been received, indicate “NONE”.

ATTACHMENT V

Purchasing Office

Attachment V – Business Information Checklist

BUSINESS INFORMATION CHECKLIST

Please check all blanks that apply:

1. SMALL BUSINESS

A small business concern is defined as a business, including its affiliates, which is independently owned and operated; is not dominant in the field of operations in which it is bidding on State contracts; and can further quality under the criteria concerning number of employees, average annual receipts, or other criteria as prescribed by the Small Business Administrations.

Check appropriate box below

This company is a small business concern.

This company is not a small business concern.

2. TYPE OF ORGANIZATION

3. PARENT COMPANY

A parent company is defined as one that either owns or controls the activities and basic business policies of the bidder. To own a company means that the parent company must own a majority of the voting rights in that company. Control of a company may also consist of the parent company being able to formulate, determine, and veto basic business policy decisions. This control may be exercised through the use of dominant minority voting rights, use of proxy voting, or use of contractual arrangements.

This company is owned or controlled by a parent company.

This company is not owned or controlled by a parent company.

AN EQUAL OPPORTUNITY AGENCY

This company operates as a sole proprietorship.

This company operates as a partnership.

This company operates as a joint venture.

This company operates as a corporation, incorporated in the State of ________.

Name of Parent Company:

Main Address:

Employee ID Number:

NON-COLLUSION AFFIDAVIT

Purchasing Office

5000 W. Carefree Highway

Phoenix, AZ 85086

NON-COLLUSION AFFIDAVIT

Offeror shall complete this Affidavit and return it with their offer.

State of Arizona )

) ss.

County of )

, affiant, the_______________________________________________________________________

(Title)

(Contractor) the persons, corporations, or company who makes the accompanying proposal having first been duly sworn, deposes and says:

That such proposal is genuine and not sham or collusive, nor made in the interest or behalf of any person not herein named, and that the Bidder has not directly or indirectly induced or solicited from any other Bidder to put in a sham bid, or any other person, firm, or corporation to refrain from bidding and that the Bidder has not in any manner sought by collusion to secure for itself an advantage over any other Bidder.

Subscribed and sworn to before me this day of , 20______.

My commission expires on: ___________________

Notary Public

BID BOND

Purchasing Office

5000 W. Carefree Highway

Phoenix, AZ 85086

SOLICITATION NO. BPM005756

BID BOND

KNOW ALL MEN BY THESE PRESENTS:

THAT,

(hereinafter called Principal), as Principal, and

, a corporation organized and existing under the laws of the

State of with its principal office in the City of

(hereinafter called the Surety), as Surety, are held and firmly bound unto the State of Arizona, (hereinafter called the

Obligee) in the amount of (Dollars) ($ ) , for the payment whereof, the said Principal and Surety bind themselves and their heirs, administrators, executors, successor assigns, jointly and severally firmly by these presents.

WHEREAS, the Principal has submitted a bid for:

NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with the

Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or Contract

Documents with good and sufficient surety for the faithful performance of such contract and for the prompt payment of labor and material furnished in the prosecution thereof, or in the event of the failure of the Principal to enter such Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith contract with another party to perform the Work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect.

The prevailing party in a suit on this bond shall recover as part of his judgment such reasonable attorneys’ fees as may be fixed by a judge of the Court.

Witness our hands this __________ day of ___________________________________20____

Principal Seal

By

Surety Seal

By

Agency of Record

PRIOR APPROVAL REQUEST FORM

Purchasing Office

5000 W. Carefree Highway

Phoenix, AZ 85086

SOLICITATION NO.

The offeror shall submit the following to request approval to substitute materials and/or equipment as indicated below.

Complete one form per substitution. REQUESTS MUST BE SUBMITTED NO LATER THAN SEVEN (7) DAYS

PRIOR TO BID DUE DATE.

Section Page Paragraph/Line Specified Item

Proposed Substitution: _______________________________________________________________________

Attach complete product description, drawings, photographs, performance, and test data, and other information necessary for evaluation. Identify specific model numbers, finishes, options, etc.

A. Will changes be required to building design (architecturally, structurally, mechanically, or electrically) in order to properly install proposed substitution? Yes No .

If yes, explain:____________________________________________________________________________

B. Will the undersigned pay for changes to building design, including engineering and drawing costs, caused by requested substitution? Yes No .

C. Does the proposed substitute comply in all respects with the specified product? Yes No .

If there are differences between proposed substitution and specified item, please list them below.

Specified Item Proposed Substitution

D. Does substitution affect drawing dimensions? Yes No .

If yes, explain:____________________________________________________________________________

E. What effect does substitution have on other trades?__________________________________________________

F. Does manufacturer's warrant of proposed substitution differ from that specified? Yes No .

If yes, explain:________________________________________________________________________

G. Will substitution affect progress schedule? Yes No .

If yes, explain:_______________________________________________________________________________

H. Will substitution require more license fees or royalties than specified product? Yes No .

If yes, explain: ______________________________________________________________________________

I. Will maintenance and service parts be locally available for substitution? Yes No .

If no, explain: ______________________________________________________________________________

Submitted by: Signature: Date:

Firm Name: Address:

Telephone Number: Fax Number:

For Architect's/Engineer's Use Only:

Accepted Accepted as Noted Not Accepted Received Late .

By: Date:

Remarks:________________________________________________________________________________________