IFB_Submittal_Forms_to_Complete.pdf

CERTIFICATION OF BIDDER

THIS FORM MUST BE PRINTED OUT, COMPLETED, AND UPLOADED BACK INTO OPENGOV

IFB

(Number and Name Entered Above)

I/We (Insert Company Name) agree to provide the goods and services as stipulated in this IFB at the pricing indicated in our submittal. I/We further agree that the below undersigned is authorized by the (Insert Company Name) to contractually bind the company for the specified contract term. All exceptions (if applicable) are attached as an addendum to solicitation response. I understand that the City may not accept exceptions to the IFB. I/We further agree that, if awarded the contract, we will abide by the terms and conditions of the contract and not materially modify such terms without express written consent of the City.

Print Contact Name: ___________

Contact Signature: ___________

Authorized Contact Title: ___________

Contact Email Address: ___________

Contact Telephone: ___________

Bidder’s (Company) Address: ___________

City, State and ZIP Code: ___________

California Secretary of State No.: ___________

Milpitas Business License No.: ___________

CSLB License No. (if applicable): ___________

DIR Registration (if applicable):1 Name of Bidder: ___________ DIR Registration No.: ___________

Small Project Exemption: ☐ Yes ☐ No

1 Pursuant to Labor Code sections 1725.5 and 1771.1, all contractors and subcontractors that wish to bid on, be listed in a bid proposal, or enter into a contract to perform public work must be registered with the Department of Industrial Relations. See http://www.dir.ca.gov/Public-Works/PublicWorks.html for additional information. No bid will be accepted nor any contract entered into without proof of the contractor’s and subcontractors’ current registration with the Department of Industrial Relations to perform public work. Contractor hereby certifies that it is aware of the registration requirements set forth in Labor Code sections 1725.5 and 1771.1 and is currently registered as a contractor with the Department of Industrial Relations. Unless Bidder is exempt pursuant to the small project exemption, Bidder further acknowledges: (1) Bidder shall maintain a current DIR registration for the duration of the project and (2) Bidder shall include the requirements of Labor Code sections 1725.5 and 1771.1 in its contract with subcontractors and ensure that all subcontractors are registered at the time of bid opening and maintain registration status for the duration of the project. If the Project is exempt from the contractor registration requirements pursuant to the small project exemption under Labor Code Sections 1725.5 and 1771.1, please mark “Yes” in response to “Small Project Exemption.”

https://bizfileonline.sos.ca.gov/search/business https://www.milpitas.gov/241/Business-License-Center

LOCAL PURCHASING PREFERENCE CERTIFICATE

I, ______________________________ (Name), certify under penalty of perjury that

_________________________________________ (Company Name)

[Check one:]

☐ is

☐ is not a Local Provider as defined in Milpitas Municipal Code Section I-2.1.03 Item 13 which states:

LOCAL PROVIDER. A supplier or provider of equipment, materials, supplies or services which has an established place of business within the City of Milpitas, which has a City of Milpitas business license, which has paid all currently due business license fees and taxes, and which began doing business within the City of Milpitas at least one (1) year prior to the City’s inviting bids or quotations for the respective purchase.

The City will apply the Local Purchasing Preference as applicable in accordance with Milpitas Municipal Code Section I-2-1.03-15.

Signature of Bidder's Authorized Representative

Name & Title of Authorized Representative

Date of Signing https://library.municode.com/ca/milpitas/codes/code_of_ordinances?nodeId=TITIAD_CH2PU_S1PUAPDE_2-1.03DE https://library.municode.com/ca/milpitas/codes/code_of_ordinances?nodeId=TITIAD_CH2PU_S3PRMEPR_2-3.15LOPUPR https://library.municode.com/ca/milpitas/codes/code_of_ordinances?nodeId=TITIAD_CH2PU_S3PRMEPR_2-3.15LOPUPR

RECYCLED PRODUCTS CERTIFICATE

The City requires all businesses doing business with the City to certify in writing the minimum, if not exact, percentage of postconsumer materials in the products or supplies offered or sold to the City. Vendors shall use environmentally preferable products, and/or products manufactured with the maximum practicable amount of post-consumer material, whenever the fitness and quality are equal to or better than that of non-recycled products and they are available at the same total cost and to the extent practicable. All paper products sold or delivered to the City must contain at least thirty percent (30%) postconsumer fiber. Such recycled products must meet any performance standards as specified in the solicitation.

Materials and Products: Please give the name of the material or product, and the percentage of postconsumer recycled material it contains, one line item at a time.

1. ______________________________________________________________________

2. ______________________________________________________________________

3. ______________________________________________________________________

4. ______________________________________________________________________

PLEASE USE EXTRA TYPE WRITTEN SHEETS AS NECESSARY.

Equipment: Please give the brand, make, and model of the equipment. Indicate the percentage of postconsumer material it contains, and give a brief description of how that material is incorporated into the equipment, one line item at a time.

1. ______________________________________________________________________

2. ______________________________________________________________________

3. ______________________________________________________________________

4. ______________________________________________________________________

PLEASE USE EXTRA TYPE WRITTEN SHEETS AS NECESSARY.

I certify under penalty of perjury that (Company Name) ______________________________ is a supplier or provider of recycled products and/or equipment, containing postconsumer material.

Signature of Bidder’s Authorized Representative Date of Signing

Name of Authorized Representative

Title of Authorized Representative

NON-COLLUSION DECLARATION

The undersigned declares:

I am the ___________________ of ______________________________, the party making the foregoing Bid.

This Bid is not made in the interest of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The Bid is genuine and not collusive or a sham. The Bidder has not directly or indirectly induced or solicited any other bidder to put in a false or sham Bid, and has not directly or indirectly colluded, conspired, connived, or agreed with any bidder or anyone else to put in a sham bid, or that anyone shall refrain from bidding.

The Bidder has not, in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the bid pricing of the Bidder or any other bidder, or to fix any overhead, profit, or cost element of the bid price, or that of any other bidder, or to secure any advantage against the public body awarding the contract of anyone interested in the proposed contract. All statements contained in the Bid are true. The Bidder has not, directly or indirectly, submitted its pricing or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company association, organization, bid depository, or to any member or agent thereof to effectuate a collusive or sham Bid and has not paid, and will not pay, any person or entity for such purpose.

Any person executing this declaration on behalf of a Bidder that is a corporation, partnership, joint venture, limited liability company, limited liability partnership, or any other entity, hereby represents that he or she has full power to execute, and does execute, this declaration on behalf of the Bidder.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration is executed on __________________ [date], at ___________________[city], _______________[state].

Name of Bidder

Signature

Name

Title

BIDDER’S STATEMENT REGARDING INSURANCE COVERAGE

BIDDER HEREBY CERTIFIES that Bidder has reviewed and understands the insurance coverage requirements specified in this IFB. Should Bidder be awarded the contract for this IFB, Bidder further certifies that the Bidder shall meet the specified requirements for insurance, including insurance coverage of the subcontractors, and agrees to name the City as an additional insured, as well as meet all other insurance provisions set forth in this IFB.

Name of Bidder (Person, Firm, or Corporation)

Signature of Bidder's Authorized Representative

Name and Title of Authorized Representative

WORKER'S COMPENSATION INSURANCE CERTIFICATION

Bidder shall execute the following form as required by the California Labor Code, Sections 1860 and 1861:

I am aware of the provisions of Section 3700 of the Labor Code, which require every employer to be insured against liability for worker's compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the performance of the work of this contract.

Signature of Bidder’s Authorized Representative

Name and Title of Authorized Representative

NON-DISCRIMINATORY EMPLOYMENT CERTIFICATE

Certificate Generally Consistent with a policy of non-discrimination in employment on contracts of the City and in furtherance of the provisions of Section 1735 and 1777.6 of the California Labor Code a "contractor's obligation for nondiscriminatory employment certificate" as hereinafter set forth shall be attached and incorporated by reference as an indispensable and integral term of all solicitation specifications and contracts of the City for the construction, repair, or improvement of public works.

Contents of Certificate The Bidder’s obligation for nondiscriminatory employment is as follows:

If awarded the contract, and In performing the work of the contract, Bidder agrees as follows:

1. Bidder will not discriminate against any employee or applicant for employment because of race, creed, color, national origin, ancestry, sexual orientation, political affiliation or beliefs, sex, age, physical handicap, medical condition, marital status, or pregnancy (as those terms are defined by the California Fair Employment and Housing Act -- Government Code Section 12900-12996), except where such discrimination is based on a bona fide occupational qualification.

2. Bidder will take positive action or ensure that applicants are employed and that employees are treated during employment, without regard to their race, creed, color, national origin, ancestry, sexual orientation, political affiliation or beliefs, sex, age, physical handicap, medical condition, marital status, or pregnancy (as those terms are defined by the California Fair Employment and Housing Act -- Government Code Section 12900-12996), except where such discrimination is based on a bona fide occupational qualification. Such action shall include, but not be limited to, the following: Employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation;

and selection for training, including apprenticeship. Bidder agrees to post in conspicuous places, accessible to employees and applicants for employment, notices setting forth the provisions of this nondiscrimination clause.

3. Bidder will, in all solicitations or advertisements for employees placed by or on behalf of the Contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, sexual orientation, political affiliation or beliefs, sex, age, physical handicap, medical condition, marital status, or pregnancy (as those terms are defined by the California Fair Employment and Housing Act -- Government Code Section 12900-12996), except where such discrimination is based on a bona fide occupational qualification.

4. Bidder will send to each labor union or representative of workers, with which

Bidder has a collective bargaining agreement or other contract or understanding, a notice advising the said labor union or workers' representative of the Bidder's commitments under this provision, and shall post copies of the notice in conspicuous places available to employees and applicants for employment.

5. Bidder will permit access to the Bidder's records of employment, employment advertisements, application forms, and other pertinent data and records by the City, the Fair Employment Practices Commission, or any other appropriate Agency of the State designated by the City for the purposes of investigation to ascertain compliance with the Bidder's Obligation for Nondiscriminatory Employment provisions of this contract, or Fair Employment Practices statute.

6. A finding of willful violation of the nondiscriminatory employment practices article of this contract or of the Fair Employment Practices Act shall be regarded by the City as a basis for determining that Bidder is a "disqualified bidder" for being "non-responsible" for any future solicitations or contracts for which the Bidder may submit responses.

7. The City shall deem a finding of willful violation of the Fair Employment Practices

Act to have occurred upon receipt of written notice from the Fair Employment Practices Commission that it has investigated and determined that the Bidder has violated the Fair Employment Practices Act and has issued an order under Labor Code Section 1426 or obtained an injunction under Labor Code Section 1429.

8. Upon receipt of any such written notice, the City shall notify the Bidder that unless he or she demonstrates to the satisfaction of the City within a stated period that the violation has been corrected, he or she shall be declared a "disqualified bidder" until such time as the Bidder can demonstrate that he or she has implemented remedial measures, satisfactory to the City, to eliminate the discriminatory employment practices which constituted the violation found by the Fair Employment Practices Commission.

9. Upon receipt from any person of a complaint of alleged discrimination under any

City contract, the City shall ascertain whether probable cause for such complaint exists. If probable cause for the complaint is found, City staff shall request the City Council to hold a public hearing to determine the existence of a discriminatory practice in violation of this contract.

10. In addition to any other remedy or action provided by law or the terms of this contract, the Bidder agrees that, should the City Council determine after a public hearing duly noticed to the Bidder that the Bidder has not complied with the nondiscriminatory employment practices provisions of this contract or has willfully violated such provisions, the City may, without liability of any kind, terminate, cancel, or suspend this contract, in whole or in part. In addition, upon such determination, Bidder shall forfeit a penalty of Twenty-Five Dollars and Zero Cents ($25.00) to City for each calendar day, or portion thereof, for each person who was denied employment as a result of such noncompliance. Such monies shall be recovered from the Bidder. The City may deduct any such penalties from any monies due the Bidder from the City.

11. Bidder certifies to the City that he or she has met or will meet the following standards for positive compliance, which shall be evaluated in each case by the City:

a. Bidder shall notify all supervisors and other personnel officers in writing of the content of the nondiscrimination provision and their responsibilities under it.

b. Bidder shall notify all sources of employee referrals (including unions, employment agencies, advertisements, Department of Employment) of the content of the nondiscrimination provision.

c. Bidder shall file a basic compliance report as required by the City.

Willfully false statements made in such reports shall be punishable as provided by law.

The compliance report shall also specify the sources of the workforce and who has the responsibility for determining whom to hire, or whether or not to hire.

d. Bidder shall notify the City of opposition to the nondiscrimination provision by individuals, firms or organizations during the period of this contract.

12. Nothing contained in this Nondiscriminatory Employment Certificate shall be construed in any manner to prevent the City from pursuing any other remedies that may be available at law.

13. Bidder certifies to the City that the Bidder will comply with the following requirements with regard to all subcontractors and suppliers:

a. In the performance of the work under this contract, Bidder will include applicable provisions of this Nondiscriminatory Employment Certificate in all subcontracts and in any supply contract to be performed within the State of California, so that such provisions will be equally binding upon each subcontractor and each supplier.

b. Bidder will take such action with respect to any subcontract or purchase order as the City may direct as a means of enforcing such provisions including sanctions for noncompliance, provided, however, that in the event the Bidder becomes involved in, or is threatened with, litigations with a subcontractor or supplier as a result of such direction by the City, the Bidder may request the City to enter into such litigation to protect the interests of the City.

Signature of Bidder's Authorized Representative

Name of Authorized Representative

Title of Authorized Representative

WAGE THEFT CERTIFICATION

THIS FORM MUST BE PRINTED OUT, COMPLETED, AND UPLOADED BACK INTO

OPENGOV

Bidder certifies subject to penalty for perjury that the option checked below relating to the Bidder and its subcontractors’ status in regard to wage theft is true and correct:

Neither Bidder nor any of its subcontractors have been found by a final court order or administrative action of an investigatory government agency to have violated federal, state, or local wage and hour laws, including, but not limited to, the federal Fair Labor Standards Act, the California Labor Code, and the Milpitas Minimum Wage Ordinance, within the past five (5) years from the solicitation submission deadline.

Bidder or its subcontractors have been found by a final court order or administrative action of an investigatory government agency to have violated federal, state, or local wage and hour laws, including, but not limited to, the federal Fair Labor Standards Act, the California Labor Code, and the Milpitas Minimum Wage Ordinance, within the past five (5) years from the solicitation submission deadline. For each violation, Bidder shall provide a copy of (i) the final court order and/or final administrative decision/action; and (ii) documents demonstrating either that the order/decision/action has been fully satisfied, or if the order/decision/action has not been fully satisfied, documents evidencing a payment or other alternative plan has been approved by the court/government agency to satisfy the order/decision/action and proof that the Bidder or its subcontractors are in compliance with that plan as of the solicitation submission deadline.

Signature:

Printed Name:

Title:

Firm Name:

Date: