ITB Attachment 1 Contractual Acceptance Form~1.doc

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Attached to
ITB 9219 Firewood and Delivery Services for Prineville Reservoir State Park
Solicitation number
S-63400-00005858
Issued by
Crook County, Oregon

About this file

This document is an Invitation to Bid (ITB) issued by the Oregon Parks and Recreation Department (OPRD) to establish a price agreement for bundled firewood to be delivered to Prineville Reservoir State Park in Prineville, Oregon. The ITB requests bids from qualified vendors to provide firewood services, including the bundling and delivery of firewood to the specified location. The contract term is not explicitly stated, but the document indicates that OPRD is seeking to fulfill its firewood needs through this procurement. The ITB includes a Contractual Acceptance Form that must be completed and returned with the bid, which collects information about the bidder's legal entity, tax identification, and certifications.

The ITB covers services within the jurisdictions of Crook County and the city of Portland, Oregon. Pricing terms, bidder qualifications, and other salient details are not provided in the document. The ITB does not mention any incumbent contractors, funding requirements, or set-aside programs, and there are no references to a bidder's conference or site visit requirements.

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Text version

OPRD PROCUREMENT No. 9219

ATTACHMENT #1

CONTRACTUAL ACCEPTANCE FORM

BIDDER SHALL PROVIDE ALL APPLICABLE INFORMATION REQUESTED BELOW

THIS ATTACHMENT MUST BE COMPLETED AND RETURNED WITH BID

BIDDER’S LEGAL NAME: (TAX FILING) __________________________________________________________ BIDDER’S MAILING ADDRESS: ________________________________________________________________

BIDDER’S BUSINESS DESIGNATION: (CHECK ONE)

FORMCHECKBOX

Partnership

FORMCHECKBOX

Limited Partnership

FORMCHECKBOX

Limited Liability Partnership

FORMCHECKBOX

Corporation

FORMCHECKBOX

Professional Corporation

FORMCHECKBOX

Limited Liability Company

FORMCHECKBOX

Sole Proprietorship

FORMCHECKBOX

Other: ____________________________________________ BIDDER’S FEDERAL TAX ID NUMBER: (NOT SOCIAL SECURITY NUMBER) _________________________ Tax information is requested pursuant to ORS 305.385 and will be used for the administration of state, federal and local tax laws. OPRD may report the information provided to the Internal Revenue Service (IRS) under the name and taxpayer identification number provided.

BIDDER’S OREGON BUSINESS REGISTRATION NUMBER: _________________________________

(OREGON SECRETARY OF STATE, CORPORATIONS DIVISION)

Go to http://www.filinginoregon.com/ for information on how to register to do business in Oregon.

BIDDER IS A RESIDENT BIDDER:

FORMCHECKBOX

YES

FORMCHECKBOX

NO

ORS 279A.120(1)(b): “Resident bidder” means a bidder that has paid unemployment taxes or income taxes in Oregon during the 12 calendar months immediately preceding submission of the bid, has a business address in Oregon and has stated in the bid whether the bidder is a “resident bidder” under this paragraph.

BIDDER IS AN OREGON CERTIFIED FIRM: (CHECK ALL THAT APPLY)

FORMCHECKBOX

Minority Business Enterprise (MBE)

FORMCHECKBOX

Emerging Small Business (ESB)

FORMCHECKBOX

Women Business Enterprise (WBE)

FORMCHECKBOX

Disadvantaged Business Enterprise (DBE)

FORMCHECKBOX

Service-Disabled Veteran Business Enterprise (SDVBE) Go to Business Oregon for information on the COBID certification program.

BIDDER’S CONTACT INFORMATION:

AUTHORIZED REPRESENTATIVE

TITLE

PHONE

FAX

EMAIL

THE INDIVIDUAL SIGNING ON BEHALF OF BIDDER HEREBY ACKNOWLEDGES AND CERTIFIES THAT:

· He/she is authorized to act on behalf of Bidder,

· The supplied Contractor data is true and accurate,

· To the best of his/her knowledge, Bidder is not in violation of any Oregon tax laws, For the purposes of this certification, “Oregon Tax Laws” means a state tax imposed by ORS 320.005 to 320.150 and 403.200 to 403.250 and ORS chapters 118, 314, 316, 317, 318, 321 and 323 and the elderly rental assistance program under ORS 310.630 to 310.706 and local taxes administered by the Department of Revenue under ORS 305.620. [ORS 305.380(4)]

· Bidder has completely read and understands the provisions of the Solicitation, including any Addenda issued,

· The Bid was prepared independently from all other Bidders, and without collusion, fraud, or other dishonesty,

· Bidder has not discriminated and will not discriminate, in violation of ORS 279A.110(1), against any minority, women or emerging small business enterprise certified under ORS 200.055 or a business that is owned or controlled by or that employs a disabled veteran as defined in ORS 408.225 in obtaining any required subcontract,

· Bidder accepts and agrees to be bound by all the terms and conditions of the Contract awarded,

· Bidder agrees to provide all Goods and Services required to be provided under the Contract,

· Bidder has the available resources, including staffing, to perform the Services in a reasonable timeframe to pursue OPRD’s objectives, and

· By submitting a response to this Solicitation, Bidder grants the State of Oregon a non-exclusive, perpetual, irrevocable, royalty-free, worldwide license for the rights to copy, distribute, display, prepare derivative works of and transmit the response for the purpose of conducting this procurement and to fulfill obligations under Oregon Public Records Laws.

SIGNATURE OF BIDDER’S AUTHORIZED REPRESENTATIVE

DATE

OregonBuys S-63400-00005858 Page 2 of 2

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