ITB Attachment 1 Contractual Acceptance Form~2.doc
DOC document 45 KB Posted
- Attached to
- 10155 Potable Water Hauling and related Delivery Services to Prineville Reservoir State Park
- Solicitation number
- S-63400-00007659
- 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 contract for potable water hauling and delivery services to the Prineville Reservoir State Park in Crook County, Oregon. The contract will require the successful bidder to provide potable water from a municipal source and deliver it to the state park located at 19020 SE Parkland Dr, Prineville, OR 97754. The ITB does not specify any item quantities or a contract term length, but it requires bidders to submit their responses by the stated due date.
The ITB includes a Contractual Acceptance Form that bidders must complete and return with their bids. The form collects information about the bidder's business designation, tax identification, and Oregon business registration. It also requires the bidder's authorized representative to acknowledge and certify various statements related to the bidder's compliance with Oregon tax laws, independence of the bid, non-discrimination, and acceptance of the contract terms. The ITB does not mention any set-asides, incumbent contractors, or funding sources and requirements.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| S-63400-00007659 BID TABULATION.docx | DOCX document | |
| ITB Attachment 3 Sample Contract~1.pdf | ||
| ITB Attachment 2 Pricing Proposal Form~2.doc | DOC document | |
| ITB S-63400-00007659.pdf | ||
| 00007660_RFB.xlsx | XLSX spreadsheet |
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Text version
OPRD PROCUREMENT No. 10155
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
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
Attachment 1 Contractual Acceptance Form OregonBuys S-63400-00007659 Page 2 of 2
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