ITB Attachments for Download_12-19-25.pdf

ITB S-14100-00015249 – Shutter Creek Electrical System Maintenance and Repair

DAS State Procurement Services, Version 2.0 – July, 2025 45

ATTACHMENT B

BID COVER SHEET

Bidder Name (printed):

Address:

City, State, Zip:

Bid Clarification Contact Person: Telephone:

Email:

State of Incorporation: Entity Type:

Oregon Secretary of State Business Registry Number (if required):

The undersigned, as Bidder’s authorized representative, certifies that:

1. Bidder understands and accepts the requirements of this ITB. Bidder acknowledges receipt of any and all Amendments to this ITB.

2. By submitting a Bid, Bidder agrees to be bound by the Contract terms and conditions in Attachment A, as modified by Amendment, if any.

3. The costs set forth in Attachment D are firm for 60 Calendar Days after the Opening.

4. Bidder has no undisclosed liquidated and delinquent debt owed to the State or any agency, board, commission, department of division of the State.

5. Bidder complies with and is not in violation of any tax laws of the state or a political subdivision of the state, including, without limitation taxes referenced in ORS 305.380(4), ORS 305.620 and ORS chapters 316, 317 and 318.

6. Bidder does not discriminate in its employment practices with regard to race, creed, age, religious affiliation, gender, disability, sexual orientation, national origin. When awarding subcontracts, Bidder does not discriminate against any business certified under ORS 200.055 as a disadvantaged business enterprise, a minority-owned business, a woman-owned business, a veteran owned business, or an emerging small business. If applicable, Bidder has, or will have prior to Contract execution, a written policy and practice, that meets the requirements described in ORS 279A.112, of preventing sexual harassment, sexual assault and discrimination against employees who are members of a protected class. Agency may not enter into a Contract with an anticipated price of $150,000 or more with a Bidder that does not certify it has such a policy and practice. See https://www.oregon.gov/DAS/Procurement/Pages/hb3060.aspx for additional information and sample policy template.

7. Bidder and Bidder’s employees, agents, and subcontractors are not included on:

A. the “Specially Designated Nationals and Blocked Persons” list maintained by the Office of

Foreign Assets Control of the United States Department of the Treasury found at:

https://www.oregon.gov/DAS/Procurement/Pages/hb3060.aspx

DAS State Procurement Services, Version 2.0 – July, 2025 46 https://www.treasury.gov/ofac/downloads/sdnlist.pdf, or B. the government wide exclusions list in the System for Award Management found at:

https://www.sam.gov/

8. Bidder certifies to the best of its knowledge, there exists no actual or potential conflict between the business or economic interests of Bidder, its employees, or its agents, on the one hand, and the business or economic interests of the State, on the other hand, arising out of, or relating in any way to, the subject matter of the ITB. If any changes occur with respect to Bidder’s status regarding conflict of interest, Bidder shall promptly notify the State in writing.

9. Bidder certifies all contents of the Bid (including any other forms or documentation, if required under this ITB), and this Bid Cover Sheet are truthful and accurate and have been prepared independently from all other Bidders, and without collusion, fraud, or other dishonesty.

10. Bidder understands any statement or representation made in response to this ITB, if determined to be false or fraudulent, a misrepresentation, or inaccurate because of the omission of material information could result in a "claim" (as defined by the Oregon False Claims Act, ORS 180.750(1)}, made under Price Agreement being a "false claim" (ORS 180.750(2)) subject to the Oregon False Claims Act, ORS 180.750 to 180.785, and to any liabilities or penalties associated with the making of a false claim under that act.

11. Bidder acknowledges these certifications are in addition to any certifications required in the Contract at the time of execution.

12. If Bidder is an Oregon benefit company, Bidder certifies that the majority of the benefit company’s regular, full-time workforce is located in Oregon.

BIDDER, Authorized Representative

Signature: _______________________________________________________________________

Print Name and Title: _______________________________________________________________

Date: ____________

Email: ________________________

Telephone Number: (______) _________ https://www.treasury.gov/ofac/downloads/sdnlist.pdf https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.sam.gov%2F&data=05%7C02%7CSandy.CLAVET-CONNOLLY%40das.oregon.gov%7C20d5c1c77a734944e43b08dd9723da80%7Caa3f6932fa7c47b4a0cea598cad161cf%7C0%7C0%7C638832902425383725%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=cEouPD556UvLKXydEeigOs5c2CFHproRy4Ils69Lgl0%3D&reserved=0

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ATTACHMENT C

REFERENCE CHECK FORM

REFERENCES COMPARABLE IN SIZE AND SCOPE: Bidder shall include references from a minimum of 2 different firms who Bidder provided similar goods and/or services to within the last 5 years. Goods and/or Services must be comparable in size and scope of the goods and/or services detailed in this Project. Bidder must describe how the goods and/or services provided qualifies Bidder to provide the goods and/or services described in this solicitation. References must be available to confirm the quality of goods and/or services that Bidder provided.

Reference #1

Name of Firm:

Reference Contact Person:

Telephone: Email:

Alternate Reference Contact Person:

Telephone: Email:

Description of goods and/or services provided, include type, size, duration and objectives:

Describe how the goods and/or services provided qualifies Bidder to provide the goods and/or perform the services described in this solicitation:

Describe the volume of work:

Reference #2

Name of Firm:

Reference Contact Person:

Telephone: Email:

Alternate Reference Contact Person:

Telephone: Email:

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Description of goods and/or services provided, include type, size, duration and objectives:

Describe how the goods and/or services provided qualifies Bidder to provide the goods and/or perform the services described in this solicitation:

Describe the volume of work:

Reference #3

Name of Firm:

Reference Contact Person:

Telephone: Email:

Alternate Reference Contact Person:

Telephone: Email:

Description of goods and/or services provided, include type, size, duration and objectives:

Describe how the goods and/or services provided qualifies Bidder to provide the goods and/or perform the services described in this solicitation:

Describe the volume of work:

ITB S-14100-00015249 – Shutter Creek Electrical System Maintenance and Repair Addendum

ATTACHMENT D

BID PRICING FORM

ITB: S-14100-00015249

Shutter Creek Electrical System Maintenance and Repair

Bidder shall complete this Bid Pricing Form or may submit an equivalent pricing schedule, provided all requested information is clearly identified and included. All prices shall be firm for sixty (60) calendar days following the Bid Opening Date.

Service Description

Unit / Basis (Hourly, Lump Sum, etc.)

Unit Price Extended Price / After-Hours Rates (if applicable)

ITB S-14100-00015249 – Shutter Creek Electrical System Maintenance and Repair Addendum

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ATTACHMENT E

RESPONSIBILITY INQUIRY

Bidder must complete and return this Responsibility Inquiry with its Bid. Agency will determine responsibility of a Bidder prior to award and execution of a Contract. In addition to this form, Agency may notify Bidder of other documentation required, which may include but is not limited to recent profit-and-loss history, current balance statements and cash flow information, assets-to-liabilities ratio, including number and amount of secured versus unsecured creditor claims, availability of short and long-term financing, bonding capacity, insurability, credit information, materials and equipment, facility capabilities, personnel information, record of performance under previous contracts, etc.

Failure to promptly provide requested information or clearly demonstrate responsibility may result in an Agency finding of non-responsibility and rejection.

Does Bidder have available the appropriate financial, material, equipment, facility and personnel resources and expertise, or ability to obtain the resources and expertise, necessary to demonstrate the capability of Bidder to meet all contractual responsibilities? YES / NO .

Within the last five years, how many contracts of a similar nature has Bidder completed that, to the extent that the costs associated with and time available to perform the contract remained within Bidder′s control, Bidder stayed within the time and budget allotted, and there were no contract claims by any party?

Number: ____

How many contracts did not meet those standards? Number: ____ If any, please explain.

Response:

Within the last three years has Bidder (incl. a partner or shareholder owning 10% or more of Bidder’s firm) or a major subcontractor (receiving 10% or more of a total contract amount) been criminally or civilly charged, indicted, or convicted in connection with:

1. Obtaining, attempting to obtain, or performing a public (federal, state, or local) contract or subcontract,

2. Violation of federal or state antitrust statutes relating to the submission of bids, or

3. Embezzlement, theft, forgery, bribery, falsification, or destruction of records, making false statements, tax evasion, or receiving stolen property?

YES / NO .

If "YES," indicate the jurisdiction, date of indictment, charge or judgment, and names and summary of charges in the response field below.

Response:

Within the last three years, has Bidder had:

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1. Any contracts terminated for default by any government agency, or

2. Any lawsuits filed against it by creditors or involving contract disputes?

YES / NO .

If "YES," please explain. (With regard to judgments, include jurisdiction and date of final judgment or dismissal.)

Response:

Does Bidder have any outstanding or pending judgments against it? YES / NO .

Is Bidder experiencing financial distress or having difficulty securing financing? YES / NO .

Does Bidder have sufficient cash flow to fund day-to-day operations throughout the proposed Contract period? YES / NO

If "YES” on the first question or second question of the three questions immediately above, or “NO” on the third question, please provide additional details.

Response:

Within the last three years, has Bidder filed a bankruptcy action, filed for reorganization, made a general assignment of assets for the benefit of creditors, or had an action for insolvency instituted against it? YES / NO .

If "YES," indicate the filing dates, jurisdictions, type of action, ultimate resolution, and dates of judgment or dismissal, if applicable.

Response:

Does Bidder have all required licenses, insurance and/or registrations, if any, and is Bidder legally authorized to do business in the State of Oregon? YES /NO .

If "NO," please explain.

Response:

Pay Equity Certificate. Does a current authorized representative of Bidder possess an unexpired Pay Equity Certificate issued by the Department of Administrative Services? YES / NO / N/A .

If applicable, submit a copy of the certificate with this form.

Response:

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AUTHORIZED SIGNATURE: By signature below, the undersigned Authorized Representative on behalf of Bidder certifies to the best of their knowledge and belief that the responses provided on this form are complete, accurate, and not misleading.

Bidder Name: ITB:

Project Name:

By: ___________________________________________ Date: _________________________ Authorized Representative

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ATTACHMENT F

CERTIFIED DISADVANTAGED BUSINESS OUTREACH PLAN

Bidder Name: Date:

Contact Name: Telephone: Email:

“Certified Firm” means a small business certified under ORS 200.055 by the Oregon Certification Office for Business Inclusion and Diversity (COBID) as minority-owned businesses, woman-owned businesses, veteran-owned businesses, and emerging small businesses.

Certified Firms must have an equal opportunity to participate in the performance of contracts financed with state funds. By submitting its offer, Bidder certifies that it has taken, and if there are further opportunities, will take reasonable steps to ensure that Certified Firms are provided an equal opportunity to compete for and participate in the performance of any subcontracts resulting from this procurement.

The information submitted in response to this clause will not be considered in any evaluation.

1. Is Bidder an Oregon Certified Firm? Yes No

If yes, indicate all certification type(s): DBE MBE WBE SDV ESB and supply

Oregon State Certification Number: __________________________

2. Include a list of Certified Firms that Bidder has had a contractual relationship with within the last two years.

3. Include a list of firms that Bidder has had a contractual relationship with within the last two years that are not Certified Firms but may be minority-owned, woman-owned, service-disabled veteran-owned or emerging small businesses.

4. Does Bidder foresee any subcontracting opportunities for this procurement? Yes No

If no, do not complete the rest of this form and submit this first page with your Bid.

If yes, please complete the following pages and submit all pages with your Bid.

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CERTIFIED DISADVANTAGED BUSINESS OUTREACH PLAN (CONT.)

1. Describe the steps Bidder will take to solicit Certified Firms for subcontracting opportunities if awarded a Contract from this procurement.

2. Describe the subcontracting opportunities and the approximate dollar value of each that may be available, if awarded a Contract.

3. Would Bidder be willing to report the identity of each subcontractor and the value of each subcontract to COBID if awarded a Contract from this procurement?