LOC_VENDOR_AFF_Fillable.pdf
PDF 83 KB Posted
- Attached to
- Tree Planting: Centreville YMCA
- Solicitation number
- BPM057808
- Issued by
- Queen Anne's County, Maryland
About this file
This is a Local Vendor Status Bid Affidavit form for Queen Anne's County, Maryland, designed to certify that bidders meet the county's local vendor procurement requirements. The form is associated with a tree planting, stock procurement, and maintenance services contract for the YMCA of Chesapeake, Inc. at the Centreville Branch located at 210 Vincit Street, Centreville, Maryland. Electronic bids must be submitted through the county's online portal at https://qacmd.seamlessdocs.com/ng/fa/YMCATrees by July 22, 2026, at 1:00 PM local time, at which point all bids will be opened publicly and read aloud. The County Commissioners of Queen Anne's County, through the Department of Parks and Recreation and Office of Budget and Finance, will award the contract to the lowest responsive and responsible bidder.
Bidders applying for local vendor consideration must allocate at least 50 percent of the procurement bid value to one or more vendors with a principal place of business in Queen Anne's County and must submit a copy of their State Department of Assessments and Taxation (SDAT) registration with their bid. The affidavit requires bidders to identify up to three local vendors, their Employer Identification Numbers (EINs), allocated contract values and percentages, and their roles as prime contractors, subcontractors, or material suppliers. The form must be completed and submitted with the cost proposal by a party authorized to enter into the contract, who must affirm the accuracy of the information under penalty of perjury.
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Text version
LOCAL VENDOR STATUS - BID AFFIDAVIT
Bidder’s Name: _____________________________________________________
Solicitation Reference: ________________________________________________
Bid Amount: ________________________________________________________
This submission is being made to the Board of County Commissioners for Queen Anne’s County through the Office of Budget and Finance, in connection with the following solicitation:
LOCAL VENDOR CERTIFICATION
50 percent or more of this procurement bid value will be allocated and executed by one or more
Local Vendors having a principal place of business in Queen Anne’s County. Bidders applying for this consideration are required to submit a copy of their SDAT registration with their bid to be considered.
The cost proposal submitted is based upon the following local vendors - list only those vendors whose principal place of business is in Queen Anne’s County (as defined in the County’s
Procurement Policy), and their related allocation of the contract value.
VENDOR 1 NAME:
VENDOR 1 EIN:
AMOUNT OF VALUE:
PERCENT OF BID: _____
Check which applies: Prime Contractor: ___ Sub-contractor: ___ Material Supplier: ___
VENDOR 2 NAME:
VENDOR 2 EIN:
VENDOR 3 NAME:
VENDOR 3 EIN:
TOTAL % ALLOCATED TO “LOCAL VENDORS”: _____
SUBMITTER INFORMATION – to be completed by the party authorized to enter into the contract:
NAME: _________________________________________________________________________
TITLE: __________________________________________________________________________
COMPANY NAME: ________________________________________________________________
COMPANY EIN: ___________________________________________________________________
I affirm under the penalty of perjury, that the foregoing information is true, to the best of my knowledge, information, and belief.
SIGNATURE____________________________________ DATE_______________
THIS COMPLETED FORM SHALL BE SUBMITTED WITH THE COST PROPOSAL
Bidders applying for this consideration are required to submit a copy of their
SDAT registration with their bid to be considered.
***END OF FORM***
| Bidder’s Name: |
| Solicitation Reference: |
| Bid Amount: |
| VENDOR 1 EIN: |
| AMOUNT OF VALUE: |
| AMOUNT OF VALUE_1: |
| PERCENT OF BID: |
| Prime Contractor: |
| Sub-contractor: |
| Material Supplier: |
| VENDOR 2 EIN: |
| AMOUNT OF VALUE_2: |
| AMOUNT OF VALUE_3: |
| PERCENT OF BID_1: |
| Prime Contractor_1: |
| Sub-contractor_1: |
| Material Supplier_1: |
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