MHEC_Affidavits~1.docx

MHEC CONTRACT #MC12-J04

AFFIDAVITS

Certificate of Non-Collusion:

The undersigned certifies under penalties of perjury that this bid or proposal has been made and submitted in good faith and without collusion or fraud with any other person. As used in this certification, the word “person” shall mean any natural person, business, partnership, corporation, unction, committee, club or other organization, entity, or group of individuals.

Company Name

Signature of Individual Submitting Bid of Proposal

_____________________________________ Date _______________________________ Typed Name

Tax Compliance Certification:

Pursuant to M.G.L. c 62C, section 49A, I certify under the penalties of perjury that, to the best of my knowledge and belief, I am in compliance with all laws of the commonwealth relating to taxes, reporting of employees and contractors, and withholdings and remitting child support.

Signature of Individual Submitting Bid of Proposal

Typed Name Date

Contract for Services:

All members require that the MHEC collect and maintain the Commonwealth of Massachusetts Standard Contract form. It must be completed with the submission in this bid response. Available by visiting the below web address:

http://www.mass.gov/dor/docs/dor/ust/forms/standard-contract-form.pdf

The terms and conditions and executive orders included in the MA contract for services form take precedence over any contract that precedes this bid document.

Typed Name

MHEC VENDOR RELATED FORMS:

Contract Service Fee

Signature Required for Contract Execution - Administrative Contract Service Fee (CSF) This contract is subject to a 1% Administrative Contract Service Fee which is in addition to discounts or rebates offered to the end users. Terms of this contract:

Contract Service Fee: Bidder agrees to authorize and / or allow for a contract service fee (administrative fee) payable to the MHEC by an awarded vendor in exchange for the management and facilitation of a Contract resulting from this contract.

· The calculation of this fee includes any member and/ or eligible entity receiving contract pricing resulting from the Awarded Contract. The price stated in any Bidder’s bid price and any MHEC Contract shall be inclusive of this fee and Contractors shall not reflect this fee as a separate line item on customer invoices.

· Any reference to the MHEC in member’s orders, purchase orders, account set up shall be deemed as volume and reported as such. The specific contract number does not need to be reflected – MHEC is sufficient.

· Eligible entities include: not-for-profit institutions of higher education; private not-for-profit technical, charter, vocational, K-12, and preparatory schools; private educational not-for-profit Institutions within New England (Massachusetts, Connecticut, Vermont, New Hampshire, Rhode Island and Maine); and municipalities and public institutions of higher education outside of Massachusetts; but only if those entities are not eligible to purchase from OSD’s contract.

· The Contract Service fee shall be 1% calculated as a percentage of the total revenue received either directly or Reporting for the sales volume and CSF will be required quarterly. Failure to report quarterly on the below outlined dates may result in contract suspension until such time that required reports are submitted to the MHEC.

Repeat incidents of non-reporting may result in contract termination or other actions.

· Quarterly Fee Payment: For each Payment Period, Contractor shall pay to MHEC a Fee equal to one percent (1%) of the total payments (adjusted for credits or refunds) received from all Eligible Entities that have purchased from the Contractor pursuant to this Agreement. All payments will be based on full calendar quarters (Payment Periods) and must be received on or before 45 days after the last day of the Payment Period (as specified below) or a contractor will be considered in breach of contract:

Quarterly payment will include any periods less than a full calendar quarter if a contract does not start at the first day of a quarter or end on the last day of the quarter. Payments are to be made by check made payable to the MHEC, 505 East Pleasant Street, Amherst, MA 01003.

Under pains and penalties of perjury, I hereby declare that we will report true and accurate report of payments and fees due pursuant to the terms of the above-referenced MHEC Contract.

Company Name: ______________________________________ REQUIRED Signed: __________________________________ Dated: _______________________ By signing this agreement you are accepting the terms and conditions of the MHEC contract and acknowledging the administrative contract service fee.

Sales Volume and Contract Service Fee Reporting: Information must be completed on this page The MHEC will send the quarterly contract service fee and sales volume report electronically to the contracts designated below. Sales volume reporting must be filed quarterly according to the CSF schedule. Awarded vendors will be required to report business from this contract for each member and nonmember entity. If volume comes from dealers it is the contracted vendor’s responsibility to retrieve sales information from each dealer. Any vendor not reporting may be suspended from the MHEC bidders list until such time as contract compliance is resolved.

Individual Responsible for Reporting Information

Name

Company Name

Department

Address

Telephone /Extension

City, State, Zip

Fax

E-mail

Supervisor Responsible for the Reporting Individual

Name

Company Name

Department

Address

Telephone /Extension

City, State, Zip

Fax

E-mail

Volume Reporting and CSF Reporting Completion:

· A reminder will be sent to the above contact quarterly with instructions on completing the needed worksheets. See below for a sample of what the worksheet will look like.

· There will be separate tab in your spreadsheet for each MHEC Contract subject to this fee. So there will be only one workbook sent to you with multiple worksheets.

Quarterly report image:

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