R-724(5)_Attachments.pdf

Rev. April 2025

ATTACHMENT A: RESPONDER DECLARATIONS

The undersigned certifies, to the best of his or her knowledge and belief, that:

A. Response Contents. The information provided is true, correct, and reliable for purposes of evaluation for potential contract award. The submission of inaccurate or misleading information may be grounds for disqualification from the award as well as subject the Responder to suspension or debarment proceedings as well as other remedies available by law

B. Authorized Signature. This Declaration is signed by the appropriate person(s), with the authority to contractually bind the Responder, as required by applicable articles, bylaws, resolutions, minutes, and ordinances.

C. Non-Collusion Certification.

1. The Proposal has been arrived at by the Responder independently and has been submitted without collusion and without any agreement, understanding or planned common course of action with any other vendor designed to limit fair or open competition; and

2. The contents of the Response have not been communicated by the Responder or its employees or agents to any person not an employee or agent of the Responder and will not be communicated to any other individual prior to the due date and time of this Solicitation. Any evidence of collusion among Responders in any form designed to defeat competitive responses will be reported to the Minnesota Attorney General for investigation and appropriate action.

D. Organizational Conflicts of Interest. To the best of Responder’s knowledge and belief, and except as otherwise disclosed, there are no relevant facts or circumstances which could give rise to an organizational conflict of interest.

An organizational conflict of interest exists when, because of existing or planned activities or because of relationships with other persons,

1. a vendor is unable or potentially unable to render impartial assistance or advice to the State;

2. the vendor’s objectivity in performing the contract work is or might be otherwise impaired; or

3. the vendor has an unfair competitive advantage.

If after award, an organizational conflict of interest is discovered, an immediate and full disclosure in writing must be made to the State’s Chief Procurement Officer which must include a description of the action which the contractor has taken or proposes to take to avoid or mitigate such conflicts. If an organizational conflict of interest is determined to exist, the State may, at its discretion, cancel the contract. In the event the Contractor was aware of an organizational conflict of interest prior to the award of the contract and did not disclose the conflict to OSP, the State may terminate the contract for default. Organizational conflicts of interest terms apply to any subcontractors for this work.

E. Certification Regarding Lobbying. For State of Minnesota Contracts and Grants over $100,000, the undersigned certifies, to the best of his or her knowledge and belief that:

1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, Disclosure Form to Report Lobbying in accordance with its instructions.

3. The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into and is a prerequisite for making or entering into this transaction imposed by 31 U.S.C. 1352.

Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

F. Copyrighted Material Waiver. By signing its Response, the Responder certifies that it has obtained all necessary approvals for the reproduction and distribution of the contents of its response.

G. Diverse Spend Reporting. The Sample Contract contains a clause for Diverse Spend Reporting. When this clause applies, Contractor will be required to register in a free portal to report diverse spend.

Please see Diverse Spend Reporting Frequently Asked Questions for additional information.

By signing this form, Responder acknowledges and certifies compliance with all applicable requirements indicated above.

Company Name:

Signature:

Printed Name:

Title:

Date:

Phone Number:

Email Address:

https://osp.admin.mn.gov/sites/osp/files/2022-11/viva_diverse_spend_reporting_faq.pdf

ATTACHMENT B: EXCEPTIONS TO STATE’S TERMS AND CONDITIONS

The State presumes a responder agrees to the terms and conditions of this solicitation unless a responder takes specific exception to one or more of the conditions on this form.

The State reserves the right to reject, negotiate, or accept any exception listed to the State’s terms and conditions (including those found in the attached Sample Contract).

INSTRUCTIONS: A responder must explicitly list all exceptions to State’s terms and conditions, if any (including those found in the attached Sample Contract). Reference the clause number and page number of the State's term and condition for each of a responder’s exceptions. If no exceptions exist, state "NONE" specifically on the form below.

Whether or not exceptions are taken, the Responder must sign and date this form and submit it as part of their response. (Add additional pages if necessary.)

Clause and Page Number Suggested Change to Clause Explanation or Justification

By signing this form, I acknowledge that the above-named responder accepts, without qualification, all terms and conditions stated in this solicitation (including the sample contract) except those clearly outlined as exceptions above.

This acknowledgement includes acceptance of the section of the Sample Contract, Exhibit A, titled “Contractor’s Documents.”

Signature:

Printed Name:

Title:

Date:

ATTACHMENT C: COST DETAIL

1. Cost Proposal. Responders should review Exhibit D of the Sample Contract for additional pricing terms related to the Cost Proposal.

Responders must download and use the Exhibit D Price Schedule attached to this Solicitation. The Price Schedule must be completed by the Responder and uploaded with the response. If pricing is not returned with your solicitation response, your response will be rejected. Failure to use the Price Schedule may be cause for rejection.

Responders are strongly encouraged to provide a price for all line items. The State reserves the right to reject responses that do not supply sufficient line items.

Responders do not have to propose pricing for all counties. Responders must complete the Exhibit D Price Schedule for each Service Category Type (auto/lt. truck, bus, etc.) they intend to participate.

Responders must also complete a price schedule tab for each county/shop location they propose or by combining all counties/shop locations for which they propose identical pricing. Responders must complete a separate Price Schedule for each county/shop location or group of counties/shop locations which has a difference for any price on the Price Schedule. Responders may submit multiple Price Schedules for each Service Category by adding additional tabs for each additional price schedule in the Exhibit D: Price Schedule workbook.

2. Pricing Instructions. The Price Schedule workbook’s first tab Price Schedule Instructions has an example for reference. Responders will complete and submit their pricing on the remaining tabs for each Service Category offered Price Schedules (and any additional tabs created) by:

Entering all information requested in the yellow cells (where applicable) throughout the Price Schedule.

Starting with the Business Information (light blue shading) in the top right.

Enter the Shop Location(s) the Price Schedule is for in the next section (orange shading).

Enter Labor Rates, Parts and Raw Material Cost-Plus % mark up, and primary supplier information in the light green 3rd section (Labor, Parts, and Material).

In the dark blue 4th section (Service Area) enter an X in the appropriate box for all counties offering services in.

Responders may also enter rates for providing on-site estimates outside of their county service area by listing additional counties where offered, the price rate per mile, and the starting point (shop address) from where the mileage will begin.

3. Alterations or Erasures. The State reserves the right to reject a response containing an alteration or erasure of any price used to determine the lowest responsible responder unless the alteration or erasure is done in a manner that is clear and authenticated by an authorized representative of the Responder. An acceptable way to make an alteration or erasure is to cross out the price, print the correction in ink adjacent to it, and have an authorized representative of the Responder initial and date that correction.

ATTACHMENT D: RESPONDER FORMS Workforce and Equal Pay Declaration Page

This form is required for all businesses executing government contracts under the following:

Select one:

☐ Businesses executing a contract with State or Metropolitan agencies in excess of $100,000 (Workforce Certificate) and if applicable $500,000 (Equal Pay Certificate)

☐ Businesses executing a contract with University of Minnesota for general obligation bond funded capital projects in excess of $100,000 (Workforce Certificate) and if applicable $500,000 (Equal Pay Certificate)

☐ Businesses executing a contract with Political Subdivisions for general obligation bond funded capital projects in excess of $250,000 (Workforce Certificate) and if applicable $1,000,000 (Equal Pay Certificate)

Select all that apply:

We are a Certificate holder:

☐ Workforce Certificate under the name: _________________________________________________________ ☐ Equal Pay Certificate under the name: __________________________________________________________

We are applying/have applied for the following certificate(s):

☐ Workforce Certificate Application date (MM/DD/YYYY): ____________________ ☐ Equal Pay Certificate Application date (MM/DD/YYYY): ____________________

We have not applied for one or both certificates:

☐ Our Company does not yet have a Workforce Certificate or Equal Pay Certificate. We acknowledge that a

Workforce and, if applicable, Equal Pay Certificate, or approved exemption by MDHR is required before a contract can be executed.

We are Exempt:

☐ We attest to MDHR that we have not employed 40 or more employees on a single day during the prior 12 months in Minnesota or the state in where we have our primary place of business. MDHR may request the names of our employees during the previous 12 months, the date of separation, if applicable, and the current employment status and count.

Business Information

Vendor/Supplier ID Business Name Name of Contracting Agency

Authorized Signatory Name Title Date

Signature Email Phone

For assistance with this form, email the Minnesota Department of Human Rights Compliance.MDHR@state.mn.us https://mn.gov/mdhr/certificates/workforce-certificate/ https://mn.gov/mdhr/certificates/equalpay/ https://mn.gov/mdhr/certificates/workforce-certificate/ https://mn.gov/mdhr/certificates/equalpay/ https://mn.gov/mdhr/certificates/workforce-certificate/ https://mn.gov/mdhr/certificates/equalpay/

ATTACHMENT E: ADDITIONAL INFORMATION

1. Contractor’s Contact Information. Provide the contact information for the representative responsible for the management of the contract and the representative receiving purchase orders.

Responder’s Legal Name

Address

Contact Person (Contract)

Email Address

Telephone Number

Contact Person (PO Order)

Email Address

Telephone Number

2. Prompt Pay Discount. What prompt pay discounts do you offer? Select all that apply, if “other,” specify terms in the comment section below:

□ 1% in 30

□ 2% in 30

□ 3% in 30

□ 1% in 10, Net 30

□ 2% in 10, Net 30

□ 3% in 10, Net 30

□ 5% in 10, Net 30

□ Other

□ 1% in 15, Net 30

□ 2% in 15, Net 30

□ 3% in 15, Net 30

□ 1% in 20, Net 30

□ 2% in 20, Net 30

□ 3% in 20, Net 30

□ Net 30

Comments:

Rev. 9.01.2021

ATTACHMENT F: PRIORITY SERVICE PROGRAM

Responders are strongly encouraged to provide as Attachment F a detailed explanation of how they are able to provide Priority Service when requested for vehicles serviced under this contract. The Priority Service Program will apply to State of Minnesota work only. Priority Service is defined as the vehicle(s) to be repaired being next in line once the Contractor has possession of the vehicle(s), or once the Contractor is in possession of both the vehicle(s) and part(s) necessary to complete repairs.

Responders should include information including, but not limited to:

• Capacity/Bays/Lifts

• Scheduling Systems

• Parts Supply Chain and Delivery

• Staff Size

• Process for Priority Service

• Detail of how the Priority Service will be executed from start to finish

ATTACHMENT G: QUALIFICATIONS AND EXPERIENCE

Responders must provide as Attachment G: Please provide context to the below items on the following page.

1. A brief history and overview of the repair shop, staff, and business capabilities.

2. Responders must include an overview of the facilities, equipment, staffing, and security.

3. Submissions of previous repair work completed with governmental entities should be included here, along with a contact person, for potential reference.

4. Responders must establish meeting the specifications listed in Exhibit C of the Sample Contract and Exhibits here in.

To assist in proving specifications are met, fill in the Business name, City where licensed as a Repair Garage, Bus Garage, and/or Body Shop and all OEM authorizations. Then indicate with an “X” the ASE or Equivalent Certified Techs which exist within the business for each Master, or Series number. Responders should establish that they have either a Certified Master Tech for each Series, or a combination of Techs certified for each Series number test.

If offering with Certifications as Proposed Equal(s) to the ASE Certifications provide detailed information about the certifications proposed, the certifying authority, and how the certifications are equal to or exceed the ASE comparable level certifications.

Business Name City where licensed as Automobile Repair Garage and/or Body Shop OEMs Authorized to perform work

ASE Series E (or Equivalent) Truck Equipment ASE Certified E Series Master Tech E1 Tech(s) E2 Tech(s) E3 Tech(s)

ASE Series T (or Equivalent) Medium and Heavy-Duty Truck ASE Certified T Series Master Tech T1 Tech(s) T2 Tech(s) T3 Tech(s) T4 Tech(s) T5 Tech(s) T6 Tech(s) T7 Tech(s) T8 Tech(s)

ASE Series B (or Equivalent) Collision Repair and Refinish ASE Certified B Series Master Tech B2 Tech(s) B3 Tech(s) B4 Tech(s) B5 Tech(s)

ASE Series H (or Equivalent) Transit Bus ASE Certified H Series Master Tech H1 Tech(s) H2 Tech(s) H3 Tech(s) H4 Tech(s) H5 Tech(s) H6 Tech(s) H7 Tech(s) H8 Tech(s)

ASE Series S (or Equivalent) School Bus

ASE Certified S Series Master Tech S1 Tech(s) S2 Tech(s) S3 Tech(s) S4 Tech(s) S5 Tech(s) S6 Tech(s) S7 Tech(s)

ASE Series MIL (or Equivalent) Military Tactical Wheeled Vehicle Certification ASE Certified T Series Master Tech MIL1 Tech(s) MIL2 Tech(s) MIL3 Tech(s) MIL4 Tech(s) MIL5 Tech(s) MIL6 Tech(s) MIL7 Tech(s) MIL8 Tech(s)

Proposed Equal for ASE Series Certification(s) Proposed Equal Certification ASE Series Equivalent to Certifying Authority

Detailed description about the certification and how equal to or exceeds ASE comparable certification.

ATTACHMENT G: QUALIFICATIONS AND EXPERIENCE SUPPLEMENTAL

(if more space is needed create an extra page(s) after this one)

1. A brief history and overview of the repair shop, staff, and business.

2. Responders must include an overview of the facilities, equipment, staffing, and security. Pictures of the grounds an facility would be helpful for visualizing the space.

3. Submissions of previous repair work completed with governmental entities should be included here, along with a contact person, for potential reference.

6. Business Information