REQUIRED FORMS ADD IN (3).pdf

Small Business Subcontracting Plan

It is the goal of the Commonwealth that over 50% of its purchases be made from small businesses. All potential bidders are required to submit the subcontractor plan by one of the following methods in order to be considered responsive:

A. Complete the subcontractor plan as specified in the electronic response; or B. Download the “paper response” form, complete the subcontractor plan section, and submit it as an attachment with the bid response.

Small Business: "Small business (including micro)” means a business that holds a certification as such by the Virginia Department of Small Business and Supplier Diversity (DSBSD) on the due date for bids. This shall also include DSBSD certified women-owned and minority-owned businesses and businesses with DSBSD service-disabled veteran-owned status when they also hold a DSBSD certification as a small business on the bid due date. Currently, DSBSD offers small business certification and micro-business designation to firms that qualify.

Certification applications are available through DSBSD online at www.SBSD.virginia.gov (Customer Service).

Bidder Name:

Preparer Name: Date:

Who will be doing the work: □ I plan to use subcontractor(s) □ I plan to complete all work

Instructions

A. If you are certified by the DSBSD as a micro/small business, complete only Section A of this form.

B. If you are not a DSBSD-certified small business, complete Section B of this form. For the bid to be considered and the bidder to be declared responsive, the bidder shall identify the portions of the contract that will be subcontracted to DSBSD certified small businesses for the initial contract period in relation to the bidder’s total price for the initial contract period in Section B.

Section A

If your firm is certified by the DSBSD provide your certification number and the date of certification.

Certification number: Certification Date:

Section B If the “I plan to use subcontractors box is checked,” populate the requested information below, per subcontractor to show your firm's plans for utilization of DSBSD-certified small businesses in the performance of this contract for the initial contract period in relation to the bidder’s total price for the initial contract period. Certified small businesses include but are not limited to DSBSD-certified women-owned and minority-owned businesses and businesses with DSBSD service-disabled veteran-owned status that has also received the DSBSD small business certification. Include plans to utilize small businesses as part of joint ventures, partnerships, subcontractors, suppliers, etc. It is important to note that this proposed participation will be incorporated into the subsequent contract and will be a requirement of the contract. Failure to obtain the proposed participation dollar value or percentages may result in a breach of the contract.

B. Plans for Utilization of DSBSD-Certified Small Businesses for this Procurement

Subcontract #1

Company Name: SBSD Cert #:

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Value % or $ (Initial Term): Contact Address:

Description of Work:

Subcontract #2

Company Name: SBSD Cert #:

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Subcontract #3

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Subcontract #4

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Subcontract #5

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

Subcontract #6

Contact Name: SBSD Certification:

Contact Phone: Contact Email:

CAPITAL OUTLAY

VENDOR QUALIFICATION CERTIFICATION FORM

All bidders responding to this IFB should complete and return all requested information applicable to performing the work. Place N/A beside all questions that do not apply. This form must be provided to the Contract Officer within 2 business days of request if not returned with the bid or the bidder may be deemed non-responsive.

1. Name of Business: _____________________________________________________________

2. Name of Owner or Chief Executive Officer: __________________________ Telephone Number: _________________

3. How many persons are currently employed by the firm?

4. List all current projects and the value of the project that is being performed by your firm.

5. Is the firm currently removed from a vendor list or debarred/enjoined from doing business with any Commonwealth of Virginia Agency?

Yes_____ No_____ If yes explain:

6. Provide the firm name, contact person, email address and telephone / fax numbers of three (3) customers, for which your firm has provided services of the same/similar scope as those requested in this inquiry. We may contact these customers as references.

FIRM’S NAME CONTACT PERSON EMAIL ADDRESS TELEPHONE / FAX #

7. Identify any VDOT locations for which your firm is currently working, the contract number associated with the work and the location where the work is being performed.

ATTACHMENT _____

State Corporation Commission Form

Failure to complete and return this attachment may result in your bid being deemed NON-RESPONSIVE.

Solicitation #:

Virginia State Corporation Commission (SCC) registration information.

The bidder:

is a corporation or other business entity with the following SCC identification number:

-OR-

is not a corporation, limited liability company, limited partnership, registered limited liability partnership, or business trust -OR-is an out-of-state business entity that does not regularly and continuously maintain as part of its ordinary and customary business any employees, agents, offices, facilities, or inventories in Virginia (not counting any employees or agents in Virginia who merely solicit orders that require acceptance outside Virginia before they become contracts, and not counting any incidental presence of the bidder in Virginia that is needed in order to assemble, maintain, and repair goods in accordance with the contracts by which such goods were sold and shipped into Virginia from bidder’s out-of-state location) -OR-is an out-of-state business entity that is including with this bid an opinion of legal counsel which accurately and completely discloses the undersigned bidder’s current contacts with Virginia and describes why those contacts do not constitute the transaction of business in Virginia within the meaning of § 13.1-757 or other similar provisions in Titles

13.1 or 50 of the Code of Virginia.

**NOTE** >> Check the following box if you have not completed any of the foregoing options but currently have pending before the SCC an application for authority to transact business in the Commonwealth of Virginia and wish to be considered for a waiver to allow you to submit the SCC identification number after the due date for bids (the Commonwealth reserves the right to determine in its sole discretion whether to allow such waiver):