RFB 2026-34 Attachment 2 - Required Submission Pages.pdf

RFB 2026-34 Attachment 2 – Required Submission Pages

SIGNATURE/PROPOSAL PRICING PAGE

RFB 2026-34 – Upgrade the Existing 911 Phone System and Installation of a New Recording System for Madison County

Madison County Purchasing Office 138 North Court Street.

Wampsville, NY 13163

I agree to provide all the material and/or labor in accordance with the furnished specifications to the County of Madison and/or its political subdivisions. I have clearly identified variations from the published specifications where applicable.

I have received, read and agree to the terms and conditions as set forth in the Instructions to Bidders/General Conditions and any special terms or conditions as set forth in the special conditions or minimum specifications. I am authorized by my company to make this commitment.

Addenda acknowledgment:

No. ___________ Dated: _____________ No. ___________ Dated: _____________

Accepts Purchasing Credit Card Payments at no additional fees to Madison County - YES NO

Item 1 - Upgrading Phone System Lump Sum: $___________________________________________

Lump Sum in words: ______________________________________________________________________

*PLEASE INCLUDE a detailed submission of each item along with the amount of hours and cost of labor*

Item 2 - New Recording System Lump sum: $__________________________________________________

Lump Sum in words: ______________________________________________________________________

*PLEASE INCLUDE a detailed submission of each item along with the amount of hours and cost of labor*

Signature: _________________________________________Title:________________________________________

Print Name:

Company Name: _______________________________________Federal ID No: ____________________________

Address: ______________________________________________________________________________________

Telephone No: _______________________________________ Fax No: ___________________________________

Contact Name: _______________________________________Telephone No.______________________________

E-mail: ________________________________________________________________________________________

E-mail address to send letters, contracts & communications:______________________________________________

This page must be signed and returned or your bid will be declared informal!

CERTIFICATION OF COMPLIANCE WITH THE IRAN DIVESTMENT ACT

As a result of the Iran Divestment Act of 2012 (Act), Chapter 1 of the 2012 Laws of New York, a new provision has been added to the State Finance Law (SFL), § 165-a, effective April 12, 2012. Under the Act, the Commissioner of the Office of General Services (OGS) will be developing a list (prohibited entities list) of “persons” who are engaged in “investment activities in Iran” (both are defined terms in the law). Pursuant to SFL § 165-a(3)(b), the initial list is expected to be issued no later than 120 days after the Act’s effective date, at which time it will be posted on the OGS website.

By submitting a bid in response to this solicitation or by assuming the responsibility of a Contract awarded hereunder, Bidder/Contractor (or any assignee) certifies that once the prohibited entities list is posted on the OGS website, it will not utilize on such Contract any subcontractor that is identified on the prohibited entities list.

Additionally, Bidder/Contractor is advised that once the list is posted on the OGS website, any Contractor seeking to renew or extend a Contract or assume the responsibility of a Contract awarded in response to the solicitation, must certify at the time the Contract is renewed, extended or assigned that it is not included on the prohibited entities list.

During the term of the Contract, should Madison County receive information that a person is in violation of the above-referenced certification, Madison County will offer the person an opportunity to respond.

If the person fails to demonstrate that it has ceased its engagement in the investment which is in violation of the Act within 90 days after the determination of such violation, then Madison County shall take such action as may be appropriate including, but not limited to, imposing sanctions, seeking compliance, recovering damages, or declaring the Contractor in default.

Madison County reserves the right to reject any bid or request for assignment for an entity that appears on the prohibited entities list prior to the award of a contract, and to pursue a responsibility review with respect to any entity that is awarded a contract and appears on the prohibited entities list after contract award.

Signed

Title

Company Name

Sworn to before me this _________day of , 2026

Notary Public

NON-COLLUSIVE BIDDING CERTIFICATION

(SEE GENERAL MUNICIPAL LAW - SECTION 103-D)

BY SUBMISSION OF THIS BID, THE BIDDER AND EACH PERSON SIGNING ON

BEHALF OF THE BIDDER, CERTIFY UNDER PENALTY OF PERJURY TO THE BEST

OF KNOWLEDGE AND BELIEF:

1. The prices in this Bid have been arrived at independently without collusion, consultation, communication or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any other Bidder or with any competitor;

2. Unless otherwise required by Law, the prices which have been quoted in the Bid have not been knowingly disclosed by the Bidder and will not knowingly be disclosed by the Bidder, prior to opening, directly or indirectly, to any other Bidder or to any competitor; and

3. No attempt has been made or will be made by the Bidder to induce any other person, partnership, or corporation to submit a Bid for the purpose of restricting competition.

THE FOREGOING STATEMENT IS AFFIRMED AS TRUE UNDER PENALTY OF PERJURY.

SIGNATURE: _________________________________________________

TITLE: _________________________________________________

DATE: _________________________________________________

Only return this page if you are unable to bid!

MADISON COUNTY

PURCHASING OFFICE

COUNTY OFFICE BUILDING

WAMPSVILLE, NEW YORK 13163

NON-BIDDER'S RESPONSE

For the purpose of maintaining accurate bidder's lists and facilitating your response to our bid proposals, Madison County is interested in ascertaining reasons for prospective bidder's failure to respond to invitations to bid.

If you are not responding to this bid, please indicate your reasons by checking any appropriate items below and returning this form to the above address. Your cooperation will be greatly appreciated.

We are not responding to this bid proposal for this reason:

_____ Items or materials are not manufactured by us or not available to our company _____ Our items or materials do not meet these specifications _____ Specifications not clearly understood or applicable (too vague, too rigid, etc.).

_____ Quantities too small _____ Insufficient time allowed for preparation of bid _____ Incorrect address used. Our correct mailing address is:

_____ Other reasons: _______________________________________

PLEASE RESPOND:

_____ We are unable to bid at this time but would like to continue to receive Bid proposals.

_____ We are unable to bid and wish to be removed from the interested Bidder's List.

FIRM NAME: __________________________________________________

ADDRESS: __________________________________________________

SIGNATURE: __________________________________________________

TITLE: _____________________________ DATE: ___________________

BID NAME: _________________________ REF. NO: _________________

Only return this page if you are unable to bid!