RFP-0184_Exhibit_D.pdf

Proposer Name: __________________________ County of Sacramento Request for Proposals EXHIBIT "D" Proposal Form

EXHIBIT "D"

PROPOSAL FORM

Responses are to be typed or printed on this form rather than on proposer prepared forms. If the space is inadequate, attach additional pages as necessary to provide complete responses. If additional pages are attached, clearly indicate to which item the response applies to. The proposer is required to provide a response to each item listed below. The responses will be considered in evaluating the proposals. Provide the name of the proposing firm at the top of each page in the space indicated for "Proposer Name: _________________." All proposers must complete and sign Section B.9 (PROPOSER'S SIGNATURE) and attach a Certificate of Secretary to any proposal submitted by a corporation. Any proposal submitted without an authorized signature or Certificate of Secretary (if applicable) will be rejected.

. RESPONSES TO RFP REQUIREMENTS

HEAVY DUTY TOW LISTING APPLICATION FORM

Each proposer must complete and sign a Sacramento County Sheriff's Department RFP Heavy Duty Tow Listing Application. Incomplete applications will not be accepted.

Any misrepresentation on the application may be grounds for criminal and/or disciplinary action.

Information About Proposer's Firm

Provide general information about the proposer's firm, including a short history of the firm, incorporation information, services provided, and prior experience.

In this section of the proposal, the proposer should detail previous experience on other similar contracts with other governmental agencies. A list of clients (including names, addresses, and telephone numbers) for which the proposer has provided services or is currently providing services is to be included in the proposal. The actual dates for these service contracts must be listed. The County may contact any or all of the references at its discretion.

CERTIFICATE OF INSURANCE

Each proposer must submit certificates of liability and workers' compensation insurance as specified herein.

TOW OPERATOR/DRIVER INFORMATION FORM

Each proposer must complete, sign and have his/her tow truck drivers sign a Sacramento County Sheriff's Department TOW OPERATOR/DRIVER INFORMATION FORM. Incomplete applications will not be accepted. Any misrepresentation on the application may be grounds for criminal and/or disciplinary action.

COPIES OF COUNTY LICENSES

Each proposer must attach copies of the following County/City licenses to their proposal:

Current County Special Business License Current County General Business License (if applicable) Current City of Citrus Heights General Business License (If applicable) Current City of Citrus Heights Special Business License (if applicable)

PROPOSED RATES FOR SERVICES

Each proposer must attach a list of proposed rates in accordance with Exhibit D to this RFP.

COPY OF LEASE FOR PRIMARY OR SECONDARY LOCATIONS

If a Proposer is leasing either its primary or secondary location, a copy of the lease(s) must be attached to the proposal.

PROOF OF PAYMENT OF DMV MOTOR CARRIER OF PROPERTY PERMIT FEE

Each Proposer must attach a copy of the DMV permit or registration issued pursuant to Section 7232 of the Revenue and Taxation Code.

SACRAMENTO SHERIFF'S DEPARTMENT

HEAVY DUTY TOW LISTING

APPLICATION

TYPE OR PRINT CLEARLY BUSINESS

BUSINESS NAME PHONE NUMBER

BUSINESS MAILING ADDRESS

BUSINESS ADDRESS IF DIFFERENT THAN ABOVE

LIST DESIGNATED AREAS FROM WHICH YOU WOULD LIKE TO TOW AND CAN MEET THE

RESPONSE TIME:

FAX NUMBER

VEHICLE STORAGE

PRIMARY STORAGE YARD ADDRESS

� OWNED � LEASED � RENTED

SECONDARY STORAGE YARD ADDRESS

� OWNED � LEASED � RENTED

TOW TRUCKS

CHECK CLASS(ES) APPLYING FOR AND INDICATE TOTAL NUMBER OF TRUCKS IN EACH CLASS.

� CLASS A (MINIMUM 14,000 GVWR) NUMBER OF CLASS A TRUCKS:

� CLASS B (MINIMUM 19,500 GVWR) NUMBER OF CLASS B TRUCKS:

� CLASS C (MINIMUM 33,000 GVWR) NUMBER OF CLASS C TRUCKS:

� CLASS D (MINIMUM 50,000 GVWR) NUMBER OF CLASS D TRUCKS

RATES

CLASS A CLASS B CLASS C CLASS D

HOURLY RATE

INSIDE STORAGE

OUTSIDE STORAGE

CONTRACT LABOR (NONSKILLED)

SPECIAL EQUIPMENT (LIST)

RENTAL/SKILLED LABOR MARKUP

APPLICANT'S CERTIFICATION

LEGAL OWNER (IF FIRM, COMPANY ASSOCIATION OR CORPORATION, LIST ALL PERSONS HAVING FINANCIAL INTEREST).

DO YOU HAVE ANY FINANCIAL INTEREST IN ANY OTHER TOW COMPANY WITHIN THE COUNTY OF SACRAMENTO?

� YES � NO NAME OF TOW COMPANY:

DOES ANY MEMBER OF YOUR FAMILY (RELATED BY BLOOD OR MARRIAGE) OPERATE ANOTHER TOW SERVICE IN THE COUNTY OF

SACRAMENTO?

�YES �NO NAME OF TOW COMPANY:

DO YOU SHARE ANY FACILITIES WITH ANY OTHER TOW COMPANY?

�YES �NO NAME OF TOW COMPANY:

HAVE YOU OR ANYONE FINANCIALLY INVOLVED WITH YOUR COMPANY EVER BEEN CONVICTED OF ANY CRIME INVOLVING STOLEN OR EMBEZZLED VEHICLES, FRAUD RELATED TO THE TOWING BUSINESS, STOLEN OR EMBEZZLED PROPERTY, CRIMES OF VIOLENCE, DRUG RELATED OFFENSES, FELONY DRIVING WHILE UNDER THE INFLUENCE OF ALCOHOL AND/OR DRUGS, MISDEMEANOR DRIVING WHILE UNDER THE INFLUENCE OF ALCOHOL AND/OR DRUGS WHILE INVOLVED IN A ROTATION TOW CALL, OR MORAL TURPITUDE?

� YES � NO

Date and Description of Crime:

I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION PROVIDED ON THIS APPLICATION IS TRUE AND CORRECT.

SIGNATURE PRINT NAME AND TITLE DATE

CERTIFICATE OF INSURANCE

This is to certify to the COUNTY OF SACRAMENTO that the insurance policies listed below have been issued to the named insured and are in force at this time.

NAMED OF INSURED:____________________________________________________________

ADDRESS::______________________________________________________________________

TYPE OF

INSURANCE

INSURER AND

POLICY NUMBER POLICY PERIOD

LIMITS OF LIABILITY

Occurrence

GENERAL LIABILITY

� Comprehensive General

� Liquor Liability

� Contractual

� Products/Completed Operations

� Personal Injury

� Broad Form Property Damage

BODILY INJURY $

PROPERTY DAMAGES $

BODILY INJURY $

AND PROPERTY

DAMAGE

COMBINED

DEDUCTIBLE $

AUTOMOBILE LIABILITY

� Owned, Non-Owned and Hired Automobiles

BODILY INJURY $

(EACH PERSON)

BODILY INJURY $

(EACH ACCIDENT)

PROPERTY DAMAGE $

BODILY INJURY $

AND PROPERTY

DAMAGE

COMBINED

UMBRELLA LIABILITY

� Umbrella/Excess Liability

SINGLE LIMIT $

SELF-INSURED RETENTION $

WORKERS’ COMPENSATION

� Workers’ Compensation and Employers Liability

EMPLOYERS LIABILITY

LIMIT $

FIRE

� Fire & Extended

Coverage Perils

AMOUNT OF INSURANCE $

MISCELLANEOUS

COVERAGES

� Aircraft Liability (including passenger injuries)

� Garagekeepers Liability

� Watercraft Liability

� Professional Liability

BODILY INJURY $

PROPERTY DAMAGE $

AMOUNT OF INSURANCE $

BODILY INJURY $

PROPERTY DAMAGE $

AMOUNT OF INSURANCE $

OTHER COVERAGE

(indicate)

THE FOLLOWING PROVISIONS APPLY:

1. None of the above describer coverages will be canceled, reduced or non-renewed until after 30 days written notice has been given to the Risk Management Manager, County of Sacramento

2. The County of Sacramento, its officials, agents and employees are named on all liability policies described above (except professional liability policies) as additional insureds as respects all operations performed for the County of Sacramento by or on behalf of the named insured.

3. The above policies include a severability of interests clause.

Any liability insurance maintained by the County of Sacramento will apply only in excess of the liability insurance coverages and limits described above.

DATE ISSUED:

AUTHORIZED REPRESENTATIVE OF INSURANCE CO.

(Title)

Address

Sacramento Sheriff Department

TOW OPERATOR/DRIVER INFORMATION

Instructions: Please type or print clearly. Form must be filled out completely

Operator/Driver Full Name __________________________ (First, Middle, Last)

Date of Birth List all AKA’s _______________________________________

(Use additional pages if necessary)

Company Name___________________________________

Driver License Number State Exp. Date________

License Class Endorsements Medical Certificate? Yes No

Medical Certificate Expiration Date Job Title/Classification______________

Number of years experience as a tow truck operator/driver in the following classes:

Class A Class B Class C Class D

Operator/Driver presently enrolled in the DMV Pull Notice Program? Yes No

Operator/Driver ever been convicted of a crime? Yes No . If yes, explain the circumstances.

Include the crimes committed, sections violated, date of convictions, country, state, and county where crimes were committed.

(Use additional pages if necessary)

I certify that the above information is true and correct, and that no omissions have been made.

�The operator and Driver are advised that giving false information to a peace officer, either orally or in writing, is a misdemeanor pursuant to Vehicle Code Sections 20 and 31.

Operator’s/Owner’s signature Date______________________

Tow driver’s signature Date______________________

A.9 PROPOSER'S APPROVED SIGNATURE

All proposers must complete and sign this section. Failure to complete and sign this section will result in rejection of the proposal.

Name of Proposer: ________________________________________________________

Business Address: ________________________________________________________

(Street) (The County) (State) (Zip Code)

Telephone: _________________________ FAX: __________________

Residence Address: ________________________________________________________

Type of Business: [ ] Corporation; [ ] Partnership; [ ] Individual doing business under own name; [ ] Individual doing business using a firm name; [ ] Joint Venture

(Attach Joint Venture Agreement)

Federal Tax I.D. Number: __________________________________________

County of Sacramento Business License Number: ________________________

NAME AND ADDRESS OF PROPOSER SUBMITTING THIS PROPOSAL:

If Individual Proposer:

Name ___________________________________ Address______________________________________

If firm or partnership, list the names and addresses of each firm principal or partner:

Name ___________________________________ Address______________________________________

Name ___________________________________ Address______________________________________

Name __________________________________ Address______________________________________

Name ___________________________________ Address______________________________________

If corporation, list the names, title and addresses of each officer of the corporation:

Name/Title_______________________________ Address______________________________________

Name/Title______________________________ Address______________________________________

Name/Title______________________________ Address______________________________________

Name/Title______________________________ Address______________________________________

To the County of Sacramento:

The undersigned, as proposer, certifies that the only persons or parties interested in this proposal as principals are those named herein as proposer; that this proposal is made without collusion with any other person, firm, or corporation; that in submitting this proposal the proposer has examined all terms, conditions, and requirements set forth in the Request for Proposals; that the proposer proposes and agrees that if this proposal is accepted, the proposer will execute and fully perform the contract for which proposals are called; that the proposer will perform all the work and/or furnish all the materials specified in the contract, in the manner and time therein prescribed, and according to the requirements as therein set forth; and that the proposer will take in full payment therefor, the prices approved by the County of Sacramento Sheriff’s Department under this RFP.

(Typed or Printed Name and Title) (Signature)

Address (if different than business address above)

COUNTY OF SACRAMENTO CERTIFICATION OF COMPLIANCE

WITH COURT ORDERED CHILD, FAMILY AND SPOUSAL SUPPORT

WHEREAS, it is in the best interest of the County that those entities with whom the County does business demonstrate financial responsibility, integrity and lawfulness; and, further, it is inequitable for those entities with whom the County does business to receive County funds while failing to pay court-ordered child, family and spousal support which shifts the support of their dependents onto the public treasury.

THEREFORE, in order to assist the Child Support Department in its efforts to collect unpaid court-ordered child, family and spousal support orders, the following certification must be provided by any individual, partnership or other entity which is seeking to contract with the County to provide goods or to perform services for or on behalf of the County.

CERTIFICATION

PROPOSER hereby certifies that:

(a) The following information has been provided to the Sacramento County Child Support

Department and/or the District Attorney for each of PROPOSER’s Principal Owners (any individual owning 25% or more in such entity) who is subject to a court-ordered child, family or spousal support order.

1. Name, title, last known residence address and social security number

2. All earnings paid to or payable to such principal owner pursuant to any contract with

Sacramento County

3. Whether dependent health insurance coverage is available to or provided to such Principal

Owner

(b) PROPOSER’s Principal Owners are currently in substantial compliance with any court-ordered child, family and spousal support order, or, in the alternative, has made a good faith effort to become current or arrange a payment schedule with the Child Support Department, District

Attorney or the court.

(c) PROPOSER has fully complied with all applicable state and federal reporting requirements relating to employment reporting for its employees.

(d) PROPOSER has fully complied with all lawfully served wage and earnings assignment orders and notices of assignment and will continue to maintain compliance.

NOTE: Failure to comply with state and federal reporting requirements regarding PROPOSER’s employees or failure to implement lawfully served wage and earnings assignment orders or notices of assignment constitutes a default under any contract with COUNTY. Failure to cure such default within 90 days of notice by the County shall be grounds for termination of contract.

Date:____________________ __________________________

PROPOSER