RFP #23-147

864 Broad Street – 4th Floor Augusta, Georgia 30901 – 1215

(706) 826-1000 Fax: (706) 826-4612

Charlie Walker, Jr. KENNETH BRADSHAW, Ed.D. BOBBY A. SMITH, CPA President Superintendent of Schools Chief Financial Officer

COVER SHEET

GRACEWOOD ELEMENTARY DISHWASHING EQUIPMENT REPLACEMENT

RFP 23-147

Date:

Vendor Name:

Address:

Phone:

Fax:

Email:

Addendum(s) Acknowledged: (If Applicable) #1 Yes: _________________ NO: _______________

#2 Yes: _________________ NO: _______________

#3 Yes: _________________ NO: _______________

#4 Yes: _________________ NO: _______________

Sealed Proposals ARE DUE May 17, 2023 @ 3:00 P.M.

864 Broad Street – 4th Floor Augusta, Georgia 30901 – 1215

(706) 826-1000 Fax: (706) 826-4612

Charlie Walker, Jr. KENNETH BRADSHAW, Ed.D. BOBBY A. SMITH, CPA President Superintendent of Schools Chief Financial Officer

TO: DEALERS IN SCHOOL DISHWASHING EQUIPMENT

FROM: RICHMOND COUNTY SCHOOL SYSTEM

DATE: April 27, 2023

SUBJECT: Gracewood Elementary Dishwashing Equipment Replacement RFP 23-147

You are invited to submit a sealed Proposal for the design, delivery and installation of new school dishwashing equipment at:

Gracewood Elementary School 2032 Tobacco Road Augusta, GA 30906

A Pre-bid will take place at the site on Tuesday, May 9, 2023 at 1:00 p.m. This will allow contractors to take measurements and view the work site.

The anticipated award date is May 31, 2023. The awarded vendor is expected to provide delivery and installation within 90 days of award notification. Delivery and installation are to be coordinated with Ms. Cathy Johnson in our School Nutrition department. Ms. Johnson can be reached at 706-826-1122 or cathyjo@boe.richmond.k12.ga.us If you are unable to meet these criteria, please do not submit a proposal. Also, note further requirements under the following general conditions:

STANDARD TERMS AND CONDITIONS

(1) TIME AND PLACE: Sealed proposals will be received by the Richmond County School System until 3:00 p.m. EST, on Wednesday, May 17, 2023 at 864 Broad Street, Augusta, Georgia 30901.

(2)

LATE BIDS AND PROPOSALS: Regardless of cause, late bids and proposals will not be accepted and will automatically be disqualified from bid consideration. It shall be solely the vendor’s responsibility to ensure delivery at the designated office by the designated time.

Late bids and proposals will not be opened and may be returned to the vendor.

mailto:cathyjo@boe.richmond.k12.ga.us

RICHMOND COUNTY SCHOOL SYSTEM MATAINENANCE and NUTRITION

APRIL 27, 2023 DEPARTMENTS

GRACEWOOD DISHWASHING

EQUIPMENT REPLACEMENT

RFP#23-147

(3) SEALED PROPOSAL REQUIREMENT: Each Proposal must be submitted in a sealed envelope addressed to Dr. Kenneth Bradshaw, Superintendent of Schools, c/o Mr. Bobby A. Smith, Chief Financial Officer, Richmond County School System, 864 Broad Street, Augusta, Georgia 30901. Each sealed envelope containing a Proposal must be plainly marked on the outside Gracewood Elementary Dishwashing Equipment Replacement RFP #23-147 and the envelope must bear on the outside the name and complete address of the vendor.

(4) Proposal shall contain specifications on dish washing equipment, peripheral equipment, shelving, existing exhaust hood removal (To include ceiling repair as required after exhaust hood removal). A scale plan view drawing, along with a color drawing showing the front and rear elevations of the proposed unit and complete with all utility connections. (paper and digital; (*.dwg) drawings) All information listed here is required in order to be eligible for bid consideration.

(5) REJECTION OF PROPOSALS: The Richmond County School System reserves the right to reject, in whole or in part, any and all Proposals received, to waive technicalities, or to negotiate any term(s) or provisions(s) of such qualifications as meet the requirements and specifications of the RFP, such rejection, waiver, or negotiation to be accomplished in any manner necessary to serve the best interests of the Richmond County School System. The Richmond County School System also reserves the right to be the sole judge of the suitability of any and all qualifications for use by the Richmond County School System.

(6) RIGHT TO RE-SOLICIT: The Richmond County School System reserves the right to reject any and all Proposals with Qualifications. The right is reserved to reject any and all qualifications, to omit any items called for or to accept the Proposal deemed best for the Richmond County School System.

(7) NON-WITHDRAWAL PERIOD: Proposals may not be withdrawn for a period of thirty (30) days from the date of opening.

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(8) STATE-MANDATED WALK AWAY PROVISION: In the event a contract is awarded for more than one year:

20-2-506 (b) (1)

“Pursuant to O.C.G.A. § 20-2-506, notwithstanding any other provision herein this contract shall terminate absolutely and without further obligation on behalf of the School System at the close of each calendar year in which it was executed and at the close of each successive calendar year for which it may be renewed provided thirty (30) days prior written notice is given by the School System to the vendor prior to the end of such calendar year.

In addition, this contract shall terminate immediately and absolutely at such time that appropriated and otherwise obligated funds are no longer available to satisfy the obligation of the School System under the contract.

This contract shall be deemed to obligate the School System for the sums payable during the calendar year the agreement was executed or in the event of a renewal by the School System for those sums payable at the end of any renewed calendar year.

(9) JURISDICTION AND VENUE: “Any contract awarded shall be governed and constructed in accordance with the laws of the State of Georgia, Richmond County. Venue and jurisdiction will be that of a court of competent jurisdiction in Richmond County, Georgia.

(10) DUTY TO PROTECT: The Contractor (or Vendor) shall not knowingly send any employee, agent or subcontractor personnel who is a registered sex offender or who has been convicted of sexual abuse to any school building or school property when students are attending school or a school related activity.

The Contractor (or Vendor) shall make periodic criminal history record inquiries as authorized by O.C.G.A. §35-3-34, as now written, or here-after amended; or allowed by all or any other laws allowing such inquiry, to identify these persons who have been convicted of sexual abuse or any other act which would require such person to be entered into a national or state sexual offender registry.

For the purpose of this policy, the term periodic shall mean that the criminal history record inquiries shall be made current by the successful bidder upon the award of a contract and checked no less than annually during the duration of the contract. See ATTACHMENT #1 for Sex Offender Acknowledgement Form.

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(11) E-VERIFY: The Contractor agrees to comply with the requirements of A.R.S.§ 41-4401.

a) The Contractor warrants compliance with all Federal immigration laws and regulations relating to employees and warrants its compliance with Section A.R.S.

§23-214, Subsection A. (That subsection reads: “After December 31, 2007, every employer, after hiring an employee, shall verify the employment eligibility of the employee through the E-Verify program.

b) A breach of a warranty regarding compliance with immigration laws and regulations shall be deemed a material breach of the Contract and the Contractor may be subject to penalties up to and including termination of the Contract.

c) The Owner retains the legal right to inspect the papers of any employee who works on the Contract to ensure that the Contractor or its subcontractor(s) is/are complying with the foregoing warranty under paragraph (a).

See ATTACHMENT #2 for E-Verify Affidavit.

(12) SMOKE FREE ENVIRONMENT: Bidder shall post notice and prohibit employees from using or displaying tobacco products, including smokeless tobacco, while the employee is on duty at the assigned location. There shall be no use of any tobacco products on any property of the Richmond County School System.

(13) INSURANCE: The contractor will be required to carry Workmen’s Compensation

Insurance, Contractor’s Protective Liability Insurance, and Contractor’s Public Liability Insurance, Personal Injury, including death limits of $300,000 for each person and $500,000 for each accident; Property Damage limits of $100,000 for each accident and $300,000 for aggregate of operations.

Certificates of Insurance must be sent to the School System prior to commencement of work, with the Richmond County Board of Education to be named as additional insured on public liability insurance for personal injury and property damage.

(14) AWARD METHOD: The Richmond County Board of Education reserves the right to award complete bid based on lowest responsible and responsive bidder meeting specifications and the overall general value received. The right is also reserved to award complete bid based on the total price of bid.

(15) TIME OF THE ESSENCE: Failure of the successful Offeror to perform contracted service or deliver the merchandise within the required time shall constitute a material breach of contract. If a breach occurs, the Offeror may be responsible for any damages the school system incurs.

(16) TAX EXEMPT: The Richmond County School System is exempt for State sales taxes. Contract prices shall exclude Federal or State taxes that can be eliminated in sales to public school systems in the state of Georgia.

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(17) SERVICE REQUIREMENT: The successful vendor agrees to accomplish all work covered by negotiated specifications.

(18) PRE-BID CONFERENCE: A pre-bid meeting will take place on Tuesday, May 9, 2023 at 1:00 p.m. Please meet ON-SITE at Gracewood Elementary; 2032 Tobacco Rd., Augusta, GA 30906.

(not mandatory)

(20) QUESTIONS, REQUESTS FOR CLARIFICATION, OR INTERPRETATIONS REGARDING THIS

REQUEST FOR QUOTATION: All communications concerning this request for proposal quotation must be submitted in writing, by electronic mail to:

Richmond County School System Attn: Ms. Cecilia Perkins Email perkice@boe.richmond.k12.ga.us

Only written questions submitted by email will be accepted. No response other than what is written and distributed by the Business Office will be binding upon the Richmond County School System.

Originating departments may be called upon for clarification in their area of expertise at the discretion of the Business Office. Written responses to questions, requests for clarification, or interpretations will be furnished to all participating vendors.

All requests for clarification or interpretations must be submitted to the Business Office on or before the close of business May 10, 2021 at 5:00 P.M.

(21) Addendums: In the event an addendum becomes necessary, it will originate in the Business Office and will be distributed via the website www.rcobe.org/bids to all participating contractors. Any addenda issued during the time of the request for proposal distribution should be acknowledged by the participating contractor and attached to their response form.

(22) INSPECTION OF PUBLIC RECORDS: All information received from vendors shall be subject to inspection once any contracts are awarded under Georgia Public Records Act.

mailto:perkice@boe.richmond.k12.ga.us http://www.rcobe.org/bids

GRACEWOOD DISHWASHING

(23) NONDISCRIMINATION CLAUSE: The U.S. Department of Agriculture (USDA) prohibits discrimination against its customers, employers, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or if all or part of an individual’s income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by the Department. (Not all prohibited bases will apply to all programs and/or employment activities.)

If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at http://www.ascr.usda.gov/complaint_filing_cust.html or at any USDA office, or call (866) 632-9992 to request the form. You many also write a letter containing all of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at program.intake@usda.gov.

Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339; or (800) 845-6136 (in Spanish).

USDA is an equal opportunity provider and employer.

(24) CERTIFICATION REGARDING DEBARMENT: The vendor certifies, by submitting proposal, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any governmental agency. Signed certification regarding lobbying; debarment, suspension and other responsibility matters; and drug-free work place requirements form (ATTACHMENT “3”) must be completed and submitted with the vendor’s proposal quotes.

http://www.ascr.usda.gov/complaint_filing_cust.html mailto:program.intake@usda.gov

GRACEWOOD DISHWASHING

SPECIFICATIONS

1. Examination of Project Work Site: It is highly recommended that before submitting a proposal, the vendor examine the site of work, and understand the conditions which will be encountered relating to the character, quality and quantity of work to be performed and the materials to be furnished. Vendors are particularly required to examine all existing conditions which may be encountered during the progress of the work. All proposals submitted shall cover all expenses and disbursements in connection with work to performed to include repair of existing walls, ceilings, piping, and etc. as affected by the installation of dishwashing equipment as outlined herein. The submission of a proposal shall be conclusive evidence that the vendor has complied with these requirements and that no submission for extra compensation will be presented with regard to the nature or amount or work to be done.

PRE-BID CONFERENCE: A pre-bid meeting will take place on Tuesday, May 9, 2023 at 1:00 p.m. Please meet ON-SITE at Gracewood Elementary; 4040 Old Waynesboro Road, Augusta, GA 30906(not mandatory)

2. Protective Area: The vendor should provide the approximate protective area as required by IBC and ASTM standards for the equipment installation proposed.

3. Installation: Installation of dishwashing equipment shall be done by a certified dishwashing equipment installer.

4. Product Liability Insurance: All suppliers of dishwashing equipment must have a minimum of $5 million in product liability insurance coverage. Proof of coverage must be included in the proposal package.

5.00 WARRANTY

5.01 Warranty to be the standard manufacturer's warranty as supplied with all equipment sold by manufacturer.

5.02 Warranty work will be performed on site in the school in which the equipment is assigned (24-hour response).

5.03 All warranty card(s) are to be delivered to Owner Representative.

5.04 If any equipment components are substituted or changed after bid is awarded, the manufacturer for the substitution part, must warrant any component deviations with the same or better warranty initiated at the time of the bid.

5.05 Component change notification must be sent to Maintenance and Facilities

Attn: Jimmy Hughes, prior to component change or delivery of the equipment.

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6.00 PERFORMANCE STANDARDS

6.01 Bidders are required to submit, at the time of the bid, a delivery schedule of the equipment based on the bidder’s best knowledge of the conditions and manufacturing dates of the manufacturer. If the delivery cannot be completed on or before the time stipulated, it is mutually agreed by and between the successful bidder and RCSS:

a. A delay in delivery would seriously affect the public and the operation of RCSS departments. Should the successful bidder be obstructed or delayed in the work required to be done herewith by changes in the work or by any default, act, or omission of RCSS, or by strikes, fires, acts of God or by the inability to obtain materials, equipment, or labor due to Federal Government restrictions arising out of the defense or war program, then the time of completion shall be extended for such periods as may be agreed upon by RCSS and the successful bidder.

b. If the bidder fails to provide delivery of the unit on or before the date specified by the bidder, and none of the subjects have been addressed in the previous paragraph, RCSS has the right to either cancel the purchase order or charge a per diem penalty, after hearing evidence to the reasons for such delay and making a finding as to the cause of same.

7. RFP Package shall contain specifications on equipment, shelving and peripheral equipment. All required new electrical connections, piping connections, stainless steel dish tables, and custom fabrication shall be the responsibility of the winning bidder.

8.00 PRODUCT SPECIFICATIONS

8.01 Quality Assurance

a. Installer Qualifications - An experienced installer familiar with local building codes and with the latest safety guidelines, who has completed installation of dishwashing equipment similar in material, design, and extent to that indicated for this project, and whose work has resulted in construction with a record of successful in-service performance. Installer must establish in the local area (24-hour response time) and available to service the equipment in a professional and timely manner.

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8.00 PRODUCT SPECIFICATIONS (continued)

8.02 Submittals

a. Product Data: Include physical characteristics such as materials, dimensions and finish.

b. Shop Drawings: Show assembly and installation details.

c. Warranty: Include manufacturer’s standard warranty.

8.03 References

Vendor must comply with USDA policy 210.21-14 and 220.17.01 buy American Provisions which requires schools and institutions participating in the National School Lunch Program (NSLP) and School Breakfast Program (SBP) in the contiguous United State to purchase, to the maximum extent practicable, domestic commodities or product for use in meals served under the NSLP and

SBP.

8.04 Delivery, Storage and Handling

Inspect all components on delivery to ensure that no damage occurred during shipping or handling. Materials shall be stored in original undamaged packaging in such a manner to ensure proper ventilation and drainage, and to protect against damage, weather, vandalism, and theft until ready for installation. Inspect components prior to installation.

GRACEWOOD DISHWASHING

8.00 PRODUCT SPECIFICATIONS (continued)

8.05 Dishwasher Basis of Design

Champion Confident Model No. 66 PRO VHR Pro Series (or owner approved equivalent)

1. Ventless Heat Recovery

2. High Rack Conveyor

3. 22” Pre-Wash

4. 30” Side Load

5. Right to Left direction through machine

6. 209 racks per hour

7. HMI display

8. Intuitive condition alerts

9. Proactive maintenance interface

10. Programable machine dwell with automatic rack alignment

11. Full 180 degree opening; leak proof hinged access doors

12. Stainless steel heavy gauge construction including base, legs and feet

13. Enclosure panels (front and sides)

14. 21kw booster – 70 degree rise

15. Automatic drain valve

16. Max water consumption per hour = 100 US Gal

17. Electrical 208/60/3

a. Rated Amps 58

b. Minimum Supply Circuit Ampacity 75

c. Maximum Overcurrent Protective Device 75

18. Existing Water Connections

Hot Water Tank Fill ½” NPT

Cold Water ½” NPT; 50 degrees min @ 40 psi

Drain 1 ½” NPT; PVR included

GRACEWOOD DISHWASHING

PART 9 Scope of Work

9.01 Demo and New Construction

a. Demo

1. Contractor shall provide all labor, materials, and equipment to demo existing dishwashing machine, vent hood, stainless steel dish counter, rack counters and sink. (see attached demo drawing)

2. All electrical and water connections shall be terminated in such a way to facilitate new equipment installation.

3. All damage to the existing facility resulting from demolition of existing and/or installation of new equipment shall be repaired by the contractor to match existing.

b. Installation of New Dishwasher, sink, stainless steel dish tables, and shelving.

1. Contractor shall provide all labor, materials, and equipment to install dishwashing machine, stainless steel dish tables, and sink. (see attached drawing) Existing materials may be re-used if possible.

2. Basis of design is The Champion 66 RO VHR Electric w/ booster and 30” side load (accepts sheet pans)

3. Existing power supply is:

a. 20A 208V 1ph

b. 40A 208V 3ph

c. Contractor shall provide and install all necessary connectors and/or peripherals required for connection of new dishwasher as required by the manufacture and local authorities having jurisdiction

GRACEWOOD DISHWASHING

4. Existing water supply is:

a. ¾” CW Supply

b. 1-1/4” HW Supply

c. 1” HW Return

d. All potable water piping is insulated

e. 3” drain for dishwasher, 1-1/2” drain for sink.

f. Contractor shall provide and install all necessary piping, fittings, valves, water hammer arrestors and etc.as required by the manufacture and authorities having jurisdiction. All new piping shall tie into existing and be of compatible specification (to include pipe insulation) and routed to be wall mounted like existing piping.

g. New Sink shall be of similar size as existing sink (re-use existing sink if possible) and located approximately as shown on installation plan. All new piping shall tie into existing and be of compatible specification to include insulation. All new piping shall be wall mounted and routed under dish tables.

h. Modification of existing stainless-steel dish tables and/or replacement is at the discretion of the qualified/certified fabrication/installation contractor. All stainless steel demolished shall remain the property of Richmond County School System.

i. IBC, ASTM, USDA, NSLP, SBP code compliance along with all authorities having jurisdiction is the responsibility of contractor.

j. All dimensions and quantities must be field verified.

GRACEWOOD DISHWASHING

BIDDING VENDOR CONTACT INFORMATION

RFP #23-147

**NOTE**

Please attach detailed specifications of your

PRODUCT WITH WARRANTY, SAFETY

STANDARDS AND PRODUCT LIABILITY

INSURANCE.

DATE:

COMPANY NAME:

ADDRESS:

PHONE NUMBER:

FAX NUMBER:

EMAIL ADDRESS:

PERSON SUBMITTING

RFP with Qualifications:

(Typed or Printed)

TITLE:

SIGNATURE:

GRACEWOOD DISHWASHING

RFP#23-147 BID FORM

Brand Name and Series Technical Data Attached

Lead Time for Delivery=______________________________

Lead Time for Installation=___________________________

Date:

Name of Company:

Address:

Signature Title:

Phone: Fax:

Email:

PRICE PER UNIT DELIVERED AND INSTALLED

Champion 66 RO VHR Electric w/ booster and 30” side load (accepts sheet pans)

$___________________________________________________ each

Demolition and Installation of New Machine and all Connections as Described Herein =

Total Bid=

GRACEWOOD DISHWASHING

GRACEWOOD DISHWASHING

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ATTACHMENT #1

Sex Offender Acknowledgement Form Read, sign and return this form to the Richmond County Board of Education The Contractor (or Vendor) shall not knowingly send any employee, agent or subcontractor personnel who is a registered sex offender or who has been convicted of sexual abuse to any school building or school property when students are attending school or a school related activity.

The Contractor (or Vendor) shall make periodic criminal history record inquiries as authorized by O.C.G.A. §35-3-34, as now written, or here-after amended; or allowed by all or any other laws allowing such inquiry, to identify these persons who have been convicted of sexual abuse or any other act which would require such person to be entered into a national or state sexual offender registry.

For the purpose of this policy, the term periodic shall mean that the criminal history record inquiries shall be made current by the successful bidder once contract award is made and checked no less than annually during the duration of the contract.

Upon notification and acceptance of the SOQ, the Contractor (or Vendor) shall certify to the Richmond County Board of Education that periodic criminal history record checks are made by the company for all employees and that to the best of the Contractor’s (or Vendor) knowledge it has no employee or agent who has been convicted of a sex offense or who is a registered sex offender, who will be assigned to any school building or school property while students are attending school or a school related activity.

I have read and understand the above Richmond County Board of Education Policy regarding my or my company’s obligation as a contractor (or vendor). I further acknowledge that the failure to comply with the requirements to identify a sex offender, to comply with any part of this policy, to assign a sex offender to any school building or school property while students are attending school or a school related activity will constitute a breach of the contract.

Contractor (or Vendor) signature Date signed

Witness signature Date signed

GRACEWOOD DISHWASHING

ATTACHMENT #2

E-VERIFY AFFIDAVIT

under O.C.G.A. § 13-10-91(b)(4)

Read, fill out and return this form to the Richmond County School System By executing this affidavit, the undersigned Contractor verifies its compliance with Immigration Reform and Control Act of 1986 (IRCA), Pub. L. 99-603, stating affirmatively that the individual firm or corporation which is engaged in services on behalf of the Richmond County School System has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established by federal law and regulation. Furthermore, the undersigned Contractor will continue to use the federal work authorization program throughout the contract period. Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:

Federal Work Authorization User Identification

Number: _________________________________________________

Date of Authorization: _________________________________________________

Name of Project: Gracewood Elementary Dishwashing Equipment Replacement

Solicitation Number (if applicable): RFP #23-147

Name of Public Employer: Richmond County School System

I hereby declare under penalty of perjury that the foregoing is true and correct.

Executed on ________, _______, 202___ in _________________(city)________(state)

Signature of Authorized Officer or Agent

Printed name and Title of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME

ON THIS THE ________ DAY OF ______________, 202_____.

NOTARY PUBLIC

My Commission Expires: ____________________________________

AD-1047 OMB No. 0505-0027 Expiration Date: 09/30/2025

Certification Regarding Debarment, Suspension, and Other Responsibility Matters Primary Covered Transactions

The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. § 552a, as amended). This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, and 2 CFR § 180.335, Participants' responsibilities. The regulations were amended and published on August 31, 2005, in 70 Fed. Reg. 51865-51880. Copies of the regulations may be obtained by contacting the Department of Agriculture agency offering the proposed covered transaction.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0505-0027. The time required to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The provisions of appropriate criminal or civil fraud, privacy, and other statutes may be applicable to the information provided.

(Read instructions on page two before completing certification.)

A. The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals:

1. Are not presently debarred, suspended, or proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;

2. Have not within a 3-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

3. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (A.2.) of this certification; and

4. Have not within a 3-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default.

B. Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.

ORGANIZATION NAME PR/AWARD NUMBER OR PROJECT NAME

NAME(S) AND TITLE(S) OF AUTHORIZED REPRESENTATIVE(S)

SIGNATURE DATE

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA's TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov.

USDA is an equal opportunity provider, employer, and lender.

https://www.usda.gov/oascr/how-to-file-a-program-discrimination-complaint mailto:program.intake@usda.gov

Instructions for Certification

(1) By signing and submitting this form, the prospective primary participant is providing the certification set out on page 1 in accordance with these instructions.

(2) The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant must submit an explanation of why it cannot provide the certification set out on this form. The certification or explanation will be considered in connection with the Department or agency's determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation will disqualify such person from participation in this transaction.

(3) The certification in this clause is a material representation of fact upon which reliance was placed when the Department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the Department or agency may terminate this transaction for cause or default.

(4) The prospective primary participant must provide immediate written notice to the Department or agency to which this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

(5) The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549, at 2 CFR Parts 180 and 417. You may contact the Department or agency to which this proposal is being submitted for assistance in obtaining a copy of those regulations.

(6) The prospective primary participant agrees by submitting this form that, should the proposed covered transaction be entered into, it may not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the Department or agency entering into this transaction.

(7) The prospective primary participant further agrees by submitting this form that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions," provided by the Department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

(8) A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the General Services Administration’s System for Award Management Exclusions database.

(9) Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

(10) Except for transactions authorized under paragraph (6) of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the Department or agency may terminate this transaction for cause or default.

Form AD-1047 (REV 12/22)