RFP - Athletic Vestibule.docx

Request for Proposal January 2024

The Homer Community School District (also referred to as “the District” in these documents) will accept sealed bids for:

Replacement HS Gym Entry Athletic Vestibule

As described in the specifications: Homer Community School District will receive proposals from certified roofing contractors for the replacement of the athletic vestibule near the HS gym entry located at 403 S. Hillsdale St., Homer MI 49245.

All sealed bids must be received at Homer Community School District, Superintendent’s Office, 403 South Hillsdale Street, Homer MI 49245, on or before Friday, February 9, 2024 at 9:00 am, EST. All bids will be opened publicly at 9:05 am, EST, on Friday, February 9, 2024 in the Superintendent’s Office. All bids must be in plain envelopes marked “2024 Athletic Vestibule Replacement Bid”.

The Homer Community School District reserves the right to accept or reject any or all bids and to waive all irregularities in proposals. A 5% Bid Bond will be required before any bid is read aloud: 100% Performance, Labor, and Material Bid will be required.

Any questions regarding school procedures should be directed to Dale Cornstubble, Director of Operations at dcornstubble@homerschools.net or 517-568-4463.

Bid documents are available online by going to the District’s web site at www.homerschools.net

The Homer Board of Education reserves the right to accept or reject any or all bids in whole or in part; or, for reasons of establishing uniformity, delivery time or preference, to award the contract to other than the low bidder.

HOMER COMMUNITY SCHOOLS

The contents of the RFP and Bidder’s (also referred to as “Contractor” in these documents) Proposal will become contractual obligations, if a contract ensues. Failure of the Bidder to accept these obligations will result in cancellation of the award. Award of a contract by the District is subject to the Contractor executing a contract, which shall incorporate the contents of this RFP and the Contractor’s Proposal and final approval if the same by the District’s legal counsel.

In compliance with MCL 380.1267, the bid shall be accompanied by a sworn and notarized statement disclosing any familial relationship that exists between the owner or any employee of the bidder and any member of the board, or the superintendent of the school district. The bid shall also be accompanied by a sworn and notarized statement disclosing whether the bidder is an Iran Linked Business in compliance with PA 517 of 2012. The Board shall not accept a bid that does not include these sworn and notarized disclosure statements.

Certified check or Bid Bond must accompany each proposal by an approved surety company in an amount not less than 5% of the proposed amount. Length of time required for completion shall be specified in the bid. All bids submitted must meet or exceed all specifications herein.

Bids are to be submitted on our Bid Proposal Form, signed by the bidder, in a sealed envelope clearly marked. Two (2) copies of the Bid Proposal Form should be addressed to the attention of:

One (1) copy of the bid form should be retained for your files. Any questions should be referred to Dale Cornstubble, Director of Operations at 517-568-4463.

INSTRUCTIONS TO BIDDERS

GENERAL CONDITIONS:

1. Proposal/Intent

· Furnish materials and labor to Replacement of HS Gym Entry Athletic Vestibule. according to the attached specifications.

· Manufacturer’s numbers are shown for convenience in identifying items. Manufacturers’ description constitutes requirement for each such item or component.

· Use of Manufacturers’ numbers and other requirements set forth in specifications are not intended to preclude use of any other approved manufacturer’s produces or procedures which may be equivalent, solely as determined by the Owner, but are given for the purpose of establishing standards for design, function and quality of materials, construction and workmanship.

2. Types of Proposals

· This lump sum proposal must include materials, labor, and all associated costs of the project.

3. Receipt of Bids

· Bids will be received at Homer Community School District Superintendent’s Office located at 403 South Hillsdale Street, Homer MI 49245 by Friday, February 9, 2024 at 9:00 am, EST. All bids will be opened publicly at 9:05 am, EST, on Friday, February 9, 2024 in the Superintendent’s Office. The district will not consider or accept a bid received after the date and time specified for bid submission. No oral, telephonic, or telegraphic proposals shall be considered.

4. Bidder’s Qualifications

· Bidders shall be reputable, recognized organization with at least five (5) years successful experience on work of this type and scope, of equal or better quality than this project.

5. Warranty

· Contractor shall warranty materials and installation of all components for a period of fifteen (15) years from date of acceptance by the owner of job completion.

6. Project Meeting

· Pre-job conference to be scheduled within five (5) days after award, to be determined by Michael Leskowich, Superintendent, Homer Community School District.

7. Work Schedule

· Failure to close out the punch list within thirty (30) days of the project’s end shall result in liquidated damages of $1,000 per day.

8. Clean-up and Disposal

· The Contractor shall be responsible to clean-up all debris and dispose of it off-site. This MUST BE DONE DAILY. If the District has to clean up after contractors, there will be a $1,000 per diem fee in addition to disposal costs.

9. Damage Repair

· A survey of the site will be conducted, and documented by the Contractor, to determine current site conditions. The Contractor shall be responsible to repair any damage to the site, which occurs during this project.

· Contractors and their Sub Contractors shall park their work vehicles in the area(s) designated for parking. Contractors and their Sub Contractors shall not park or drive on sidewalks or grassy areas. There will be a $500 fee assessed for each and any Contractor vehicles that are documented to be parking on sidewalks or grassy areas.

10. Submittal of Bid

· Before submitting a bid, bidders shall carefully read all of the specifications in order to avoid omission or duplications. To ensure a complete project, bidders shall visit the premises, verify site conditions and conditions under which work under the contract must be conducted. Submission of a bid signifies that the bidder has visited the project premises, has made examinations and verifications and is fully conversant with all conditions under which the work is to be performed. No claims for additional compensation will be considered or paid to the successful bidder, due to said successful bidder’s failure to be so informed.

· Any exceptions to the terms and conditions contained in this RFP or the form Contract attached to this RFP, if there is one attached, or any other special considerations or conditions requested or required by the bidder MUST be specifically enumerated by the bidder and be submitted as part of its proposal, together with an explanation as to the reason such terms and conditions of this RFP or form of contract cannot be met by, or in the bidder’s opinion should not be applicable to, the bidder. The bidder shall be required and expected to meet the specification and the requirements as set forth in this RFP and the form of Contract in their entirety, except to the extent exceptions or special considerations or conditions are expressly set forth in the bidder’s Proposal and those exceptions or special considerations or conditions are expressly accepted by the District.

11. Familial Relationship

· All bidders must provide familial disclosure in compliance with MCL 380.1267 and attach this information to the bid. The bid shall be accompanied by a sworn and notarized statement disclosing any familial relationship that exists between the owner or any employee of the bidder and any member of the board or the superintendent of the school district. The District shall not accept a bid that does not include this sworn and notarized disclosure statement.

12. Iran Economics Sanctions Act

· Each bid must be accompanied by a sworn and notarized statement certifying that the Contractor is not an “Iran linked business” within the meaning of the Iran Economic Sanctions Act, PA 517 of 2012.

13. Withdrawal of Bids

· Any bidder may withdraw his bid at any time prior to the scheduled time for receipt of bids. No proposals may be withdrawn for at least sixty (60) days after the scheduled closing time of the bid.

14. Firm Prices

· Prices and notations must be typed or in ink. No erasures are permitted. Mistakes may be crossed out and corrections entered and initialed, in ink, by the person signing the proposal.

· In the event of discrepancy between the unit price and the extension, the UNIT PRICE SHALL GOVERN. The price inserted must be net including all freight, discounts, rebates, and allowances.

15. Delivery/Installation

· Time of delivery is part of the consideration. It is understood that the bidder agrees to deliver prepaid to the schools, specified from the resulting contract, all items. All cost of delivery, drayage, freight, packing, unpacking, and setup are to be included in the prices bid.

· The Contractor is responsible for removing from the project all waste materials and rubbish resulting from his operations and installation including all packing cartons and debris. Removal is to occur on a daily basis. Failure to do so will result in the Owner doing so and the cost thereof shall be charged to the Contractor as a deduction in his contract price.

· The Contractor shall provide an adequate number of qualified, experienced installer, in harmony with other works at the site.

16. Termination by the District for Convenience

· The District may, at any time, terminate the Contract for the District’s convenience and without cause.

· Upon receipt of written notice from the District of such termination for the District’s convenience, the Contractor shall:

i. Cease operations as directed by the District in the notice;

ii. Take actions necessary, or that the District may direct, for the protection and preservation of the Work; and

iii. Except for Work directed to performed prior to the effective date of termination stated in the notice, terminate all existing subcontracts and purchase orders and enter into no further Subcontracts and purchase orders.

17. Bonds

· Bid Bond or certified check, for an amount not less than five (5%) percent of the amount of the bid, must accompany each bid. The check or bond of each unsuccessful bidder will be returned within ten (10) days after the bid is awarded. Failure of any accepted bidder to enter into a contract to complete the specified work may forfeiture of his bid security. Failure to submit proper bid security shall constitute rejection of bid.

· Performance Bond/Payment Bond – Within fourteen (14) days after date of issuance of written notice of selection for the award of a contract, which shall be considered as the notice to proceed, the successful bidder shall enter into a contract with the District and shall execute and file with the District, the following in the amount 100% equal to full contract sum.

· The Performance Bond must insure the faithful performance of all provisions of the contract and satisfactory completion of the specified work, within the time agreed upon.

· The Payment Bond must insure the payment and protection of claimants supplying labor or materials to the principal contractor or his subcontractors in the prosecution of the work provided for in the contract. The successful contractor’s bond company must be listed by the State of Michigan as a licensed carrier and have an excellent or superior rating from AM Best Company.

18. Prevailing Wage

· Prevailing wage is not required given that bids are made and due before the effective date of Michigan Act No. 10, Public Acts of 2023 (i.e., February 13, 2024). See MCL 408.1109.

19. Safety

· Under the “General Conditions of the Contract for Construction” of the contract to be awarded, the Contractor;

i. Shall be solely responsible for and have control over construction means, methods, techniques, sequences and procedures;

ii. Shall be responsible for initiating, maintaining, and supervising all safety precautions and programs in connection with the performance of the contract;

iii. Shall take reasonable precautions for safety of all persons who maybe affected, including employees of the Contractor and Subcontractor; and

iv. Shall have an accident prevention representative on site.

· The general conditions of the contract for construction and the agreement also require that the Contractor indemnify the Owner in the event of certain claims arising out of the performance of the work.

20. Compliance with School Safety Initiative Legislation

· Meeting the requirements of the School Safety Initiative Legislation being MCL 380.1230, 380.1230a, 380.1230c, 380.1230d, and 380.1230g.

· The Bidder acknowledges and agrees that the Bidder will have any and all of its installation personnel (including sub-contractors) subjected to criminal history and background checks. Criminal history and background checks will be done within a year of the beginning of the project and should be completed before work begins on this project.

· The Bidder is required to provide written documentation listing all personnel who fall into the group indicated in the above paragraph. The documentation will also verify that none of the personnel have a “listed offense” as indicated below. The documentation is to be provided before the beginning of the project and updated as necessary for any additions or subtractions from the list as long as the project lasts.

· The Bidder shall indemnify, defend and hold the District, its employees, Board of Education, and each member thereof, agents and consultants, harmless from and against any and all claims, counter-claims, suits, debts, demands, actions, judgements, liens, liabilities, costs, expenses, including actual attorney’s fees and actual expert witness fees, arising out of or in connection with any violation of, or the Bidder’s failure to comply with the above paragraphs.

· The Bidder shall be responsible for all costs and expenses associated with the above-required criminal history and background checks.

· LISTED OFFENSES

i. MCL 750.145a – Accosting, enticing or soliciting child (less than 16 years of age) for immoral purposes.

ii. MCL 750.145b – Accosting, enticing or soliciting child (less than 16 years of age) for immoral purposes – second or subsequence offenses.

iii. MCL 750.145c – Involvement in child sexually abusive activity or material, including possession of child sexually abusive material (“child” is a person less than 18 years of age who has not been legally emancipated.)

iv. MCL 750.158 – Crime against nature (i.e., sodomy and bestiality) if the victim is an individual less than 18 years of age.

v. A third of subsequent violation of any combination of the following:

1. MCL 750.167 (1)(f) – indecent or obscene conduct in a public place;

2. MCL 750.335a – indecent exposure;

3. A local ordinance of a municipality substantially corresponding to a section described in (a) or (b), supra

vi. Except for juvenile disposition or adjudication, a violation of:

1. MCL 750.338 – gross indecency between males; fellatio or masturbation;

2. MCL 750.338a – gross indecency between females; oral sex

3. MCL 750.338b – gross indecency between male and female persons; if the victim is an individual less than 18 years of age.

vii. MCL 750.349 – Kidnapping, if victim is an individual less than 18 years of age.

viii. MCL 750.350 – Kidnapping; child under 14 years of age with intent to detain or conceal from child’s parent or legal guardian.

ix. MCL 750.448 – Soliciting or accosting by a person 16 years of age or older, if victim is an individual less than 18 years of age.

x. MCL 750.455 – Pandering

xi. MCL 750.520b – First degree criminal sexual conduct

xii. MCL 750.520c – Second degree criminal sexual conduct

xiii. MCL 750.520d – Third degree criminal sexual conduct

xiv. MCL 750.520e – Fourth degree criminal sexual conduct

xv. MCL 750.520g – Assault with intent to commit criminal sexual conduct.

xvi. Any other violation of a law of the state or local ordinance of municipality that by its nature constitutes a sexual offense against an individual who is less than 18 years of age.

xvii. MCL 750.10a – Offense by sexually delinquent person (i.e., “any person whose sexual behavior is characterized by repetitive or compulsive acts which indicate a disregard of consequences or the recognized rights of others, or by the use of force upon another person in attempting sexual relations of either a heterosexual or homosexual nature, or by the commission of sexual aggressions against children under the age of 16”)

xviii. An attempt or conspiracy to commit an offense described in (1) through (17)

xix. An offense substantially similar to an offense described in (1) through (17) under a law of the United States, any state, or any country or any tribal or military law.

21. Insurance Requirements

· The contractor shall protect, defend and indemnify the Owner, its officers, agents, servants, volunteers, and employees from any and all liabilities, claims, liens, demands, and costs of whatsoever kind and nature which may result in injury or death to any persons, and for any result in injury or death to any person, and for loss or damage to any property, including property owned or in the care, custody, or control of the Owner in connection with or in any way incident to or arising out of the occupancy, use, with this Agreement resulting in whole or in part from negligent acts or omissions of the Contractor, any Subcontractor, or any employee, agent or representative of the Contractor or any Subcontractor.

· The Contractor shall maintain, at its expense, during the term of this contract the following insurance:

i. Workers’ Compensation Insurance with statutory limits and Employer’s Liability Insurance with a minimum limit of $1,000,000 each occurrence

ii. Comprehensive General Liability Insurance with a minimum combined single limit of $1,000,000 per occurrence, $2,000,000 aggregate, in the same amount made for bodily injury and property damage. The policy is to include products and completed operations, cross liability, broad form property damage, independent contractors, and contractual liability coverage. The policy shall be endorsed to provide sixty (60) days written notice to the District of any material change of coverage, cancellation, or non-renewal of coverage.

iii. If Subcontractors are likely to be used, the Comprehensive General Liability policy shall include coverage for independent Contractors.

iv. Owner’s Contractor’s Protective Policy – comprehensive in the name of the Owner, with a minimum combined single limit of $1,000,000 per occurrence in the same amount for bodily injury or property damage.

v. Automobile Liability insurance covering all owned, hired, and non-owned vehicles with personal protection insurance and property insurance to comply with the provisions of the Michigan no-fault Insurance Law, including residual liability insurance with a minimum combined single limit of $1,000,000 each occurrence of bodily injury and property damage.

vi. All insurance policies shall be issued by companies licensed to do business in the State of Michigan. The companies issuing the policies must be domestic (on-shore) companies and have an A rating by AM Best.

vii. The Contractor shall be responsible for payment of all deductibles contained in any insurance policy required in this contract.

22. Permits, Fees, Regulations, and Taxes

· The Contractor shall obtain and pay for all permits, assessments, fees, bonds, and other charges as necessary to perform and complete the work of this contract, including disconnection charges, capping and unplugging utilities.

· The Contractor shall be responsible for obtaining all permits and licenses necessary for the proper completion of project. Permits and licenses are available from the appropriate agencies having jurisdiction. The Contractor shall give all notices, pay all fees, and comply with all laws, ordinances, rules and regulations bearing on the work.

· At the completion of the project, the contract will provide to the District all paperwork related to the full execution of the permits(s), including all payments and inspections.

· If any of the work of the Contractor is done contrary to such laws, ordinance rules and regulations without such notice, he shall bear all costs arising therefrom. The Contractor shall include all cost and taxes in its bid, and make proper provisions for payment of all other State and Federal applicable taxes, fees, or other costs.

· The District is NOT automatically exempt from State of Michigan Sales and Use Taxes. The District must pay these taxes when materials are to be incorporated into realty. Hence, for materials that are permanently attached, built-in, incorporated or otherwise made part of the structure all applicable taxes shall be paid by the Contractor. The District is exempt from sales and use taxes if the materials are movable and are not permanently made part of the structure.

23. Bids, Notifications, Claims, and Statements shall be signed as follows:

· Corporations; Signature of officials shall be accompanied by a certified copy of resolution of the Board of Directors authorizing the individual signing to bind the corporation. Affix official corporate seal.

· Partnerships; Signature of official shall be accompanied by a certified copy of the Power of Attorney authorizing the individual signing to bind all partners.

24. Owner Is An Equal Opportunity Employer

· The Owner is an Equal Opportunity Employer. Pursuant to the Executive Order 11246 as amended, you are advised that under the provisions of this order, Contractors and Subcontractors are obligated to take affirmative action to provide equal opportunity without regard to race, creed, color, national origin, age, or sex.

25. Michigan Right to Know Law

· School District will comply with the Michigan Right to Know Law by informing Contractors of hazardous chemicals to which they may be exposed. All Contractors will be required to provide Material Safety Data Sheets for any hazardous chemicals brought to the workplace. The Contractor shall comply with all applicable provisions of the Occupational Safety and health Act for the duration of the specified work.

26. Asbestos Hazard Emergency Response Act

· As required by the Environmental Protection Agency Asbestos Hazard Emergency Response Act, each school district is responsible for providing contractors with information regarding locations of known or assumed asbestos containing material prior to the Contractor entering a building under the school district’s jurisdiction. The successful bidder will be required to complete the school district’s Contractor Notification forms.

27. Notification of Assumed Lead-Containing Materials

· The intent of this section is to formally notify all contractors and Sub-Contractors applying for or bidding on work covered within this specification that, due to the age of the facilities within this District, there is the presumption that building components do contain lead-based paint pursuant to OSHA definition. The District has not conducted lead-based paint pursuant to OSHA definition. The District has not conducted lead-based paint inspections. As a result, all Contractors and Sub-Contractors bidding must assume that building components do contain lead-based paint.

28. General Conditions

· The District reserves the right to accept or reject any or all proposals, to waive irregularities, and to accept a proposal which, in the District’s opinion, is in the District’s best interest.

· The District reserved the right to declare as non-responsive, and reject, any bid which is incomplete or where material information requested is not furnished, or where indirect or incomplete answers or information is provided.

· In the event, the Administration Building is closed due to unforeseen circumstances on the day Proposals are due, Proposals will be due at the same time on the next day that the District and/or the Administration Building is open.

· Negligence in preparation, improper preparation, errors in, or omissions from, proposal shall not relieve a bidder from fulfillment of any and all obligations and requirements of the proposed Contract Documents.

· The District expects that the awarded bidder will complete the work as outlined in the specification for the amount bid by the bidder. Any additional costs above the amount bid and awarded, must be approved by the District in advance of any work.

· Voluntary alternates for bids are acceptable but should NOT be put in the space for the Base Bid on the Bd Response Form but on an attached sheet, clearly labeled Voluntary Alternative. Such Alternatives should be described in enough detail for the District to understand the Bidder’s intent.

· Any exceptions to the terms and conditions contained in this RFP or any special considerations or conditions requested by the Contractor MUST be specifically enumerated by the Contractor and be submitted as part of its Proposal, together with an explanation as to the reason such terms and conditions of this RFP cannot be met by, or in the Contractor’s opinion should not be applicable to, the Contractor. The Contractor shall be required and expected to meet the specifications and the requirements as set forth in this RFP in their entirety, except to the extent exceptions or special considerations or conditions are expressly set forth in the Contractor’s Proposal and those exceptions or special considerations or conditions are expressly accepted by the District.

· No responsibility shall attach to the District, or the authorized representatives of either one, for the premature opening of any proposal, which is not properly addressed and identified.

· The Contract Documents, as outlined in the executed Agreement, shall imply the inclusion of the entire agreement between the parties thereto, and the Contractor shall not claim any modification thereof resulting from any representation or promise made at any time by an officer, agent or employee of the District or by any other person.

29. Opening and Awarding of Bids

· All bids will be opened publicly at 9:05 am, EST, on Friday, February 9, 2024 in the Superintendent’s Office.

· The tally sheet of the bidders’ responses will be available on line approximately seven days after the opening of the bid.

· The recommendation for award will be submitted to the Board of Education at the regular Board of Education Meeting to be held on Monday, February 19, 2024 6:00 pm, EST.

BID PROPOSAL FORM

COMPANY NAME: _________________________________________________

The undersigned certifies that the bid contained meets or exceeds the attached specifications. Include the bond amount in the price. Project will be awarded to one (1) contractor. The parties agree that the School District is not waiving any rights its insurer(s) may have to subrogation. To the extent any term in the Agreement is contrary to this provision, such term is void and unenforceable.

To provide labor, materials, and equipment for as specified/where specified:

TOTAL BID $ ________________________

Acknowledge receipt of Addendums: _______________________________________________

Can you complete this project in the time line specified? Yes No

Please state your warranty: _______________________________________________________

State any prompt payment terms: __________ % __________ days.

Do you conduct background checks on your employees? Yes No

Bid Bond included? Yes No

Familial Relationship affidavit included? Yes No

Iran Linked Business affidavit included? Yes No

Are you on the Excluded Parties List, which excluded you from receiving Federal Contracts or certain sub contracts, pursuant to the provisions of 31 U.S.C. 6101, note E.O. 12549, E.O. 12689, 48 C.F.R. 9.404? Yes No Unknown Provide your DUNS number, if you have one: ________________________________________

BID PROPOSAL FORM continued

At least 3 references with contact person:

Company: _________________ Contact: ___________________ Phone: __________________

My signature certifies that the Proposal as submitted complies with all of the terms and conditions set forth in the Request for Proposal unless specifically enumerated as an exception as part of our proposal.

COMPANY NAME: ____________________________________________________________

ADDRESS: ___________________________________________________________________

AUTHORIZED SIGNATURE: ___________________________________________________

AUTHORIZED NAME (please print): ______________________________________________

TITLE: ___________________________________ DATE: _______________________

PHONE #: ______________________________ FAX #: ____________________________

E-MAIL: _____________________________________________________________________

CONSTRUCTION BID DISCLOSURE STATEMENT – FAMILIAL RELATIONSHIP

Pursuant to MCL 380.1267, a sworn and notarized statement disclosing any familial relationship that exists between the owner or any employee of the bidder and any member of the Homer School Board of Education or the Homer School District Superintendent must be accompanied with the bid. Bids without this disclosure statement will not be accepted.

The members of the Homer Schools Board of Education are: Gary Tompkins, Jr., Kimberly Willis, Isabell Nazar, Catherine Yates, Chad Rocco, Josh McCullough, and Tamara Winchell.

The Homer School District Superintendent is Michael Leskowich.

The following are the familial relationships:

There are none.

STATE OF MICHIGAN

COUNTY OF ________________

The undersigned, authorized representative of bidder (insert name) ________________________ Does hereby acknowledge that bidder has read the foregoing disclosure statement and the statements herein contained are true.

Signature of Bidder Representative

Print Name

Title

Subscribed and sworn to me before this _____ day of __________________, _____.

Acting in the County of:_____________________

AFFIDAVIT OF COMPLIANCE – IRAN ECONOMIC SANCTIONS ACT

Michigan Public Act No. 517 of 2012

The undersigned, the owner or authorized officer of the below named contractor (the “Contractor”), pursuant to the compliance certification requirement provided in Homer Community School Districts Request for Proposal marked 2024 Athletic Vestibule Replacement Bid, hereby certifies, represents and warrants that the Contractor (including its officers, directors, and employees) is not an “Iran Linked Business” within the meaning of the Iran Economic Sanctions Act, Michigan Public Act No. 517 of 2012 (the “Act”), and that in the event Contractor is awarded a contract as a result of the aforementioned RFP, the Contractor will not become an “Iran Linked Business” at any time during the course of performing the Work or any services under the contract.

The Contractor further acknowledges that any person who is found to have submitted a false certification is responsible for a civil penalty of not more than $250,000.00 or 2 times the amount of the contract or proposed contract for which the false certification was made, whichever is greater, the cost of the School District’s investigation, and reasonable attorney fees, in addition to the fine. Moreover, any person who submitted a false certification shall be ineligible to bid on a request for proposal for three (3) years from the date it is determined that the person has submitted the false certification.

Signature of Bidder Representative

Print Name

Title

Subscribed and sworn to me before this _____ day of __________________, _____.

Acting in the County of:_____________________