RFP_No.S-10700-00017778_Attachment_B_Proposer_Information_Certification_Form~1.pdf
PDF 473 KB Posted
- Attached to
- Fleet Vehicles Solicitation
- Solicitation number
- S-10700-00017778
- Issued by
- Oregon
About this file
This is a Proposer Information/Certification Form (Attachment B) for an Oregon Department of Administrative Services (DAS) Procurement Services solicitation for fleet vehicles. The form serves as a standardized certification document that requires proposers to provide their legal name, address, state of incorporation, entity type, contact information, and Oregon Business Registry Number if applicable. Proposers must certify their understanding and acceptance of RFP requirements, acknowledge receipt of all addenda, and confirm that their proposal constitutes a firm offer valid for 90 days following the closing date. If awarded a price agreement, the proposer agrees to be bound by the terms and conditions of the sample price agreement in Attachment A and to perform according to established performance standards.
The certification form requires proposers to make extensive representations regarding tax compliance, non-discrimination in employment and subcontracting practices, sexual harassment prevention policies (mandatory for agreements with anticipated value of $150,000 or more), wage equity compliance under ORS 652.220, broadband internet access service compliance with Oregon Law Chapter 88, and exclusion from federal sanctions lists maintained by the Office of Foreign Assets Control and the System for Award Management. Proposers must also certify the absence of conflicts of interest with the State, confirm the truthfulness and accuracy of all proposal contents, and acknowledge that false statements or material omissions may constitute false claims under the Oregon False Claims Act, subjecting the proposer to associated liabilities and penalties. The form requires an authorized representative's signature, printed name, and date.
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Text version
DAS Procurement Services, Version 4.0 – December 21, 2018 Page 1 of 2
ATTACHMENT B
Proposer Information/Certification Form
Legal Name of Proposer:
Address: City, State, Zip:
State of Incorporation: Entity Type:
Contact Name: Telephone: Email:
Oregon Business Registry Number (if required):
Any individual signing hereby certifies they are an authorized representative of proposer and:
1. Proposer understands and accepts the requirements of this RFP. Company agrees if awarded a Price Agreement to be bound by the terms and conditions of the sample price agreement in Attachment A except for those DAS-SPS has reserved for negotiation.
2. Acknowledges receipt of all Addenda to this RFP.
3. Proposal is a Firm Offer for 90 days following the Closing.
4. If awarded a Price Agreement, company agrees to perform and meet the performance standards set forth in the Price Agreement.
5. I have knowledge regarding payment of taxes and by signing below I hereby certify, to the best of my knowledge, company is not in violation of any tax laws of the state or a political subdivision of the state, including, without limitation, ORS 305.620 and ORS chapters 316, 317 and 318.
6. Proposer does not discriminate in its employment practices regarding race, creed, age, religious affiliation, gender, disability, sexual orientation, national origin. When awarding subcontracts, Bidder does not discriminate against any business certified under ORS 200.055 as a disadvantaged business enterprise, a minority-owned business, a woman-owned business, a business that a service-disabled veteran owns or an emerging small business. If applicable, proposer has, or will have prior to contract execution, a written policy and practice, meeting the requirements described in ORS 279A.112 (formerly HB 3060), of preventing sexual harassment, sexual assault and discrimination against employees who are members of a protected class. DAS-SPS may not enter into a price agreement with an anticipated value of $150,000 or more with a successful proposer that does not certify it has such a policy and practice. See https://www.oregon.gov/DAS/Procurement/Pages/ hb3060.aspx for additional information and sample policy template.
7. Proposer complies with ORS 652.220 and does not unlawfully discriminate against any of its employees in the payment of wages or other compensation for work of comparable character based on an employee’s membership in a protected class. “Protected class” means a group of persons distinguished by race, color, religion, sex, sexual orientation, national origin, marital status, veteran status, disability or age.
https://www.oregon.gov/DAS/Procurement/Pages/hb3060.aspx
DAS Procurement Services, Version 4.0 – December 21, 2018 Page 2 of 2
Proposer's continuing compliance, if awarded a Price Agreement, constitutes a material element of the Price Agreement and a failure to comply constitutes a breach entitling Agency to terminate the Price Agreement for cause.
Proposer, if awarded a Price Agreement, may not prohibit any of its employees from discussing the employee’s rate of wage, salary, benefits, or other compensation with another employee or another person and may not retaliate against an employee who discusses the employee’s rate of wage, salary, benefits, or other compensation with another employee or another person.
8. Proposer is not engaged in the provision of broadband Internet access service, or , if at any time, is engaged in, or may engage in, the provision of broadband Internet access service which is in compliance with Oregon Laws 2018, Chapter 88 (HB 4155) and applicable Public Utility Commission rules and will remain in compliance throughout the term of the Price Agreement.
9. Proposer and its employees, agents, and subcontractors are not included in:
A. the “Specially Designated Nationals and Blocked Persons” list maintained by the Office of Foreign Assets Control of the United States Department of the Treasury found at:
https://www.treasury.gov/ofac/downloads/sdnlist.pdf., or
B. the government wide exclusions lists in the System for Award Management found at:
https://www.sam.gov/portal/
10. Proposer certifies, to the best of its knowledge, there exists no actual or potential conflict between the business or economic interests of proposer, its employees, or its agents, on the one hand, and the business or economic interests of the State, on the other hand, arising out of, or relating in any way to, the subject matter of the RFP. If any changes occur with respect to proposer's status regarding conflict of interest, they shall promptly notify the State in writing.
11. Proposer certifies all contents of the proposal (including any other forms or documentation, if required under this RFP) and data requested in this form are truthful and accurate and have been prepared independently from all other proposers without collusion, fraud, or other dishonesty.
12. Proposer understands any statement or representation it makes, in response to this RFP, if determined to be false, fraudulent, misrepresented, or inaccurate because of the omission of material information could result in a "claim" {as defined by the Oregon False Claims Act, ORS 180.750(1)}, made under Price Agreement being a "false claim" {ORS 180.750(2)} subject to the Oregon False Claims Act, ORS 180.750 to 180.785, and to any liabilities or penalties associated with the making of a false claim under that Act.
13. Proposer acknowledges these certifications are in addition to any certifications required in the Price Agreement and Statement of Work in Attachment A at the time of Price Agreement execution.
Authorized Signature Date
Printed Name https://www.treasury.gov/ofac/downloads/sdnlist.pdf https://www.sam.gov/portal/
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