RFP159505 Required Documents.pdf

Administrative Services/ Procurement

RFP #159505

Title: LPW Conference Registration Services

ATTACHMENT A

OFFEROR'S DATA SHEET

1. QUALIFICATIONS OF OFFEROR: The Offeror must have the capability and capacity in all respects to fully satisfy all of the contractual requirements.

2. YEARS IN BUSINESS: Indicate the length of time you have been in business providing this type of service.

_______ Years ______ Months

3. REFERENCES: Indicate either below or by attachment a listing of at least three (3) clients that your firm has provided the products and/or services described in the proposal. Include the dates service was furnished, and the name, address, email address, telephone and fax number of the person the purchasing agency has your permission to contact. A narrative statement should be provided for each reference, describing the scope, size and type of service provided to each reference. Please verify that the contact persons whom you have listed below are still employed with these firms prior to submitting their names.

4. Is your firm currently registered as an eVA vendor? __No ___Yes Registration is a requirement to receive an award.

5. Is your firm a faith-based organization? ___No ____Yes

CLIENT'S NAME AND

ADDRESS

BEGIN &

END DATES

OF SERVICE

NARRATIVE STATEMENT PERSON TO

CONTACT AND

TELEPHONE, FAX

NUMBER AND

EMAIL

Administrative Services/ Procurement

RFP #159505

Title: LPW Conference Registration Services

ATTACHMENT B

PROPRIETARY/CONFIDENTIAL INFORMATION

SUMMARY FORM

SECTION/TITLE PAGE

NUMBER(S)

REASON(S) FOR WITHHOLDING FROM

DISCLOSURE

*Identify the reason for withholding from disclosure in accordance with the Code of Virginia § 2.2-4342F.

Administrative Services/Procurement-Attachment C

State Corporation Commission Form

Failure to complete and return this attachment may result in your bid being deemed NON-RESPONSIVE.

IFB #:

Virginia State Corporation Commission (SCC) registration information.

The bidder:

is a corporation or other business entity with the following SCC identification number: ____________

-OR-

is not a corporation, limited liability company, limited partnership, registered limited liability partnership, or business trust -OR-is an out-of-state business entity that does not regularly and continuously maintain as part of its ordinary and customary business any employees, agents, offices, facilities, or inventories in Virginia (not counting any employees or agents in Virginia who merely solicit orders that require acceptance outside Virginia before they become contracts, and not counting any incidental presence of the bidder in Virginia that is needed in order to assemble, maintain, and repair goods in accordance with the contracts by which such goods were sold and shipped into Virginia from bidder’s out-of-state location) -OR-is an out-of-state business entity that is including with this bid an opinion of legal counsel which accurately and completely discloses the undersigned bidder’s current contacts with Virginia and describes why those contacts do not constitute the transaction of business in Virginia within the meaning of § 13.1-757 or other similar provisions in Titles

13.1 or 50 of the Code of Virginia.

**NOTE** >> Check the following box if you have not completed any of the foregoing options but currently have pending before the SCC an application for authority to transact business in the Commonwealth of Virginia and wish to be considered for a waiver to allow you to submit the SCC identification number after the due date for bids (the Commonwealth reserves the right to determine in its sole discretion whether to allow such waiver):

Administrative Services/Procurement

RFP 159505

LPW Conference Registration Services

FIRM (OR INDIVIDUAL’S)

NAME & ADDRESS

CONTACT PERSON AND

PHONE NUMBER

TYPE OF WORK TO BE

PERFORMED

TYPE OF EQUIPMENT PROPOSED SUBCONTRACTOR WILL PROVIDE

QUALIFICATIONS / EXPERIENCE LEVEL OF PROPOSED SUBCONTRACTOR

Please Indicate which above proposed subcontractors are certified (with DMBE) as Small, Women Owned or Minority Businesses.

Certification Number(s):

FOR VDOT USE ONLY:

The proposed subcontractor(s) listed above is/are approved and accepted under the terms and conditions of the contract requirements herein.

Signature of Authorized VDOT Representative Date Telephone Number

ATTACHMENT D

SUBCONTRACTOR APPROVAL REQUEST

No portion of the work (including equipment) shall be subcontracted to another firm or individual without prior written consent of Virginia Department of Transportation (herein referred to as VDOT). In the event that the Contractor desires to subcontract some part of the work specified herein, the Contractor shall furnish VDOT with the names, qualifications, and experience of their proposed subcontractors for agency approval. The primary contractor shall, however, remain fully liable and responsible for the work performed by its subcontractor(s) and shall assure compliance with all requirements of the contract. No subcontractor will be allowed to start work until VDOT has received a copy of the subcontractor’s Certificate of Insurance with the appropriate liability coverage. Certificate of Insurance should be sent to: Virginia Department of Transportation; 1401

East Broad Street; Richmond, Virginia 23219.

List proposed subcontractor(s), including name, address, contact person, and type of work to be performed under this contract below.

Administrative Services/Procurement

Local Assistance Division

LPW Conference Registration Services

RFP#159505

ATTACHMENT E

PRICING SCHEDULE

A. REGISTRATION

Registration

Services Fee

Per Person

Appx. # of

Registrations by

Type

Total

Speaker/Staff Registration X 150= $

Local Public Agency Registration

X 220= $

Private Sector Registration X 220= $

Sponsorship Registration X 45= $

Misc. Fees Extended Total $