RFPAttC - PROPOSER INFORMATION AND CERTIFICATION SHEET~4.doc

RFP 6192: Reverse Osmosis Point of Use Water Treatment Installation and Maintenance AttC (OregonBuys Bid # S-44300-00015159)

ATTACHMENT C — PROPOSER INFORMATION

AND CERTIFICATION SHEET

Legal Name of Proposer:

Address:

City, State, Zip:

Entity Type:

State of Incorporation:

Contact Name:

Telephone:

Email:

Oregon Business Registry Number (if required):

(Check one box): NO YES Comment, if applicable:

Any individual signing below hereby certifies they are an authorized representative of Proposer and that:

1. Proposer understands and accepts the requirements of this RFP. By submitting a Proposal, Proposer agrees to be bound by the Contract terms and conditions in Attachment A and as modified by any Addenda, except for those terms and conditions that Agency has reserved for negotiation, as identified in the RFP.

2. Proposer acknowledges receipt of any and all Addenda to this RFP.

3. Proposal is a Firm Offer for 180 days following the Closing.

4. If awarded a Contract, Proposer agrees to perform the scope of work and meet the performance standards set forth in the final negotiated scope of work of the Contract.

5. I have knowledge regarding Proposer’s payment of taxes and by signing below I hereby certify that, to the best of my knowledge, Proposer 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 with regard to race, creed, age, religious affiliation, gender, disability, sexual orientation, national origin. When awarding subcontracts, Proposer 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, that meets 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. Agency may not enter into a contract with an anticipated contract price of $150,000 or more with a 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 Proposer’s employees in the payment of wages or other compensation for work of comparable character on the basis of 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.

Contractor’s continuing compliance constitutes a material element of this Contract and a failure to comply constitutes a breach that entitles Agency to terminate this Contract for cause.

Contractor may not prohibit any of Contractor’s employees from discussing the employee’s rate of wage, salary, benefits, or other compensation with another employee or another person. Contractor 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 Proposer is engaged in or may engage in the provision of broadband Internet access service Proposer 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 Contract.

9. Proposer and Proposer’s employees, agents, and subcontractors are not included on:

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 that, 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, Proposer shall promptly notify the State in writing.

11. Proposer certifies that all contents of the Proposal (including any other forms or documentation, if required under this RFP) and this Proposal Certification Sheet , including the attached ATTACHMENTS C-1 and C-2 listed in Note below* are truthful and accurate and have been prepared independently from all other Proposers, and without collusion, fraud, or other dishonesty.

12. Proposer understands that any statement or representation it makes, in response to this RFP, if determined to be false or fraudulent, a misrepresentation, 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 Contract 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 Contract and Statement of Work in Attachment A at the time of Contract execution.

Authorized Signature

Date

*Note: the following attachments must be completed by Proposer and attached to this Attachment C:

· Attachment C-1 - Proposer’s Minimum QualificationS Statement; and

· Attachment C-2 - Proposer’s Responses to all Section 3.3.2.1 – 3.3.2.4 Requirements re: Key Persons’ Qualifications and Experience

AttACHMENT C-1:

PROPOSER’S Minimum Qualifications Statement

3.1 MINIMUM QUALIFICATIONS

To be considered for evaluation, Proposer must certify in the Attachment C-1 - Minimum Qualifications Statement attached to Attachment C - Proposer Information and Certification Sheet, as supported by Key Person resumes required by Section 3.3.2, that Proposer’s Key Persons(s) meet(s) all of the following requirements.

Note: if a Proposer submits multiple Key Persons and only some of those Key Persons meet the above minimum qualifications, OHA reserves the right to reject the non-qualified Key Persons, if OHA awards a Contract to that Proposer.

3.1.1 At least one of Proposer’s Key Persons must be a currently licensed plumber or water treatment specialist having an active license with the Oregon Construction Contractors Board – Building Code Division and have provided plumbing or water treatment services for a minimum of 5 years;

Instructions to Proposers: State how the above requirement is met by one or more of Proposer’s Key Persons the space provided below.

Proposer response re: Section 3.1.1:

3.1.2 At least one of Proposer’s Key Persons must have language proficiency in Spanish.

This requirement can be met by:

(a) demonstrating that one of Proposer’s Key Persons has a minimum of 18 months’ previous work experience in translation and interpretation in Spanish; or

(b) Proposer’s certification in Attachment C-1 that Proposer will hire a Key Person having the qualifications stated in Section 3.1.2 (a) prior to OHA’s execution of a Contract with Proposer.

Instructions to Proposers: State how the above requirement is met by one or more of Proposer’s Key Persons the space provided below.

Proposer response re: Section 3.1.2:

3.1.3 Each of Proposer’s Key Persons who will use a vehicle to travel to Participants’ residences to perform Services detailed in Section 2.4 Scope of Work must have a current Oregon driver’s license.

Instructions to Proposers: State how the above requirement is met by one or more of Proposer’s Key Persons the space provided below.

Proposer response re: Section 3.1.3:

AttACHMENT C-2:

PROPOSER’S Responses to all Section 3.3.2.1 – 3.3.2.4 Requirements re: Key Persons’ Qualifications and Experience

3.3.2.1 Specify Key Persons to be assigned to this project, and each Key Person’s responsibilities and roles. If Proposers must hire new staff or subcontractors to perform the Work , Proposers must state its intention to do so within 30 days of Contract execution.

Instructions to Proposer: respond to the above requirement in the space provided below.

Proposer response re: Section 3.3.2.1:

3.3.2.2 Include a statement indicating the length of time the Proposer has been licensed through the State of Oregon Construction Contractor’s Board and confirming that Proposer has operated continuously in the state of Oregon for no fewer than 5 years until the present.

Instructions to Proposer: respond to the above requirement in the space provided below.

Proposer response re: Section 3.3.2.2:

3.3.2.3 Include a current resume (not to exceed two pages each) for each Key Person to be assigned to the project that demonstrates the person’s qualifications and experience for the Work described in this RFP, including but not limited to experience in providing services, similar to the work described in Section 2.4 Scope of Work.

Instructions to Proposer: submit your Key Person resumes as attachments to this document.

3.3.2.4 Describe the qualifications and experience level of each Key Person, including the project manager, supervisors responsible for daily operations, site supervisors and field staff, and describe all Key Persons’ Spanish language proficiency qualifications, as applicable.

Instructions to Proposer: respond to the above requirement in the space provided below.

Proposer response re: Section 3.3.2.4:

� See Definition of Key Person from Section 2.2 above:�

Key Personnel or Key Persons means the person or persons on Proposer’s staff to be assigned to perform the Work under the Contract, including any proposed subcontractors. For Key Persons not identified prior to Proposal submission, a position description must be submitted.

COMMENTS \* FirstCap \* MERGEFORMAT DAS Procurement Services, Version 4.0 – December 21, 2018