RFP(SOQ) Hoquiam M&O Fillable Forms.docx

APPENDIX A – PROPOSAL SUBMITTAL DOCUMENTS

Instructions: The following documents constitute the required SOQ Submittal. Failure to submit all the required documents along with their Proposal may cause a Submittal to be non-responsive. Proposers are advised to read all portions of the Contract documents carefully and to comply with all requirements therein.

Below low is a checklist of the proposal packet in order for your convenience. DO NOT SUBMIT with the proposal packet.

☐Cover Letter (1-page limit) ☐Statement of Qualifications (12-page limit) ☐Proposer(s) Acknowledgements (Appendix 6.1, 1-page limit) ☐Proposer(s) Information (Appendix 6.2, 2-page limit) ☐Subconsultant(s) Information (Appendix 6.3, 1 original page plus upto 3 additional pages in the original format) ☐References (Appendix 6.4, 1-page limit) ☐Certification Regarding Conflict of Interest (1-page limit)

The Appendices are provided in fillable Word format.

Your organization may choose how to complete these forms and add them to the packet, such as

· Separating the pages, saving as a pdf, and sign electronically

· Print, sign, and scan into the Proposal packet.

Formatting and page limits affect the pass/fail criteria.

PROPOSER ACKNOWLEDGEMENTS

Hoquiam M&O A&E Environmental and PS&E – RFQ # GHT-2025-001 Issued by Grays Harbor Transportation Authority, Grays Harbor County WA Having carefully examined all requirements and terms and conditions identified in this Request for Qualifications (RFQ), the undersigned, declares that I/we have examined all of the solicitation documents and that I/we will Contract with Grays Harbor Transportation Authority (GHTA) to do everything necessary for fulfillment of RFQ # GHT-2025-001 A&E Environmental and PS&E and the resulting Contract, at the prices and on the terms and conditions contained herein.

I/We certify, under penalty of perjury, that this is not a sham or collusive Proposal, nor made in the interest or on behalf of any person not herein named. I/We have not directly or indirectly induced or solicited any Proposer(s) on the above work, or suppliers to put in a sham Proposal, nor any other person or corporation to refrain from Proposing. I/We have not in any manner sought by collusion to secure advantage over any other Proposer(s)s.

I/We agree that our Proposal constitutes an offer to GHTA, which shall be binding for sixty (60) Calendar Days from the Proposal due date. If our Proposal is accepted, we agree to sign the Contract form and furnish evidences of insurance required herein within ten (10) Business Days after receipt from GHTA of written notice of award of Contract.

I/We certify that we are, at the time of submitting this Proposal and shall remain throughout the period of the Contract, registered, and licensed by the state of Washington to perform the type of work required under the procurement. We further certify that we are skilled and regularly engaged in the general class and type of work called for in procurement.

I/We further agree, if our Proposal is accepted and a Contract is awarded by GHTA, to plan and prosecute the work with such diligence that the work and portions thereof shall be completed and ready for use within the period set forth.

I/We acknowledge receipt of addenda numbers 1 through ?? (enter the number of Addenda from the procurement website) and have been considered as part of our Proposal. The following information is accurate to the best of our knowledge. Any required documentation has been attached separately. I/We understand that failure to complete this form in its entirety may deem our Proposal “Non‐Responsive”.

The signatory below represents that he/she has the GHTA to bind the company named below to the Proposal submitted and any Contract awarded as a result of this Solicitation. The authorized signatory acknowledges having read and understood the entire Solicitation and agrees to comply with the terms and conditions of the Solicitation in submitting and fulfilling the offer made in its Proposal.

By submitting this Proposal, Proposer hereby offers to furnish materials, supplies, services and/or equipment in compliance with all terms, conditions, and specifications contained in this Solicitation.

I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct:

Proposer(s) Signature

Company Name

Print Name and Title

Location Executed (City/State) Date

End of Form

PROPOSER INFORMATION

Proposer Profile Proposer must provide the following:

Firm Name:

DBA Name (if applicable):

Street Address:

City, State, Zip:

Federal Tax ID Number:

WA State UBI Number:

DUNS (or UEI) Number:

Proposer Authorized Representative Proposer must designate an Authorized Representative who will be the principal point of contact for the Procurement Coordinator for the duration of the RFQ process. Proposers’ Authorized Representative will serve as the focal point for business matters and administrative activities.

Representative Name:

Street Address:

City, State, Zip:

Telephone Number:

Email Address:

Proprietary or Confidential Information Proposer must indicate any pages and/or sections of their Response that Proposer desires to claim as proprietary and exempt from disclosure under the provisions of Chapter 42.56 RCW below. Indicate the pages of the Proposers’ Response that have been marked “Confidential” and the particular exception from disclosure upon which the Proposer is making the claim below. Please see the Solicitation Standards document for more detail on Proprietary or Confidential Information as it relates to this Solicitation. If not applicable, Proposer(s) is instructed to enter “NA” in the box below.

Statement of Prior Contract Termination Using the space below, Proposer must disclose if the Proposers’ firm and/or proposed Subconsultant(s) have had a Contract terminated for either cause or convenience in the last five (5) years. If a Contract was terminated for cause or convenience during its lifetime, submit full details of the termination including, but not limited to, the reason for the termination, the other party’s contact information (name, address, email address, and telephone number), and the Proposers’ position on the matter. GHTA will evaluate the information and may, at its sole discretion, reject the Response based on the risk to the Agency. If not applicable, Proposer is instructed to enter “NA” in the box below.

End of Form

SUBCONSULTANT(S) INFORMATION

Check the Applicable Box:

Proposer will be required to perform all work under this Contract using his/her own employees carried on payroll or by using Subconsultant(s). Where Subconsultant(s) are used in the performance of the Contract, Proposer will indicate as required with the Response. Service Provider will be held responsible for all work performed or not performed by the Subconsultant(s). Subconsultant(s)will be required to bill through the Proposer. Proposer can make up to 3 copies (4-pages total) of this document and the additional pages count towards the page limit.

If revisions are required in the Subcontract assignment, new parties are to be proposed in advance of assignment, in writing to the Procurement Coordinator.

If applicable, Proposer will identify below all Subconsultant(s) who will perform services in fulfillment of Contract requirements, including their name, the nature of services to be performed, address, telephone number, email address, federal tax identification number (TIN), Federal Unique Entity Identifier (listed with SAM.gov),Washington State Unified Business Identifier (UBI), and DBE or SBE certification status:

Subconsultant 1

Subconsultant 2

Name:

Name:

Services:

Services:

Address:

Address:

Email:

Email:

Federal TIN:

Federal TIN:

Federal UEI:

Federal UEI:

Washington UBI:

Washington UBI:

Subconsultant 3

Subconsultant 4

Name:

Name:

Services:

Services:

Address:

Address:

Email:

Email:

Federal TIN:

Federal TIN:

Federal UEI:

Federal UEI:

Washington UBI:

Washington UBI:

END OF FORM

REFERENCES

Proposer must provide a minimum of three (3) references for which the Proposer has provided services like those described in this Solicitation. References must not be from an individual, company or organization with any special interest, financial or otherwise, to the Proposer.

Reference 1

Reference 2

Org. Name:

Org. Name:

Org Type*:

Org Type*:

Contact Name:

Contact Name:

Job Title:

Job Title:

Street Address:

Street Address:

City, State, Zip:

City, State, Zip:

Telephone:

Telephone:

Email:

Email:

Brief Overview of Project Description:

Brief Overview of Project Description:

Reference 3

Reference 4

Org. Name:

Org. Name:

Org Type*:

Org Type*:

Contact Name:

Contact Name:

Job Title:

Job Title:

Street Address:

Street Address:

City, State, Zip:

City, State, Zip:

Telephone:

Telephone:

Email:

Email:

Brief Overview of Project Description:

Brief Overview of Project Description:

*Type of Organization: Municipality, Public Agency, Transit or Transportation Agency, etc.

CERTIFICATION REGARDING CONFLICT OF INTEREST

The Proposer is required to certify performance of the work will not create any conflicts of interests (RCW 42.23) nor disclose any actual or potential conflicts of interest, including working on or having interest in prior phases of the project, by completing and signing ONE of the two statements below:

The Proposer herby certifies that, to the best of its knowledge and belief, performance of the services described in the Scope of Work will not create any conflicts of interest for the Proposer, any affiliates, any proposed Subconsultant(s) or key personnel of any of these organizations.

Date:

Authorized Signature:

Title:

Company Name:

OR

The Proposer hereby discloses the following circumstances that could give rise to a conflict of interest for the Proposer, any affiliates, any proposed Subconsultant(s) or key personnel of any of these organizations (Attach additional sheets as needed).

Name of Individual or Company to which the potential conflict of interest may apply:

Nature of potential conflict of interest:

Proposed remedy:

Date:

Authorized Signature:

Title:

Company Name:

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