S-44300-00017510 Attachment B Bid Cover Sheet.pdf
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- Solicitation number
- S-44300-00017510
- Issued by
- Oregon
About this file
This is a Bid Cover Sheet for Invitation to Bid S-44300-00017510 issued by the State of Oregon, acting through its Oregon Health Authority at Oregon State Hospital, for the procurement of various sized non-ligature shower curtains. The ITB seeks bids for multiple quantities of non-ligature shower curtains in different sizes to meet the facility's operational needs. The cover sheet serves as the formal submission document that bidders must complete and submit with their proposals, establishing the bidder's identity, authorized representative information, and acknowledgment of bid terms and conditions.
The bid cover sheet requires bidders to certify their understanding of the solicitation requirements, confirm receipt of all addenda, and provide attestation regarding their eligibility and compliance with applicable state and local regulations. This document functions as the administrative vehicle for bid submission, ensuring that all proposals are submitted in a uniform format and that bidders acknowledge the specifications, delivery requirements, and evaluation criteria outlined in the ITB. The cover sheet is a standard procurement document that facilitates the organized receipt and processing of competitive bids for the non-ligature shower curtain requirements.
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Attachment B S-44300-00017510
ATTACHMENT B
BID COVER SHEET
Bidder Name (printed):
Address: City, State, Zip:
Bid Clarification Contact Person: Telephone:
Email:
State of Incorporation: Entity Type:
Oregon Secretary of State Business Registry Number (if required):
The undersigned, as Bidder’s authorized representative, certifies that:
1. Bidder understands and accepts the requirements of this ITB. Bidder acknowledges receipt of any and all Amendments to this ITB.
2. By submitting a Bid, Bidder agrees to be bound by the Price Agreement terms and conditions in Attachment A, as modified by Amendment, if any.
3. The costs set forth in Attachment D are firm for 90 Calendar Days after the Opening.
4. Bidder has no undisclosed liquidated and delinquent debt owed to the State or any agency, board, commission, department of division of the State.
5. Bidder complies with and is not in violation of any tax laws of the state or a political subdivision of the state, including, without limitation taxes referenced in ORS 305.380(4), ORS 305.620 and ORS chapters 316, 317 and 318.
6. Bidder does not discriminate in its employment practices with regard to 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 veteran owned business, or an emerging small business. If applicable, Bidder has, or will have prior to Price Agreement execution, a written policy and practice, that meets the requirements described in ORS 279A.112, of preventing sexual harassment, sexual assault and discrimination against employees who are members of a protected class. Agency may not enter into a Price Agreement with an anticipated price of $150,000 or more with a Bidder 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. Bidder and Bidder’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.oregon.gov/DAS/Procurement/Pages/hb3060.aspx
Attachment B S-44300-00017510 https://www.treasury.gov/ofac/downloads/sdnlist.pdf, or B. the government wide exclusions list in the System for Award Management found at:
https://www.sam.gov/
8. Bidder certifies to the best of its knowledge, there exists no actual or potential conflict between the business or economic interests of Bidder, 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 ITB. If any changes occur with respect to Bidder’s status regarding conflict of interest, Bidder shall promptly notify the State in writing.
9. Bidder certifies all contents of the Bid (including any other forms or documentation, if required under this ITB), and this Bid Cover Sheet are truthful and accurate and have been prepared independently from all other Bidders, and without collusion, fraud, or other dishonesty.
10. Bidder understands any statement or representation made in response to this ITB, 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 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.
11. Bidder acknowledges these certifications are in addition to any certifications required in the Price Agreement at the time of execution.
12. If Bidder is an Oregon benefit company, Bidder certifies that the majority of the benefit company’s regular, full-time workforce is located in Oregon.
BIDDER, Authorized Representative
Signature: _______________________________________________________________________
Print Name and Title: _______________________________________________________________
Date: ____________
Email: ________________________
Telephone Number: (______) _________ https://www.treasury.gov/ofac/downloads/sdnlist.pdf https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.sam.gov%2F&data=05%7C02%7CSandy.CLAVET-CONNOLLY%40das.oregon.gov%7C20d5c1c77a734944e43b08dd9723da80%7Caa3f6932fa7c47b4a0cea598cad161cf%7C0%7C0%7C638832902425383725%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=cEouPD556UvLKXydEeigOs5c2CFHproRy4Ils69Lgl0%3D&reserved=0
| 1. Bidder understands and accepts the requirements of this ITB. Bidder acknowledges receipt of any and all Amendments to this ITB. |
| 2. By submitting a Bid, Bidder agrees to be bound by the Price Agreement terms and conditions in Attachment A, as modified by Amendment, if any. |
| 3. The costs set forth in Attachment D are firm for 90 Calendar Days after the Opening. |
| 4. Bidder has no undisclosed liquidated and delinquent debt owed to the State or any agency, board, commission, department of division of the State. |
| 5. Bidder complies with and is not in violation of any tax laws of the state or a political subdivision of the state, including, without limitation taxes referenced in ORS 305.380(4), ORS 305.620 and ORS chapters 316, 317 and 318. |
| 6. Bidder does not discriminate in its employment practices with regard to race, creed, age, religious affiliation, gender, disability, sexual orientation, national origin. When awarding subcontracts, Bidder does not discriminate against any business ... |
| 7. Bidder and Bidder’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 list in the System for Award Management found at: https://www.sam.gov/ |
| 8. Bidder certifies to the best of its knowledge, there exists no actual or potential conflict between the business or economic interests of Bidder, its employees, or its agents, on the one hand, and the business or economic interests of the State, on... |
| 9. Bidder certifies all contents of the Bid (including any other forms or documentation, if required under this ITB), and this Bid Cover Sheet are truthful and accurate and have been prepared independently from all other Bidders, and without collusion... |
| 10. Bidder understands any statement or representation made in response to this ITB, 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 t... |
| 11. Bidder acknowledges these certifications are in addition to any certifications required in the Price Agreement at the time of execution. |
| 12. If Bidder is an Oregon benefit company, Bidder certifies that the majority of the benefit company’s regular, full-time workforce is located in Oregon. |
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