S000000028 IFB Response Packet~2.pdf

BID RESPONSE PACKET

S000000028

BID SIGNATURE PAGE

Type or Print the following information.

PROSPECTIVE CONTRACTOR’S INFORMATION

Company:

Address:

City: State: Zip Code:

Business Designation:

☐ Individual ☐ Sole Proprietorship ☐ Public Service Corp ☐ Partnership ☐ Corporation ☐ Nonprofit

Minority and Women- Owned Designation*:

☐ Not Applicable ☐ American Indian ☐ Service Disabled Veteran ☐ African American ☐ Hispanic American ☐ Women-Owned

☐ Asian American ☐ Pacific Islander American

AR Certification #: ________________ * See Minority and Women-Owned Business Policy

PROSPECTIVE CONTRACTOR CONTACT INFORMATION

Provide contact information to be used for solicitation related matters.

Contact Person: Title:

Phone: Alternate Phone:

Email:

CONFIRMATION OF REDACTED COPY

☐ YES, a redacted copy of submission documents is enclosed.

☐ NO, a redacted copy of submission documents is not enclosed. I understand a full copy of non-redacted submission documents will be released if requested.

Note: If a redacted copy of the submission documents is not provided with Prospective Contractor’s response packet, and neither box is checked, a copy of the non-redacted documents, with the exception of financial data (other than pricing), will be released in response to any request made under the Arkansas Freedom of Information Act (FOIA). See Solicitation Terms and Conditions for additional information.

ILLEGAL IMMIGRANT CONFIRMATION

By signing and submitting a response to this Solicitation, Prospective Contractor agrees and certifies that they do not employ or contract with illegal immigrants and shall not employ or contract with illegal immigrants during the term of a contract awarded as a result of this solicitation.

ISRAEL BOYCOTT RESTRICTION CONFIRMATION

By checking the box below, Prospective Contractor agrees and certifies that they do not boycott Israel and shall not boycott Israel during the term of a contract awarded as a result of this solicitation.

☐ Prospective Contractor does not and shall not boycott Israel.

An official authorized to bind the Prospective Contractor to a resultant contract shall sign below.

The signature below signifies agreement that any exception that conflicts with a Requirement of this Solicitation may cause the Prospective Contractor’s proposal to be rejected.

Authorized Signature: _________________________________ Title: ____________________________

Printed/Typed Name: _________________________________ Date:____________________________

SUBMISSION REQUIREMENTS CHECKLIST

The following items must be submitted with the Prospective Contractor’s bid response:

� Bid Signature Page

� Proposed Subcontractors Form

� Exceptions Form, if applicable

� Completed Pricing Response

The following items, which must be submitted prior to a contract award to the Prospective Contractor, may also be included with the Prospective Contractor’s bid response:

� EO 98-04: Contract and Grant Disclosure Form

� Copy of Prospective Contractor’s Equal Opportunity Policy

The following should be included in the Prospective Contractor’s bid response:

� Signed addenda, if applicable

PROPOSED SUBCONTRACTORS FORM

• Do not include additional information relating to subcontractors on this form or as an attachment to this form.

PROSPECTIVE CONTRACTOR PROPOSES TO USE THE FOLLOWING SUBCONTRACTOR(S)

TO PROVIDE SERVICES.

Type or Print the following information

Subcontractor’s Company Name Street Address City, State, ZIP

☐ PROSPECTIVE CONTRACTOR DOES NOT PROPOSE TO USE

SUBCONTRACTORS TO PERFORM SERVICES.

EXCEPTIONS FORM

Prospective Contractor shall document all exceptions related to requirements in the Solicitation and terms in the “Standard Commodities Contract” and “Solicitation Terms and Conditions” located on the TSS OSP website. See Sections

2.4 and 2.5 of the Solicitation.

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