S63500 00010581 RFP Attachments B-F.pdf

RFP S-63500-00010581 – Riverside Wildlife Area Property Boundary Survey - Phase 1

ATTACHMENT B — PROPOSER INFORMATION AND

CERTIFICATION FORM

Legal Name of Proposer: _______________________________________________________

Address: ________________________________________________________ City, State, Zip: _______________________________________

State of Incorporation: _______________________________________________ Entity Type: _________________________________

Contact Name: _________________________________________ Telephone: _______________________ Email: ____________________

Oregon Business Registry Number (if required): __________________________________________________________

Certifications: Any individual signing below (the undersigned) 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 Amendments to this RFP.

3. Proposal is a Firm Offer for 90 days following the Proposal Due Date/Time.

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

5. The undersigned has authority and knowledge regarding Consultant’s payment of taxes, and to the best of the undersigned’s knowledge, Consultant is not in violation of any Oregon Tax Laws.

For purposes of this certification, “Oregon Tax Laws” means (i) all tax laws of this state, including but not limited to ORS 305.380(4), ORS 305.620 and ORS chapters 316, 317, and 318; and (ii) any tax provisions imposed by a political subdivision of this state that applied to Consultant, to Consultant’s property, operations, receipts, or income, or to Consultant’s performance of or compensation for any work performed by Consultant; and (iii) any tax provisions imposed by a political subdivision of this state that applied to Contractor, or to goods, services, or property, whether tangible or intangible, provided by Contractor; and (iv) any rules, regulations, charter provisions, or ordinances that implemented or enforced any of the foregoing tax laws or provisions.

6. Proposer does not discriminate in its employment practices with regard to race, color, ethnicity, age, religious affiliation, sex, gender, sexual orientation, disability, marital status, or 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 as defined therein. Contracting 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. For purposes of this section, “Protected class” means a group of persons distinguished by race, color, religion, sex, sexual orientation, national origin, marital status, veteran status, disability or age.

Proposer acknowledges that continuing compliance with this section constitutes a material element of this RFP and any resulting Contract and a failure to comply constitutes a breach that entitles the Contracting Agency to terminate any resulting Contract for cause.

Proposer acknowledges that it may not prohibit any of Proposer’s employees from discussing the employee’s rate of wage, salary, benefits, or other compensation with another employee or another person. Proposer 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 certifies that no officer, agent or employee of the State has a pecuniary interest in this Proposal; that the Proposal is made in good faith without fraud, collusion or connection of any kind with any other Proposer and that the Proposer is competing solely in its own behalf without connection with, or obligation to, any undisclosed person or firm.

9. Proposer understands that any statement or representation contained in or attached to its Proposal, and any statement, representation, or application the Proposer may submit under any contract Contracting Agency may award under this RFP, that constitutes a “claim” (as defined by the Oregon False Claims Act, ORS 180.750(1)), will be 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.

10. 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.

11. 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/

12. 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 https://www.sam.gov/portal/ 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.

13. Proposer certifies that all contents of its Proposal (including any other forms or documentation, if required under this RFP) and this Proposal Certification Sheet are truthful and accurate and have been prepared independently from all other Proposers, and without collusion, fraud, or other dishonesty.

14. Proper acknowledges that, at Contracting Agency’s request, Proposer shall provide all necessary information to allow background checks (“Criminal Records Checks” also referred to as “CRCs” and individually as a “CRC”) and screening of each employee or Sub-consultant employee before that employee will be allowed unescorted access to Contracting Agency’s premises or be authorized to perform any Services under any resulting Contract to this RFP. Proposer acknowledges it must require each Consultant or Sub-consultant employee to complete the security clearance background request forms and submit these completed forms by mail, common carrier or hand carry to the Owner for screening. Proposer shall not submit completed CRC forms by email or other electronically transmitting means.

15. Proposer acknowledges these certifications are in addition to any certifications required in the Contract and Statement of Work (RFP Attachment A) at the time of Contract execution.

Authorized Signature________________________________

Printed Name and Title_______________________________

Date________________________________________

S-63500-00010581 - Riverside Wildlife Area Property Boundary Survey - Phase 1

DAS Procurement Services Page 1 of 2

ATTACHMENT D –CERTIFIED DISADVANTAGED BUSINESS

FORM AND OUTREACH PLAN

Proposer: Date:

Contact Name: Telephone: Email:

“Certified Firm” means a small business certified under ORS 200.055 by the Oregon Certification Office for Business Inclusion and Diversity (COBID) as minority-owned businesses, woman-owned businesses, businesses that service-disabled veterans owned, and emerging small businesses.

Certified Firms must have an equal opportunity to participate in the performance of contracts financed with state funds. By submitting its Proposal, Proposer certifies that it has taken, and if there are further opportunities, will take reasonable steps to ensure that Certified Firms are provided an equal opportunity to compete for and participate in the performance of any subcontracts resulting from this procurement.

The information submitted in response to this clause will not be considered in any scored evaluation.

1. Is Proposer an Oregon certified firm? Yes No

If yes, indicate all certification type(s): DBE MBE WBE SDV ESB and supply

Oregon State Certification Number: __________________________

2. Include a list of Certified Firms that Proposer has had a contractual relationship with within the last two years.

3. Include a list of firms that Proposer has had a contractual relationship with within the last two years that are not Certified Firms but may be minority-owned, woman-owned, service-disabled veteran-owned or emerging small businesses.

4. Does Proposer foresee any subcontracting opportunities for this procurement? Yes No

If no, do not complete the rest of this form and submit this first page with your Offer.

If yes, please complete the following pages and submit all pages with your Offer.

S-63500-00010581 - Riverside Wildlife Area Property Boundary Survey - Phase 1

DAS Procurement Services Page 2 of 2

CERTIFIED DISADVANTAGED BUSINESS OUTREACH PLAN

5. Describe the steps Proposer will take to solicit Certified Firms for subcontracting opportunities if awarded a contract from this procurement.

6. Describe the subcontracting opportunities and the approximate dollar value of each that may be available, if awarded a Contract.

7. Would Proposer be willing to report the identity of each subcontractor and the value of each subcontract to COBID if awarded a Contract from this procurement?

ATTACHMENT E- RESPONSIBILITY INQUIRY

Contracting Agency will determine responsibility of a Proposer prior to award and execution of a Contract. In addition to this form, Contracting Agency may notify Proposer of other documentation required, which may include but is not limited to recent profit-and-loss history, current balance statements and cash flow information, assets-to-liabilities ratio, including number and amount of secured versus unsecured creditor claims, availability of short and long-term financing, bonding capacity, insurability, credit information, materials and equipment, facility capabilities, personnel information, record of performance under previous contracts, etc. Failure to promptly provide requested information or clearly demonstrate responsibility may result in Contracting Agency finding of non-responsibility and rejection.

1. Does Proposer have available the appropriate financial, material, equipment, facility and personnel resources and expertise, or ability to obtain the resources and expertise, necessary to demonstrate the capability of Proposer to meet all contractual responsibilities? YES / NO .

2. Within the last five years, how many contracts of a similar nature has Proposer completed that, to the extent that the costs associated with and time available to perform the contract remained within Proposer′s control, Proposer stayed within the time and budget allotted, and there were no contract claims by any party? Number: ____

How many contracts did not meet those standards? Number: ____ If any, please explain.

Response:

3. Within the last three years has Proposer (incl. a partner or shareholder owning 10% or more of Proposer’s firm) or a major subcontractor (receiving 10% or more of a total contract amount) been criminally or civilly charged, indicted or convicted in connection with:

• obtaining, attempting to obtain, or performing a public (Federal, state, or local) contract or subcontract,

• violation of federal or state antitrust statutes relating to the submission of bids or Proposals, or

• embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, or receiving stolen property? YES / NO .

If "YES," indicate the jurisdiction, date of indictment, charge or judgment, and names and summary of charges in the response field below.

Response:

4. Within the last three years, has Proposer had:

• any contracts terminated for default by any government agency, or

• any lawsuits filed against it by creditors or involving contract disputes? YES / NO .

If "YES," please explain. (With regard to judgments, include jurisdiction and date of final judgment or dismissal.)

Response:

5. Does Proposer have any outstanding or pending judgments against it? YES / NO .

Is Proposer experiencing financial distress or having difficulty securing financing? YES / NO .

Does Proposer have sufficient cash flow to fund day-to-day operations throughout the proposed contract period? YES / NO

If "YES” on the first question or second question, or “NO” on the third question, please provide additional details.

Response:

6. Within the last three years, has Proposer filed a bankruptcy action, filed for reorganization, made a general assignment of assets for the benefit of creditors, or had an action for insolvency instituted against it? YES / NO .

If "YES," indicate the filing dates, jurisdictions, type of action, ultimate resolution, and dates of judgment or dismissal, if applicable.

Response:

7. Does Proposer have all required licenses, insurance and/or registrations, if any, and is Proposer legally authorized to do business in the State of Oregon? YES /NO .

If "NO," please explain.

Response:

8. Pay Equity Certificate. This certificate is required if Proposer employs 50 or more full-time workers and the prospective contract price is estimated to exceed $500,000. Does a current authorized representative of Proposer possess an unexpired Pay Equity Certificate issued by the Department of Administrative Services? YES / NO / N/A . [If the certificate was provided with the Bid or Proposal submitted for a solicitation related to the prospective contract, then it is not necessary to resubmit it. Just indicate “see Bid” or “see Proposal” in the response field. Otherwise, if applicable, submit a copy of the certificate with this form.]

Response:

9. Does Proposer have documented diversity, equity and inclusion values and practices as required pursuant to Executive Order 22-15? YES /NO .

Response:

10. REFERENCES: Provide three references from current or former clients within the last five years:

1.) Reference

a. Reference Entity:

b. Reference Contact Name:

c. Contact Telephone Number:

d. Contact Email:

e. Project Title:

2.) Reference

a. Reference Entity:

b. Reference Contact Name:

c. Contact Telephone Number:

d. Contact Email:

e. Project Title:

3.) Reference

a. Reference Entity

b. Reference Contact Name:

c. Contact Telephone Number:

d. Contact Email:

e. Project Title:

AUTHORIZED SIGNATURE

By signature below, the undersigned Authorized Representative on behalf of Proposer certifies to the best of his or her knowledge and belief that the responses provided on this form are complete, accurate, and not misleading.

Proposer Name: RFP:

Project Name:

Authorized Signature Date

Print Name Title

ATTACHMENT F –REFERENCE QUESTIONNAIRE

RFP# S- RFP S-63500-00010581 – Riverside Wildlife Area Property Boundary Survey - Phase 1 Reference requested for: (Proposer’s Company Name)

Consultants, please complete the blue highlighted areas and then delete this drafter’s note.

As part of a Request for Proposal Solicitation to provide surveying and mapping services, the (Oregon Department of Fish and Wildlife) has requested reference checks on the company named above. Please return your responses to (Name and email address or physical address) by (July 2, 2024). These references will be scored, so your response is important to the Consultant’s final evaluation score.

• For what type of services did you engage Proposer?

• Describe the services listed in response to question 1.

• With which aspect(s) of Proposer’s services are you the most satisfied?

• With which aspect(s) of Proposer’s services are you the least satisfied?

• How well did Proposer coordinate/communicate with its staff, subcontractors, client staff, and other stakeholders?

• How would you rate the quality of the Proposer’s draft and/or final deliverables?

• How well did Proposer perform on meeting schedule requirements?

• How would you rate your overall experience with the Proposer?

Any other comments?

Reference provided by: ________________________________________________________________________________________________

Representing:

Email address: Phone: