RFP #S-63500-00012301- 2025 Aerial Sage-Grouse LEK Surveys Att B

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ATTACHMENT B — DISCLOSURE EXEMPTION AFFIDAVIT

____________________ (Affiant), being first duly sworn under oath, and representing [insert Offeror Name] (hereafter “Offeror”), hereby deposes and swears or affirms under penalty of perjury that:

1. I am an employee of the Offeror, I have knowledge of the Intermediate Procurement referenced herein, and I have full authority from the Offeror to submit this affidavit and accept the responsibilities stated herein.

2. I am aware that the Offeror has submitted an Offer, dated on or about [insert date] (the “Offer”), to the State of Oregon (State) in response to Intermediate Procurement [insert Oregon Buys Bid #], for [insert description of Intermediate Procurement], and I am familiar with the contents of the Intermediate Procurement and Offer.

3. I have read and am familiar with the provisions of Oregon’s Public Records Law, Oregon Revised Statutes (“ORS”) 192.311 through 192.478, and the Uniform Trade Secrets Act as adopted by the State of Oregon, which is set forth in ORS 646.461 through ORS 646.475. I understand that the Offer is a public record held by a public body and is subject to disclosure under the Oregon Public Records Law unless specifically exempt from disclosure under that law.

4. I have reviewed the information contained in the Offer. The Offeror believes the information listed in Exhibit A is exempt from public disclosure (collectively, the “Exempt Information”), which is incorporated herein by this reference. It is my opinion that the Exempt Information is exempt from disclosure under Oregon’s Public Records Law under the specifically designated sections as set forth in Exhibit A or constitutes “Trade Secrets” under either the Oregon Public Records Law or the Uniform Trade Secrets Act as adopted in Oregon because that information is either:

A. A formula, plan, pattern, process, tool, mechanism, compound, procedure, production data, or compilation of information that:

i. is not patented,

ii. is known only to certain individuals within the Offeror’s organization and that is used in a business the Offeror conducts,

iii. has actual or potential commercial value, and

iv. gives its user an opportunity to obtain a business advantage over competitors who do not know or use it.

or

B. Information, including a drawing, cost data, customer list, formula, pattern, compilation, program, device, method, technique or process that:

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i. Derives independent economic value, actual or potential, from not being generally known to the public or to other persons who can obtain economic value from its disclosure or use; and

ii. Is the subject of efforts by the Offeror that are reasonable under the circumstances to maintain its secrecy.

5. I understand that disclosure of the information referenced in Exhibit A may depend on official or judicial determinations made in accordance with the Public Records Law.

Affiant’s Signature

State of ___________)

) ss:

County of ________)

Signed and sworn to before me on ___________ (date) by ______________________ (Affiant’s name).

Notary Public for the State of _________________

My Commission Expires: _________

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EXHIBIT A TO ATTACHMENT B

Offeror identifies the following information as exempt from public disclosure under the following designated exemption(s):

OregonBuys RFP #S-63500-00012301 – 2025 Aerial Sage-Grouse LEK Surveys Title Att C

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ATTACHMENT C — OFFEROR INFORMATION AND

CERTIFICATION SHEET

Legal Name of Offeror:

Address:

City, State, Zip:

State of Incorporation: Entity Type:

Contact Name: Telephone: Email:

Oregon Business Registry Number (if required):

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

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

2. Offeror acknowledges receipt of any and all Amendments to this INTERMEDIATE PROCUREMENT.

3. Offer is a Firm Offer for 180 days following the Opening.

4. If awarded a Contract, Offeror 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 Offeror’s payment of taxes and by signing below. I hereby certify that, to the best of my knowledge, Offeror 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. Offeror does not discriminate in its employment practices with regard to race, creed, age, religious affiliation, gender, disability, sexual orientation, national origin. When awarding subcontracts, Offeror 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 owned or an emerging small business. If applicable, Offeror 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

Offeror 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. Offeror complies with ORS 652.220 and does not unlawfully discriminate against any of Offeror’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.

https://www.oregon.gov/DAS/Procurement/Pages/hb3060.aspx

Title Att C

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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. Offeror is not engaged in the provision of broadband Internet access service, or if at any time Offeror is engaged in or may engage in the provision of broadband Internet access service Offeror 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. Offeror and Offeror’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. Offeror certifies that, to the best of its knowledge, there exists no actual or potential conflict between the business or economic interests of Offeror, 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 INTERMEDIATE PROCUREMENT. If any changes occur with respect to Offeror’s status regarding conflict of interest, Offeror shall promptly notify the State in writing.

11. Offeror certifies that all contents of the Offer (including any other forms or documentation, if required under this INTERMEDIATE PROCUREMENT) and this Offer Certification Sheet are truthful and accurate and have been prepared independently from all other Offerors, and without collusion, fraud, or other dishonesty.

12. Offeror understands that any statement or representation it makes, in response to this INTERMEDIATE

PROCUREMENT, 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. Offeror 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.

14. 15.

Authorized Signature Date

16. 17. 18.

Printed Signature https://www.treasury.gov/ofac/downloads/sdnlist.pdf https://www.sam.gov/portal/

AttD

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ATTACHMENT D - REFERENCE CHECK FORM

Grand Total Points Possible (15)

Offeror shall submit completed Reference Check Forms from three (3) References.

Offeror must provide at least two (2) current professional references and one (1) professional reference for work (from different firms and clients) supportive of Offeror’s ability to comply with the requirements of this RFP. Offeror shall submit reference names and contact information.

Offeror must submit one (1) attachment D for each Reference.

Offeror Name: __________________________________________

Reference Entity: __________________________________________

Reference Contact Name: __________________________________________

Contact Telephone Number: __________________________________________

Contact Email Address: __________________________________________

Agency will make three (3) attempts to contact each of the references provided by the Offeror. If these attempts are unsuccessful, the Offeror will receive a score of zero for that reference.

When Agency contacts each Reference, the following questions will be rated on a scale of 0-5:

0 = Not satisfied 2 = Moderately satisfied 5 = Extremely satisfied.

1. How would you rate the Offeror’s overall quality of services provided and your overall relationship with the Offeror?

2. How would you rate the Offeror’s delivery of service?

3. How would you rate the Proposer’s overall Safety?

4. How would you rate the Offeror’s responsiveness to customer service issues and special requests (e.g., reported problems, changes billing, etc.)?

5. How likely would you be to use Offeror’s services again?

Offeror could receive a grand total of 5 points for each reference.

AttE

ATTACHMENT E –

COST SHEET

Offeror shall submit a Price Proposal stating the proposed for each item for the entire project including travel expenses. The Offeror shall furnish all required material, equipment, labor and perform all Work for the Oregon Department of Fish and Wildlife Project designated for the

Helicopter Flights to survey sage grouse. All travel must follow the Department of Administrative

Services Travel Policies and guidance for allowable expenses.

Total Points Possible (10)

For scoring purposes ODFW has put an estimated number of Hours, Miles, and, Days for Per Diem.

Hourly Rate for Ferry Flights @ 10 hours

Hourly Rate for Helicopter and Pilot @ 50 hours

Set-up & Mobilization fee

Hourly Rate for Fuel Truck Driver @ 40 hours

Milage for Fuel Truck @ 1500 miles

Per diem Crew Members @ 10-15 days

Cost / per Hr.

Cost / per Hr.

Cost .

Cost /per Hr.

Cost /per Mile

Per Diem per person for Overnight Stay/per day.

Total Proposed

Total Proposed

Total Proposed

Total Proposed

Total Proposed

Total Proposed

NOTES:

Offeror price is total including all costs and contractor’s profit and overhead. Items not explicitly listed in the Cost Proposal Form are considered incidental.

The undersigned understands that the State reserves the right to increase or decrease or to remove the amount of days as necessary to meet budgetary constraints. If the State increases or decreases the number of days of work, the State will increase or decrease the total price by the per day price amount.

Cost Sheet submitted by: ___________________________________________________________________________

(Type or print legibly, name and company)

Att F

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ATTACHMENT F –CERTIFIED DISADVANTAGED BUSINESS

OUTREACH PLAN

Offeror Name: 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 offer, Offeror 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 Offeror 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 Offeror has had a contractual relationship with within the last two years.

3. Include a list of firms that Offeror 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 Offeror 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.

Att F

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CERTIFIED DISADVANTAGED BUSINESS OUTREACH PLAN

5. Describe the steps Offeror 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 Offeror be willing to report the identity of each subcontractor and the value of each subcontract to COBID if awarded a Contract from this procurement?

AttG

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ATTACHMENT G - RESPONSIBILITY INQUIRY

Agency will determine responsibility of an Offeror prior to award and execution of a Contract. In addition to this form, Agency may notify Offeror 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 an Agency finding of non-responsibility and rejection.

1. Does Offeror 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 Offeror to meet all contractual responsibilities? YES / NO .

2. Within the last five years, how many contracts of a similar nature has Offeror completed that, to the extent that the costs associated with and time available to perform the contract remained within Offeror′s control, Offeror 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 Offeror (incl. a partner or shareholder owning 10% or more of Offeror’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 Offerors, 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 Offeror 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.)

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Response:

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

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

Does Offeror 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 Offeror 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 Offeror have all required licenses, insurance and/or registrations, if any, and is Offeror 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 Offeror employs 50 or more full-time workers and the prospective contract price is estimated to exceed $500,000. [This requirement does not apply to architectural, engineering, photogrammetric mapping, transportation planning or land surveying and related services contracts.] Does a current authorized representative of Offeror 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:

AUTHORIZED SIGNATURE

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

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Offeror Name: RFP:

Project Name:

Authorized Signature Date

Print Name Title

AttH

ATTACHMENT H

SCORED COMPONENTS FORM

(Attach additional sheets if necessary)

A. Cost Sheet (Use Attachment E) 10 points possible

B. References (Use Attachment D) 15 points possible

C. General Qualifications 40 points possible

D. Understanding of Requested Services/Project 50 points possible

E. Pilot Qualifications 30 points possible

D.Understanding of Requested Services/Project 50 points possible

ATTACHMENT H –

SCORED COMPONENTS FORM

Continued

C. General Qualifications 40 points possible

SCORED PROPOSAL COMPONENTS FORM

D. Pilot(s) Qualifications: 30 points possible

1) List of each pilot (‘s) name. Identify which pilot(s) are primary and which pilots are back-up:

Primary Pilot =

Back up Pilot #1 =

Back up Pilot #2 =

Back up Pilot #3 =

2) List experience, history, and qualifications for each Pilot. Address each Pilot’s experience compared to all criteria listed in 3.1.4

SCORED PROPOSAL COMPONENTS FORM

E. References 15 points possible

Signed by Offeror’s Duly Authorized Representative.

Signature Date

Printed Name Title