SOELCT30SB - Price Form.pdf

P R I C E F O R M - P A G E 1 O F 2 C O N T R A C T B I D F O R M & S B R A F F I D A V I T –

A T T A C H M E N T - B

Th i s fo rm i s t o b e c o mp le t e d i n i t s e n t i r e t y , i s no t t o b e a l t e red i n a n y wa y an d i s t o con t a i n o n ly t he p r i ce o r p r i c es s t i pu l a t e d o n t h e fo rm.

SHA IFB No.: SOELCT30SB

Column A Column B Column C Column D

Item / Description Estimated Quantity

Vendor’s Bid per unit Total Cost ($)

(over contract duration) (Column B x C)

Electrical Technician Hourly Rate

300 hours $ ___________ / Hr $ ___________

Daily Trip Charge 30 Ea $ ___________/ Ea $ ___________

Scissor Lift or Bucket truck 0-20' Working

Height 5 Unit Days $ ___________/ UD $ ___________

Scissor Lift or Bucket Truck 21-35' Working

Height 5 Unit Days $ ___________/ UD $ ___________

Parts/Materials for

Repairs to be billed as incurred at Retail or MSRP (do not alter)

$ 4,000.00

TOTAL BID AMOUNT (Sum of Column D)

NOTE:

MDO T SH A, i s ex em pt f ro m Ma ry la nd Sa l es a n d U s e Tax es by Ex em pt ion C ert i f ic a te N um b er 3 00 02 5 6- 3 an d f ro m Fe d er al Ex c is e T axe s by Ex em pt io n N um b er 52- 7 3- 03 5 8K. Do no t inc l ud e sa le s tax i n b id p r i ce s .

Bid Due Date and Time : 08/18/26 1:15 pm Local Time

For the Contractor:

Company Name & Address

City State Zip

Phone _____________________ Fax ______________________Email _____________________________________

Representing the above Company _______________________________

SIGNATURE

Print Name & Title

SOCIAL SECURITY NO. OR

FEDERAL TAX ID NO. _________________________ DATE: ___________________

P R I C E F O R M - P A G E 2 O F 2 C O N T R A C T B I D F O R M & S B R A F F I D A V I T –

A T T A C H M E N T - B

Maryland Department of Transportation

SMALL BUSINESS CONTRACT AFFIDAVIT

********** PROVIDING FALSE INFORMATION **********

Anyone providing false information to the State of Maryland in connection with obtaining or attempting to obtain a contract under Small Business Reserve or Preference procurement may be subject to the following:

1. A determination by a Procurement Officer that a bidder/offeror is not responsible;

2. A determination that a contract entered into is void or voidable under § 11-204 of the State Finance and Procurement Article of the Annotated Code of Maryland;

3. Suspension and debarment under Title 16 of the State Finance and Procurement Article;

4. Criminal prosecution for procurement fraud (§ 11-205.1 of the State Finance and Procurement Article), perjury, or other crimes; and

5. Other actions permitted by law.

********** FAILURE TO MEET MINIMUM QUALIFICATIONS **********

Any Bidder or potential bidder failing to meet the qualifications of a "small business" specified in § 14-501(c) of the State Finance and Procurement Article will be ineligible to participate in a procurement designated for a Small Business Reserve under § 14-504 or Small Business Preference under § 14-206 - 207. Any person or company bidding on Small Business Reserve or Preference procurement and not qualifying as a small business under § 14-501(c) will have its bid or offer rejected on the ground that the bidder is not responsible.

I AFFIRM THAT:

To the best of my knowledge, information, and belief, as of the date of submission of this Bid/Proposal, (name of firm) meets the qualifications for certification as a Small Business in Maryland. I further affirm that, if for any reason during the term of the contract (name of firm) no longer meets the qualifications of certification as a Small Business in Maryland, I will notify the Procurement Officer within 30 days. I agree that a failure to so notify the Procurement Officer of this change in circumstances may result in this contract being terminated for default.

I DO SOLEMNLY DECLARE AND AFFIRM UNDER THE PENALTIES OF PERJURY THAT THE CONTENTS OF THIS AFFIDAVIT ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE, INFORMATION, AND BELIEF.

SMALL BUSINESS QUALIFICATION NUMBER ___________________

Date of Most Recent Qualification__________________________________

DATE:_____________

BY:_____________________________________________________________

Signature (Authorized Representative and Affidavit)