Solicitation Attachments - Sidewalk and Pedestrian Bridge Snow Removal.pdf

SECTION 6

SOLICITATION ATTACHMENTS

Prince George’s County, Maryland Office of Procurement requires the completion of documents to accompany solicitation responses. Not every document is required for every solicitation. Review the information below to determine which completed attachments must be submitted.

ATTACHMENT A — Pricing Schedule. Must be signed and submitted with proposal to acknowledge acceptance of the

County-established rates.

ATTACHMENT B — Bidder Information and Certifications Form. Must be completed and submitted with proposal.

ATTACHMENT C — Equipment Inventory Form. Must be completed and submitted with proposal.

ATTACHMENT D — Supplier Utilization Plan. Participation requirements are waived; submit only if subcontractors are utilized during the term.

ATTACHMENT E — Wage Requirements for Service Contracts. Must be completed and submitted with proposal.

ATTACHMENT F — 501(c)(3) Nonprofit Organization’s Employees’ Wage and Health Insurance Form. Must be completed and submitted when a nonprofit organization is submitting a proposal.

ATTACHMENT G — Certificate of Compliance Regarding Fair Labor Standards Act. Must be completed and submitted with proposal.

ATTACHMENT H — Professional References. Must be completed and submitted with proposal.

ATTACHMENT I – Frequently Asked Questions - The County has prepared a Frequently Asked Questions (FAQ) document, included as Attachment I, to summarize this Solicitation and to answer questions the County anticipates from prospective Contractors. The FAQ does not amend the Solicitation, and in the event of any conflict between the FAQ and the Solicitation, the Statement of Work, or any amendment, the Solicitation documents control.

Prospective Contractors remain responsible for reviewing the entire Solicitation and for monitoring the SPEED eProcurement Platform and eMaryland Marketplace Advantage (eMMA) for amendments.

******* END OF ATTACHMENTS LIST *********

ATTACHMENT A

PRICING SCHEDULE

Sidewalk and Pedestrian Bridge Snow Removal

County-Established Crew Rates — Offeror Acknowledgment Required

INSTRUCTIONS

The County has established uniform hourly crew rates for this solicitation, as set forth below. These rates are fixed and are not subject to offeror-proposed pricing; there is nothing for the Offeror to price or propose. The Offeror shall review this Pricing

Schedule and execute the signature block in Section 2 below to confirm its acceptance of the established rates, in addition to the

Pricing and Contract Terms Acknowledgment in Section 7 of Attachment B (Bidder Information and Certifications Form).

1 Established Hourly Crew Rates

Service Established Hourly Rate

Crew Activation Rate — active sidewalk and bridge sidewalk snow and ice removal performed by a crew meeting the minimum formation required by Statement of

Work §3.4.1: four (4) crew members plus one (1) supervisor; four (4) walk-behind snow blowers and/or powered brooms (gas or electric); one (1) light-duty support vehicle (van, pickup truck, or SUV); all required hand tools and equipment; and materials, not including deicing agents (reimbursed separately per SOW §3.4.1).

$301.00 per hour

Stand-By Rate — County-authorized stand-by time per crew, as defined in SOW

§3.6.2 (fifty percent (50%) of the Activation Rate).

$150.50 per hour (50% of Activation

Rate)

The established hourly Crew Activation Rate applies uniformly to every awarded Contractor and covers all personnel, equipment, fuel, maintenance, communication, and other incidentals necessary to perform the crew formation described above, except for deicing materials, which are reimbursed separately as set forth in SOW §3.4.1. The County is not negotiating, evaluating, or accepting alternate or Bidder-proposed rates. Rates for each option period may be adjusted as set forth in SOW §3.8 and Section 1.25 of this solicitation.

2 Offeror Acknowledgment and Signature

By signing below, the undersigned, on behalf of the Offeror, certifies that the Offeror has reviewed this Pricing Schedule and agrees to perform the work described in the Statement of Work at the County-established Crew Activation Rate of $301.00 per crew, per hour, and the County-established Stand-By Rate of $150.50 per crew, per hour; that these rates are all-inclusive and firm for the base period;

and that the Offeror will not invoice, request, or seek any charge of any kind that is not expressly provided for above, consistent with the Pricing and Contract Terms Acknowledgment in Section 7 of Attachment B.

2A. Solicitation No.

2B. Legal Company Name

2C. Signature of Authorized Representative

2D. Date Signed

2E. Printed Name

2F. Title

ATTACHMENT B

INFORMATION AND CERTIFICATIONS FORM

Sidewalk and Pedestrian Bridge Snow Removal

Consolidated Required Submittal

INSTRUCTIONS

This consolidated form combines the Bidder Information, Drug and Alcohol Testing Program Certification, Non-Collusion

Affidavit, Debarment and Suspension Certification, and Pricing and Contract Terms Acknowledgment required by Section

5.2 of the solicitation. The Bidder shall complete all sections and provide a single signature in Section 8. All sections are required. Failure to complete this form in full may result in a determination of non-responsiveness. Electronic signatures are acceptable.

1 Solicitation Identification

1A. Solicitation No.

1B. Reserved

2 Bidder Information

2A. Legal Company Name

2B. Trade Name / DBA (if different)

2C. Business Address (Street, City, State, Zip)

2D. Mailing Address (if different from 2C)

2E. Federal Employer Identification Number (EIN)

2F. SAM.gov Unique Entity ID (if registered — not required)

2G. Business Entity Type (LLC, Corp, Sole Prop, etc.)

2H. State of Formation

2I. Primary Administrative Contact (Name, Title)

2J. Administrative Contact Phone and E-mail

2K. 24-Hour Storm Operations Contact (Name, Title)

2L. 24-Hour Contact Phone (after-hours)

3 Certification Status (Optional)

Certification is not required to be eligible for award. If the Bidder holds any of the following certifications, indicate below.

✓ Certification Certification No. (if applicable)

☐ Prince George’s County Based Minority Business Enterprise (CBMBE) .

Prince George’s County Based Small Minority Business Enterprise

(CBSMBE)

☐ Prince George’s County-Based Small Business (CBSB)

☐ Prince George’s County Based Business (CBB)

☐ Prince George’s County Located Business (CLB)

✓ Certification Certification No. (if applicable)

☐ Other (specify)

4 Drug and Alcohol Testing Program Certification

The Bidder hereby certifies, under penalty of perjury, that:

(a) the Bidder maintains, and will continue to maintain throughout the contract term, a drug and alcohol testing program applicable to all crew members and supervisors deployed under this Contract, that complies with all applicable federal and

State of Maryland requirements;

(b) no crew member or supervisor will be deployed who has had a verified positive drug or alcohol test, a refusal to test, or an outstanding return-to-duty or follow-up testing obligation within the preceding twelve (12) months;

(c) the Bidder will immediately notify the County and remove from service any crew member or supervisor who tests positive, refuses to test, or is otherwise disqualified during the contract term; and

(d) the Bidder will produce documentation of its testing program and crew member testing records upon written request by the County.

5 Non-Collusion Affidavit

The Bidder hereby certifies, under penalty of perjury, that:

(a) this Bid has been arrived at independently and submitted without collusion with any other vendor designed to limit independent bidding or competition;

(b) no person, firm, or corporation has been retained to solicit or secure the contract upon any agreement for a commission, percentage, brokerage, or contingent fee, except a bona fide regularly employed employee of the Bidder; and

(c) no member of the Prince George’s County Council, the Office of Procurement, or any other official or employee of the

County has any direct or indirect financial interest in the Bidder, in this Bid, or in any subcontract, except as expressly disclosed in writing in advance of award.

6 Debarment and Suspension Certification

The Bidder hereby certifies, under penalty of perjury, that the Bidder and its principals, to the best of the Bidder’s knowledge and belief:

(a) are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in any procurement by any federal, State, or local government;

(b) have not within the preceding three (3) years been convicted of, or had a civil judgment rendered against them for, fraud or a criminal offense in connection with a public transaction; antitrust violation; or embezzlement, theft, forgery, bribery, falsification of records, making false statements, or receiving stolen property;

(c) are not presently indicted for or otherwise criminally or civilly charged with commission of any of the offenses enumerated in (b) above; and

(d) have not within the preceding three (3) years had one or more public transactions terminated for cause or default.

7 Pricing and Contract Terms Acknowledgment

The Bidder hereby acknowledges and agrees that:

(a) the Bidder has reviewed Attachment A (Pricing Schedule) and accepts the County-established hourly Crew Activation Rate of $301.00 per crew, per hour, and the County-established hourly Stand-By Rate of $150.50 per crew, per hour;

(b) the County-established rates are sufficient to enable the Bidder’s performance under the Statement of Work, and the Bidder has based its decision to bid on its own independent analysis of its costs of performance;

(c) the Bidder will not invoice, request, or seek any charge of any kind that is not expressly provided for in Attachment A;

(d) the Bidder will not seek any rate adjustment during the base period except as expressly authorized by written contract amendment, and acknowledges that option-year adjustments are limited to not more than three percent (3%) per year;

(e) the Bidder has reviewed the Statement of Work, Attachment A (Pricing Schedule), Attachment C (Equipment Inventory

Form), and all other solicitation documents and accepts all terms and conditions of the solicitation; and

(f) any submittal that attempts to modify, condition, or qualify the County-established rates set forth in Attachment A, or that proposes alternate pricing, surcharges, fees, or markups of any kind, may be deemed non-responsive by the County.

8 Combined Certification and Authorized Signature

The undersigned, on behalf of the Bidder, hereby certifies under penalty of perjury that all information provided in this form is true, complete, and accurate to the best of the undersigned’s knowledge and belief; that all certifications, affidavits, and acknowledgments set forth in Sections 4, 5, 6, and 7 above are true and correct; and that the undersigned is duly authorized to execute this form and to bind the Bidder.

8A. Signature of Authorized Representative

8B. Date Signed

8C. Printed Name

8D. Title

ATTACHMENT C

EQUIPMENT INVENTORY FORM

Sidewalk and Pedestrian Bridge Snow Removal

Equipment Documentation

INSTRUCTIONS

This form documents the Equipment Documentation required under Section 5.4. The Offeror shall complete this form for the equipment proposed for this crew. Equipment must meet the minimum requirements set forth in Statement of Work §3.4. The

Offeror may add rows or attach additional sheets in the same format; each supplemental sheet shall be marked with the Solicitation

No. and a sequential page number.

1 Solicitation and Offeror Identification

1A. Solicitation No.

1B. Legal Company Name

2 Equipment Inventory

List the equipment the Offeror proposes to deploy for this crew, consistent with the minimum crew formation required by Statement of Work §3.4.1. Use additional sheets in the same format if necessary.

# Equipment Type Make / Model / Year Quantity Status (Owned / Leased)

Walk-Behind Snow Blower and/or Powered

Broom (Gas or Electric)

Light-Duty Support Vehicle (Van, Pickup Truck, or SUV)

Hand Tools and Equipment (shovels, pushers, ice-melt spreaders, PPE, etc.)

2A. Total Equipment Units Listed

2B. Supplemental Sheets Attached (Yes / No, and Count)

2C. Location where equipment will be available for the County’s pre-season inspection under SOW §3.4.3.1, if needed

3 Crew Compliance Confirmation

By signing this form, the Offeror confirms that, with respect to all crew members and supervisors deployed under this Contract:

(a) each crew member will be physically able and properly equipped to perform the manual snow and ice removal duties described in the Statement of Work;

(b) any crew member designated to operate the light-duty support vehicle will hold a valid, unrestricted driver’s license, with no current suspension, revocation, or restriction;

(c) each crew member will be in compliance with the Offeror’s drug and alcohol testing program as certified in Attachment B; and

(d) the Offeror will produce, upon County request, documentation confirming the qualifications of any crew member, including a copy of the driver’s license for any crew member authorized to operate the light-duty support vehicle.

4 Equipment Compliance Confirmation

By signing this form, the Offeror confirms with respect to the equipment listed in Section 2 that:

(a) the equipment meets the minimum requirements of Statement of Work §3.4, including all equipment and operating-condition requirements;

(b) the light-duty support vehicle is properly registered, licensed, and insured in accordance with Maryland law and the insurance requirements of this solicitation, and all other equipment is maintained in safe operating condition;

(c) the equipment is available for the County’s pre-season safety and operational inspection under SOW §3.4.3.1 at the location identified in Item 2C and is subject to inspection at any time during the operational season; and

(d) equipment listed in Section 2 that is not available for deployment when activated may be removed by the County from the Offeror’s approved equipment list.

5 Authorized Signature

The undersigned, on behalf of the Offeror, hereby certifies under penalty of perjury that all information provided in this form is true, complete, and accurate; that the confirmations set forth in Sections 3 and 4 are true and correct; and that the undersigned is duly authorized to execute this form and to bind the Offeror.

5A. Signature of Authorized Representative

5B. Date Signed

5C. Printed Name

5D. Title

ATTACHMENT D

SUPPLIER UTILIZATION PLAN

Instructions: Complete all applicable sections. Submit one Part 3 form for each business listed in Part 2, Use additional copies as needed.

Prime Contractor Name Click or tap here to enter text.

Prime Contact Name Click or tap here to enter text.

Prime Contact Information (Phone Number/Email

Address) Click or tap here to enter text.

Date Click or tap here to enter text.

Part 1 - Work to Be Performed by Bidder/Offeror

Prime

Contractor

NCB CBB CBSB MBE CBMBE CBSMBE CLB DBE

Certification #

(if applicable)

% Self

Performed

Click or tap here to enter business name.

Additional bidder entry (if needed)

Total Percentage of

CBSB Participation

Total Percentage of

MBE Participation

Part 2 - Work to Be Performed by Subcontractors and Their Subcontractors

Subcontract or Name

NCB CBB CBSB

M

B

E

CBMBE CLB

CB

SM

BE

DBE Cert #

Bonding

Required

(if applicabl e)

Work

Select TIER from dropdown menu

Enter subcontract or name

Enter subcontract or name

Enter

Type /

Amount Enter

Choose an item.

Percentages should include both the work being performed by the subcontractors and their subcontractors.

Part 3 - Subcontractor Commitment Form

Submit one form for each business listed in Part 2 of this Supplier Utilization Plan.

TOTAL

NCB %:

TOTAL

CBB %:

TOTAL CBSB

TOTAL MBE

TOTAL

CBMBE

TOTAL

CLB %:

TOTAL

CBSMBE %:

TOTAL DBE

The undersigned acknowledges that under-utilization or failure to utilize the subcontractors listed on this Supplier

Utilization Plan may adversely affect award.

Signature of Authorized Signatory Date

Printed Name Date

Offeror/Quoter/Bidder Name

Solicitation No.

Project / Contract Title

Subcontractor Name

Bidder Signature Sign here

Name Print name

Title Enter title

Date Enter date

ATTACHMENT E

WAGE REQUIREMENTS FOR SERVICE CONTRACTS

Statutory Authority & Current Wage Rate

This solicitation is subject to the County’s Wage Requirements Law for Service Contracts under Section 10A-144 of the

Prince George’s County Code (Subtitle 10A - Purchasing). Failure to complete and submit the required certification and any applicable form(s) with your Bid will render your Bid unacceptable and it will be rejected for non-responsiveness.

Livable Wage Rate for Fiscal Year 2027 for July 1, 2026 – June 30, 2027: $18.10

SECTION 1 — CONTRACTOR INFORMATION

Company Name:

Street Address:

City: State:

Zip

Code:

Telephone

No.: E-Mail:

SECTION 2 — APPLICABLE WAGE REQUIREMENTS

The following requirements apply to this Contract under Prince George’s County Code § 10A-144:

1. A County contract for the procurement of services must require the Contractor and any of its subcontractors to comply with the wage requirements of § 10A-144, subject to exceptions for particular contractors under § 10A-144(b) and for particular employees under §

10A-144(f).

2. If any federal, State, or County law or federal or state contract or grant requires payment of a higher wage or precludes compliance with § 10A-144, that law shall prevail.

3. A Contractor must not split or subdivide a contract, pay an employee through a third party, or treat an employee as a subcontractor or independent contractor, to avoid imposition of any requirements under § 10A-144.

4. Each covered Contractor and subcontractor must: certify awareness of and intent to comply with applicable wage requirements; keep and submit verifiable compliance records upon request; and conspicuously post notices informing employees of the wage requirements, sending a copy of each such notice to the County Purchasing Agent.

5. An employer must comply with § 10A-144 during the initial contract term and all renewal periods, and must automatically apply any wage rate adjustment effective July 1 of each year, as determined by the County’s Wage Determination Board based on the annual average increase in the Consumer Price Index for all urban consumers for the Washington–Baltimore Metropolitan Area (or successor index), rounded to the nearest five cents (§ 10A-144).

6. An employer must not discharge or otherwise retaliate against an employee for asserting any right or filing a complaint under § 10A-

144. Any retaliation is subject to all sanctions applicable for non-compliance (§ 10A-144).

7. The County may assess liquidated damages for noncompliance at the rate of one percent (1%) per day of the total contract amount

(or estimated annual contract value for requirements contracts) for each day of violation, including the amount of any unpaid wages with interest. The Contractor is jointly and severally liable for subcontractor noncompliance. An aggrieved employee, as a third-party beneficiary, may enforce payment of wages due under § 10A-144 by civil action and recover unpaid wages with interest, reasonable attorney’s fees, and damages for retaliation (§ 10A-144).

8. The Purchasing Agent may conduct random audits and on-site inspections to verify compliance. Failure to submit documentation demonstrating compliance upon request constitutes a breach of contract, subject to liquidated damages under Provision 7 above (§

10A-144).

SECTION 3 — CONTRACTOR CERTIFICATION — CHECK ALL THAT APPLY

Check all boxes that apply in the event you, as Bidder/Offeror, are awarded the Contract and become “Contractor.”

3.1. Wage Requirements Compliance

☐ This Contractor, as a “covered employer,” will comply with the requirements under County Code § 10A-144. Contractor will pay all employees not exempt under the wage requirements, and who perform direct measurable work for the County, at least the wage requirements effective at the time the work is performed. The price(s) submitted under this solicitation include(s) sufficient funds to meet the wage requirements. [§ 10A-144]

3.2. Exemption Status (Check one if applicable)

☐ Contractor employs fewer than ten (10) employees when submitting this Bid and will continue to be exempt as long as it does not employ ten (10) or more employees at any time the Contract is in effect. [§ 10A-144(b)(1)]

☐ Contractor, at the time a contract is signed: (a) has received less than $50,000 from the County in the most recent 12-month period;

and (b) will be entitled to receive less than $50,000 from the County in the next 12-month period. [§ 10A-144(b)(2)(A)&(B)]

☐ Contractor is a public entity. [§ 10A-144(b)(3)]

☐ Contractor is a nonprofit organization that has qualified for exemption from federal income taxes under Section 501(c)(3) of the

Internal Revenue Code (26 U.S.C. § 501(c)(3)). [§ 10A-144(b)(4)]

If selected, Contractor must also complete Item 3.3 below and submit the 501(c)(3) Nonprofit Organization’s Employee Wage and

Health Insurance Form (Attachment F).

☐ Contractor is expressly precluded from complying with § 10A-144 by the terms of a federal or state law, contract, or grant. [§ 10A-

144(b)(7)]

If selected, specify the law or furnish a copy of the applicable contract or grant:

Law / Contract / Grant Reference: _______________________________________________

☐ Contractor has entered into a participation agreement under County Code § 10A-141. [§ 10A-144(b)(8)]

3.3. Nonprofit Wage and Health Information

☐ This Contractor is a § 501(c)(3) nonprofit organization exempt from coverage under § 10A-144(b)(4) and has completed and attached the 501(c)(3) Nonprofit Organization’s Employee Wage and Health Insurance Form (Attachment F), specifying the wage the organization intends to pay to those employees who will perform direct, measurable work under the Contract and any health insurance the organization intends to provide. [§ 10A-144(c)(2)]

3.4. Nonprofit Comparison Price (if applicable)

☐ This Contractor is a nonprofit organization opting to pay its covered employees the hourly rate specified in the wage requirements.

Accordingly, Contractor is submitting a duplicate cost proposal clearly marked “Comparison Cost” showing its costs had it not opted to pay the specified hourly rate, including how the difference was calculated. This duplicate form is submitted with this proposal and will not be accepted after the proposal closing date. [§ 10A-144(c)(2)]

3.5. Wage Requirements Rate Reduction (if applicable)

☐ This Contractor is a “covered employer” and desires to reduce its hourly rate paid under the wage requirements by an amount equal to or less than the per-employee hourly cost of the employer’s share of the health insurance premium. [§ 10A-144(d)(1)&(2)]

If selected, enter the per-employee hourly cost of the employer’s share of the health insurance premium:

Per-employee hourly cost of employer’s health insurance premium: $ _______________________________________________

SECTION 4 — COMPLIANCE MONITOR DESIGNATION

Provide the name and contact information of the person designated by your firm to monitor compliance with the County’s Wage

Requirements under § 10A-144:

Name:

Title:

Phone: E-Mail:

SECTION 5 — CONTRACTOR CERTIFICATION & SIGNATURE

Contractor submits this Certification Form in accordance with Section 10A-144 of the Prince George’s County Code. Contractor certifies that it, and all of its subcontractors that perform services under the resultant contract with the County, shall adhere to all requirements of §

10A-144 of the Prince George’s County Code.

Signature — Authorized Corporate Officer / Partner /

Proprietor

Date

Typed / Printed Name of Signatory

Title of Authorized Signatory

ATTACHMENT F

501(c)(3) NONPROFIT ORGANIZATION’S

EMPLOYEE WAGE AND HEALTH INSURANCE FORM

Instructions: Provide the employee labor category of all employee(s) who will perform direct, measurable work under this

Contract, the hourly wage the organization pays for each labor category, and any health insurance the organization intends to provide for that labor category.

Important: If no health insurance plan is provided for a labor category, enter "NONE" in the Health Insurance column.

SECTION 1 — ORGANIZATION INFORMATION

Company Name:

Street Address:

City: State:

Zip

Code:

Fax No.: E-Mail:

SECTION 2 – EMPLOYEE WAGE & HEALTH INSURANCE

Employee Labor Category Wage Per

Hour

Name of Health Insurance Provider(s) and Plan Name e.g., ABC Insurer, Inc., HMO Medical and Dental — Enter "NONE" if not provided

Attach additional sheets if more labor categories are required — reference Attachment F on each additional page.

SECTION 3 — CERTIFICATION & SIGNATURE

The undersigned authorized representative of the above-named 501(c)(3) nonprofit organization hereby certifies that the wage and health insurance information provided above is accurate and complete as of the date signed below, and that this organization meets the applicable requirements under Prince George's County Code.

Authorized Signature

Printed Name

Title / Position

ATTACHMENT G

CERTIFICATE OF COMPLIANCE

FAIR LABOR STANDARDS ACT OF 1938

📋 Citation Note: This form was updated to reflect the correct statutory citation. The original form (P.G.C. Form

#4318, Rev. 12/93) cited “29 USCS, Sections 201-216, 217-219, 557.” Section 557 does not exist within Title 29, Chapter 8 of the U.S. Code. The correct and current citation is 29 U.S.C. §§ 201–219, which encompasses the full text of the Fair Labor Standards Act of 1938, as amended. The “217–219” range was a redundant subset of the same chapter and has been consolidated into the unified citation.

Legal Authority: In accordance with the Fair Labor Standards Act of 1938, as amended (29 U.S.C. §§ 201–219), and the implementing rules and regulations thereof, a Certificate of Compliance is required of all Bidders/Offerors or prospective Contractors receiving a contract or award from Prince George's County, Maryland.

⚠️ Prerequisite: Receipt of a fully executed Certificate of Compliance is a prerequisite to the award of any contract and the processing of any payment thereunder.

FLSA COMPLIANCE REQUIREMENTS COVERED BY THIS CERTIFICATION

✓ REQUIREMENT STATUTORY REFERENCE & DESCRIPTION

✓ Minimum Wage 29 U.S.C. § 206 — Covered nonexempt workers must receive at least the applicable federal minimum wage for all hours worked.

✓ Overtime Pay 29 U.S.C. § 207 — Nonexempt employees who work more than 40 hours per workweek must receive overtime pay at not less than one and one-half times their regular rate.

✓ Child Labor 29 U.S.C. § 212 — Employers must comply with restrictions on the employment of minors, including prohibited occupations and hour limitations.

✓ Recordkeeping 29 U.S.C. § 211 — Employers must maintain accurate records of employees’ wages, hours, and other conditions and practices of employment.

✓ Equal Pay 29 U.S.C. § 206(d) — Employers may not pay wages at a rate less than the rate paid to employees of the opposite sex for equal work.

✓ Anti-Retaliation 29 U.S.C. § 215(a)(3) — Employers may not discharge or discriminate against any employee who has filed a complaint or exercised rights under the

FLSA.

✓ Enforcement / Penalties 29 U.S.C. § 216 — Violations may result in civil liability for back wages, liquidated damages, civil money penalties, and criminal prosecution.

✓ Injunctive Relief 29 U.S.C. § 217 — Courts may restrain violations of FLSA by injunction at the request of the Secretary of Labor.

Solicitation No.

Certification Statement: I (We) hereby certify that our firm, as producer of the goods and/or services to be purchased by Prince George's County, Maryland, has complied with all applicable requirements of the Fair Labor

Standards Act of 1938, as amended (29 U.S.C. §§ 201–219), including but not limited to minimum wage, overtime pay, child labor, recordkeeping, equal pay, and anti-retaliation requirements, and that the undersigned is an authorized representative of the firm with authority to execute this certification.

Name of Firm / Partnership /

Corporation

Business Address

Phone Number

Email Address

Federal Employer ID No.

(FEIN)

Printed Name of Authorized Representative

Title

Handwritten Signature of Authorized Principal

X

PART II ADDITIONAL DISCLOSURE — KNOWN VIOLATIONS

If the firm or any of its principals has been subject to a Department of Labor investigation, citation, consent judgment, or court order relating to FLSA violations within the past three (3) years, check the applicable item and attach a written explanation.

☐ The firm has NOT been cited, investigated, or subject to any court order or consent judgment for

FLSA violations within the past three (3) years.

☐ The firm OR one or more principals HAS been cited, investigated, or subject to a court order or consent judgment for FLSA violations within the past three (3) years. Details are attached.

📎 If the second box is checked: Attach a written statement identifying the nature of the violation, the governmental entity or court involved, the applicable date(s), and the resolution or current status.

⚠️ Penalty Notice: Any person who makes a false, fictitious, or fraudulent certification may be subject to criminal prosecution and civil penalties under applicable federal and state law, including under 29 U.S.C. § 216 (civil and criminal penalties for FLSA violations) and 18 U.S.C. § 1001 (false statements to the federal government). Prince George's County reserves the right to terminate any contract and pursue all available legal remedies if a false certification is discovered.

ATTACHMENT H

PROFESSIONAL REFERENCES

Instructions

Bidder must provide three (3) professional references for the Prime Contractor only. References must concern supplies or services similar to those outlined in the Statement of Work and must have been performed within the last five (5) years.

References from current Prince George’s County contracts are acceptable. Do not list the Bidder’s own affiliates or subsidiaries as references. All reference contacts must be reachable for verification.

PRIME CONTRACTOR INFORMATION

Name of Prime Contractor:

Solicitation (IFB/RFP/RFQ)

Number:

REFERENCE 1 OF 3

Organization / Agency Name:

Address:

City: State: Zip:

Contact Name: Contact Phone:

Contact Email:

Contract / PO

Contract Award

Date:

Contract Start

Contract End

Date:

Total Contract Value:

Description of Goods /

Services Provided:

REFERENCE 2 OF 3

Address:

City: State: Zip:

Contact Name: Contact Phone:

Contact Email:

Contract End

Total Contract Value:

REFERENCE 3 OF 3

Address:

City: State: Zip:

Contact Name: Contact Phone:

Contact Email:

Contract End

Total Contract Value:

CERTIFICATION

The undersigned authorized representative of the Prime Contractor certifies that the professional references provided above are accurate and complete, that all contracts listed were performed within the last five (5) years, and that the listed contacts are available for verification by Prince George’s County.

Authorized Signature of Prime Contractor Representative

Typed / Printed Name

Title