WILTTR27SB Attachment B- Price Form.docx
DOCX document 21 KB Posted
- Solicitation number
- BPM054016
- Issued by
- Wicomico County, Maryland
About this file
This is a Price Form and Small Business Reserve Affidavit for an Invitation for Bid (IFB) issued by the Maryland Department of Transportation State Highway Administration (MDOT SHA) for roadside litter pickup services in Wicomico County, identified as IFB No. WILTTR27SB. The contract requires litter pickup crew services with an estimated quantity of 40 crew days. Bidders must submit their per-day rate for the crew work and calculate the total cost by multiplying the unit price by the estimated quantity.
Bidders must complete the price form without alteration and include only the stipulated pricing information. The contract is designated as a Small Business Reserve procurement, requiring all bidding firms to meet Maryland's small business qualifications under State Finance and Procurement Article § 14-501(c). Bidders must sign an affidavit affirming their small business status as of the bid submission date and commit to notifying the Procurement Officer within 30 days if circumstances change during contract performance. MDOT SHA is exempt from Maryland Sales and Use Taxes and Federal Excise Taxes, and bidders are instructed not to include sales tax in their bid prices. False information or failure to maintain small business qualification status may result in bid rejection, contract termination for default, suspension and debarment, or criminal prosecution.
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Other files
| File | Type | Posted |
|---|---|---|
| WILTTR27SB - Category II Procurement Invitation For Bid Template.docx | DOCX document |
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Text version
PRICE FORM
CONTRACT BID FORM & SBR AFFIDAVIT– ATTACHMENT-B
This form is to be completed in its entirety, is not to be altered in any way and is to contain only the price or prices stipulated on the form.
SHA IFB No.: WILTTR27SB
| Column A |
| Column B |
| Column C |
| Column D |
| Item / Description |
| Estimated Quantity |
| Vendor’s Bid |
| Total Cost ($) |
| per Unit of Measure |
| (Column B x C) |
| Litter Pickup crew days - Per specifications |
| 40 crew days |
| $ per Day |
| $ |
| TOTAL BID AMOUNT (Sum of Column D items) |
| $________________ |
NOTE:
MDOT SHA, is exempt from Maryland Sales and Use Taxes by Exemption Certificate Number 3000256-3 and from Federal Excise Taxes by Exemption Number 52-73-0358K. Do not include sales tax in bid prices.
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: ___________________
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)
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