Section 5310 (Formerly Section 16)/ Community Transportation NON-VEHICLE 8/20/2009

Transcription

1 D. BID FORMS Section 5310 (Formerly Section 16)/ Community Transportation NON-VEHICLE 8/20/2009 D.1 BID PROPOSAL FORM D.2 BUY AMERICA CERTIFICATION D.3 PENNSYLVANIA STEEL PRODUCTS PROCUREMENT ACT CERTIFICATION D.4 LOBBYING CERTIFICATION D.5 LIST OF RECENT CUSTOMERS IMPORTANT NOTE TO BIDDER: All bid forms listed above (unless deleted by addendum) must be executed and submitted with the bid; otherwise the bid will be rejected. If any of the above forms was inappropriately omitted from this copy of the IFB, it is the responsibility of the bidder to request a copy of the missing form(s) from the purchaser in order to submit the form(s) with the bid. An original Bid Bond (if required by this IFB) must be submitted in the correct amount with the bid; otherwise the bid will be rejected. All addenda to the IFB must be acknowledged on the Bid Proposal form or acknowledged in a separate letter that is signed by the individual signing the Bid Proposal Form and received by the purchaser prior to the bid opening. Failure to acknowledge addenda will result in the automatic rejection of the bid unless receipt of addenda by the bidder can be verified by certified mail receipt or acknowledgement of receipt by fax machine. The documentation requested by IFB Sections A.12.2, A.12.3, A.12.4, and A.12.5 shall be submitted after bid opening when the apparent low bidder has been determined. The bid shall be submitted in duplicate. The bidder shall reference this particular sealed bid opening (by IFB Number, date of bid opening, description of items being bid, or some other clearly identifiable means) on the face of its sealed bid envelope.

2 BID PROPOSAL FORM TO: (Name of Purchaser) (Address of Purchaser) In compliance with your Invitation for Bids (IFB), number for solicitation of bids to be opened on, the undersigned proposes to furnish all labor, equipment and materials as listed below and perform all work for furnishing same in strict accordance with the above referenced IFB: DESCRIPTION OF ITEM UNIT PRICE TOTAL PRICE TOTAL BID PRICE (without tax)* The undersigned acknowledged receipt of the following addenda to the above referenced IFB: Addendum No. 1, dated Included with IFB Addendum No., dated Addendum No., dated Addendum No., dated Name of Individual, Partnership or Corporation Address Name of Authorized Person Title of Authorized Person Signature Date By execution below, the Purchaser accepts offer as indicated above: Contracting Officer Signature Date of Award *Exclusive of Customer Rebates, if any (see Section A.3) 8/15/2006

3 BUY AMERICA CERTIFICATION BUY AMERICA CERTIFICATE OF COMPLIANCE WITH FTA REQUIREMENTS FOR BUSES, OTHER ROLLING STOCK, AND ASSOCIATED EQUIPMENT (To be submitted with a bid or offer exceeding the small purchase threshold for Federal assistance programs, currently set at $100,000.) Certificate of Compliance with Section 165(b)(3) The bidder hereby certifies that it will comply with the requirements of section 165(b)(3), of the Surface Transportation Assistance Act of 1982, as amended, and the regulations of 49 C.F.R Date: Signature: Company Name: Title: Certificate of Non-Compliance with Section 165(b)(3) The bidder hereby certifies that it cannot comply with the requirements of section 165(b)(3) of the Surface Transportation Assistance Act of 1982, as amended, but may qualify for an exception to the requirement consistent with section 165(b)(2) or (b)(4) of the Surface Transportation Assistance Act of 1982, as amended, and regulations in 49 CFR Date: Signature: Company Name: Title: 8/20/2009

4 PENNSYLVANIA STEEL PRODUCTS PROCUREMENT ACT CERTIFICATION* hereby certifies (Bidder) that it complies with the Steel Products Procurement Act, Act No. 3 of 1978, March 3, P.L. 6, as amended by Act No. 144 of 1984, July 9 (73 P.S. Section 1871 et seq.). Name of Individual, Partnership or Corporation Address Name of Authorized Person Title of Authorized Person Signature Date * This certification is required only if the vehicle(s) being procured has fifteen or more seats excluding the driver. 8/15/2006

5 8/15/2006 LOBBYING CERTIFICATION (To be submitted with each bid or offer exceeding $100,000) The undersigned bidder certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for making lobbying contacts to an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL, Disclosure Form to Report Lobbying, in accordance with its instructions [as amended by Government wide Guidance for New Restrictions on Lobbying, 61 Fed. Reg (1/19/96). Note: Language in paragraph (2) herein has been modified in accordance with Section 10 of the Lobbying Disclosure Act of 1995 (P.L , to be codified at 2 U.S.C. 1601, et seq.)] (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C (as amended by the Lobbying Disclosure Act of 1995). Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. [Note: Pursuant to 31 U.S.C. 1352(c)(1)-(2)(A), any person who makes a prohibited expenditure or fails to file or amend a required certification or disclosure form shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such expenditure or failure.] The bidder certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the bidder understands and agrees that the provisions of 31 U.S.C. A 3801, et seq., apply to this certification and disclosure, if any. Signature of Bidder s Authorized Official Name & Title of Bidder s Authorized Official Name of Company Date

6 LIST OF RECENT CUSTOMERS Bidder Name: In order to better assess the responsibility of bidders, we are requiring each bidder to submit a list of their ten most recent customers of similar or vehicular products, the product provided, and contact information. Contact information includes the address and telephone number and, preferably, a contact person for the customer. This information must be provided on this sheet. 1 1 CUSTOMER NAME DATE OF DELIVERY PRODUCT/SERVICE DESCRIPTION CONTACT INFORMATION If the bidder has had less than 10 customers whom it sold similar products, it must provide information for those customers it has had and then state, no other prior customers of similar products at this time.