BID FORMS & OTHER SUBMITTALS For PROVIDE and INSTALL CARPET, SHEET VINYL, and VTC FLOORING for PUBLIC & SPECIALTY HOUSING ITB #2016.094B DUE 11:00AM Thursday September 1, 2016
Certifications and Representations of Offerors Non-Construction Contract U.S. Department of Housing and Urban Development Office of Public and Indian Housing Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This form includes clauses required by OMB s common rule on bidding/offering procedures, implemented by HUD in 24 CFR 85.36, and those requirements set forth in Executive Order 11625 for small, minority, women-owned businesses, and certifications for independent price determination, and conflict of interest. The form is required for nonconstruction contracts awarded by Housing Agencies (HAs). The form is used by bidders/offerors to certify to the HA's Contracting Officer for contract compliance. If the form were not used, HAs would be unable to enforce their contracts. Responses to the collection of information are required to obtain a benefit or to retain a benefit. The information requested does not lend itself to confidentiality. 1. Contingent Fee Representation and Agreement (a) The bidder/offeror represents and certifies as part of its bid/ offer that, except for full-time bona fide employees working solely for the bidder/offeror, the bidder/offeror: (1) [ ] has, [ ] has not employed or retained any person or company to solicit or obtain this contract; and (2) [ ] has, [ ] has not paid or agreed to pay to any person or company employed or retained to solicit or obtain this contract any commission, percentage, brokerage, or other fee contingent upon or resulting from the award of this contract. (b) If the answer to either (a)(1) or (a) (2) above is affirmative, the bidder/offeror shall make an immediate and full written disclosure to the PHA Contracting Officer. (c) Any misrepresentation by the bidder/offeror shall give the PHA the right to (1) terminate the resultant contract; (2) at its discretion, to deduct from contract payments the amount of any commission, percentage, brokerage, or other contingent fee; or (3) take other remedy pursuant to the contract. 2. Small, Minority, Women-Owned Business Concern Representation The bidder/offeror represents and certifies as part of its bid/ offer that it: (a) [ ] is, [ ] is not a small business concern. Small business concern, as used in this provision, means a concern, including its affiliates, that is independently owned and operated, not dominant in the field of operation in which it is bidding, and qualified as a small business under the criteria and size standards in 13 CFR 121. (b) [ ] is, [ ] is not a women-owned small business concern. Women-owned, as used in this provision, means a small business that is at least 51 percent owned by a woman or women who are U.S. citizens and who also control and operate the business. (c) [ ] is, [ ] is not a minority enterprise which, pursuant to Executive Order 11625, is defined as a business which is at least 51 percent owned by one or more minority group members or, in the case of a publicly owned business, at least 51 percent of its voting stock is owned by one or more minority group members, and whose management and daily operations are controlled by one or more such individuals. For the purpose of this definition, minority group members are: (Check the block applicable to you) [ ] Black Americans [ ] Asian Pacific Americans [ ] Hispanic Americans [ ] Asian Indian Americans [ ] Native Americans [ ] Hasidic Jewish Americans 3. Certificate of Independent Price Determination (a) The bidder/offeror certifies that (1) The prices in this bid/offer have been arrived at independently, without, for the purpose of restricting competition, any consultation, communication, or agreement with any other bidder/offeror or competitor relating to (i) those prices, (ii) the intention to submit a bid/offer, or (iii) the methods or factors used to calculate the prices offered; (2) The prices in this bid/offer have not been and will not be knowingly disclosed by the bidder/offeror, directly or indirectly, to any other bidder/offeror or competitor before bid opening (in the case of a sealed bid solicitation) or contract award (in the case of a negotiated solicitation) unless otherwise required by law; and (3) No attempt has been made or will be made by the bidder/ offeror to induce any other concern to submit or not to submit a bid/offer for the purpose of restricting competition. (b) Each signature on the bid/offer is considered to be a certification by the signatory that the signatory: (1) Is the person in the bidder/offeror s organization responsible for determining the prices being offered in this bid or proposal, and that the signatory has not participated and will not participate in any action contrary to subparagraphs (a)(l) through (a)(3) above; or (2) (i) Has been authorized, in writing, to act as agent for the following principals in certifying that those principals have not participated, and will not participate in any action contrary to subparagraphs (a)(l) through (a)(3) above (insert full name of person(s) in the bidder/offeror s organization responsible for determining the prices offered in this bid or proposal, and the title of his or her position in the bidder/offeror s organization); (ii) As an authorized agent, does certify that the principals named in subdivision (b)(2)(i) above have not participated, and will not participate, in any action contrary to subparagraphs (a)(l) through (a)(3) above; and Previous edition is obsolete page 1 of 2 form HUD-5369-C (8/93) ref. Handbook 7460.8
(iii) As an agent, has not personally participated, and will not participate in any action contrary to subparagraphs (a)(l) through (a)(3) above. (c) If the bidder/offeror deletes or modifies subparagraph (a)2 above, the bidder/offeror must furnish with its bid/offer a signed statement setting forth in detail the circumstances of the disclosure. 6. Conflict of Interest In the absence of any actual or apparent conflict, the offeror, by submission of a proposal, hereby warrants that to the best of its knowledge and belief, no actual or apparent conflict of interest exists with regard to my possible performance of this procurement, as described in the clause in this solicitation titled Organizational Conflict of Interest. 4. Organizational Conflicts of Interest Certification (a) The Contractor warrants that to the best of its knowledge and belief and except as otherwise disclosed, it does not have any organizational conflict of interest which is defined as a situation in which the nature of work under a proposed contract and a prospective contractor s organizational, financial, contractual or other interest are such that: (i) Award of the contract may result in an unfair competitive advantage; (ii) The Contractor s objectivity in performing the contract work may be impaired; or (iii) That the Contractor has disclosed all relevant information and requested the HA to make a determination with respect to this Contract. (b) The Contractor agrees that if after award he or she discovers an organizational conflict of interest with respect to this contract, he or she shall make an immediate and full disclosure in writing to the HA which shall include a description of the action which the Contractor has taken or intends to eliminate or neutralize the conflict. The HA may, however, terminate the Contract for the convenience of HA if it would be in the best interest of HA. (c) In the event the Contractor was aware of an organizational conflict of interest before the award of this Contract and intentionally did not disclose the conflict to the HA, the HA may terminate the Contract for default. (d) The Contractor shall require a disclosure or representation from subcontractors and consultants who may be in a position to influence the advice or assistance rendered to the HA and shall include any necessary provisions to eliminate or neutralize conflicts of interest in consultant agreements or subcontracts involving performance or work under this Contract. 7. Offeror's Signature The offeror hereby certifies that the information contained in these certifications and representations is accurate, complete, and current. Signature & Date: Typed or Printed Name: Title: 5. Authorized Negotiators (RFPs only) The offeror represents that the following persons are authorized to negotiate on its behalf with the PHA in connection with this request for proposals: (list names, titles, and telephone numbers of the authorized negotiators): Previous edition is obsolete page 2 of 2 form HUD-5369-C (8/93) ref. Handbook 7460.8
CERTIFICATION AND CONTRACT OFFER PROPOSAL TITLE: (#2016.094B) Provide and Install Carpet, Sheet Vinyl, and VCT Flooring for Public & Specialty Housing PROPOSAL DUE DATE: 11:00 AM, Thursday, September 1, 2016 The undersigned after having carefully examined the Special Instructions, Project/Proposal Information, General Instructions and all other related material and information, agrees to comply with the terms set forth in those documents and to furnish the services described at the rates proposed. The proposer further agrees that this offer will remain in effect at the rates proposed for a period of not less than 180 calendar days from the date that proposals are due and that this offer may not be withdrawn or modified during that time. The proposer hereby certifies that this proposal is genuine and that it has not entered into collusion with any other vendor(s) or any other person(s). The proposer hereby certifies that they have complied with the tax laws of Oregon and all political subdivisions of the State of Oregon, including ORS 305.620 and ORS chapters 316, 317 and 318. The proposer hereby certifies that it has not discriminated and will not discriminate against any minority, women or emerging small business enterprise or against a business enterprise that is owned or controlled by or that employs a disabled veteran as defined in ORS 408.225 in obtaining any required subcontract per ORS 279A.110. The responder hereby certifies that they have complied with the tax laws of Oregon and all political subdivision of the State of Oregon, including ORS 305.620 and ORS chapters 316, 317 and 318. Washington County may terminate the contract if contractor fails to comply with any tax laws during the term of the contract. CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS The proposer certifies to the best of its knowledge and belief that neither it nor any of its principals: 1. Are presently debarred, suspended, proposed for debarment, or declared ineligible from submitting bids or proposals by any federal, state or local entity, department or agency; 2. Have within a three-year period preceding this offer, been convicted or had a civil judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performance of a public (Federal, state or local) contract or subcontract; violation of Federal or state antitrust statues relating to the submission of offers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statement, tax evasion, or receiving stolen property; 3. Are presently indicted for, or otherwise criminally or civilly charged by a governmental entity with, commission of any of the offenses enumerated in paragraph 2 of this certification; 4. Have within a three-year period preceding this offer, had one or more contracts terminated for default by any Federal, state or local public agency. Rev. 9/15/15
CERTIFICATION AND CONTRACT OFFER Continued The proposer will provide immediate written notice to the County if at any time prior to contract award, the proposer learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. Where proposer is unable to certify to any of the statements in this certification, proposer shall attach an explanation to this offer. A certification that any of the items in the above paragraphs exists will not necessarily result in withholding of an award under this solicitation. However, the certification will be considered in connection with a determination of the proposer s responsibility. The proposer has carefully examined all of the solicitation documents and addenda (if any) numbered through inclusive. The proposer will extend pricing and terms to other public agencies Yes or No The proposer is a resident bidder as defined in ORS 279A.120* Yes or No SIGNED BY: DATE: PRINTED NAME: TITLE: FIRM: DUNS Number (if applicable): MAILING ADDRESS: PHYSICAL ADDRESS: CITY, STATE and ZIP E-MAIL ADDRESS: PHONE: (AREA CODE) FAX: (AREA CODE) *ORS 279A.120(1)(b) Resident bidder means a bidder that has paid unemployment taxes or income taxes in this state during the 12 calendar months immediately preceding submission of the bid, has a business address in this state and has stated in the bid whether the bidder is a resident bidder. Nonresident bidders shall comply with the provisions of ORS 279A.120(3). Rev. 9/15/15
BID FORMS 1.0 BID STATEMENT After examination of the Project Manual developed by the Housing Authority of Washington County for the project noted above, I hereby state that I will perform all work described in strict adherence to the Contract Documents for the Bid Items for which I have submitted Bids. 1.1 Compliance Reports. The bidder represents that all previous projects that bidder has participated in as contractor or subcontractor, when subject to the Equal Opportunity Clause prescribed by Executive Orders 10925, 11114, 11246 or the Secretary of Labor, Bidder has filed all required compliance reports; and that representations indicating submission of required compliance reports, signed by proposed subcontractors, will be obtained on this project prior to subcontract awards. 1.2 Contract Period. The contract is for a period of three years. Contractor may elect to escalate prices equal to the Portland Area Consumer Price Index (CPI) every six months from the date of contract execution. Project shall be completed within the time stated on each change order of be subject to liquidated damages as defined in the specifications. 1.3 Addenda (If Any) Receipt of Addenda through is hereby acknowledged. Bidder s Signature date 1.4 Attachments *1. Representations, Certifications & Other statements of Bidders HUD-Form-5369-C * Documents required to be submitted with bid ATTEST: Bidder Signature: Date: CREDENTIALS Bidder s Name: Soc. Sec. No: Address: SAIF No.: Federal Tax I.D. No.: Or Builders Reg. No.: Phone (Bus) E-mail Address: Other phones (Cell, res.): FAX:
2.0 PRICE SUBMITTAL FORM BID TITLE: REPLACEMENT OF CARPET, SHEET VINYL FLOORING & VCT FLOORING SERVICES for PUBLIC HOUSING #2016.094B BID CLOSING: 11:00 A.M., _THURSDAY SEPTEMBER 01, 2016 FIRM SUBMITTING BID: FIRM'S FINANCIAL PAYMENT TERMS (2%-10, NET-30, ETC.): Bid price is to include labor, equipment, consumable materials and supplies, overhead, supervision, mileage, travel time, and truck charge necessary or incidental to providing flooring services per attached specifications. No fees or charges shall be invoiced outside of this rate. ITEM DESCRIPTION UNIT 1 2 3 4 Sheet vinyl overlay. Typical prep with embossing leveler only Vinyl Composite Tile (VCT). Remove and Replace. Remove existing Carpet and Dispose of per Specifications Remove and Dispose of Existing Carpet, Provide and Install Primary Carpet and Pad per Specifications BID PRICE EST. USAGE Sq. Yd. $ 500 $ Sq. Ft. $ 600 $ Sq. Yd. $ 3800 $ Sq. Yd. $ 3800 $ 5 Install Four inch rubber base. Ln. Ft. $ 1100 $ TOTAL 6 Remove existing underlayment and install 1/2" APA approved plywood underlayment. Per Sheet (32 sq. ft.) $ 50 $ 7 Install 1/4" HALEX or HAWC approved substitute over existing floor. 8 Remove and Re-set kitchen appliances Per Sheet (20 sq. ft.) Per appliance $ 70 $ $ 50 $ 9 Remove Toilet Per toilet $ 20 $ 10 Apply Floor sealer over pet stained areas (odor encapsulation) Sq. Ft. $ 400 $ 11 Wall to Wall carpet on stairs Per Step $ 30 $ TOTAL (Add 1 through 11) AVERAGE UNIT COST (Total divided by 11) For information only: Standard hourly service rate $ $ $ $ $
3.0 GENERAL INFORMATION FORM Please provide the following information and respond to the following questions. We ask that you keep you responses short and provide only the information requested. Name of Firm CCB# Address of your firm Phone No. FAX No. Email (Please note that, as a condition of this contract, your firm must be able to be reached by telephone, FAX, and e-mail. If you do not have these forms of communication at the time of this bid submittal, you must have these systems in place at the time of the contract signing.) Type of firm (Corporation, partnership, etc.) ESB/MBE/WBE/DBE status Your Bonding limit Please briefly describe your firm s history. Include the age of the firm, number of employees, the type of projects you typically do, etc.
4.0 PROJECT LIST FORM Provide a list of five projects that illustrate your firm s ability to satisfactorily perform the work outlined in this project. These projects do not necessarily need to be the same type of projects but should clearly illustrate your firm s ability do the work specified. Project 1. Project 2. Project 3. Project 4. Project 5.
5.0 REFERENCE FORM Provide a list of five references from recent clients (within the past 24 months). Please include a very brief description of the work your firm performed, the value of your contract or agreement, the client s name, address, and telephone number. Reference 1. Reference 2. Reference 3. Reference 4. Reference 5.
FORM OF NON-COLLUSIVE AFFIDAVIT State of )ss. County of ) A F F I D A V I T (Prime Bidder), being first duly sworn deposes and says: That he is (a partner or officer of the firm of, etc.) the party making the foregoing proposal or bid, that such proposal or bid is genuine and not collusive or sham; that said Bidder has not colluded, conspired, connived or agreed, directly or indirectly, with any Bidder or person, to put in a sham bid or to refrain from bidding, and has not in any manner, directly or indirectly, sought by agreement or collusion, or communication or conference, with any person, to fix the bid price of affiant or of any other Bidder, or to fix any overhead, profit or cost element of said price, or of that of any other Bidder, or to secure any advantage against the Housing Authority of Washington County or any person interested in the proposed contract; and that all statements in said proposal or bid are true. By Title (Affix Corporate Seal if required) Subscribed and sworn to before me this day of, 20. My commission expires. (Notary Seal Required)
FORM OF NON-COLLUSIVE AFFIDAVIT A F F I D A V I T (Subbidder) State of )ss. County of ) 0., being first duly sworn deposes and says: That he is the party making a certain proposal or bid dated,, to for subcontract work in connection with the construction of HUD-aided, located in Washington County Oregon, and the party proposed by said as subcontractor for said work as a result of said bid, that such bid is genuine and not collusive or sham; that said Bidder has not colluded, conspired, connived or agreed, directly or indirectly, with any Bidder or person, to put in a sham bid or to refrain from bidding, and has not in any manner, directly or indirectly, sought by agreement or collusion, or communication or conference, with any person, to fix the bid price of affiant or of any other Bidder, or to fix any overhead, profit or cost element of said price, or of that of any other Bidder, or to secure any advantage against the Housing Authority of Washington County or any person interested in the proposed contract; and that all statements in said proposal or bid are true. By Title (Affix Corporate Seal if required) Subscribed and sworn to before me this day of, 20. My commission expires. (Notary Seal Required)
SUBSTITUTION REQUEST FORM TO: BID NUMBER: # SPECIFIED ITEM: Section Page Paragraph Description The undersigned requests consideration of the following: PROPOSED SUBSTITUTION: Attached data includes product description, specifications, drawings, photographs, performance and test data adequate for evaluation of the request; applicable portions of the data are clearly identified. Attached data also includes description of changes to Contract Documents that the proposed substitution will require for its proper installation. The undersigned states that the following paragraphs, unless modified on attachments, are correct: 1. The proposed substitution does not affect dimensions shown on Drawings. 2. The proposed substitution will have no adverse affect on other trades, the construction schedule, or specified warranty requirements. 3. Maintenance and service parts will be locally available for the proposed substitution. The undersigned further states that the function, appearance and quality of the Proposed Substitution are equivalent or superior to the Specified Item. Submitted by: Signature Firm Address For use by Consultant: Accepted Accepted as noted Not Accepted Received Late By Date Telephone Date Remarks