Solicitation RFQ PR812-752-14 - Norfolk Redevelopment and

Transcription

Norfolk Redevelopment and
Housing Authority
Request for Quotes
# PR812-752-14
for
Towing Services
March 13, 2014
RFQ PR812-752-14
Page 1 of 15
GENERAL INFORMATION FORM
QUESTIONS: All inquiries for information regarding this solicitation should be directed to: Tom Winder, e-mail: [email protected].
Deadlines for questions are one week before submittal date. No question shall be answered after that date.
DUE DATE: Quotes will be received until March 28, 2014, not later than 3:00 p.m., Eastern Standard Time. Failure to submit offers
to the correct location by the designated date and hour will result in disqualification.
ADDRESS: Quotes may be mailed, emailed, faxed or hand delivered to: NRHA Purchasing Services Office, 201 Granby Street, 7th
Floor, Norfolk, VA 23510. Reference the Opening Date and Hour, and RFQ Number in the lower left corner of the return envelope or
package. It shall be the vendors’ responsibility to ascertain that faxed or emailed quotes are received in a timely manner.
In compliance with this Request for Quotes and to all the conditions imposed therein and hereby incorporated by reference, the
undersigned offers and agrees to furnish the services in accordance with the attached signed proposal and as mutually agreed upon by
subsequent negotiation.
PRE-PROPOSAL CONFERENCE: None for this solicitation.
TYPE OF BUSINESS: (Please check all applicable classifications). If your classification is certified by the Virginia Department of
Minority Business Enterprise, provide your certification number: ___________. For certification assistance, please visit:
http:/www.dmbe.state.va.us.
Large
Small business – An independently owned and operated business which, together with affiliates, has 250 or fewer employees
or average annual gross receipts of $10 million or less averaged over the previous three years. Department of Minority
Business Enterprise (DMBE) certified women-owned and minority-owned business shall also be considered small business
when they have received DMBE small business certification.
Women-owned business – A business concern that is at least 51% owned by one or more women who are U. S. citizens or
legal resident aliens, or in the case of a corporation, partnership, or limited liability company or other entity, at least 51% of the
equity ownership interest is owned by one or more women who are citizens of the United States or non-citizens who are in full
compliance with the United States immigration law, and both the management and daily business operations are controlled by
one or more women who are U. S. citizens or legal resident aliens.
Minority-owned business – A business concern that is at least 51% owned by one or more minority individuals (see Section
2.2-1401, Code of Virginia) or in the case of a corporation, partnership, or limited liability company or other entity, at least 51%
of the equity ownership interest in the corporation, partnership, or limited liability company or other entity is owned by one or
more minority individuals and both the management and daily business operations are controlled by one or more minority
individuals.
COMPANY INFORMATION/SIGNATURE: In compliance with this Request for Proposal and to all the conditions imposed therein and
hereby incorporated by reference, the undersigned offers and agrees to furnish the services in accordance with the attached signed
proposal and as mutually agreed upon by subsequent negotiation. Providing false data on this sheet is grounds for deciding that
your company is non-responsive in regards to proposal submittal and may be removed from the competition.
FULL LEGAL NAME (PRINT)
FEDERAL TAXPAYER NUMBER (ID#)
(Company name as it appears with your Federal Taxpayer Number)
BUSINESS NAME/DBA NAME/TA NAME
FEDERAL TAXPAYER NUMBER
(If different than the Full Legal Name)
(If different than ID# above)
BILLING NAME
(Company name as it appears on your invoice)
IDENTIFICATION NUMBER issued by the State Corporation Commission
(See Section III, paragraph 9)
CONTRACT AND TASK ORDER ADDRESS
PAYMENT ADDRESS
CONTACT NAME/TITLE (PRINT)
SIGNATURE (IN INK) for Quote PR812-752-14
E-MAIL ADDRESS
TELEPHONE NUMBER
TOLL FREE TELEPHONE NUMBER
DATE SIGNED
FAX NUMBER TO RECEIVE
RFQ PR812-752-14
I.
Page 2 of 15
PRICING
A. Pricing shall be all inclusive of transportation, labor, overhead, G&A, and fee. No
other charges are applicable to the resultant contract and thus disapproved on all
invoices.
B. The Offeror hereby agrees to provide all material, equipment, transportation and
incidentals in accordance with the conditions of the solicitation and specifications.
C. This solicitation shall result in an indefinite delivery, indefinite quantity term contract
for Towing Services at the offered and awarded unit prices, to be ordered on an as
needed, as ordered basis.
D. Based on previous 2 years of towing services provided to NRHA, the expected level
of need for emergency towing is 15 - 20 tows per year. The amount of services
actually ordered may be more or less than the amount stated herein and the
awarded service provider(s) should not rely on this estimate. The figure is provided
as information only.
CLIN - Contract Line Item Number
The pricing lines pertain to all work under Section V. A, B, and D through G.
CLIN 0001 - Base Period, Contract Award through June 30, 2014:
Cost Per Tow – within
Norfolk City Limits
Description
Estimated #
of Tows
Vehicles 4,000 lbs and under
$
5*
Vehicles 4,001 to 10,000 lbs
$
8*
Vehicles 10,001 lbs to 20,000 lbs
$
2*
Tractors and Lawn Equipment
$
5*
Overage Mileage Rate
Estimated
Annual cost
$_____________ X 75* miles = estimated annual cost $_____________
CLIN 0001 price (Total of all CLIN 0001 lines above)
$_____________
RFQ PR812-752-14
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CLIN 0002 – Option Year 1, July 1, 2014 through June 30, 2015:
Norfolk City Limits
Description
Estimated #
of Tows
$
5*
$
8*
$
2*
$
5*
Estimated
Annual cost
$_____________
Norfolk City Limits
Description
Estimated #
of Tows
$
5*
$
8*
$
2*
$
5*
Estimated
Annual cost
$_____________
Norfolk City Limits
Description
Estimated #
of Tows
$
5*
$
8*
$
2*
$
5*
Estimated
Annual cost
$_____________
RFQ PR812-752-14
Page 4 of 15
Norfolk City Limits
Description
Estimated #
of Tows
$
5*
$
8*
$
2*
$
5*
Estimated
Annual cost
TOTAL EVALUATED PRICE (Total of CLIN 0001 through 0005)
$_____________
$_______________
CASH DISCOUNT FOR PROMPT PAYMENT______% 10 DAYS/ NET __30___ DAYS
(Service provider may offer prompt payment discount, otherwise, terms are net 30)
*
II.
Estimated amounts are for evaluation purposes, only. Amounts actually ordered may be more
or less than the estimated amounts.
PURPOSE
Norfolk Redevelopment and Housing Authority (NRHA) is seeking a qualified Contractor to
provide vehicle towing services on a firm-fixed unit price, indefinite quantity, indefinite delivery
basis.
III.
CONTRACT PERIOD
This effort will be for up to a five-year contract; base performance period plus four one-year
options. The base performance period is:
Base Year – Contract Award through June 30, 2014. Option year performance periods are:
Option Year 1 – July 1, 2014 through June 30, 2015
Exercise of options is the sole right and prerogative of NRHA. The Contractor shall be
obligated by acceptance of an awarded contract, to execute the base year and each option
year of the contract. The Contractor will be notified thirty (30) days prior to the end of each
contractual year of NRHA’s decision to exercise the option year.
IV.
BACKGROUND
A. NRHA is a political subdivision, created under the laws of the State of Virginia to
provide public and other affordable housing and related services to eligible low-
RFQ PR812-752-14
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income families of Norfolk, Virginia. NRHA, primarily funded by the U.S. Department
of Housing and Urban Development (“HUD”), develops, maintains and manages lowrent public housing and other low-income housing. NRHA currently manages over
3,229 units of public housing.
B. In order to properly ensure continuity of operations, NRHA requires, from time to
time, towing services for removal of improperly parked vehicles and emergency
towing services for Authority vehicles and equipment.
V.
STATEMENT OF NEED
NIGP Commodity Code(s) for this effort are/is: 96890
A. Minimum Contractor Qualifications:
1. The Contractor selected shall be an established company, or sole proprietorship,
with not less than three (3) years in business and three (3) years experience in
providing Towing Services similar to the requirements identified herein.
2. The Contractor shall have sufficient equipment and capacity to provide the
towing of all vehicles identified herein or provide evidence of the ability to provide
such capacity within the time frames specified herein.
3. The contractor shall have sufficient financial resources to successfully provide
the scope of services identified herein, including the identified permissible billing
frequency.
B. GENERAL REQUIREMENTS
1. The Contractor shall ensure that they are in compliance with all law and
regulations in executing the work, including any Federal, State, or local Safety
and Environmental law and regulations.
2. The Contractor shall notify the Authority of any damage to NRHA property or
private property caused by performance of work under this contract including, but
not limited to, damage to grounds, trees, shrubbery, beds, sidewalks, driveways,
parking lots, vehicles, building exteriors, floors, walls, doorways, or elevators
during the work. Contractor shall be responsible for repairs to, or replacement of,
damaged property and timely remediation of any water damage, at no additional
cost to the Authority.
3. For security measures, Contractor shall wear uniforms, carry company
identification badges, or provide other means, acceptable to the Authority, that
identifies authorized employees or subcontractor personnel at all times while
working on NRHA properties.
4. The Contractor is responsible for the security of all materials, tools, and
equipment used in the conduct of the work while on NRHA properties whether
the Contractor’s personnel or subcontractor personnel are present, or not.
5. All tow truck drivers/operators shall be licensed by the Virginia Department of
Criminal Justice Service. *Note - Per subsection C in Section 46.2-116 of the
code of Virginia, it is prohibited to issue a registration to any person who has
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been convicted of a violent crime as defined in subsection C of Section 17.1-805
of the Code or has been convicted of any crime involving a tow truck, including
drug or alcohol offenses but not including traffic infractions. The law still prohibits
issuing registrations to persons requiring to register as sex offenders.
6. The Contractor shall be available and in compliance with the terms of the
awarded contract twenty-four (24) hours, seven (7) days per week including
weekend and holidays.
7. The Contractor shall determine the appropriate wrecker to be sent on any call for
service. The NRHA employee requesting the service will describe the vehicle
needing towing service.
8. Drivers/operators shall be at least 18 years of age. Under no circumstances
shall the Contractor, while performing under the terms of the awarded contract,
allow or permit minor aged passengers to ride in vehicles while performing work
under the awarded contract.
9. Drivers/operators shall be fluent in the English Language.
10. Hold Harmless:
A. The Contractor shall indemnify and hold harmless, NRHA from any and all
claims arising out of and/or as a result of the operations of the Contractor on
NRHA’s property, Including:
i.
Any and all damages to vehicles incurred in the process of Contractor
towing vehicles, removing vehicles, or any other activity of Contractor
towing or its agents that occur on NRHA property.
ii. Any and all liabilities and obligations and any and all claims arising from
the Contractor’s use of the premises, or from conduct or from any activity,
work, or things done, permitted or suffered by the Contractor and NRHA
11. Insurance Requirements:
A. The Contractor shall maintain a full coverage liability insurance policy in the
amount of not less than one million ($1,000,000.00). The insurance policy
shall cover all acts of the Contractor performed under the awarded contract.
A copy of the insurance policy shall be provided to NRHA not later than 10
days after the signing of the awarded contract.
B. The Contractor shall obtain and maintain worker’s compensation insurance
as required by the NRHA Terms and Conditions.
1. Worker’s compensation coverage is compulsory for employers of three
(3) or more employees, to include the employer.
2. Contractors who fail to notify NRHA of increases in the number of
employees that change their worker’s compensation requirements under
the Code of Virginia during the course of the contract shall be in noncompliance with the contract.
RFQ PR812-752-14
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C. WORK SCOPE – Improperly Parked Vehicles – Property Management
The Contractor shall provide all supervision, personnel, labor, materials, tools,
equipment, utilities, and transportation necessary to provide towing services of
improperly parked vehicles from NRHA Public Housing Properties.
1. Towing services shall be provided for the following NRHA Properties:
NRHA Property
Name
Location
Bobbitt Midrise
5920 Poplar Hall Drive
Sykes Midrise
Tidewater
Gardens
555 E. Liberty Street
Diggs Town
1619 Vernon Avenue
Grandy Village
3151 Kimball Terrance
Oakleaf Forest
1701 Greenleaf Drive
Calvert Square
900 Bagnall Road
Partrea Midrise
Franklin Arms
Midrise
701 Easy Street
Property Manager
Valerie Brandon-Hamlin
Carrie Johnson
Perry Clay
450 Walke Street
Kay Britt
Kecia Reed
Saheem Staggers
Yolanda Wiggins
Jacqueline Copeland
April Espree
2500 Princess Anne Road
Jody Duso
Young Terrace
816 Whitaker Lane
Hunter Square
Yvette Tate
Midrise
825 Goff Street
** Addresses are, in some cases, general locations predominantly based on management
office locations. NRHA reserves the right to add other property locations to the contract. **
2. The Contractor shall provide towing services at no charge to NRHA. NRHA, its
agents or employees shall not be obligated at any time for any charges incurred
by towing or storage of any vehicle that the Contractor removes from NRHA’s
property by either request or Contractor patrolling.
3. Charges for towing shall remain the sole responsibility of the owner, lessee or
custodian of the vehicle towed, removed or stored until claimed.
4. Towing service shall include patrolling the trashcan zones on Tuesdays, (trash
days). Towing should occur after 7:00 a.m. on trash days.
5. The Contractor shall comply with all local, state and Federal requirements for
removal and storage of any vehicles removed from NRHA Properties.
6. Vehicles must be towed to the Contractor’s secured, (fully enclosed/fenced in);
impound lot located within the City of Norfolk limits. The owner of the vehicle
RFQ PR812-752-14
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must have access to the vehicle upon request. The impound lot shall be open
during normal business hours.
7. As required by local ordinances, the Contractor shall to convert all towing
information signs currently on the NRHA’s Property to towing information signs
containing the Contractor’s name and any required information.
8. Unless required by formal instructions issued by a Court of Law in accordance
with Statutes of the State of Virginia, NRHA’s name, the names of any NRHA
agents, or the names of NRHA employees shall not be divulged to any owner,
lessee, or custodian of any vehicle towed or removed from NRHA properties.
D. WORK SCOPE – 24 Hour Emergency Towing Service – Housing Operations
The contractor shall provide all supervision, personnel, labor, materials, tools,
equipment, utilities, and transportation necessary to provide emergency towing
services for NRHA’s Housing Operations Division.
1. The Contractor shall provide 24 hour emergency towing service.
2. Towing services shall be provided within three (3) hours of the initial call for
towing service.
3. The Contractor shall have a 24 hour call in emergency line.
4. The Contractor shall be able to tow all NRHA vehicles under Attachment A. The
heaviest vehicle is a back/hoe front end loader weighing 19,865 lbs.
5. The Contractor shall leave a service ticket with the vehicle after towing.
6. The below information must be noted on the service ticket:
a. Vehicle name
b. Date of service
c. Time service took place
d. Name of NRHA employee who initiated the call for service
e. Cost of service
*Note – Failure to leave service tickets with the vehicles will cause delay in
Contractor payment. Excessive failure to leave service tickets with vehicles may
be cause for contract termination.*
7. The below NRHA employees are authorized initiate tow services:
a. Ron Ward
b. Rafael Hernandez
c. Matt Winstead
RFQ PR812-752-14
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d. James Higginbotham
e. Brandon Banks
f.
William (Louie) Jordan
g. Rick O’Neal
h. Barbara Ernst
E. TOWING LOCATIONS
1. At NRHA’s request, vehicles may require towing to/from the below locations:
a. NRHA Housing Operations building – 910 Ballentine Blvd, Norfolk, VA
b. On or around NRHA properties and to or from locations within the Norfolk
City Limits.
c. Chesapeake Redevelopment and Housing Authority and from locations in
and around Chesapeake, VA.
d. Various local automotive dealerships.
F. SERVICE CALLS – Working Hours
1. During working hours (7:30 a.m. until 4:30 p.m.) towing services shall be
requested by, and coordinated through, the NRHA Auto Shop located at 910
Ballentine Blvd., Norfolk, VA 23504; telephone number (757) 314-1697.
2. Vehicles towed back to the Auto Shop shall be dropped at the back of the
complex, 910 Ballentine Blvd., Norfolk, VA 23504. Exact location will be covered
at time of contract award.
3. For all tows, a service ticket shall be left with an NRHA Auto Shop responsible
party, as established at time of contract award. This is a mandatory requirement,
failure to comply may be considered a material breach of the contract.
G. SERVICE CALLS – After Working Hours
1. Afterhours tow services shall be coordinated with the NRHA employee
responsible for the afterhours duty phone, including access to the Housing
Operations compound.
2. Contact information will be provided at time of contract award.
VI.
PRICING SCHEDULE
1. The Bidder agrees to provide all material, equipment, transportation and incidentals in
accordance with the conditions of the bid and specifications for service requirements.
RFQ PR812-752-14
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2. The Bidder shall complete and submit the pricing schedule hereunder (paragraph 1,
above).
VII.
BILLING SPECIFICATIONS
1. The contractor shall provide monthly invoices in electronic format; both in PDF and/or
Excel. Invoices shall be in accordance to the requirements listed in this RFP. Electronic
format shall be emailed to:
[email protected]
2. Electronic invoicing is in compliance with the Paper Reduction Act of 1995. However, if a
contractor can show that the utilization of electronic means for invoicing is causing a
hardship, a waiver may be granted. If you are a small business, you must contact the
NRHA Small Business Representative prior to proposal submittal to register as a small
business and complete the applicable paperwork.
3. All invoices shall show the contract number and/or purchase order number; and the
federal employer identification number (for proprietorships, partnerships, and
corporations).
4. Any payment terms requiring payment in less than 30 days will be regarded as requiring
payment 30 days after invoice or delivery, whichever occurs last. This shall not affect
offers of discounts for payment in less than 30 days, however.
5. All goods or services provided under this contract or purchase order, that are to be paid
for with public funds, shall be billed by the contractor at the contract price, regardless of
which public agency is being billed.
6. NRHA adheres to the prompt payment regulations as listed under 5 CFR Part 1315. The
due date for making an invoice payment is as follows:
a. The later of the following two events:
i) The 30th day after the NRHA Purchasing Department receives a proper and
payable invoice from the contractor/vendor.
ii) The 30th day after NRHA's acceptance of supplies delivered or services
performed issued under a signed NRHA Purchase Order.
b. For a final invoice, when the payment amount is subject to contract settlement
actions, acceptance is deemed to occur on the effective date of the contract
settlement.
Please refer to the following website for more information on submitting a proper and
payable invoice, and when an invoice is considered late:
http://www.fms.treas.gov/prompt/index.html
7. The following shall be deemed to be the date of payment: the date of postmark in all
cases where payment is made by mail, or the date of offset when offset proceedings
have been instituted as authorized under the Virginia Debt Collection Act.
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8. Unreasonable Charges. Under certain emergency procurements and for most time and
material purchases, final job costs cannot be accurately determined at the time orders
are placed. In such cases, contractors should be put on notice that final payment in full
is contingent on a determination of reasonableness with respect to all invoiced charges.
Charges which appear to be unreasonable will be researched and challenged, and that
portion of the invoice held in abeyance until a settlement can be reached. Upon
determining that invoiced charges are not reasonable, NRHA shall promptly notify the
contractor, in writing, as to those charges which it considers unreasonable and the basis
for the determination. A contractor may not institute legal action unless a settlement
cannot be reached within thirty (30) days of notification. The provisions of this section
do not relieve an agency of its prompt payment obligations with respect to those charges
which are not in dispute (Code of Virginia, § 2.2-4363).
VIII.
CONTRACT ADMINISTRATION
1. Upon award, NRHA will designate individual(s) as Technical Contract
Administrator(s) to administer all work performed in conjunction with this contract.
The NRHA contract administrator(s) shall be the interpreter(s) of the conditions of the
contract and the judge of its performance. The Technical Contract Administrator(s)
shall use all powers under the contract to enforce its faithful performance, shall
determine the amount, quality, acceptability, and fitness of all aspects of the services
and shall decide all other questions in connection with the services. The NRHA
Technical Contract Administrator, inspector, or designated official, shall have no
authority to approve changes in the services which alter the concept, or which call for
an extension of time, or a change in contract terms or price. Any contract
modifications made shall be authorized by the NRHA Contracting Officer and issued
as a written modification to the contract.
IX.
SUBMISSION OF QUOTES
A. General Requirements:
1. RFQ Response: In order to be considered for selection, Offerors must submit a
written quote in response to this RFQ. One original must be submitted to:
Norfolk Redevelopment and Housing Authority
Purchasing Services Office
201 Granby Street, 7th Floor
Norfolk, VA 23510
Reference the Opening Date and Hour, and RFQ Number in the lower left hand
corner of the return envelope or package. No other distribution of the proposals shall
be made by the Offeror.
Outer envelope and each page must have the Offeror’s name, proposal number, and
submission due date and time.
DO NOT RETURN THE SOLICITATION IN YOUR SUBMITTAL PACKAGE. ONLY
SUBMIT THE REQUIRED INFORMATION.
Quote submission via facsimile transmission or email will not be considered.
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2. Proposal Preparation:
Contractor must provide the following information in their quote packet.
a. The Contractor must complete and submit the Bidder Questionnaire and submit
an equipment inventory list (Attachment B).
b. The Contractor must complete and submit three (3) reference forms
(Attachment C) for contracts completed or currently working within the last three
(3) years. Contractors are highly encouraged to contact their references prior to
submitting their names to ensure they will complete a questionnaire that will be
submitted to them for completion on Contractor’s performance.
a. The Contractor must complete and submit three (3) past performance write ups
(Attachment D) for contracts completed or currently working within the last three
(3) years.
b. The Contractor shall review Attachment E – HUD 5369-B Instructions to
Offerors
c. The Contract shall complete and submit Attachment F – HUD 5369C Certifications and Representations of Offerors
d. The Contractor shall complete and submit Attachment G – Certificate of
Compliance – Section 3
e. The Contractor shall complete and submit Attachment H – W9 Form
f.
The Contractor shall complete and submit Attachment I – NRHA Certifications
and Representations.
g. NRHA encourages the use of recycled paper in proposal preparation.
h. Do not use color or expensive stock in preparing proposal.
i.
Proposals should be prepared simply and economically providing a
straightforward, concise description of capabilities to satisfy the requirements of
the IFQ. Emphasis should be on completeness and clarity of content.
j.
Additional information such as company brochures, literature, or other marketing
material, will be discarded and not used in the evaluation process. Non compliant
proposals may be removed from the competitive range.
k. Ownership of all data, material, and documentation originated and prepared for
NRHA pursuant to the IFQ shall belong exclusively to NRHA and be subject to
public inspection in accordance with the Virginia Freedom of Information Act.
Trade secrets or proprietary information submitted by an Offeror shall not be
subject to public disclosure under the Virginia Freedom of Information Act.
However, to prevent disclosure the Offeror must invoke the protections of Section
2.2-4342F of the Code of Virginia, in writing, either before or at the time the data
or other materials is submitted. The written request must specifically identify the
data or other materials to be protected and state the reasons why protection is
necessary. The proprietary or trade secret material submitted must be identified
by some distinct method such as highlighting or underlining and must indicate
RFQ PR812-752-14
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only the specific words, figures, or paragraphs that constitute trade secret or
proprietary information. The classification of an entire proposal document, line
item prices and/or total proposal prices as proprietary or trade secrets is not
acceptable and may result in rejection of the proposal.
NOTE: Failure to submit the required information and/or Attachments may result in the
elimination of the Contractor’s quote from the competition. Contractors are encouraged
to review their quotes and attachments prior to submittal to ensure total compliance with
Section VII, of this Request for Quote.
X.
SELECTION CRITERIA AND AWARD
A. Selection Criteria:
Selection may be made without discussions with one or multiple responsive and
qualified contractor(s) who offers the lowest responsible quote and whose offer totally
complies with all required quote requirements.
B. Procedure for Determining Lowest Quote:
The apparent low quote will be determined by the lowest Lump Sum Total or Line by
Line total of a qualified quote. The contract amount will be based on the Base Quote
(including allowances), provided the qualified quote is within budget limitations. If the
Base Quote exceeds budget limitations, NRHA reserves the right to take action in
accordance with Attachment E - Instructions to Offerors for Contracts, HUD-5369,
Clause 8. (Specification Section 00100-2)
XI.
TERMS AND CONDITIONS
A. NRHA Required General Terms and Conditions apply to this solicitation and
resultant contract. Pertinent documents, including the Commonwealth of Virginia
Vendors Manual and the NRHA Required General Terms and Conditions may be
found at:
1. The Commonwealth of Virginia Vendors Manual
http://www.eva.virginia.gov/learn-about-eva/vendors-manual.htm
2. NRHA’s Terms and Conditions
http://www.nrha.us/opportunities
B. Mandatory Clauses – In accordance with the Department of Housing and Urban
Development (HUD) Handbook No. 7460.8 REV 2, the following terms apply to this
contract:
MANDATORY CONTRACT CLAUSES FOR SMALL PURCHASES OTHER THAN
CONSTRUCTION
The following contract clauses are required in contracts pursuant to 24 CFR 85.36(i) and
Section 6002 of the Solid Waste Disposal Act, as amended by the Resource
Conservation and Recovery Act. HUD is permitted to require changes, remedies,
changed conditions, access and records retention, suspension of work, and other clauses
RFQ PR812-752-14
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approved by the Office of Federal Procurement Policy. The PHA and contractor is also
subject to other Federal laws including the U.S. Housing Act of 1937, as amended, Federal
regulations, and state law and regulations.
A. Examination and Retention of Contractor’s Records. The PHA, HUD, or
Comptroller General of the United States, or any of their duly authorized
representatives shall, until three years after final payment under this contract, have
access to and the right to examine any of the Contractor’s directly pertinent books,
documents, papers, or other records involving transactions related to this contract for
the purpose of making audit, examination, excerpts, and transcriptions.
B. Right in Data and Patent Rights (Ownership and Proprietary Interest). The PHA
shall have exclusive ownership of, all proprietary interest in, and the right to full and
exclusive possession of all information, materials, and documents discovered or
produced by Contractor pursuant to the terms of this Contract, including, but not
limited to, reports, memoranda or letters concerning the research and reporting tasks
of the Contract.
C. Energy Efficiency. The Contractor shall comply with all mandatory standards and
policies relating to energy efficiency which are contained in the energy conservation
plan issued in compliance with the Energy Policy and Conservation Act (Pub.L. 94163) for the State in which the work under this contract is performed.
D. Procurement of Recovered Materials
(1) In accordance with Section 6002 of the Solid Waste Disposal Act, as amended by
the Resource Conservation and Recovery Act, the Contractor shall procure items
designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR
Part 247 that contain the highest percentage of recovered materials practicable,
consistent with maintaining a satisfactory level of competition. The Contractor shall
procure items designated in the EPA guidelines that contain the highest percentage of
recovered materials practicable unless the Contractor determines that such items: (a)
are not reasonably available in a reasonable period of time; (b) fail to meet reasonable
performance standards, which shall be determined on the basis of the guidelines of the
National Institute of Standards and Technology, if applicable to the item; or (c) are only
available at an unreasonable price.
(2) Paragraph (a) of this clause shall apply to items purchased under this contract
where: (i) the Contractor purchases in excess of $10,000 of the item under this
contract; or (ii) during the preceding Federal fiscal year, the Contractor: (1) purchased
any amount of the items for use under a contract that was funded with Federal
appropriations and was with a Federal agency or a State agency or agency of a
political subdivision of a State; and (2) purchased a total of in excess of $10,000 of the
item both under and outside that contract.
E. Termination for Cause and for Convenience (contracts of $10,000 or more).
(1) The PHA may terminate this contract in whole, or from time to time in part, for the
PHA’s convenience or the failure of the Contractor to fulfill the contract obligations
(cause/default). The PHA shall terminate by delivering to the Contractor a written
Notice of Termination specifying the nature, extent, and effective date of the
termination. Upon receipt of the notice, the Contractor shall: (a) immediately
discontinue all services affected (unless the notice directs otherwise), and (b) deliver to
RFQ PR812-752-14
Page 15 of 15
the PHA all information, reports, papers, and other materials accumulated or
generated in performing the contract, whether completed or in process.
(2) If the termination is for the convenience of the PHA, the PHA shall be liable only for
payment for services rendered before the effective date of the termination.
(3) If the termination is due to the failure of the Contractor to fulfill its obligations under
the contract (cause/default), the PHA may (a) require the Contractor to deliver to it, in
the manner and to the extent directed by the PHA, any work described in the Notice of
Termination; (b) take over the work and prosecute the same to completion by contract
of otherwise, and the Contractor shall be liable for any additional cost incurred by the
PHA; and (c) withhold any payments to the Contractor, for the purpose of set-off or
partial payment, as the case may be, of amounts owned by the PHA by the Contractor.
In the event of termination for cause/default, the PHA shall be liable to the Contractor
for reasonable costs incurred by the Contractor before the effective date of the
termination. Any dispute shall be decided by the Contracting Officer.
(END OF CLAUSE)
XII.
PRE-PROPOSAL CONFERENCE
No pre-proposal conference is scheduled for this effort.
XIII.
AMENDMENTS
Any AMENDMENTS issued for this solicitation may be accessed at:
www.nrha.norfolk.va.us/opportunities/solicitations/open
Since a paper copy of the amendments will not be mailed to you, we encourage you to check
the web site regularly.
XIV.
ATTACHMENTS
Attachment A – List of vehicles
Attachment B – Bidder Questionnaire and Contractor Equipment List
Attachment C – Reference Sheet
Attachment D – Past Performance Write Up
Attachment E – HUD – 5369 – B Instructions to Offerors
Attachment F – Certifications and Representations of Offerors
Attachment G – Certificate of Compliance – Section 3
Attachment H – W9
Attachment I – NRHA Certifications and Representations
ATTACHMENT A ‐ TOWING LIST
NRHA VEHICLES/EQUIPMENT
60
91
95
111
68
96
74
105
46
47
87
117
59
61
90
106
A-16
92
27
69
80
94
98
114
119
121
122
A-18
75
83
89
123
39
60x5
91x2
95x3
111
68x3
96x2
Ax4x1
105x2
46x6
47x4
87x3
Sell
201368
201406
201369
106x3
000414
000218
000219
000787
000187
000340
000208
000641
000644
000674
000675
000991
001009
001010
001011
001056
001336
1990
1990
1993
1993
1994
1994
1995
1995
1996
1997
1997
1997
1998
1998
1999
1999
2000
2000
2001
2001
2001
2001
2001
2001
2001
2001
2001
2002
2002
2002
2002
2002
2003
F-600 Dump
Ford F- 600 dump
Chev van 20
Chevy van 20
Chevy S-10
Chev van 20
Ford van E-350
GMC 1500 p/u Bi
Buick Century
Ford Aerostar
Ford F-250
Ford F-700 dump
GMC 1ton Dump
Ford F-150
Ford F-800
Ford F-450 dump
Ford E-350 Van
Dodge 1500 van
Chrys Sebring
GMC Dump
Dodge pick up
Dodge 1500 p/u
Dodge 1500 p/u
Dodge 1500
Ford F350 crew
Dodge p/u 1500
Dodge p/u 1500
Ford E-350 Van
Dodge 1500 P/U
Dodge 1500 P/U
Dodge1500 P/U
GMC p/u
Chevy Impala
Grounds
Grounds
Grounds
Auto pool
Tidewater
Paint
201 Pool
Auto pool
Ed Balance
Meter reading
carpentry
auto pool
Tile
Grounds
Auto pool
Auto pool
Scattered sites
paint
green/taylor
CDA
grounds
paint
Diggs
Hvac / Plumbing
Grounds
Hvac / Plumbing
Calvert
auto pool
carpentry
youngs
carpentry
CDA
Inspection
1 of 3
1FDNF60HX LVA04010
1FDNF60H5LVA04013
1GCEG25H5PF319722
1GCEG25HOPF319837
1GCCS1444 RK162712
1GCEG25H7RF167672
1FBJS31H6 SHA95211
1GTEC14Z8SZ548175
1G4AG55M4 T6460056
1FMDA11U2 VZA94919
3FTHF25H2VMA6801
1FDNF70J7VVA31158
GDJC34R3 WFO66520
1FTRF17Z8 WKC04302
3FENF80CX XMA02060
1FDXW468XXFA91378
1FBSS31L9 YHB91562
2B7HB11X7YK136389
1C3EL46U5 1N560152
1GDM7H1C2 1J511270
1B7HC16X2 1S676475
1B7HC16X91S745341
1B7HC16X41S676476
2B7HB11XX1K521953
1FTSW30L51EB81782
1B7HC16X31S222056
1B7HC16XX1S222054
1FBSS31LX 2HA52662
1D7HA16KX 2J181190
1D7HA16K5 2J181193
1D7HA16K32J181192
1GTEC19V82Z261831
2G1WF52E9 39246871
13194L
13195L
13132L
20424L
137429L
13157L
21250L
99111L
27809L
31290L
35-157L
31292L
35141L
40035L
35144L
35-137L
122322L
48345l
48344L
106012L
48301L
48397L
48316L
102276L
102277L
102293L
102291L
108473L
108489L
108488L
108486L
110763l
JCG6875
52
53
55
116
A-4
58
82
38
54
66
76
86
109
37
42
65
101
102
107
112
115
22
34
41
43
44
45
77
79
30
31
33
78
001548
001363
001356
001340
001757
001756
001755
002018
002006
002012
002007
002011
002085
002267
002268
002163
002164
002354
002222
002289
002269
002778
002951
002654
002674
002675
002676
002659
002660
002942
002950
002964
002956
2003
2003
2003
2003
2004
2004
2004
2005
2005
2005
2005
2005
2005
2006
2006
2006
2006
2006
2006
2006
2006
2008
2008
2008
2008
2008
2008
2008
2008
2009
2009
2009
2009
Ford F-150
GMC 4x4 P.U.
Chevy 3500 p/u
Ford-F150
Chevy van 2500
Chevy van 3500
Chevy 3500 van
Chevy Malibu
Ford F-150
Ford F-150
Ford F-150
C 3500 Box van
Ford F-650 Bucket truck
Chevy Malibu
Chevy Malibu
Chevy Colorado
Chevy Colorado
GMC C-7500 Dump
Ford F-150
Ford F-350
Chevy 2500 Van
Dodge Charger
Chevy Cobalt
Ford Explorer
Chevy Uplander
Chevy Uplander
Chevy Uplander
Ford F-150
Ford F150
GMC Savanah 2500
GMC Savanah 2500
Ford E-350
Ford F-250
2FTRF1724 3CB14454
1GTHK24U7 3Z239227
1GCHG35U6 31155209
1FTRF17253NB05160
1GJGG25U2 41169303
1GCHG35UO 41168149
1GCHG35U0 41168149
1G1ZS5281 5F222657
1FTRF1229 5NA62775
1FTRF1222 5NA62777
1FTRF1220 5NA62776
1GBHG314041184054
3FRNF65Y65V177479
1G1ZS518X 6F248693
1G1ZS5184 6F248916
1GCCS1488 68218680
1GCCS148668217382
1GDK7C1336F425101
1FTRF12276NB18391
1FDWF36576EA86640
1GCGG25V861229121
2B3KA43R38H183815
Mills/Kramer
1G1AT58HX 97269283
Inspection
1FMEU73E7 8UA96056
O'neal
1GNDV23W4 8D184577
Pool 201
1GNDV23W7 8D184153
JR Hammond
1GNDV23WX 8D183580
K Huges
Oakleaf
1FTRF1221 8KD60372
Hvac / Plumbing 1FTRF1223 8KD60373
1GJGG25K7 91153006
Res Service
1GJGG25K6 91152431
Res Service
1FTSS34L5 9DA20369
Res Service
Auto shop
1FTNF20519EA47484
Oakmont North
Hvac / Plumbing
Tile
Grounds
Res Service
Hvac / Plumbing
Hvac / Plumbing
K Crawley
CDA
Merrimac
carpentry
Carpentry
Electrical
Pool 201
Inspection
Extermination
Mail
Grounds
carpentry
Grounds
Hvac / Plumbing
2 of 3
118258L
40679L
103480L
40678L
118263L
118264L
118264L
119914L
119897L
119904L
119898L
119896L
49122L
131258L
131259L
130241L
130242L
137419L
130243L
137376L
131266L
XWG1825
151279L
147-477L
149-072L
149-073L
149-071L
147188L
147489L
151277L
151280L
151278L
A-2
23
40
51
56
62
110
70
71
72
85
88
97
103
108
A-3
A-3
36
100
113
120
A-5
24
25
67
003286
003421
002320
003224
003234
003235
003225
003476
003417
003477
003490
003437
003435
003436
003438
Freedom01L
Freedom01M
003596
003595
003598
003621
003732
003812
003813
003734
4x4
6x2
000650
6x2
2010
2010
2010
2010
2010
2010
2010
2011
2011
2011
2011
2011
2011
2011
2011
2012
2012
2012
2012
2012
2012
2013
2013
2013
2013
Chevy van 3500
Ford Explorer
Dodge Caravan
2010 Chev van 2500
Ford F-150 p/u
Ford F-150 p/u
Ford F 550 Bucket
Chevy van 2011
Isuzu NQR dump
Chevy van 2500
Ford F-750
Ford F-150
Ford F-150
Ford F-150
Ford F-550 DUMP
Chevy Bus 4500
Chevy Bus 4500
Nissan Versa
Ford F-150 p/u
Ford F-350 4x4
Ford F-350 crew
GMC Savanah 2500
Ford Fusion
Ford Fusion
Isuzu NQR dump
Extra Heavy Equipment
2001 New holland back hoe
1988 Lull all terrain forklift
1GA2GZDG3 A1149801
1FMEU6DE1AUB15991
S Montgomery
2D4RN4DE4 AR206003
Pool 201
1GCZGFBA7 A1124919
Electronics
1FTMF1CW4 AKE01370
Grandy Maint.
1FTMF1CW6 AKE01371
Extermination
Grounds
1FDAF5GR3AEB09203
Electrical
1GCWGDA5B1121648
Sanitation
JALE5W164B7900597
Hvac / Plumbing 1GCWFCA8B1103645
Grounds
3FRNF7FC4BV620670
Grounds
1FTNF1CF5BKD35482
CDA
1FTNF1CF7BKD35483
carpentry
1FTNF1CF9BKD35484
Grounds
1FDOW5GY6BEC25645
1GB6G5BG0D1116588
Res Service
1GB6G5BG0D1116588
Res Service
Inspection
3N1CN7AP1CL-875410
AUTO
1FTNF1CF8CKD45134
Hvac / Plumbing 1FTRF3B64CEB23820
Grounds
1FT8W3A65CEB84932
Res Service
1GJW7PFA8D1149375
3FA6P0G73DR380441
Donnell Brown
3FA6P0G75DR380442
Clara Graves
JALE5W162D7900519
Sanitation
Res Service
19,865 pounds
15,400 pounds
3 of 3
162302L
KDX2279
151290L
151291L
151-299L
151-298L
151292L
166367L
162-310L
166365L
166390L
166362L
166363L
166401L
166361L
175-091L
175-091L
166414L
166413L
166-419L
166423L
175097L
XWG1824
XWG1823
175098L
RFQ PR812-752-14
ATTACHMENT B
STATEMENT OF BIDDER/OFFEROR QUALIFICATIONS & CERTIFICATIONS
All questions must be answered with the appropriate response, clarifications and explanations shall be clear and comprehensive.
Additional pages may be attached, if necessary and Bidder/Offeror may provide additional information to demonstrate
qualifications.
IDENTIFICATION, LOCATION & CONTACTS
1. Name of Bidder/Offeror: ___________________________________________________________
2. Trade Name (DBA): _______________________________________________________________
3. Business Physical Address: _________________________________________________________
_________________________________________________________
_________________________________________________________
4. Billing Address:
_________________________________________________________
_________________________________________________________
_________________________________________________________
5. Business Phone: ____________________________
Fax: ____________________________
6. Tax ID Number: _________________________ 7. DUNS Number: ______________________
8. CAGE Code: ____________________________ 9. Virginia SCC No.: ____________________
10. Point of Contact Name: ____________________________________________________________
11. Point of Contact Title: _____________________________________________________________
12. Point of Contact Phone Number(s): __________________________________________________
BUSINESS ORGANIZATION AND MINORITY STATUS CERTIFICATIONS
13. Business Type:
Sole-Proprietorship
Corporation
LLC
LLP
Partnership
Joint Venture
Other: _____________________________
14. Business Ownership (check all that apply):
Minority Business Enterprise
Woman-Owned Business
Small Business
Small Disadvantaged Business
HUB Zone Certified
Section 3 Certified
RFQ PR812-752-14
ATTACHMENT B
Business Ownership, Continued (check all that apply):
SWAM Certified
Service-Disabled Veteran
Veteran-Owned
QUALIFICATION STATEMENTS AND OTHER CONTRACTOR INFORMATION
15. Business Start Date: ________________________ 16. Years in Business __________________
(Under current business name, only)
(Under current business name, only)
Additional relevant information: ____________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
17. State Contractor License Number and Type/Class: ____________________________________
18. Current Contracts (list 3 current or most recent):
Company/Agency
Award Date
Final Contract Amount
____________________________
____________________________
_____________________
____________________________
____________________________
_____________________
____________________________
____________________________
_____________________
19. List most recently completed projects/contracts relevant to this procurement:
Project/Contract Name/Description
Award Date
Final Contract Amount
____________________________
____________________________
_____________________
____________________________
____________________________
_____________________
20. Describe relevant experience of your firm in providing supplies or services similar in scope and
magnitude to that specified in the solicitation (attach additional pages, as required):
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
21. List background experience of the principal owners, officers, and employees of your firm
relevant to the solicitation and specified requirements:
RFQ PR812-752-14
ATTACHMENT B
Name/Title
Years Experience
Type of Experience
____________________________
____________________________
_____________________
____________________________
____________________________
_____________________
____________________________
____________________________
_____________________
22. List the major equipment available for this contract:
____________________________
____________________________
_____________________
____________________________
____________________________
_____________________
23. What is the general nature or character of work performed by your firm? _________________
_________________________________________________________________________________
24. List any additional minimum qualifications, including special licenses, certifications,
equipment or capabilities as required by the solicitation:_________________________________
_________________________________________________________________________________
_________________________________________________________________________________
CONTRACTOR RESPONSIBILITY/CAPABILITY
25. The firm is
is not
currently debarred, suspended, or ineligible for contract award.
26. Has the firm ever failed to complete any awarded contract, in accordance with the contract
YES
NO
requirements?
If YES is checked, provide contract name/description, awarding company, agency, or
individual and provide explanation (attach additional pages, as required): ______________________
_________________________________________________________________________________
_________________________________________________________________________________
27. Has the firm ever had a contract terminated for default?
YES
NO
If YES is checked, provide contract name/description, awarding company, agency, or
individual and provide explanation (attach additional pages, as required): ______________________
_________________________________________________________________________________
________________________________________________________________________________
RFQ PR812-752-14
ATTACHMENT B
28. Current Credit Available to Firm: $_____________________________
29. Bank Reference(s):
Name of Bank
____________________________
Account Number
____________________________
Point of Contact
_____________________
Contact Phone Number and/or Email Address: ________________________________________
Name of Bank
____________________________
Account Number
____________________________
Point of Contact
_____________________
Contact Phone Number and/or Email Address: ________________________________________
The information provided herein will be used to determine the firm’s minimum qualifications, in accordance with the solicitation requirements,
to be considered eligible for award of a contract pursuant to this procurement. Additionally, the form provides some minimum information
required to make a responsibility determination. Prior to award of a contract, additional information may be required including audited financial
statements, further statements of capabilities and resources, and may require a pre-award site survey.
The undersigned hereby certifies that the information provided in this document is accurate, complete, and
current and that the signatory is authorized by the firm submitting this document to obligate the firm and
attest to the accuracy of the statements and other information provided herein.
______________________________________________
Signature
_______________________
Date
______________________________________________
Printed Name and Title of Person Signing
______________________________________________________
Firm Name
Attachment C - Reference Sheet
NOTE: Leaving the Email Blank give a zero score for that reference.
Solicitation Number:
Contractor Name:
Reference 1:
Company:
Address:
Point of Contact:
Phone Number:
Fax Number:
Email Address:
DO NOT LEAVE BLANK
Dollar Value:
Description of Work:
FRM 25-019
Contractor Name:
Reference 1:
Company:
Address:
Point of Contact:
Phone Number:
Fax Number:
Email Address:
DO NOT LEAVE BLANK
Dollar Value:
FRM 25-019
Contractor Name:
Reference 1:
Company:
Address:
Point of Contact:
Phone Number:
Fax Number:
Email Address:
DO NOT LEAVE BLANK
Dollar Value:
FRM 25-019
RFQ PR812-752-14
Attachment D - Corporate Experience (Three (3) required)
NAME OF CONTRACTOR
1. Contract Number or other Control Number:
2. Complete Name and Address of Contract Reference (Government agency, commercial firm,
or other organization):
Name:
Address:
3. Date of Contract:
4. Date work was begun:
5. Date work was completed:
6. Contract Information:
Contract Type:
Contract Amount (Total ceiling):
7. Point of Contact for this Reference:
Name:
Telephone Number:
E-mail:
8. Location of work (country, state, or province, county, city):
9. Current status of contract (choose one):
Work continuing, on schedule
Work completed, no further action pending or underway
Work completed, claims negotiations pending or underway
Work completed, litigation pending or underway
Terminated for Default
Work continuing, behind schedule
Work completed, routine administrative
action pending or underway
Terminated for Convenience
Other (explain)
10. Provide a summary description of contract work, not to exceed 1 page in length (not
inclusive of this form). Describe the nature and scope of work, its relevancy to this contract,
and a description of any problems encountered and your corrective actions.
RFQ PR812-752-14
NAME OF CONTRACTOR
Name:
Address:
Contract Type:
Name:
Telephone Number:
E-mail:
Other (explain)
RFQ PR812-752-14
NAME OF CONTRACTOR
Name:
Address:
Contract Type:
Name:
Telephone Number:
E-mail:
Other (explain)
RFQ PR812-752-14
ATTACHMENT E
RFQ PR812-752-14
ATTACHMENT E
2
RFQ PR812-752-14
ATTACHMENT F
RFQ PR812-752-14
ATTACHMENT F
ATTACHMENT G
RFQ PR812-752-14
Certificate of Compliance – Section 3
P.O. Box 968
Norfolk, Virginia 23501
(757) 623-1111
TDD# (800) 545-1833
Certification of Compliance with Regulations to Section 3 of Housing and Urban Development Act of 1968 as required for
participate in:
PURPOSE, AUTHORITY AND RESPONSIBILITY
Section 3 is a provision of the Housing and Urban Development (HUD) Act of 1968 that promotes local economic development,
neighborhood economic improvement, and individual self-sufficiency.
Section 3 requires that recipients of certain HUD financial assistance, to the greatest extent possible, provide job training,
employment, and contract opportunities for low- or very-low income residents, particularly persons who are recipients of HUD
assistance for housing.
upon being awarded a contract to
Municipality of the City of Norfolk, Virginia, that the Company:
a)
(hereinafter called the Company), CERTIFIES that
in the
is under no contractual or other impediment that would prevent it from complying with requirements of Section 3 as set
forth in 24 CFR part 135; and
b) will comply with HUD's regulations in 24 CFR Part 135; and
c)
will submit to NRHA a Section 3 Work Plan (see Section 3 Appendix), before a “Notice to Proceed” is issued or start date
projected. The developer or prime contractors will require all subcontractors to submit a Section 3 Work Plan prior to
proceeding with their respective scope of work.
d) will send to each labor organization or representative of workers with which the Company has a collective bargaining
agreement or other understanding, a notice advising the labor organization or the representative or workers of the
Company's commitments under Section 3; and
e)
will include this Section 3 Certification of Compliance in every subcontract subject to compliance with the regulations
found in 24 CR Park 135 and further agrees to take the appropriate action pursuant to those regulations in the event the
subcontractor is found to be in violation of 24 CFR Part 135; and
f)
will not subcontract with any subcontractor where the Company has notice or knowledge that the subcontractor has been
found in violation of any provision of 24 CFR Part 135; and
g) will not fill any vacant employment positions, including training positions, (1) after the Company is selected but before the
contract is executed, and (2) with persons other than those to whom the regulations in 24 CFR Part 135 require employment
opportunities to be directed, to circumvent the Company's obligations under 24 CFR Part 135; and
h) will, to the extent feasible, make a good faith effort to utilize the services of businesses located in or substantially owned by
persons who live within the project boundaries.
Company Name
Name and Title
Signature
Date
Distribution: Contract File
NOV 09 - NRHA FRM 25-022
RFQ PR812-752-14
ATTACHMENT H
W-9
Request for Taxpayer
Identification Number and Certification
Form
(Rev. October 2007)
Department of the Treasury
Internal Revenue Service
Give form to the
requester. Do not
send to the IRS.
Print or type
See Specific Instructions on page 2.
Name (as shown on your income tax return)
Business name, if different from above
Check appropriate box:
Individual/Sole proprietor
Corporation
Partnership
Limited liability company. Enter the tax classification (D=disregarded entity, C=corporation, P=partnership)
Other (see instructions)
©
Exempt
payee
©
Address (number, street, and apt. or suite no.)
Requester’s name and address (optional)
City, state, and ZIP code
List account number(s) here (optional)
Part I
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid
backup withholding. For individuals, this is your social security number (SSN). However, for a resident
alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is
your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.
Social security number
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter.
Employer identification number
Part II
or
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup withholding, and
3. I am a U.S. citizen or other U.S. person (defined below).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.
For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. See the instructions on page 4.
Sign
Here
Signature of
U.S. person ©
Date ©
General Instructions
Section references are to the Internal Revenue Code unless
otherwise noted.
Purpose of Form
A person who is required to file an information return with the
IRS must obtain your correct taxpayer identification number (TIN)
to report, for example, income paid to you, real estate
transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or
contributions you made to an IRA.
Use Form W-9 only if you are a U.S. person (including a
resident alien), to provide your correct TIN to the person
requesting it (the requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are
waiting for a number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S.
exempt payee. If applicable, you are also certifying that as a
U.S. person, your allocable share of any partnership income from
a U.S. trade or business is not subject to the withholding tax on
foreign partners’ share of effectively connected income.
Note. If a requester gives you a form other than Form W-9 to
request your TIN, you must use the requester’s form if it is
substantially similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
● An individual who is a U.S. citizen or U.S. resident alien,
● A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United
States,
● An estate (other than a foreign estate), or
● A domestic trust (as defined in Regulations section
301.7701-7).
Special rules for partnerships. Partnerships that conduct a
trade or business in the United States are generally required to
pay a withholding tax on any foreign partners’ share of income
from such business. Further, in certain cases where a Form W-9
has not been received, a partnership is required to presume that
a partner is a foreign person, and pay the withholding tax.
Therefore, if you are a U.S. person that is a partner in a
partnership conducting a trade or business in the United States,
provide Form W-9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership
income.
The person who gives Form W-9 to the partnership for
purposes of establishing its U.S. status and avoiding withholding
on its allocable share of net income from the partnership
conducting a trade or business in the United States is in the
following cases:
● The U.S. owner of a disregarded entity and not the entity,
Cat. No. 10231X
Form
W-9
(Rev. 10-2007)
FRM 256-021
Form W-9 (Rev. 10-2007)
Page
2
● The U.S. grantor or other owner of a grantor trust and not the
trust, and
● The U.S. trust (other than a grantor trust) and not the
beneficiaries of the trust.
4. The IRS tells you that you are subject to backup
withholding because you did not report all your interest and
dividends on your tax return (for reportable interest and
dividends only), or
Foreign person. If you are a foreign person, do not use Form
W-9. Instead, use the appropriate Form W-8 (see Publication
515, Withholding of Tax on Nonresident Aliens and Foreign
Entities).
5. You do not certify to the requester that you are not subject
to backup withholding under 4 above (for reportable interest and
dividend accounts opened after 1983 only).
Certain payees and payments are exempt from backup
withholding. See the instructions below and the separate
Instructions for the Requester of Form W-9.
Also see Special rules for partnerships on page 1.
Nonresident alien who becomes a resident alien. Generally,
only a nonresident alien individual may use the terms of a tax
treaty to reduce or eliminate U.S. tax on certain types of income.
However, most tax treaties contain a provision known as a
“saving clause.” Exceptions specified in the saving clause may
permit an exemption from tax to continue for certain types of
income even after the payee has otherwise become a U.S.
resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception
contained in the saving clause of a tax treaty to claim an
exemption from U.S. tax on certain types of income, you must
attach a statement to Form W-9 that specifies the following five
items:
1. The treaty country. Generally, this must be the same treaty
under which you claimed exemption from tax as a nonresident
alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that
contains the saving clause and its exceptions.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a
requester, you are subject to a penalty of $50 for each such
failure unless your failure is due to reasonable cause and not to
willful neglect.
Civil penalty for false information with respect to
withholding. If you make a false statement with no reasonable
basis that results in no backup withholding, you are subject to a
$500 penalty.
Criminal penalty for falsifying information. Willfully falsifying
certifications or affirmations may subject you to criminal
penalties including fines and/or imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in
violation of federal law, the requester may be subject to civil and
criminal penalties.
4. The type and amount of income that qualifies for the
exemption from tax.
Specific Instructions
5. Sufficient facts to justify the exemption from tax under the
terms of the treaty article.
Name
Example. Article 20 of the U.S.-China income tax treaty allows
an exemption from tax for scholarship income received by a
Chinese student temporarily present in the United States. Under
U.S. law, this student will become a resident alien for tax
purposes if his or her stay in the United States exceeds 5
calendar years. However, paragraph 2 of the first Protocol to the
U.S.-China treaty (dated April 30, 1984) allows the provisions of
Article 20 to continue to apply even after the Chinese student
becomes a resident alien of the United States. A Chinese
student who qualifies for this exception (under paragraph 2 of
the first protocol) and is relying on this exception to claim an
exemption from tax on his or her scholarship or fellowship
income would attach to Form W-9 a statement that includes the
information described above to support that exemption.
If you are a nonresident alien or a foreign entity not subject to
backup withholding, give the requester the appropriate
completed Form W-8.
If you are an individual, you must generally enter the name
shown on your income tax return. However, if you have changed
your last name, for instance, due to marriage without informing
the Social Security Administration of the name change, enter
your first name, the last name shown on your social security
card, and your new last name.
What is backup withholding? Persons making certain payments
to you must under certain conditions withhold and pay to the
IRS 28% of such payments. This is called “backup withholding.”
Payments that may be subject to backup withholding include
interest, tax-exempt interest, dividends, broker and barter
exchange transactions, rents, royalties, nonemployee pay, and
certain payments from fishing boat operators. Real estate
transactions are not subject to backup withholding.
You will not be subject to backup withholding on payments
you receive if you give the requester your correct TIN, make the
proper certifications, and report all your taxable interest and
dividends on your tax return.
Payments you receive will be subject to backup
withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the Part II
instructions on page 3 for details),
3. The IRS tells the requester that you furnished an incorrect
TIN,
If the account is in joint names, list first, and then circle, the
name of the person or entity whose number you entered in Part I
of the form.
Sole proprietor. Enter your individual name as shown on your
income tax return on the “Name” line. You may enter your
business, trade, or “doing business as (DBA)” name on the
“Business name” line.
Limited liability company (LLC). Check the “Limited liability
company” box only and enter the appropriate code for the tax
classification (“D” for disregarded entity, “C” for corporation, “P”
for partnership) in the space provided.
For a single-member LLC (including a foreign LLC with a
domestic owner) that is disregarded as an entity separate from
its owner under Regulations section 301.7701-3, enter the
owner’s name on the “Name” line. Enter the LLC’s name on the
“Business name” line.
For an LLC classified as a partnership or a corporation, enter
the LLC’s name on the “Name” line and any business, trade, or
DBA name on the “Business name” line.
Other entities. Enter your business name as shown on required
federal tax documents on the “Name” line. This name should
match the name shown on the charter or other legal document
creating the entity. You may enter any business, trade, or DBA
name on the “Business name” line.
Note. You are requested to check the appropriate box for your
status (individual/sole proprietor, corporation, etc.).
Exempt Payee
If you are exempt from backup withholding, enter your name as
described above and check the appropriate box for your status,
then check the “Exempt payee” box in the line following the
business name, sign and date the form.
Form W-9 (Rev. 10-2007)
Page
Generally, individuals (including sole proprietors) are not exempt
from backup withholding. Corporations are exempt from backup
withholding for certain payments, such as interest and dividends.
Note. If you are exempt from backup withholding, you should
still complete this form to avoid possible erroneous backup
withholding.
The following payees are exempt from backup withholding:
1. An organization exempt from tax under section 501(a), any
IRA, or a custodial account under section 403(b)(7) if the account
satisfies the requirements of section 401(f)(2),
3
Part I. Taxpayer Identification
Number (TIN)
The chart below shows types of payments that may be
exempt from backup withholding. The chart applies to the
exempt payees listed above, 1 through 15.
Enter your TIN in the appropriate box. If you are a resident
alien and you do not have and are not eligible to get an SSN,
your TIN is your IRS individual taxpayer identification number
(ITIN). Enter it in the social security number box. If you do not
have an ITIN, see How to get a TIN below.
If you are a sole proprietor and you have an EIN, you may
enter either your SSN or EIN. However, the IRS prefers that you
use your SSN.
If you are a single-member LLC that is disregarded as an
entity separate from its owner (see Limited liability company
(LLC) on page 2), enter the owner’s SSN (or EIN, if the owner
has one). Do not enter the disregarded entity’s EIN. If the LLC is
classified as a corporation or partnership, enter the entity’s EIN.
Note. See the chart on page 4 for further clarification of name
and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one
immediately. To apply for an SSN, get Form SS-5, Application
for a Social Security Card, from your local Social Security
Administration office or get this form online at www.ssa.gov. You
may also get this form by calling 1-800-772-1213. Use Form
W-7, Application for IRS Individual Taxpayer Identification
Number, to apply for an ITIN, or Form SS-4, Application for
Employer Identification Number, to apply for an EIN. You can
apply for an EIN online by accessing the IRS website at
www.irs.gov/businesses and clicking on Employer Identification
Number (EIN) under Starting a Business. You can get Forms W-7
and SS-4 from the IRS by visiting www.irs.gov or by calling
1-800-TAX-FORM (1-800-829-3676).
If you are asked to complete Form W-9 but do not have a TIN,
write “Applied For” in the space for the TIN, sign and date the
form, and give it to the requester. For interest and dividend
payments, and certain payments made with respect to readily
tradable instruments, generally you will have 60 days to get a
TIN and give it to the requester before you are subject to backup
withholding on payments. The 60-day rule does not apply to
other types of payments. You will be subject to backup
withholding on all such payments until you provide your TIN to
the requester.
Note. Entering “Applied For” means that you have already
applied for a TIN or that you intend to apply for one soon.
Caution: A disregarded domestic entity that has a foreign owner
must use the appropriate Form W-8.
IF the payment is for . . .
THEN the payment is exempt
for . . .
Part II. Certification
Interest and dividend payments
All exempt payees except
for 9
Broker transactions
Exempt payees 1 through 13.
Also, a person registered under
the Investment Advisers Act of
1940 who regularly acts as a
broker
Barter exchange transactions
and patronage dividends
Exempt payees 1 through 5
Payments over $600 required
to be reported and direct
1
sales over $5,000
Generally, exempt
payees
2
1 through 7
2. The United States or any of its agencies or
instrumentalities,
3. A state, the District of Columbia, a possession of the United
States, or any of their political subdivisions or instrumentalities,
4. A foreign government or any of its political subdivisions,
agencies, or instrumentalities, or
5. An international organization or any of its agencies or
instrumentalities.
Other payees that may be exempt from backup withholding
include:
6. A corporation,
7. A foreign central bank of issue,
8. A dealer in securities or commodities required to register in
the United States, the District of Columbia, or a possession of
the United States,
9. A futures commission merchant registered with the
Commodity Futures Trading Commission,
10. A real estate investment trust,
11. An entity registered at all times during the tax year under
the Investment Company Act of 1940,
12. A common trust fund operated by a bank under section
584(a),
13. A financial institution,
14. A middleman known in the investment community as a
nominee or custodian, or
15. A trust exempt from tax under section 664 or described in
section 4947.
1
2
See Form 1099-MISC, Miscellaneous Income, and its instructions.
However, the following payments made to a corporation (including gross
proceeds paid to an attorney under section 6045(f), even if the attorney is a
corporation) and reportable on Form 1099-MISC are not exempt from
backup withholding: medical and health care payments, attorneys’ fees, and
payments for services paid by a federal executive agency.
To establish to the withholding agent that you are a U.S. person,
or resident alien, sign Form W-9. You may be requested to sign
by the withholding agent even if items 1, 4, and 5 below indicate
otherwise.
For a joint account, only the person whose TIN is shown in
Part I should sign (when required). Exempt payees, see Exempt
Payee on page 2.
Signature requirements. Complete the certification as indicated
in 1 through 5 below.
1. Interest, dividend, and barter exchange accounts
opened before 1984 and broker accounts considered active
during 1983. You must give your correct TIN, but you do not
have to sign the certification.
2. Interest, dividend, broker, and barter exchange
accounts opened after 1983 and broker accounts considered
inactive during 1983. You must sign the certification or backup
withholding will apply. If you are subject to backup withholding
and you are merely providing your correct TIN to the requester,
you must cross out item 2 in the certification before signing the
form.
Form W-9 (Rev. 10-2007)
Page
3. Real estate transactions. You must sign the certification.
You may cross out item 2 of the certification.
4. Other payments. You must give your correct TIN, but you
do not have to sign the certification unless you have been
notified that you have previously given an incorrect TIN. “Other
payments” include payments made in the course of the
requester’s trade or business for rents, royalties, goods (other
than bills for merchandise), medical and health care services
(including payments to corporations), payments to a
nonemployee for services, payments to certain fishing boat crew
members and fishermen, and gross proceeds paid to attorneys
(including payments to corporations).
5. Mortgage interest paid by you, acquisition or
abandonment of secured property, cancellation of debt,
qualified tuition program payments (under section 529), IRA,
Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give your
correct TIN, but you do not have to sign the certification.
What Name and Number To Give the Requester
For this type of account:
1. Individual
2. Two or more individuals (joint
account)
3. Custodian account of a minor
(Uniform Gift to Minors Act)
4. a. The usual revocable savings
trust (grantor is also trustee)
b. So-called trust account that is
not a legal or valid trust under
state law
5. Sole proprietorship or disregarded
entity owned by an individual
Give name and SSN of:
The individual
The actual owner of the account or,
if combined funds, the first
1
individual on the account
2
The minor
The grantor-trustee
The actual owner
The owner
1
2
3
4
1
3
Give name and EIN of:
For this type of account:
6. Disregarded entity not owned by an
individual
7. A valid trust, estate, or pension trust
8. Corporate or LLC electing
corporate status on Form 8832
9. Association, club, religious,
charitable, educational, or other
tax-exempt organization
10. Partnership or multi-member LLC
11. A broker or registered nominee
12. Account with the Department of
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
1
The owner
4
Legal entity
The corporation
The organization
4
Secure Your Tax Records from Identity Theft
Identity theft occurs when someone uses your personal
information such as your name, social security number (SSN), or
other identifying information, without your permission, to commit
fraud or other crimes. An identity thief may use your SSN to get
a job or may file a tax return using your SSN to receive a refund.
To reduce your risk:
● Protect your SSN,
● Ensure your employer is protecting your SSN, and
● Be careful when choosing a tax preparer.
Call the IRS at 1-800-829-1040 if you think your identity has
been used inappropriately for tax purposes.
Victims of identity theft who are experiencing economic harm
or a system problem, or are seeking help in resolving tax
problems that have not been resolved through normal channels,
may be eligible for Taxpayer Advocate Service (TAS) assistance.
You can reach TAS by calling the TAS toll-free case intake line
at 1-877-777-4778 or TTY/TDD 1-800-829-4059.
Protect yourself from suspicious emails or phishing
schemes. Phishing is the creation and use of email and
websites designed to mimic legitimate business emails and
websites. The most common act is sending an email to a user
falsely claiming to be an established legitimate enterprise in an
attempt to scam the user into surrendering private information
that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via emails.
Also, the IRS does not request personal detailed information
through email or ask taxpayers for the PIN numbers, passwords,
or similar secret access information for their credit card, bank, or
other financial accounts.
If you receive an unsolicited email claiming to be from the IRS,
forward this message to [email protected]. You may also report
misuse of the IRS name, logo, or other IRS personal property to
the Treasury Inspector General for Tax Administration at
1-800-366-4484. You can forward suspicious emails to the
Federal Trade Commission at: [email protected] or contact them at
www.consumer.gov/idtheft or 1-877-IDTHEFT(438-4338).
Visit the IRS website at www.irs.gov to learn more about
identity theft and how to reduce your risk.
The partnership
The broker or nominee
The public entity
List first and circle the name of the person whose number you furnish. If only one person
on a joint account has an SSN, that person’s number must be furnished.
Circle the minor’s name and furnish the minor’s SSN.
You must show your individual name and you may also enter your business or “DBA”
name on the second name line. You may use either your SSN or EIN (if you have one),
but the IRS encourages you to use your SSN.
List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN
of the personal representative or trustee unless the legal entity itself is not designated in
the account title.) Also see Special rules for partnerships on page 1.
Note. If no name is circled when more than one name is listed,
the number will be considered to be that of the first name listed.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who must file information returns with the IRS to report interest,
dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, or
contributions you made to an IRA, or Archer MSA or HSA. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return.
The IRS may also provide this information to the Department of Justice for civil and criminal litigation, and to cities, states, the District of Columbia, and U.S.
possessions to carry out their tax laws. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal
nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.
You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 28% of taxable interest, dividend, and certain other
payments to a payee who does not give a TIN to a payer. Certain penalties may also apply.
RFQ PR812-752-14
ATTACHMENT I
NRHA Certifications and Representations of Offerors
Non-Construction Contract
Company Name:
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 non-construction contracts awarded by NRHA. The form is used by bidders/offerors to certify to NRHA's Contracting Officer for
contract compliance. If the form were not used, NRHA 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. Section 3 Resident-Owned Businesses
(a) Definitions:
Low income is defined as 80% or below the median
household income for the metropolitan area.
Section 3 Business Concern – a concern, that is a business
that (1) is at least 51% owned and controlled by Section 3
residents under the Section 3 of the Housing and Urban
Development Act of 1968 (24 CFR 135); (2) at least 30
percent of its full time employees include persons that are
currently Section 3 residents, or were Section 3 residents
within three years of the date of first hire*; or (3) Provides
evidence, as required, of a commitment to subcontract in
excess of 25 percent of the dollar award of all subcontracts
to business concerns that meet one of the first two
qualifications above.
Section 3 Residents are defined as Public Housing
residents or, low and very-low income persons living in
the metropolitan area of NRHA.
Very-low income is defined a 50 % or below the median
household income for the metropolitan area.
*Example: Alysha was an unemployed Section 3 resident
that was first hired by ABC Company on January 1, 2011.
She received a raise of $2,500 in March 2012, thereby
boosting her household income above the local low
income level. ABC Company may continue to count
Alysha as one of their Section 3 employees until December
31, 2013 (i.e. within three years of the date of first hire).
Additional information may be obtained by contacting:
NRHA Office of Economic Opportunities
(757) 314-2026
(b) The bidder/offeror represents and certifies as part of its
bid/ offer that it:
[
] is, [
] is not a Section 3 business concern.
2. Non-Collusion Affidavit of Prime Bidder
(a) Contractor warrants that He/She is the bidder that has
submitted the attached bid;
(b) That He/She is fully informed respecting the
preparation and contexts of the attached Bid and all of
all pertinent circumstances respecting such Bid;
(c) Such Bid is genuine and is not a collusive or sham Bid;
(d) Neither the said Bidder nor any of its officers, partners,
owners, agents, representatives, employees or parties in interest,
including this affiant, has in any way colluded, conspired,
connived or agreed, directly or indirectly with any other Bidder,
firm or person to submit a collusive or sham Bid in connection
with the Contract for which the attached Bid has been submitted
or to refrain from bidding in connection with such Contract, or
has in any manner, directly or indirectly, sought by agreement or
collusion or communication or conference with any other
Bidder, firm or person to fix the price or bid price or prices in
the attached Bid or of any other Bidder, or to fix any overhead,
profit, or cost element of the bid price or the bid price of any
other Bidder, or to secure through any collusion, conspiracy,
connivance or unlawful agreement any advantage against the
Norfolk Redevelopment and Housing Authority or any person
interested in the proposed Contract; and,
(e) The Price or prices quoted in the attached Bid are fair and proper
and are not tainted by any collusion, conspiracy, connivance or
unlawful agreement on the part of the Bidder or any of its
agents, representatives, owners, employees, or parties in interest,
including this affiant.
3. Certificate of Insurance
Contractor agrees to provide a Certificate of Insurance within 10
days, but not later than start of performance, upon award and
acceptance of a contract. Failure to submit proof of insurance is
ground for termination of the contract.
4. Authorization of Offeror for Verification of References
The Offeror warrants that He/She has submitted a proposal to the
Norfolk Redevelopment and Housing Authority (NRHA) in
response to the RFP. The Offeror hereby authorizes and requests
any and all persons, firms, corporations and/or government entities
to furnish any information requested by NRHA in verification of
the references provided, for determination of the quality and
timeliness of the services provided by Offeror, and all other legal
purposes. A copy of this document, after execution by the Offeror,
presented by NRHA to any such person, firm, corporation and/or
government entity shall be as valid as the original.
RFQ PR812-752-14
5. Certification Regarding Debarment, Suspension,
Proposed Debarment
(a) The officer certifies, to the best of its knowledge and
belief that:
1. The offeror and/or any of its Principles:
a. Are
Are not
presently debarred,
suspended, proposed for debarment, or
declared ineligible for the award of contracts
by any agency using Federal funds;
b. Have
Have not
, within a three-year
period preceding this offer, been convicted of
or had a civil judgment rendered against them
for: commission of fraud or a criminal offense
in connection with obtaining, attempting to
obtain, or performing public (Federal, State, or
local) contract or subcontract; violation of
Federal or state antitrust statue's relating to the
submission of offers; or commission of
embezzlement, theft, forgery, bribery,
falsification or destruction of records, making
false statements, or receiving stolen property;
and
c. Are
Are not
presently indicted for, or
otherwise criminally or civilly charged by a
government entity with, commission of any of
the offenses enumerated above.
2. The Officer has
has not
, within a threeyear period preceding this offer, had one or more
contracts terminated for default by any Federal,
state, or local agency.
(b) “Principals,” for the purpose of this certification, means
officers; directors; owners; partners; and, persons
having primary management or supervisory
responsibilities within a business entity (e.g., general
manager; plant manager; head of a subsidiary, division,
or business segment, and similar positions).
THIS CERTIFICATION CONCERNS A MATTER
WITHIN THE JURISDICTION OF ANY AGENCY
OF THE UNITED STATES AND THE MAKING OF
A FALSE, FICTITIOUS, OR FRAUDULENT
CERTIFICATION MAY RENDER THE MAKER
SUBJECT TO PROSECUTION UNDER SECTION
1001, TITLE 18, UNITED STATES CODE.
1. The Offeror shall provide immediate written notice
to the contracting Officer if at any time prior to
contract award, the Offeror learns that its
certification was erroneous when submitted or has
become erroneous by reason of changed
circumstances.
2. A certification that any of the items in Section I of
this provision exists will not necessarily result in
withholding award under this proposal. However,
the certification will be considered in connection
with a determination of the Offeror’s responsibility.
Failure of the Offeror to furnish a certification or
ATTACHMENT I
provide such additional information as requested by the
Contracting Officer may render the Offeror nonresponsive.
3. Nothing contained in the foregoing shall be construed to
require establishment of a system of records in order to render,
in good faith, the certification required by Section I of this
provision. The knowledge and information of an Offeror are
not required to exceed that which is normally possessed by as
prudent person in the ordinary course of business dealings.
4. The certification in Section I of this provision is a material
representation of fact upon which reliance was placed when
making award. If it is later determined that the Offeror
knowingly rendered an erroneous certification, in addition to
other remedies available to NRHA, the Contracting Officer
may terminate the contract resulting from this proposal for
default.
6. 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:

Solicitation RFQ PR812-752-14 - Norfolk Redevelopment and

Transcription

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