Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Request for Proposals (RFP) Interest Form

                                                  RFP Form #1

 Instructions: I...
City of Brockton
                                            Procurement Department
JAMES E. HARRINGTON                   ...
D. Experience with Review and Inspection of Downtown Projects, Site Plan
         Review and Project Inspection.

      1....
CITY OF BROCKTON
                                    Brockton Planning Board

                             REQUEST FOR PRO...
CITY OF BROCKTON
                                   PLANNING DEPARTMENT
                          CONSULTANT SERVICES - EN...
4. INFORMATION FOR PROPOSERS:

        1.          In order for the City to process payment, the Consultant shall invoice ...
6. Time of Performance

             A proposed outline of the work necessary to complete this project is profiled in
    ...
RFP RESPONSE CONTENTS:


PART I – City of Brockton Engineering Review Consultant to the Planning Board:
Non Price Proposal...
1. A statement of understanding of the requested services, sufficient to
             demonstrate an understanding of the ...
PRICE PROPOSAL




 PART II – City of Brockton Engineering Review Consultant to the Planning
Board: Price Proposal

All in...
SCOPE OF SERVICES

The services described below shall be rendered under the general direction of the
Planning Department t...
MINIMUM EVALUATION CRITERIA

Please respond in writing to each of the following minimum evaluation criteria.
Proposers who...
COMPARATIVE EVALUATION CRITERIA

Proposals will be considered pursuant to M.G.L. c 30B, the Uniform Procurement Act
(Act)....
D. Experience with Municipal 40R (Smart Growth), Site Plan Review and Project
   Inspection.

      4. Highly advantageous...
CITY OF BROCKTON
                                      TAX CERTIFICATE
                                        APPENDIX “A...
APPENDIX “B”
                                  AFFIDAVIT OF CLERK OF CORPORTION VENDOR
                                   ...
REGISTRATION FORM
                                                  APPENDIX “C”


DATE:                     _____________...
ATTESTATION CLAUSE
                                                 APPENDIX “D”


Under Section 35 of Chapter 233, politi...
DEVIATION SHEET
                                             APPENDIX “E”


All deviations and/or substitutions from the o...
CERTIFICATE OF INSURANCE
                                                   APPENDIX “F”



As successful proposer on the ...
ASSURANCE OF NONDISCRIMINATION COMPLIANCE
                                              APPENDIX “G”


The undersigned cer...
APPENDIX “H”


A. The undersigned proposes to supply:              __________________________________________________

   ...
APPENDIX “I”


                           CERTIFICATE OF INDEMNIFICATION & RELEASE



The Recipient shall indemnify and ho...
APPENDIX “J”



                                  CERTIFICATE OF NON-COLLUSION



The undersigned certifies under the pena...
Upcoming SlideShare
Loading in …5
×

City of Brockton

353 views

Published on

  • Be the first to comment

  • Be the first to like this

City of Brockton

  1. 1. Request for Proposals (RFP) Interest Form RFP Form #1 Instructions: If your firm/company is interested in responding to this RFP, then RFP Form #1 MUST be submitted to the Procurement Dept. immediately following download. This form is crucial in providing pertinent company information for bidder’s list tracking and distribution of any potential addendum. Awarding Authority: City of Brockton Project No.: #BPB 09-001 Project Name: Consultant Services – Engineering Review Mail or Fax this BID Interest #1 Form to: City of Brockton/Procurement Dept. Basement Level, Room B2 45 School Street, Brockton, MA. 02301 Fax: 508-941-0204 By submitting this RFP Interest Form the below identified firm is expressing its interest in the above- referenced public bidding project and is requesting that it be added to the list of firms that will receive any addenda to the RFP that might occur. The Awarding Authority assumes no responsibility for a firm’s failure to receive any addenda or other correspondence related to this RFP due to the firm’s failure to submit an RFP Interest Form as directed above or for any other reason. Company Name:       Company Address:       Company Telephone #:       Company Fax #:       Company Contact Person/Title:       Date Submitted:       By: _______________________________________ (Signature of Authorized Representative)
  2. 2. City of Brockton Procurement Department JAMES E. HARRINGTON MICHAEL C. MORRIS MAYOR CHIEF PROCUREMENT OFFICER ADDENDUM #1 TO: All Potential Proposers FROM: Michael Morris/Chief Procurement Officer SUBJ: Addendum #1 to the Consultant Services-Engineering Review RFP Project #BPB 09-001 DATE: February 11, 2009 ------------------------------------------------------------------------------------------- Please be advised of the following changes/clarifications: Comparative Evaluation Criteria page, Letter D. Change From: Experience with Municipal 40R (Smart Growth), Site Plan Review and Project Inspection. Change To: Experience with Review and Inspection of Downtown Projects, Site Plan Review and Project Inspection. Any questions or concerns please feel free to contact me at (508) 580-7191. Brockton Planning Board BPD 09-001 2
  3. 3. D. Experience with Review and Inspection of Downtown Projects, Site Plan Review and Project Inspection. 1. Highly advantageous – Proposer has more than five (5) years of experience with Review and Inspection of Downtown Projects, Site Plan Review and Project Inspection. 2. Advantageous – Proposer has at least three (3) years of experience with Review and Inspection of Downtown Projects, Site Plan Review and Project Inspection. 3. Not advantageous – Proposer has less than three (3) years of experience with Review and Inspection of Downtown Projects, Site Plan Review and Project Inspection. Brockton Planning Board BPD 09-001 3
  4. 4. CITY OF BROCKTON Brockton Planning Board REQUEST FOR PROPOSALS (BPB-09-001) CONSULTANT SERVICES - ENGINEERING REVIEW The City of Brockton through the Planning Board request proposals from parties interested in providing Engineering Review Services as a Consultant to the Planning Board. Copies of the Request for Proposal (RFP) may be obtained on and after Friday, January 30, 2009 at the Department of Procurement, Basement Level, Room B2, City Hall, 45 School Street, Brockton Massachusetts. Three (3) sets of the proposal should be delivered no later than 4:00 P.M. on Friday, February 20, 2009 to: Michael Morris, Chief Procurement Officer City of Brockton City Hall, Basement Level, Rm. B2 45 School Street Brockton, MA 02301 Proposals must be submitted separately in sealed envelopes marked as follows: Part I –City of Brockton Consultant Services-Engineering Review to the Planning Board: Non-Price Proposal Part II –City of Brockton Consultant Services-Engineering Review to the Planning Board: Price Proposal The City reserves the right to accept and/or reject and/or to waive any informality on any/all proposals. The City reserves the right to accept part, all, or none of the selected respondent’s proposal and is subject to availability of funds. The City of Brockton is an Affirmative Action/Equal Opportunity/Title IX Employer. John F. Murphy, Chairperson Brockton Planning Board Michael Morris Chief Procurement Officer Brockton Planning Board BPD 09-001 4
  5. 5. CITY OF BROCKTON PLANNING DEPARTMENT CONSULTANT SERVICES - ENGINEERING REVIEW Instructions for Request for Proposal (RFP) Response 1. GENERAL This Request for Proposals (RFP) invites qualified Consultants to submit proposals for the specific services described in the attached Scope of Work Section of this RFP. 2. PREPARATION OF RFP RESPONSE The preparation of the RFP Response shall be at the expense of the prospective Consultant. It is the sole responsibility of the prospective Consultants to fully examine this RFP’s addenda (if any). Questions shall be addressed in writing to John Murphy, Chairperson, Brockton Planning Board, 45 School Street, Brockton, MA 02301; (fax) #508-580-7132, this contact must be made by February 13, 2009. All such questions will be responded to by John Murphy, Chairperson, in the form of a written addenda to the RFP, these addenda will be faxed or mailed to parties listed by the Procurement Office as having received the RFP. Bound proposals shall be submitted in accordance with the following Article 3.0 (RFP Response Format and Contents). All proposals submitted become the property of the Brockton Planning Board and will be subject to applicable Public Record Laws. 3. RFP RESPONSE FORMAT AND CONTENTS The RFP Response shall be provided in two (2) separately bound parts as described in the following sections. The two (2) parts shall be marked Part I – City of Brockton Engineering Review Consultant to Planning Board: Non Price Proposal and Part II –City of Brockton Engineering Review Consultant to the Planning Board: Price Proposal. They must be submitted in separate sealed envelopes. Upon receipt of the RFP responses, a review committee consisting of representatives from the Brockton Planning Board will evaluate Part I of all respondents. For the prospective Consultant deemed to be best qualified under Part I; the City will open Part II. Proposals should be prepared simply, providing a straightforward description of the prospective Consultant’s ability to satisfy the requirement of the RFP. Emphasis should be on completeness and clarity of contents. The City of Brockton assumes no responsibility and no liability for costs incurred relevant to the preparation and submission of the RFP by prospective Consultants, or any other costs prior to issuance of a contract. The City may reject any RFP Response that does not meet these requirements. Brockton Planning Board BPD 09-001 5
  6. 6. 4. INFORMATION FOR PROPOSERS: 1. In order for the City to process payment, the Consultant shall invoice the City monthly for work performed and documented related expenses incurred for each Site Plan Review for the Downtown Brockton 40R Smart Growth Overlay District (DBSGOD) during the invoice period. The processing of payments to the Consultant shall be predicated upon the availability of sufficient funds within each developer’s account. The Planning Department shall be responsible for ensuring each developer’s account has adequate funds, and shall notify the Consultant in the event an active account is depleted and the developer fails to replenish it, at which time Consultant services may be suspended until the account is brought up to date. 2. Compensation to the Consultant shall be in accordance with rates negotiated for respective classes of services as identified in the Consultant’s proposal submitted in response to the City’s RFP for Engineering Review Services. 3. The Consultant shall not engage in any activity that would be considered a “Conflict of Interest” or would be “perceived as a Conflict of Interest” as defined and regulated by the State Ethics Commission. To ensure compliance with this, it is the intent of the City that the Consultant shall not perform work for clients within the City of Brockton that would be subject to come before the Planning Board, Zoning Board of Appeals, or Conservation Commission. 5. USE AND OWNERSHIP OF DOCUMENTS 1. Drawings, estimates, and reports prepared under this Agreement will become property of the City at the completion of services. 2. Reproducible copies of documents will be retained by the Consultant for a period of at least seven (7) years. 3. All documents, including Drawings and Specifications prepared by the Consultant pursuant to the Agreement are instruments of service with respect to the project. They are not intended or represented to be suitable for reuse by the City or others on extensions of the project or any other projects. Any reuse without written verification or adaptation by the Consultant for the specific purpose intended will be at the City’s risk and without liability or legal exposure to the consultant. Brockton Planning Board BPD 09-001 6
  7. 7. 6. Time of Performance A proposed outline of the work necessary to complete this project is profiled in Attachment A- Scope of Services. The contract for services will be for a one (1) year period of time. The City shall have the option of extending or renewing this contract for two (2) consecutive one (1) year periods, for the same discount rate and upon the same conditions as are contained in the contract at the time said option is exercised; except as such conditions shall have been modified by mutual agreement of the parties. Said options shall deem to have been exercised by the City, provided the vendor has been given preliminary notice of the City’s intention to renew this contract. Such a preliminary notice shall not be deemed to commit the City to renewal. The Consultant selected will enter into a contract with the City of Brockton for the completion of all work necessary to meet the requirements outlined in the scope of services. Brockton Planning Board BPD 09-001 7
  8. 8. RFP RESPONSE CONTENTS: PART I – City of Brockton Engineering Review Consultant to the Planning Board: Non Price Proposal. The prospective Consultant’s technical portion of its RFP Response shall contain the following information under the indicated headings. A. Letter of Transmittal The prospective Consultant’s Response shall include a letter of transmittal not to exceed one (1) page, signed by an individual(s) authorized to bind the prospective Consultant contractually. This letter must state that proposal will remain in effect for a period of 90 calendar days from the deadline for the submission of proposals or until it is formally withdrawn, or a contract is executed, or this RFP is cancelled, whichever occurs first. The transmittal letter shall include the name, title, address, and telephone number of one or more individuals who can respond to requests for additional information and also, of one or more individuals who are authorized to negotiate and execute a contract on the prospective Consultant’s behalf, if applicable. B. Proposal Format and Quality Understand the Scope of Work - The proposal must describe the prospective Consultant’s general understanding of the scope of work and the key issues associated with performing the required consulting services in the specific disciplines involved. In addition, it must include statements covering prospective Consultant’s familiarity with the project and describe unusual conditions or problems prospective Consultant believes may be encountered. The selection of the Consultant will be based upon the professional qualification, past performance records in similar projects, the content of the proposal and consideration of the City’s overall needs in terms of the project. D. Recent Projects and References Provide a description of the history, experience and qualifications of individual/firm and any proposed subcontractors to perform the Scope of Services. Please provide: • Resumes and professional qualifications of all principals who will be assigned to work with the Brockton Conservation Commission; • List of other similar projects undertaken; • Submission shall include details of the applicant’s work with municipal boards and commissions and familiarity with the relevant statues and regulations. Brockton Planning Board BPD 09-001 8
  9. 9. 1. A statement of understanding of the requested services, sufficient to demonstrate an understanding of the scope of work and the goals and objectives of the City of Brockton. 2. A list of members of the Project Team (Consulting Engineer's support staff) with resumes and background of each. 3. A complete list of public and private clients, past – dating back at least five (5) years – and present, in Massachusetts, with particular emphasis on municipalities for which the firm has been involved in the review of site plans with particular emphasis on 40R Smart Growth Overlay District Proposals. The submission shall be evaluated on the basis of current relevant experience for similar projects and the ability to respond to request for services in a timely manner. 4. SUBMISSION OF RFP RESPONSES Three (3) sealed sets of prospective Consultant’s response to the RFP shall be submitted no later than Friday, February 20, 2009 at 4:00 p.m. to: Michael Morris Chief Procurement Officer City of Brockton City Hall, Basement Level, Rm. B2 45 School Street Brockton, MA 02301 Responses received later than the specified date and time shall be rejected. PROPOSAL OPENING Proposals will be opened on Friday, February 20, 2009 at 4:10 p.m. (not publicly) by the Chief Procurement Officer in the presence of one or more witnesses. A register of proposals including the name of each proposer, along with the name(s) of the witness(es) will be made available for public inspection. Brockton Planning Board BPD 09-001 9
  10. 10. PRICE PROPOSAL PART II – City of Brockton Engineering Review Consultant to the Planning Board: Price Proposal All interested parties must submit a separately sealed price proposal specifying the hourly rates for each team member and any built-in rate increases. Job-related expenses incurred by the Consultant shall be billed to the City of Brockton at cost, said costs to be passed through to the applicant for all work associated with a review of a 40R Smart Growth Overlay District projects. Brockton Planning Board BPD 09-001 10
  11. 11. SCOPE OF SERVICES The services described below shall be rendered under the general direction of the Planning Department through the authority of the Planning Board. Additional information regarding the City of Brockton’s Downtown Brockton 40R Smart Growth Overlay, can be found on our website at www.brockton.ma.us Please go to the Government tab, All Departments, Planning, then select topic (40R Planning Smart Growth) that is highlighted blue. 1. Site Plan Review for Downtown Brockton 40R Smart Growth Overlay District (DBSGOD) Proposals The Planning Board is charged with the responsibility for completing site plan reviews under Article XVI of the Zoning Bylaw, Downtown Brockton 40R Smart Growth Overlay District. The Board is seeking the following services in relation to reviews for such projects. Note that time is of the essence for these applications and delays caused solely by the reviewing engineer will not be acceptable under any circumstances (under state law, the City is required to act on the application within 120 days of receipt). a. Review application for completeness within 21 days of receipt by the City of Brockton. To allow sufficient time to do this, the City will transmit the full application package within three (3) business days of receipt to the Engineering Firm. Once reviewed, a report shall be submitted to the Planning Department who will complete the Certification process to allow the process to continue (if certified as complete, the application moves forward, if not, a letter stating what items are incomplete is sent to the applicant and the process stops until the revisions are submitted). b. Review application for compliance with the applicable regulations and standards (set forth in Article XVI of the Zoning Bylaw and the Smart Growth District Design Standards). Attendance at the Technical Review Committee meetings is required. Submit a report to the Planning Department within four (4) weeks of receipt of plans (unless revised plans are submitted, in which case the timeline is reset) detailing any issues with compliance of the plan to the regulations and standards. Attendance at Planning Board hearings/meetings may be required. c. Review application for impacts to the infrastructure and nearby properties, including but not limited to traffic, pedestrian, water, sewer, and adverse impacts on abutting properties (visual or otherwise). Provide written report on findings and recommendations for potential mitigation of the impacts. Brockton Planning Board BPD 09-001 11
  12. 12. MINIMUM EVALUATION CRITERIA Please respond in writing to each of the following minimum evaluation criteria. Proposers who do not meet all the minimum evaluation criteria shall have their proposals rejected. Criteria 1. Provide samples or illustrations of reports and other documentation of Engineering Expertise, including reports for reviews prepared for other municipalities. 2. Submit a disclosure of any clients which the firm has represented before any City of Brockton board or commission in the past five (5) years, and any City of Brockton board or commission member who has been a client of the individual or firm responding to the request for proposal. 3. Provide a clear designation of the Key Person or Project Manager to be assigned to the City as a contact person on a consistent basis. 4. Indicate availability of project team members and any notice requirements. Also, provide required notice procedure, if any, for routine and regular inspections and meetings, as well as unforeseen/unanticipated consultations and/or meetings. Brockton Planning Board BPD 09-001 12
  13. 13. COMPARATIVE EVALUATION CRITERIA Proposals will be considered pursuant to M.G.L. c 30B, the Uniform Procurement Act (Act). It is the intention of the City to fulfill the intent and purposes of the Act. The City shall apply the criteria which follow, in its evaluation of the proposals. The purpose of the information requested in this section is to assist the evaluation committee in making decisions about the proposers overall qualifications, including technical abilities and previous experience. Proposers should respond in writing to each criterion, responses to the following areas shall be complete and full. A. Expertise, knowledge and familiarity with Subdivision Control Laws and Review Process in the Commonwealth of Massachusetts. 1. Highly advantageous – clearly demonstrates high degree of expertise and experience in communities similar to Brockton. 2. Advantageous – clearly demonstrates expertise and experience 3. Not advantageous – less than five years experience in Subdivision and Site Plan Review. B. Proposer’s References and Experience 1. Highly advantageous – Proposer’s references are of uniformly high quality. 2. Advantageous – Proposer’s references are generally good but with certain qualifications. 3. Not advantageous – Proposer’s references have raised serious questions regarding performance. C. Qualifications of the Project Team with particular emphasis on the Project Manager. 1. Highly advantageous – The Project Manager as well as more than one (1) individual from the proposed Project Team are highly qualified to accomplish all the tasks. 2. Advantageous – The Project Manager and at least one (1) individual from the proposed Project Team are qualified to accomplish all the tasks. 3. Not advantageous – Neither the Project Manager, nor the Project Team are qualified to accomplish the required tasks. Brockton Planning Board BPD 09-001 13
  14. 14. D. Experience with Municipal 40R (Smart Growth), Site Plan Review and Project Inspection. 4. Highly advantageous – Proposer has more than five (5) years of experience with 40R (Smart Growth) review and inspection tasks. 5. Advantageous – Proposer has at least three (3) years of experience with 40R (Smart Growth) review and inspection tasks. 6. Not advantageous – Proposer has less than three (3) years of experience with 40R (Smart Growth) review and inspection tasks. Brockton Planning Board BPD 09-001 14
  15. 15. CITY OF BROCKTON TAX CERTIFICATE APPENDIX “A” I CERTIFY UNDER THE PAINS AND PENALTIES OF PERJURY THAT I TO THE BEST OF MY KNOWLEDGE AND BELIEF HAVE FILED ALL STATE TAX RETURNS AND PAID ALL STATE TAXES REQUIRED UNDER THE LAW. FOR USE BY CORPORATONS ONLY: __________________________________________________ CORPORATE NAME (MANDATORY IF A CORPORATION) BY_________________________________________________ SIGNATURE OF COPORATE OFFICER __________________________________________________ FEDERAL IDENTIFICATION NUMBER FOR USE BY INDIVIDUALS OR COMPANIES OTHER THAN CORPORATION ONLY: *__________________________________________________ SIGNATURE OF INDIVIDUAL (MANDATORY IF NOT A CORPORATION) **__________________________________________________ SOCIAL SECURITY NUMBER *APPROVAL OF CONTRACT OR OTHER AGREEMENT WILL NOT BE GRANTED UNLESS THIS CERTIFICATION CLAUSE IS SINGED BY THE APPLICANT. **YOUR SOCIAL SECURITY NUMBER WILL BE FURNISHED TO THE MASSACHUSETTS DEPARTMENT OF REVENUE TO DETERMINE WHETHER YOU HAVE MET TAX FILING OR TAX PAYMENT OBLIGATIONS. CERTIFICATE OF VOTE (CORPORATIONS ONLY) I,______________________________________:CLERK/OFFICER OF __________________________________ ___________________________________HEREBY NOTIFY THAT AT A MEETING OF THE BOARD OF DIRECTORS/OFFICIALS OF SAID CORPORATION/COMPANY, HELD ON ____________________________ THE FOLLOWING VOTE WAS PASSED: VOTE TO AUTHORIZE ______________________________________________TO SIGN IN BEHALF OF THE CORPORATION/COMPANY WITH THE CITY OF BROCKTON FOR __________________________________ __________________________________________ CLERK/OFFICER Brockton Planning Board BPD 09-001 15
  16. 16. APPENDIX “B” AFFIDAVIT OF CLERK OF CORPORTION VENDOR (To be signed and completed by Clerk) I, _________________________________________________________________, certify as follows: (Print full name of Clerk) 1. I am the Clerk of ______________________________________________________(print exact name of corporation) which is duly organized and incorporated under the laws of the Commonwealth of Massachusetts (or State of ______________________________) and is/is not (circle one) duly registered to do business in the Commonwealth of Massachusetts with a principal place of business at ____________________________. 2. That the names, residential addresses and title officers of the above named corporation are as follows: ______________________________________ ____________________________________ President Address ______________________________________ ____________________________________ Vice President Address ______________________________________ ____________________________________ Treasurer Address ______________________________________ ____________________________________ Resident Agent Address 3. That the above named corporation was incorporated on _______________________________. 4. The federal tax identification number of said corporation is ____________________________________. 5. That the above named corporation is in good standing with the Secretary of the Commonwealth of Massachusetts or the State of _________________________(if incorporated under the laws of a foreign State) and has filed all federal and state tax returns and paid all federal, state and/or local taxes required under law. 6. ____________________________________is authorized to sign contract/agreements on behalf of _______________________________pursuant to a vote of the Board of Directors/Officers on _____________. PERTAINING TO NON-MASSACHUSETTS CORPORATIONS: 7. I, on behalf of the within corporation, do hereby acknowledge that by this contract, this corporation is transacting business within the Commonwealth of Massachusetts as defined by M.G.L. Chapter 223 A, Section 1, et seq. And is subject to the jurisdiction of its courts. SIGNED under the pains and penalties of perjury this ______day of _______________________, 2009. __________________________________________ Signature of Clerk Brockton Planning Board BPD 09-001 16
  17. 17. REGISTRATION FORM APPENDIX “C” DATE: ______________________________________________________________________________ TYPED NAME: ______________________________________________________________________________ SIGNATURE: ______________________________________________________________________________ TITLE: ______________________________________________________________________________ COMPANY: ______________________________________________________________________________ BUSINESS ADDRESS: _______________________________________________________________________ the CITY, STATE, ZIP: _______________________________________________________________________ TELEPHONE NO: ______________________________FAX NO: ____________________________ IF CORPORATION: 1. GIVE YOUR CORRECT CORPORATE NAME: ______________________________________________________________________________ 2. STATE AND DATE OF INCORPORATION: __________________________________________ ______________________________________________________________________________ 3. IF FOREIGN CORPORATION, GIVE MASSACHUSETTS REGISTRATION DATE: ______________________________________________________________________________ IF COMPANY, GIVE the CITY’S NAME AND TITLE: ____________________________________________________________________________________ IF PARTNERSHIP, GIVE NAMES AND ADDRESSES OF PARTNERS: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ IF TRUST OR LEGAL ENTITY, GIVE NAMES AND ADDRESSES OF TRUST OR LEGAL ENTITY: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Brockton Planning Board BPD 09-001 17
  18. 18. ATTESTATION CLAUSE APPENDIX “D” Under Section 35 of Chapter 233, political subdivisions and agencies of the Commonwealth must annually furnish to the Commissioner of Revenue a list of all persons who have provided goods, services or real estate space in the aggregate of five thousand dollars ($5,000) or more. Chapter 233 of the Acts of 1983, Sections 35 & 36 require that each provider or vendor of goods and services to any municipal agency must attest that it/he is in compliance of all the laws relating to taxes. The Attestation must occur at the time of issuing, renewing, or extending a license, contract, or agreement. Any person/company failing to execute the Attestation Clause shall not be allowed to obtain, renew, or extend a license, contract, or agreement. Each successful bidder shall certify that he is in compliance with Chapter 233 by providing a social security number of a federal identification number when a contract is issued. COMPANY: ______________________________________________________________________________ TYPED NAME: ______________________________________________________________________________ SIGNATURE: ______________________________________________________________________________ TITLE: ______________________________________________________________________________ BONA FIDE PROPOSAL As per Chapter 30B, Section 10, any person submitting a proposal for the procurement or disposal of supplies or services to any governmental body shall certify in writing, on the bid or proposal, as follows: The undersigned certifies under penalties of perjury that this proposal has been made and submitted in good faith and made without collusion or fraud with any other person. As used in this certification, the word “person” shall mean any natural person, business, partnership, corporation, union, committee, club, or other organization, entity, or group of individuals. Name of person signing proposal ________________________________________________________________ Company: ______________________________________________________________________________ EACH VENDOR SHOULD SIGN BOTH PARTS OF THIS FORM AND SUBMIT IT WITH THE BID. Brockton Planning Board BPD 09-001 18
  19. 19. DEVIATION SHEET APPENDIX “E” All deviations and/or substitutions from the original specified item (or equal) must be noted in writing and submitted along with proposal documents. PLEASE LIST BELOW: COMPANY: ____________________________________________________________________________ TYPED NAME: _____________________________________________________________________________ SIGNATURE: _____________________________________________________________________________ TITLE: _____________________________________________________________________________ Brockton Planning Board BPD 09-001 19
  20. 20. CERTIFICATE OF INSURANCE APPENDIX “F” As successful proposer on the ________________________________________________________contract you must supply the City of Brockton with a properly endorsed CERTIFICATE OF INSURANCE. Both the City of Brockton and the vendor shall be named as co-insured and the City shall be named as owner, and certificates of insurance shall be furnished to both parties. Reporting of accidents and claims shall be done by the vendor. This Certificate must accompany the Contract. INSURANCE REQUIREMENTS: WORKERS’ COMPENSATION: The Contractor, before commencing performance of the work required to be done under the Contract, shall provide for the payment of compensation, provided by the General Laws (ter. Ed.) Chapter 152 as amended to all persons to be employed by him in connection with said performance and shall continue in full force throughout the period of this Contract. PUBLIC LIABILITY: The Contractor will indemnify and hold harmless the City of Brockton and departments, against all suits, actions, claims, costs or damages to which the City of its department may be subject or put by reason of damages to the property of anyone other than the City, arising or resulting from the fault, negligence or wrongful omission of the Contract. Within fifteen (15) days after the award of this Contract the Contractor shall, at his own expense, procure and maintain any Public Liability in limits of $500,000/$1,000,000 and Property Damage Insurance of $50,000/$100,000. The above policies shall contain a provision worded as follows. “The insurance Company waives any right to subrogation against the City of Brockton which may arise by reason of any payments under this policy.” The policy must contain on the face a notation that it cannot be canceled without at least thirty (30) days notice in writing to the City as owner. The certificates of all policies shall provide for notice of cancellation of the Contracting officer and the certificates shall indicate that the above provisions have been included. Brockton Planning Board BPD 09-001 20
  21. 21. ASSURANCE OF NONDISCRIMINATION COMPLIANCE APPENDIX “G” The undersigned certifies that it does not subject employees or applicants for employment by this firm to discrimination on the basis of race, color, national origin, handicap, age or sex, in any of the following areas: 1. Recruitment, hiring, upgrading, promotion, whether for full-time or part-time employment, consideration for demotion, transfer, layoff, or rehires. 2. Rates of pay or any other form of compensation and changed in compensation. 3. Job assignments and seniority status. 4. Granting and returning from leaves of absence, leave for pregnancy, or any other leave. 5. Fringe benefits available by virtue of employment, whether or not administered by the recipient. 6. Selection and financial support for training, including apprenticeship, professional meetings, conferences, and other related activities, selection for tuition assistance, and selection for sabbaticals and leaves of absence to pursue training. 7. Employer-sponsored activities, including social or recreational programs. 8. Any other term, condition, or privilege or employment. NAME OF PROPOSER: _______________________________________________________________________ BY: _____________________________________________________________________________________ TITLE: _____________________________________________________________________________________ ADDRESS: ______________________________________________________________________________ TELEPHONE: ______________________________________________________________________________ DATE: ________________________ If Corporation, must be signed and sealed by duly authorized officer; if partnership, so state and give names of all partners; or if any individual, so state and sign. MINORITY/WOMEN BUSINESS CLASSIFICATION STATEMENT 1. Our firm is principally (more than 50%) minority owned. YES____________ NO____________ 2. Our firm is principally (more than 50%0 woman owned. YES____________ NO____________ 3. Our firm is registered with S.O.M.B.A. (State Office of Minority & Business Assistance) YES____________ NO____________ SOMWBA CERTIFICATION CATEGORY:_________________________________________________ MBE________________________________WBE__________________________________ Brockton Planning Board BPD 09-001 21
  22. 22. APPENDIX “H” A. The undersigned proposes to supply: __________________________________________________ _______________________________________________________________________________ B. The undersigned offers the following information as evidence of his qualifications to perform the work as bid upon, according to all the requirements of the specifications. 1. Have been in business under present business name for ___________years. 2. Are you fully licensed to do business under this contract? _________________ 3. Do you comply with all ordinances and regulations mandated by M.G.L. and the community in which you are located? ______________ 4. Ever fail to complete any work awarded? _______________ 5. Have you been involved in litigation in the past five (5) years? _____________ 6. List at least three (3) state, local or private companies and/or organizations which you have served recently of similar character as required for the above-mentioned. LOCATION DESCRIPTION OF WORK 1. ______________________________________________________________________________ 2. ______________________________________________________________________________ 3. ______________________________________________________________________________ C. Bidders shall indicate firm date of delivery on receipt of contract and subsequent purchase order form the City of Brockton. DELIVERY DATE: ________________________________ COMPANY: _______________________________________ TYPED NAME: _______________________________________ SIGNATURE: _______________________________________ TITLE: ____________________________________ Brockton Planning Board BPD 09-001 22
  23. 23. APPENDIX “I” CERTIFICATE OF INDEMNIFICATION & RELEASE The Recipient shall indemnify and hold the City of Brockton harmless from any and all acts & omissions arising out of this contract. Further, the recipient shall indemnify and hold harmless the City of Brockton against any/all suits, claims, actions, costs or damages to which the City may be subject to by reason of damages to the property or person of anyone, arising or resulting from fault, negligence, or wrongful omissions by the recipient. The recipient, their agent(s), representatives or employees shall release and hold the City of Brockton harmless for any injury to themselves, corporate officers, agents, representatives or employees in connection with the performance of this agreement or any related sub-contract thereof. ____________________________________________ Authorized Signature Brockton Planning Board BPD 09-001 23
  24. 24. APPENDIX “J” CERTIFICATE OF NON-COLLUSION The undersigned certifies under the penalty of perjury that this bid or proposal has been made and submitted in good faith and without collusion or fraud with any other person. As used in this certification, the word “person” shall mean any natural person, business partnership, corporation, union, committee, club, or other organization, entity, or group of individuals. _________________________________________ (Name of person signing bid or proposal) _________________________________________ (Name of business) Brockton Planning Board BPD 09-001 24

×