HomeMy WebLinkAboutOpening of Quotations - Janitorial Supplies 2018 - KSS EnterprisesBID/PROPOSAL
CITY OF SOUTH BEND
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BID NAME Janitorial Supplies 2018
FOR BIDS DUE June 12,2018,9:30 am., local time
Bidder (Firm): -s f S
Address: 6 6
City/State/Zip:
Telephone Number: 5' 7 Fax Number: ? 2r. 7 1, q,,
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CITY OF SOUTH BEND, INDIANA
SELLER'S BID FOR SALE OR LEASE OF MATERIALS
AND NON -COLLUSION AND NON DEBARMENT AFFIDAVIT AND
NON-DISCRIMINATION COMMITMENT FOR SELLERS
BID NAME Janitorial Supplies 2018
FOR BIDS DUE June 12, 201 8,_9:30, a.m., local time
Bidder
Date: (Firm
Address:
ry
City/State/Zip: -"Yelephone Number: 3 7
Agent of Bidder (if ApplicE ble):
O'hen the prospective Contractor is unable to anexplanation tothisAffidavit
CONTRACTOR'S NON -COLLUSION AND NON -DE BARMENT AFFIDAVIT,
CERTIFICA'110N REGARDING INVESTMENT WITH IRAN, E MPLOYMENT
ELIGIBILITY VERIFICATION, NONN-DISCRIM1 NATION COMMITMENT AND
CEIITIFICATION OF USE OF UNITED STATES STEEL PRODUCTS OR FOUNDRY
PRODUCTS
(Must be completed for all quotes and bids, Please type or print)
STATE OF
SS:
COUNTY
The undersigned Contractor, being duly sworn upon his/hor/its oath, affirms undQr the ponatties of perjury
that:
I. Contract(,- has not, nor has any other member, representative, or agent of the firill,
cornpany, corporation or partnership represented by hini, entered into any cornbination,
collusion or agreement with any person relative to the price to be bid by anyone at such
letting nor to prevent any person fi-orn bidding nor to induce anyone to refrain fi-0111
bidding, and that this bid is niade without reference toany other bid and without any
agreement, understanding or combination with any other person in reference to such
bidding. Contractor further says that no person �or persons, firins, or corporation has, have
or will receivd.directly or indirectly, any rebate, fee, gift., commission or thing of value
on account of such sale; and
2. Contractor certifies by submission of this proposal that neither contractor nor any
of its principals Eire presently debarred, suspended, proposed for debarnient, declared
ineligible, Or Voluntarily excluded from participation in this transaction by any Federal
department or agency; and
3. Contractor has not, nor has any successor to, nor an affiliate of, Contractor, engaged in
invcstment activities in Iran.
I hereby affirm under tile penalties of perjury that the facts and information contained in the foregoing bid
for public works are true and correct.
Dated this 7 — day of 20
Contractor/Bidder (Firrfi)
Signature of Contractor/Bidder or Its Agent
&
Printed Name and Title te
Subscribed and sworn to before nle this day of 20
1�4:4 My Commission Expires kIAL-126411 i V), 'VLen1,,1%—,1'
NtOlt�y Public
SUSAN K FENDER County of Residence
NOTARY PUBLIC, STATE OF MP
COUNTY OF KkAMAZOO
My COMMISSION EXPIRES AtQ 3,2oig
ACPNG IN COUNTY Or
Contractor's good faith efforts to obtain participation by those Contractors certified by
the State of Indiana as a Minority Business ("MBE") or as a Women's Business
Enterprise ("WBE") as a factor in determining the lowest, responsible, responsive
bidder.
In no event shall persons or entities seeking the award of a City contract be required to
award a subcontract to an MBE/WBE; however, it may not unlawfully discriminate
against said WBE/MBE. A finding of a discriminatory practice by the City's MBE/WBE
Utilization Board shall prohibit that person or entity from being awarded a City contract
for a period of one (1) year from the date of such determination, and such determination
may also be grounds for terminating the contact for which the discriminatory practice or
noncompliance pertains.
7. The undersigned contractor agrees that the following nondiscrimination
commitment shall be made a part of any contract which it may henceforth enter into with
the City of South Bend, Indiana or any of its agencies, boards or commissions.
Contractor agrees not to discriminate against or intimidate any employee or applicant for
employment in the performance of this contract with privileges of employment, or any
matter directly or indirectly related to employment, because of race, religion, color, sex,
gender expression, gender identity, sexual orientation, handicap, national origin or
ancestry. Breach of this provision may be regarded as material breach of contract.
I, the undersigned bidder or agent as contractor on a public works project, understand my
statutory obligations to the use of steel products or foundry products made in the United
States (I.C. 5-16-8-1). 1 hereby certify that I and all subcontractors employed by me for
this project will use steel products or foundry products .made in the United States on this
project if awarded. I understand 1 have an affirmative duty to notify the City in my bid
that my proposal does not include the use of steel products or foundry products made in
the United States, I understand it is my sole obligation and responsibility to provide a
justification to the City, subject to review and approval, why the cost of United States
made steel or foundry products is unreasonable, Prior to award and upon submission of
kid which does not use steel products or foundry products made in the United States, the
City, through its director of public works, shall make a determination if the price of
United States made steel or foundry is unreasonable. 1 understand that violations
hereunder may result in forfeiture of contractual payments.
(To be completed only by Contractor•slHidder:s claiming to be a "local Indiana husines's"pursuant it) I.C..36-1-12-22)
INDIANA LOCAL BUSINESS PREFERENCE CLAIM
.................
A "local hndtatna business" refers to any o/ the follois+ing:
(1) A business whose principal place gf'brrsiness is located in an ajffcted county.
(2) A business that pays a majorio, of its payroll (in dollar whine) to residents of affected counties.
(3) A btt.shress that employs residents of afJectcd counties as k tuajaritj of its employees.
(4) A business that makes significant capital investments in the aj]ected counties as dented in rules adopted by the political
subdivision.
(5) A business that has a ,substantial positive econontic impact on the crffecled counties as defined by criteria its rales adopted bythe political subdivision.
An "affected county" refers to St. Joseph County, Indiana, or the fallowing counties located adjacent to St. Joseph Corarty:
Elkhart County, Marshall County, Starkc County and LaPorte County
There are the followirng price preferences for supplies purchased from a local Indiana business;
• 5%fora purchase expected 1»> the purchasing agency to be less than $50,000
• 3%for a purchase expected 41, the purchasing agency to beat least S50,000 but less than $100,000,
• 1 % fora purchase ex reeled by the purchasing a encv to be al least $100, 000.
Date:
Pursuant to I.C. 36-1-12-22,
preference for Project
South Bend, St. Joseph County, Indiana.
❑ The location of the principal place of business is
claims a local Indiana business
(Project # ) located within the City of
(Andress)
❑ St. Joseph County, Indiana
❑ The following county located adjacent to St, Joseph County, Indiana:
❑ The majority of the business's payroll for the 12 months prior to the date of this Bid is to residents of St.
Joseph County, Indiana or the adjacent county noted above.
❑ The majority of the business's employees for the 12 months prior to the date of this Bid are residents of
St. Joseph County, Indiana, or the adjacent county rioted above.
If the business is deemed to be the apparent lowest, responsible, responsive bidder, then it shall provide
supporting docrnnentation for the 12 month period prior to the date of the Bid of (i) the total payroll
amount paid to all employees of the business, and. (ii) the total payroll amount paid to employees who are
residents of St. Joseph County and the adjacent county noted above.
WHEN SUPPLYING SUPPORTING PAYROLL RECORDS, BIDDER SHALL REDACTALL
SOCIAL SECURITYNUMBERS.
Dated this day of 20
Contractor/Bidder (Firm)
Signature of Contractor/Bidder or Its Agent
Printed Name and Title