RFP #23-023
Attachment “A”
ATTACHMENT “A”
REQUEST FOR PROPOSAL #23-023
Comprehensive Development Impact Fee, User Fee Update
and Nexus Study Update
SIGNATURE AUTHORIZATION
PROPOSER: ___________________________________________________________________________
A. I hereby certify that I have the authority to submit this Proposal to the City of Rialto for the above listed individual or co mpany. I certify that I have the authority to bind myself/this company in a contract should I be successful in my proposal.
____________________________________
SIGNATURE
B. The following infor mation relates to the legal contractor list ed above, whether an individual or a company. Place check marks as appropriate:
1. If successful, the contract language should refer to me/my company as:
____ An individual;
____ A partnership, Partners’ names:
____ A company; (registered in ________)
____ A corporation; (incorporated in _______)
2. My tax identification number is: __________________________
ADDENDA ACKNOWLEDGMENT:
Acknowledgment of Receipt of any Addend a is sued by the City fo r this RF P is required by incl uding t he acknowledgment with your proposal. Failure to acknowledge the Addenda issued may result in your pro posal being deemed non-responsive.
In the space provided below, please acknowledge receipt of each Addenda:
Addendum(s) # _______________ is/are hereby acknowledged.
The “Small Business Concerns Information” sheet shall be included as part of Attachment “A”.
RFP #23-023
Attachment “A”
Attachment “A” – Small Business Concerns Information
The Proposer shall furnish the following information. Additional sheets may be attached, if necessary.
(1) Name: ________________________________________________________________ (2) Address: _ _______________________________________________________________ (3) Phone No.: ______________________________Fax No.:___________________________ (4) E- Mail: ________________________________________________________________ (5) Type of Firm: (Check all that apply)
______ Individual ______ Partnership ______ Corporation ______ Minority Business Enterprise (MBE) ______ Women Business Enterprise (WBE) ______ Small Disadvantaged Business (SDB) ______ Veteran Owned Business ______ Disabled Veteran Owned Business ______ Other (6) Business License: _____Yes _____No License Number: ___________________________ (7) T ax Identification Number: _____________________________________________________ (8) Names and Titles of corporate members of the firm:
____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ (9) Three (3) projects of this type recently completed:
Type of project: ________________________________________________________________ Contract Amount: _________________________ Date Completed: _______________________ Owner: _________________________________ Phone: _______________________________ Type of project: ________________________________________________________________ Contract Amount: _________________________ Date Completed: _______________________ Owner: _________________________________ Phone: _______________________________ Type of project: ________________________________________________________________ Contract Amount: _________________________ Date Completed: _______________________ Owner: _________________________________ Phone: _______________________________
RFP #23-023
Attachment “C”
ATTACHMENT “C”
REQUEST FOR PROPOSAL #23-023
Comprehensive Development Impact Fee, User Fee Update and Nexus Study Update
CONFLICT DISCLOSURE FORM
RFP #23-023
Attachment “C”
ATTACHMENT “C”
CONFLICT DISCLOSURE FORM
RFP #23-023
Attachment “C”
ATTACHMENT “C”
CONFLICT DISCLOSURE FORM
RFP #23-023
Attachment “D”
ATTACHMENT “D”
REQUEST FOR PROPOSAL #23-023
Comprehensive Development Impact Fee, User Fee Update
and Nexus Study Update
DEBARMENT AND SUSPENSION CERTIFICATION
The Consultant, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, and manager:
• Is not currently under susp ension, debarment, volu ntary excl usion, or determination of ineligibility by any federal agency;
• Has not been suspended, debarred, voluntarily e xcluded or determined ineligible by any federal agency within the past 3 years;
• Does not have a proposed debarment pending; and
• Has not been indi cted, c onvicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter i nvolving fraud or official misconduct within the past 3 years.
If there are any exceptions to this certification, insert the exceptions in the following space.
Exceptions will not necessarily result in denial of award but will be considered in determ ining Proposer responsibility. For any exception noted above, indicate below to whom it app lies, initiating agency, and dates of action.
Notes: Providing false information may result in criminal prosecution or administrative sanctions.
Consultant Name:
(Date) (Signature)
(Name & Title)
RFP #23-023
Attachment “E”
ATTACHMENT “E”
REQUEST FOR PROPOSAL #23-023
Comprehensive Development Impact Fee, User Fee Update
and Nexus Study Update
NON-DISCRIMINATION CERTIFICATION
In connection with its performance under this Agreement, the Consultant hereby ce rtifies that it shall not discriminate in its employment with regard to age, handicap, race, color, religion, gender, gender identity, sex, sexual orientation, or national origin; that it is in compliance with all federal, state, local directives, and exec utive orde rs regarding non -discrimination in employment; and t hat it a grees to demonstrate p ositively and aggressively the principle of equal em ployment opportunity in employment.
We agree specifically:
1. To establish or observe employment policies which a ffirmatively promote opportunities for minority persons at all job levels.
2. To communicate this policy to all per sons concerned, including all company employees, outside recruiting services, especially those serving minority communities, and to the minor ity communities at large.
3. To take affirmative steps to hire minority employees within the company.
Consultant Name:
(Date) (Signature)
(Name & Title)
Attached herewith is a copy of the Consultant’s currently adopted equal opportunity employment program.
RFP #23-023
Attachment “C”
ATTACHMENT “C”
REQUEST FOR PROPOSAL #23-023
Comprehensive Development Impact Fee, User Fee Update and Nexus Study Update
CONFLICT DISCLOSURE FORM
1RQH
9LFH3UHVLGHQW
0*7RI$PHULFD&RQVXOWLQJ//&
FH 333333333333333333333333333333UHUHHUHUHUHUHUHHHHHUHUHUHHUHHHHUHHHUHHHHHUHUHUHUUUHUUUUUUUUUUUUU VLVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVVV GHGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG QW
RFP #23-023
Attachment “C”
ATTACHMENT “C”
CONFLICT DISCLOSURE FORM
RFP #23-023
Attachment “C”
ATTACHMENT “C”
CONFLICT DISCLOSURE FORM
RFP #23-023
Attachment “D”
ATTACHMENT “D”
REQUEST FOR PROPOSAL #23-023
Comprehensive Development Impact Fee, User Fee Update
and Nexus Study Update
DEBARMENT AND SUSPENSION CERTIFICATION
The Consultant, under penalty of perjury, certifies that, except as noted below, he/she or any other person associated therewith in the capacity of owner, partner, director, officer, and manager:
x Is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal agency;
x Has not been suspended, debarred, voluntarily excluded or determined ineligible by any federal agency within the past 3 years;
x Does not have a proposed debarment pending; and
x Has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years.
If there are any exceptions to this certification, insert the exceptions in the following space.
Exceptions will not necessarily result in denial of award but will be considered in determining Proposer responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and dates of action.
Notes: Providing false information may result in criminal prosecution or administrative sanctions.
Consultant Name:
(Date) (Signature)
(Name & Title)
0*7RI$PHULFD&RQVXOWLQJ//&
3DWULFN-'\HU9LFH3UHVLGHQW
(S(S(S(S(S(S(S(S((S(S(((S((((((((S(((S(S((((((S((S(((S(S(((S(SSSS(SSSSSSSSSSSSSigiggigigigigiggggiggggggggggggiggggggggggiigigiigii nature) RFP #23-023
Attachment “E”
ATTACHMENT “E”
REQUEST FOR PROPOSAL #23-023
Comprehensive Development Impact Fee, User Fee Update
and Nexus Study Update
NON-DISCRIMINATION CERTIFICATION
In connection with its performance under this Agreement, the Consultant hereby certifies that it shall not discriminate in its employment with regard to age, handicap, race, color, religion, gender, gender identity, sex, sexual orientation, or national origin; that it is in compliance with all federal, state, local directives, and executive orders regarding non-discrimination in employment; and that it agrees to demonstrate positively and aggressively the principle of equal employment opportunity in employment.
We agree specifically:
1. To establish or observe employment policies which affirmatively promote opportunities for minority persons at all job levels.
2. To communicate this policy to all persons concerned, including all company employees, outside recruiting services, especially those serving minority communities, and to the minority communities at large.
3. To take affirmative steps to hire minority employees within the company.
Consultant Name:
(Date) (Signature)
(Name & Title)
Attached herewith is a copy of the Consul tant’s currently adopte d equal opportunity employment program.
0*7RI$PHULFD&RQVXOWLQJ//&
3DWULFN-'\HU9LFH3UHVLGHQW
(SSSSSSSSSSSSigigigiggigigigiggigigigigigigigggigigiigggigigigiigigiiiiigiggggggggggggggggnanaanaaanaananaanananaaaaaaanaaananaanaanaaaaaananaannannnnnnnnnnnnnnnn tutututututututtuttutttuttttttttttttttttttt re)