RFP 1310-002

Attachment D – Bidder Certifications

ATTACHMENT D

BIDDER CERTIFICATIONS

  1. Suspension/Debarment/Tax Delinquent - I certify that neither Click here to enter text. (insert the name of your company) nor any of its proposed subcontractors are currently under suspension or debarment by any state or federal government agency, and that neither Bidder nor any of its proposed subcontractors are tax delinquent with the State of California.
  1. Conflict of Interest - I certify that Click here to enter text. (insert the name of your company) has no interest that would constitute a conflict of interest under California Public Contract Code sections 10365.5, 10410 or 10411; Government Code sections 1090 et seq. or 87100 et seq.; or rule 10.103 or rule 10.104 of the California Rules of Court, which restrict employees and former employees from contracting with judicial branch entities.
  1. Conflict Minerals - I certify that Click here to enter text. (insert the name of your company) is not a scrutinized company under the California Public Contract Code 10490(b), or the goods or services provided under this proposal do not contain conflict materials as defined in the Securities Exchange Act of 1934, Section 13(p).
  1. Good Standing in the State of California – If a Corporation (or Limited Liability Company), I certify that Click here to enter text. (insert the name of your company) is in good standing and qualified to do business in California.(Bidder to attach Certificate of Good Standing to proposal documents.)
  1. Contracts Terminated for Cause or Default

Below, I have listed all contracts with government or commercial customers during the five years preceding submission of this Proposal that have terminated for cause or default.

I acknowledge that if my company or any of its subcontractors subsequently are placed under suspension or debarment by a local, state or federal government entity, or if Bidder or any of its subcontractors subsequently become delinquent in California taxes, our Proposal may be disqualified.

List of all Contracts with Government or Commercial Customers during the Five Years preceding Submission of this Proposal that have terminated for cause or default:

Click here to enter text. /
  1. Acceptance of Insurance Requirements

Mark the Appropriate Choice, below:

☐Bidder currently maintains, and will continue to maintain, insurance that meets the requirements set forth in the Bid/RFP document, specifically in the Master Services Agreement or the included Terms and Conditions, and satisfies the requirements illustrated on the attached Sample Insurance Certificate.

(In case of any conflict or discrepancy between the insurance requirements in the RFP vs. the Sample Insurance Certificate, the RFP insurance requirements take precedence and prevail.)

OR

☐Bidder is ready, willing and able to maintain insurance that meets the requirements set forth in the Bid/RFP document, specifically in the Master Services Agreement and satisfies the requirements illustrated on the attached Sample Insurance Certificate.

(In case of any conflict or discrepancy between the insurance requirements in the Bid/RFP vs. the Sample Insurance Certificate, the Bid/RFP insurance requirements take precedence and prevail.)

OR

☐Bidder takes exceptions to the insurance requirements of this Bid/RFP and has provided an explanation of these exceptions in the box below.

Click here to enter text. /

CERTIFICATION OF ACCEPTANCE

Bidder: Click here to enter text.

EMPLOYER IDENTIFICATION NUMBER: Click here to enter text.

In response to the Bid/Request for Proposal, I/we the undersigned hereby declare that I/we have carefully read and examined the Bid/RFP documents and all other documents and information posted online at the Court Online Procurement Website and hereby propose to perform the Statement of Work and/or provide the goods/products as required in this solicitation.

The Contract pursuant to this Bid/RFP may not be exclusive. Court expressly reserves the right to contract for performance of services and/or procurement of goods/products such as those described herein through other Bidders.

The undersigned agrees to supply the services set forth and/or provide the goods/products in its submitted Bid/Proposal at the costs indicated, if the Bid/Proposal is accepted within 90 days, or as otherwise set forth in this solicitation, from the Bid/Proposal submission deadline date. If recommended for Contract award, the undersigned agrees to execute a Contract that will be prepared by Court for execution, within thirty (30) calendar days following Notification of Award.

Bidder represents that the following person is authorized to negotiate on its behalf with Court in connection with this Bid/RFP:

The undersigned certifies that he/she has examined and is fully familiar with all of the provisions of the Bid/RFP Documents, Addenda, etc. The undersigned hereby agrees that Court will not be responsible for any errors or omissions in these Bid/RFP Documents and Addenda. The undersigned certifies that he/she has the legal capacity to sign on behalf of the Bidder listed above, and that this signature is a legally binding signature upon the Bidder.

Click here to enter text.

(Signature) (Email)

Click here to enter text.Click here to enter text.

(Type or Print Name) (Phone)

Click here to enter text.Click here to enter text.

(Title) (Name of Company)

Updated: 3/22/13