ATTACHMENT D

TRANSMITTAL LETTER FORM

(To be typed on Respondent’s Letterhead)

[Date]

Michael Lindquist, PE

Project Manager

City of Davis

23 Russell Blvd.

Davis, CA 95616

Re:Statement of Qualifications for Wastewater Treatment Plant ImprovementsProject

______(the Respondent) hereby submits its Statement of Qualifications (SOQ) in response to the Request for Qualifications (RFQ) for the Wastewater Treatment Plant Secondary and Tertiary Improvements Project(Project) issued by the City of Davis (City) on May 29, 2013, as amended.

As a duly authorized representative of the Respondent, I hereby certify, represent, and warrant as follows in connection with the SOQ:

  1. The Respondent acknowledges receipt of the RFQ and the following addenda:

No. / Date
  1. The submittal of the SOQ has been duly authorized by, and in all respects is binding upon, the Respondent. Attachment 1 to this form is a notarized Certificate of Authorization which evidences my authority to submit the SOQ and bind the Respondent.
  1. The Respondent’s obligations under the DB Agreement will be guaranteed absolutely, unconditionally, and irrevocably by ______, as evidenced by the Guarantor Acknowledgment submitted as SOQ Form 5. (If the Guarantor is different from the Respondent, another Certificate of Authorization (see Attachment 1 to this Transmittal Letter) will be signed and notarized to evidence the signer’s authority to submit the Guarantor Acknowledgment certificate and enter into a Guaranty Agreement with the City).
  1. The Performance Bond issued on behalf of ______as the Respondent, assuring that the Respondent will perform the DB Contractor’s duties in accordance with the terms of the DB Agreement, will be provided by ______.
  1. The Payment Bond issued on behalf of ______as the Respondent, assuring that the Respondent will perform the DB Contractor’s duties in accordance with the terms of the DB Agreement, will be provided by ______.
  1. The Insurance that meets the Project requirements described in this RFQ will be provided or brokered by ______.
  1. All information and statements contained in the SOQ are current, correct and complete, and are made with full knowledge that the City will rely on such information and statements in selecting the DB Contractor and executing the DB Agreement.
  1. The SOQ has been prepared and is submitted without collusion, fraud or any other action taken in restraint of free and open competition for the services contemplated by the RFQ.
  1. Neither the Respondent, the Guarantor nor any Project Team Member is currently suspended or debarred from doing business with any governmental entity.
  1. The Respondent has reviewed all of the engagements and pending engagements of the Respondent and the Guarantor, and no potential exists for any conflict of interest or unfair advantage.
  1. No person or selling agency has been employed or retained to solicit the award of the DB Agreement under an arrangement for a commission, percentage, brokerage or contingency fee or on any other success fee basis, except bona fide employees of the Respondent or the Guarantor.
  1. The principal Respondent contact person who will serve as the interface between the City and the Respondent for all communications is:

Name:
Title:
Address:
Phone
Fax:
Email:

The statements made in this Statement of Qualifications are true of my own knowledge and belief, except as to those stated on information and belief, and as to those statements I believe them to be true. I declare under penalty of perjury under the laws of the State of California that the foregoing is correct.

Name of Respondent
Name of Designated Signatory
Signature
Title

Attachment 1to SOQ Transmittal Letter

CERTIFICATE OF AUTHORIZATION*

I, ______, a resident of ______in the State of ______, DO HEREBY CERTIFY that I am the Clerk/Secretary of ______, a [corporation] duly organized and existing under and by virtue of the laws of ______; that I have custody of the records of the [corporation]; and that as of the date of this certification, ______holds the title of ______the [corporation], and is authorized to execute and deliver in the name and on behalf of the [corporation] the Statement of Qualifications (“SOQ”) submitted by the [corporation] in response to the Request for Qualifications for the City of Davis Wastewater Treatment Plant Secondary and Tertiary ImprovementsProject issued by the City of Davis on ______, 2013, as amended; and all documents, letters, certificates and other instruments which have been executed by such officer on behalf of the [corporation] in connection therewith.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of the [corporation] this ______day of ______2013.

(Affix Seal Here)

Clerk/Secretary

* Note: Separate certifications shall be submitted if more than one corporate officer has executed documents as part of the SOQ. Respondents shall make appropriate conforming modifications to this Certificate in the event that the signatory’s address is outside of the United States.

ACKNOWLEDGMENT

State of California

County of ______)

On ______before me,______,

(Date) (Here Insert Name and Title of the Officer)

personally appeared______

______,

who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to this Statement of Qualifications for the Davis Wastewater Treatment Plant Secondary and Tertiary Improvements Project and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

Signature:______

Place Notary Seal Above (Signature of Notary Public)