SECTION 6. PROPOSAL RESPONSE FORM

DATE ______

Proposal of: ______, (herein after called Offeror), a Corporation/Partnership/an Individual doing business as

______.

TO: Oklahoma Office of State Finance on behalf of the State of Oklahoma

The Offeror, in compliance with your Request for Proposals for the Oklahoma Community Anchor Network Project, having examined the RFP and Statement of Work with related documents and being familiar with all of the conditions surrounding the work, hereby agrees to perform the work required by the contract documents at the price which will be mutually agreed upon between the Offeror and the State during the negotiation phase. The negotiated price will cover all expenses incurred in performing the work required by the contract documents, of which this proposal is a part.

Offeror acknowledges receipt of the following addenda in the event subsequently issued.

______

Offeror agrees to provide services described in the RFP Statement of Work.

Oklahoma Sales Tax Permit

__ Yes – Permit Number______

__ No – Exempt pursuant to Oklahoma Laws or Rules

Registration with Oklahoma Secretary of State

__ Yes – Filing Number ______

__ No – Prior to the contract award, the successful bidder will be required to register with the Secretary of State or must attach a signed statement that provides specific details supporting the exemption the supplier is claiming ( or 405-521-3911).

Submitted by:

______

Firm FEI/SSN

______

Signature Typed Name & Title

______

Address City, State, Zip Code

______

Telephone Fax Number

SECTION 7. FORM OF CERTIFICATION

RFP Number:B-1101
State of Oklahoma
Office of State Finance / Certification for Competitive Bid and/or Contract (Non-Collusion Certification)
Solicitation or Purchase Order #:
Supplier Legal Name:
SECTION I [74 O.S. § 85.22]:
A. For purposes of competitive bid,
  1. I am the duly authorized agent of the above named bidder submitting the competitive bid
herewith, for the purpose of certifying the facts pertaining to the existence of collusion
among bidders and between bidders and state officials or employees, as well as facts
pertaining to the giving or offering of things of value to government personnel in return for
special consideration in the letting of any contract pursuant to said bid;
  1. I am fully aware of the facts and circumstances surrounding the making of the bid to which
this statement is attached and have been personally and directly involved in the proceedings
leading to the submission of such bid; and
  1. Neither the bidder nor anyone subject to the bidder's direction or control has been a party:
  1. to any collusion among bidders in restraint of freedom of competition by agreement to
bid at a fixed price or to refrain from bidding,
  1. to any collusion with any state official or employee as to quantity, quality or price in the prospective contract, or as to any other terms of such prospective contract, nor
  1. in any discussions between bidders and any state official concerning exchange of money
or other thing of value for special consideration in the letting of a contract.
B. I certify, if awarded the contract, whether competitively bid or not, neither the contractor nor
anyone subject to the contractor’s direction or control has paid, given or donated or agreed to pay,
give or donate to any officer or employee of the State of Oklahoma any money or other thing of
value, either directly or indirectly, in procuring this contract herein.
SECTION II [74 O.S. § 85.42]:
For the purpose of a contract for services, the supplier also certifies that no person who has been
involved in any manner in the development of this contract while employed by the State of
Oklahoma shall be employed by the supplier to fulfill any of the services provided for under said
contract.
The undersigned, duly authorized agent for the above named supplier, by signing below
acknowledges this certification statement is executed for the purposes of:
the competitive bid attached herewith and contract, if awarded to said supplier;
OR
the contract attached herewith, which was not competitively bid and awarded by the agency
pursuant to applicable Oklahoma statutes.

______

Supplier Authorized Signature / Certified This Date
______
Printed Name
______/ ______
Title
______
Phone Number
______/ Email
Fax Number

SECTION 8. CONTACT & PARENT COMPANY INFORMATION

If contact individual for this proposal is different from the signature affixed to this offer so state:

Name:

______

Title:

______

Phone:

______

Fax:

______

Email:

______

Address:

______

______

______

Check ( ) if your firm is a subsidiary or affiliate of another company. If either, identify such by name and explain the relationship(s) between said companies.

Subsidiary ______Affiliate ______

______

Parent Company Name ______

Address ______

Tax ID No. ______

SECTION 9. STATEMENT OF PRICE

RFP Number: B-1101

RFP Title: Oklahoma Community Anchor Network Project

Price will be negotiated with offeror(s). Offeror agrees to negotiate with the State in good faith and to comply with the Program Rules for BTOP Round 2 recipients as set forth by the NTIA. See www2.ntia.doc.gov/rules.

Offeror Name______

Signature______

Typed Name and Title Date

SECTION 10. EXCEPTIONS TO REQUEST FOR PROPOSAL

If the offeror has exceptions to the RFP, they must be identified on this page. Please state if there are no exceptions.

Offeror Name______

Signature______

Typed Name and Title Date