TO BE RETURNED SEALED PROPOSALS Bid Proposal Form

SEALED PROPOSALS
TO BE RETURNED
Bid Proposal Form
BLACK HORSE PIKE REGIONAL BOARD OF EDUCATION
Bread – Bid #
C3 - 14/15
The undersigned proposes to furnish and deliver the above goods/services pursuant to the bid specification and
made part hereof.
COMPANY NAME
ADDRESS
CONTACT PERSON
FAX NUMBER
E-MAIL
BID PRICE PER SPECIFICATIONS: (As per attached)
Signature of Authorized Agent
Date
Type or Print Name
Title
SPECIFICATIONS AVAILABLE BY CONTACTING JEAN GRUBB AT 856-227-4106, EXT. 8007.
BLACK HORSE PIKE REGIONAL BOARD OF EDUCATION
BID SPECIFICATIONS FOR BREAD
2014 – 2015
Quality
The bread shall meet the standards and regulations of the New Jersey State Department of Agriculture
and Health and the Board of Health of the Township of Gloucester and the Borough of Runnemede, New
Jersey.
The bread shall be fresh.
Packaging
The bread shall be packaged and free from soil, dirt or foreign matter of any kind. Damaged packages
shall be replaced and/or credited to the purchaser.
All containers shall be dated for fresh bread identification.
Delivery Service
The Board of Education, through it representative, reserves the right to control, orders as well as
reorders and have omissions corrected promptly and without delay.
All bread shall be delivered in clean and sanitary trucks.
Bid prices will be valid from July 1, 2014 through June 30, 2015. Included in the bid price are all
delivery costs.
Please furnish a list of additional items not listed on the bid, as well as packaging and purchase price for
each item should we want to purchase additional products.
It is at the discretion of the Board or Designated Authorities to award the bid on all or nothing, or line by
line basis, whichever is determined to be in the best interest of the district.
Daily deliveries shall be made available to all district schools based upon request by order. Deliveries
shall be made inside the schools. No deliveries shall be left outside. The school district will not be responsible
to pay for any bread left outside the proper delivery location.
Daily deliveries by 8:00 am, September 2014 through June 30, 2015 to the following schools:
Triton High School – 250 Schubert Ave., Runnemede, NJ 08078
Highland High School – 450 Erial Rd., Blackwood, NJ 08012
Timber Creek High School – 501 Jarvis Rd., Erial, NJ 08081
Orders will be called in daily by each school’s kitchen manager for the next day’s delivery.
Bread shall be delivered in clean bread cases and empty cases will be picked up by the bread vendor the
following day.
If any type of bread in containers that have not been opened is returned to the supplier, the Board of
Education shall receive full credit for those returned.
No deliveries shall be made in the event of an emergency school closing, announcements of which
would be made on radio station KYW or Channel 3.
Billing – Monthly statements shall be sent to the School District Central Office by the 5th day of the
month. Payment will be made by the School District Central Office on or about the 20th of the month.
Render statements and signed voucher on or before the 5th of the month to:
580 Erial Rd.
Black Horse Pike Regional School District
Food Service Department
Blackwood, NJ 08081
APPROXIMATE DAILY QUANTITIES NEEDED
TYPE
DAILY QUANTITY
Hamburger Rolls
17 Dozen
Frankfurter Rolls
3 Dozen
Club Rolls
3 Dozen
Round Dinner Rolls
4 Dozen
Large Soft Torpedo Rolls
40 Dozen
English Muffins
2 Dozen
Bagels, Assorted
6 Dozen
Donuts, Assorted
1 Dozen
We propose to furnish the following items, all the prices listed opposite the items. Quantities as
indicated in the bread bid specifications are only approximate and may vary from day to day.
Cost Per Dozen
Hamburger Rolls
Hamburger Rolls – Whole Grain
Frankfurter Rolls
Frankfurter Rolls – Whole Grain
Club Rolls
Club Rolls – Whole Grain
Round Dinner Rolls
Round Dinner Rolls – Whole Grain
Large Soft Torpedo Rolls
Large Soft Torpedo Rolls – Whole Grain
English Muffins
English Muffins – Whole Grain
Donuts
Donuts – Whole Grain
Bagels
Company Name
Street Address
City, State, Zip
Telephone
Signature, Title
Date
________________________
INSTRUCTIONS TO BIDDERS
Submission of Bids:
1. Sealed bids shall be received by the Black Horse Pike Regional School District Board of Education in
accordance with public advertisement as required by law, with a copy of said notice being attached
hereto and made a part of these specifications.
2. Bids must be placed in a sealed envelope marked as shown below on the front of the envelope. Bidders
should also keep a complete copy of the bid packet, exactly as submitted.
Envelope Label Information:
District:
Bid #:
Bid Title:
Bid Date:
Bid Time:
Black Horse Pike Regional School District
C3 - 14/15
Bread
Thursday, February 19, 2015
9:00 AM
Bidder:
Name of Company
Address
City, State, Zip
3. Bids will be publicly opened in the Black Horse Pike Regional Board of Education, 580 Erial Rd.,
Blackwood, NJ 08012, and read beginning at 9:00 am on Thursday, February 19, 2015. Bidders and/or
their authorized agents, and the general public are invited to be present at the bid opening. It is the
responsibility of each bidder to ensure that their bid is complete, and presented to the Business Office
before the bid date and time. Bids will not be accepted or received by the Board of Education after the
advertised bid date and time. (N.J.S.A. 18A:18A-21(b).
4. Sealed bids forwarded to the owner before the time of opening of bids may be withdrawn upon written
application of the bidder who shall be required to produce evidence showing that the individual is or
represents the principal or principals involved in the bid. Once bids have been opened, they shall remain
firm for a period of sixty (60) calendar days.
5. All prices and amounts must be written in ink or preferably machine-printed. Bids containing any
conditions, omissions, unexplained erasures or alterations, items not called for in the bid proposal form,
attachment of additive information not required by the specifications, or irregularities of any kind, may
be rejected by the owner. Any changes, whiteouts, strikeouts, etc. in the bid must be initialed in ink by
the person signing the bid.
6. Each bid proposal form must give the full business address, business phone, fax, email if available, the
contact person of the bidder, and be signed by an authorized representative as follows:
a. Bids by partnerships must furnish the full name of all partners and must be signed in the
partnership name by one of the members of the partnership or by an authorized representative,
followed by the signature and designation of the person signing.
b. Bids by corporation must be signed in the legal name of the corporation, followed by the name of
the State in which incorporated and must contain the signature and designation of the president,
secretary or other person authorized to bind the corporation in the matter.
c. Bids by sole-proprietorship shall be signed by the proprietor.
d. When requested, satisfactory evidence of the authority of the officer signing shall be furnished.
7. Bidder should be aware of the following statutes that represent “Truth in Contracting” laws:
a. N.J.S.A. 2C:21-34, et seq. governs false claims and representations by bidders. It is a serious
crime for the bidder to knowingly submit a false claim and/or knowingly make material
misrepresentation.
b. N.J.S.A. 2C:27-10 provides that a person commits a crime if said person offers a benefit to a
public servant for an official act performed or to be performed by a public servant, which is a
violation of official duty.
c. N.J.S.A. 2C-27-11 provides that a bidder commits a crime if said person, directly or indirectly,
confers or agrees to confer any benefit not allowed by law to a public servant.
d. Bidder should consult the statutes or legal counsel for further information.
Bid Security and Bonding and Requirements
8. Bid Guarantee- Bidder shall submit with the bid a certified check, cashier’s check or bid bond in the
amount of ten percent (10%) of the total price of bid, but not in excess of $20,000, payable
unconditionally to the Black Horse Pike Regional Board of Education. All bid bonds submitted must be
signed and witnessed with original signatures. The Board will not accept facsimile or rubber stamp
signature on the bid bond. Failure to sign the bid bond by either the Surety or Principal shall be deemed
cause for disqualification of the bid. The Attorney-in-Fact who executes the bond on behalf of the
surety shall affix to the bond a certified and current copy of the Power of Attorney.
The check or bond of the unsuccessful bidder(s) shall be returned pursuant to N.J.S.A. 40A:11-24a. The
check or bond of the bidder to whom the contract is awarded shall be retained until a contract is
executed. The check or bond of the successful bidder shall be forfeited if the bidder fails to enter into a
contract pursuant to N.J.S.A. 40A:11-21.
Failure to submit a bid guarantee shall result in rejection of the bid.
9. Pre-Bid Conference-If stated in the Notice to Bidders:
A pre-bid conference is not required for this bid.
Brand Names, Standards of Quality and Performance
10. Brand names and/or descriptions used in these specifications are to acquaint bidders with the types of
goods and services desired and will be used as a standard by which goods and services offered as
equivalent will be evaluated.
Variations between the goods and services described and the goods and services offered are to be fully
identified and described by the bidder on a separate sheet and submitted with the bid proposal form.
Vendor literature WILL NOT suffice in explaining exceptions to these specifications. In the absence of
any exceptions by the bidder, it will be presumed and required that the goods and services as described
in the bid specification be provided or performed.
It is the responsibility of the bidder to document and/or demonstrate the equivalency of the goods and
services offered. The owner reserves the right to evaluate the equivalency of the goods and services.
In submitting its bid, the bidder certifies that the goods and services to be furnished will not infringe
upon any valid patent or trademark and that the successful bidder shall, at its own expense, defend any
and all actions or suits charging such infringement, and will save the Black Horse Pike Regional Board
of Education harmless from any damages resulting from such infringement.
Only manufactured and farm products of the United States, wherever available, shall be used pursuant to
N.J.S.A. 40A:18-18.
The contractor shall guarantee any or all goods and services supplied under these specifications.
Defective or inferior goods shall be replaced at the expense of the contractor. The contractor will be
responsible for return freight or restocking charges.
Certificates of Required Insurance
11. Certificates of Insurance for those policies required above shall be submitted with the contract. Such
coverage shall be with an insurance company authorized to do business in the State of New Jersey and
shall name the Black Horse Pike Regional Board of Education as an additional insured.
Self-insured contractors shall submit an affidavit attesting to their self-insured coverage and shall name
the Black Horse Pike Regional Board of Education as an additional insured.
Indemnification
12. The bidder shall indemnify and hold harmless the Black Horse Pike Regional Board of Education from
all claims, suits or actions, and damages or costs of every name and description to which the Black
Horse Pike Regional Board of Education may be subjected or put by reason of injury to the person or
property of another, or the property of the owner, resulting from negligent acts or omissions on the part
of the contractor, the contractor’s agents, servants or subcontractors in the delivery of goods and
services, or in the performance of the work under the contract.
Pricing Information for Preparation of Bids
13. The Black Horse Pike Regional Board of Education is exempt from any local, state or federal sales, use
or excise tax.
Estimated Quantities (Open-End Contracts): The Black Horse Pike Regional Board of Education has
attempted to identify the item(s) and the estimated amounts of each item bid to cover its requirements;
however, past experience shows that the amount ordered may be different than that submitted for
bidding. The right is reserved to decrease or increase the quantities specified in the specifications
pursuant to N.J.A.C. 5:30-11.2 and 11.10 NO MINIMUM PURCHASE IS IMPLIED OR
GUARANTEED.
Contractor shall be responsible for obtaining any applicable permits or licenses from any government
entity that has jurisdiction to require the same. All bids submitted shall have included this cost.
Bidders shall insert prices for furnishing goods and services required by these specifications. Prices
shall be net, including any charges for packing, crating, containers, etc. All transportation charges shall
be fully prepaid by the contractor, F.O.B. destination and placement at locations specified by the owner.
As specified, placement may require inside deliveries. No additional charges will be allowed for any
transportation costs resulting from partial shipments made for the contractor’s convenience.
Statutory and Other Requirements
14. The following are mandatory requirements of bid and contract.
Mandatory Affirmative Action Certification – No firm may be issued a contract unless it complies
with the affirmative provisions of N.J.S.A. 10:5-31 et seq. and N.J.A.C. 17:27-1 et seq. The following
information summarizes the full, required regulatory text, which is included as Exhibit A of this bid
specifications.
a. Goods and Services (including professional services) Contracts
Each contractor shall submit to the public agency, after notification of award but prior to
execution of a goods and services contract, one of the following three documents:
i. A photocopy of a valid letter that the contractor is operating under an existing Federally
approved or sanctioned affirmative action program (good for one year from the date of
the letter); or
ii. A photocopy of a Certificate of Employee Information Report approval, issued in
accordance with N.J.A.C. 17:27-4;or
iii. A photocopy of an Employee Information Report (From AA302) provided by the
Division and distributed to the public agency to be completed by the contractor in
accordance with N.J.A.C. 17:27-4.
Americans With Disabilities Act of 1990 – Discrimination on the basis of disability in contracting for
the purchase of goods and services is prohibited. Bidders are required to read Americans With
Disabilities language that is included as Appendix A of this specification and agree that the provisions
of Title II of the Act are made a part of the contract. The contractor is obligated to comply with the Act
and to hold the owner harmless.
Stockholder Disclosure – N.J.S.A. 52:25-24.2 provides that no corporation or partnership shall be
awarded any contract for the performance of any work or the furnishing of any goods and services,
unless, prior to the receipt of the bid or accompanying the bid of said corporation or partnership, bidders
shall submit a statement setting forth the names and addresses of all stockholders in the corporation or
partnership who own ten percent (10%) or more of its stock of any class, or of all individual partners in
the partnership who own a ten percent (10%) or greater interest therein. The included Statement of
Ownership shall be completed and attached to the bid proposal. This requirement applies to all forms of
corporations and partnerships, including, but not limited to, limited partnerships, limited liability
corporations, limited liability partnerships and Subchapter S corporations. Failure to submit a
stockholder disclosure document shall result in rejection of the bid.
Proof of Business Registration – N.J.S.A, 52:32-44 requires that each bidder (contractor) submit proof
of business registration with the bid proposal. Proof of registration shall be a copy of the bidder’s
Business Registration Certificate (BRC). A BRC is obtained from the NJ Division of Revenue.
Information on obtaining a BRC is available on the internet www.nj.gov/jngs or by phone at (609)2921732.
Non-Collusion Affidavit-The Affidavit shall be properly executed and submitted with the bid proposal.
Chapter 271 Political Contribution Disclosure Form – Required – N.J.A.C. 6A:23A-6.3 (a4) – All
bidders shall submit with their bid package a completed and signed Chapter 271 Political Contribution
Disclosure Form. The Chapter 271 form will be reviewed by the district to determine whether the
vendor is in compliance with the aforementioned N.J.A.C 6A:23A-6.3 (s2) Award of Contract.
Political Contributions Disclosure Statement – Pay to Play – Starting in January 2007, business
entities are advised of their responsibility to file an annual disclosure statement of political contributions
with the NJ Election Law Enforcement Commission (ELEC) pursuant to N.J.S.A. 19:44A-20.27, if they
receive contracts in excess of $50,000 from public entities in a calendar year.
Business entities are responsible for determining if filing is necessary. Additional information on this
requirement is available from ELEC at 888-313-3532 or at www.elec.state.nj.us.
Method of Contract Award
15. The length of the contract shall be stated in the technical specifications. Pursuant to requirement of
N.J.A.C. 5:30-5.1 et seq., any contract resulting from this bid shall be subject to the availability and
appropriation of sufficient funds annually. Please see Section 21, Termination of Contract, for
additional information.
The Board of Education may, at its discretion, request that a contract for services be renewed in full
accordance with N.J.S.A. 18A:18A-42. The Purchasing Agent may negotiate terms for a renewal of
contract proposal and present such negotiated proposal to the Board of Education. All multi-year
contracts and renewals are subject to the availability and appropriation annually of sufficient funds as
may be needed to meet the extended obligation.
The Board of Education is the final authority in awarding renewals of contracts.
If the award is to be made on the basis of a base bid only, it shall be made to that responsible bidder
submitting the lowest base bid.
If the award is to be made on the basis of a combination of a base bid with selected options, it shall be
made to that responsible bidder submitting the lowest net bid.
The owner may also elect to award the contract on the basis of unit prices.
The form of contract shall be submitted by the Black Horse Pike Regional Board of Education to the
successful bidder. Terms of the specifications/bid package prevail. Bidder exceptions must be formally
accepted by the Black Horse Pike Regional Board of Education.
Causes for Rejecting Bids
16. Bids may be rejected for any of the following reasons:
a. All bids pursuant to N.J.S.A. 40A:11-13.2;
b. If more than one bid is received from any individual, firm or partnership, corporation or
association under the same name;
c. Multiple bids from an agent representing competing bidders;
d. The bid is inappropriately unbalanced;
e. The bidder is determined to possess, pursuant to N.J.S.A. 40A:11-4b, Prior Negative Experience;
or,
f. If the successful bidder fails to enter into a contract within 31 days, Sundays and holidays
excepted, or as otherwise agreed upon by the parties to the contract. In this case at its option, the
owner may accept the bid of the next lowest responsible bidder. (N.J.S.A. 40A:11-24b)
Termination of Contract
17. If, through any cause, the contractor shall fail to fulfill in a timely and proper manner obligations under
the contract or if the contractor shall violate any of the requirements of the contract, the owner shall
there upon have the right to terminate the contract by giving written notice to the contractor of such
termination and specifying the effective date of termination. Such termination shall relieve the Black
Horse Pike Regional Board of Education of any obligation for balances to the contractor of any sum or
sums set forth in the contract. Owner will pay only for goods and services accepted prior to termination.
Notwithstanding the above, the contractor shall not be relieved of liability to the Black Horse Pike
Regional Board of Education from damages sustained by the Black Horse Pike Regional School Board
of Education by virtue of any breach of the contract by the contractor and the Black Horse Pike Regional
Board of Education may withhold any payments to the contractor for the purpose of compensation until
such time as the exact amount of the damage due the Black Horse Pike Regional Board of Education
from the contractor is determined.
The contractor agrees to indemnify and hold the Black Horse Pike Regional Board of Education
harmless from any liability to subcontractors/suppliers concerning payment for work performed or
goods supplied arising out of the lawful termination of the contract by the Black Horse Pike Regional
Board of Education under this provision.
In case of default by the contractor, the Black Horse Pike Regional Board of Education may procure the
goods or services from other sources and hold the contractor responsible for any excess cost.
Continuation of the terms of the contract beyond the fiscal year is contingent on availability of funds in
the following year’s budget. In the event of unavailability of such funds, the owner reserves the right to
cancel the contract.
Acquisition, Merger, Sale and/or Transfer of Business, Etc. – It is understood by all parties that if,
during the life of the contract, the contractor disposes of his/her interest(s) to another party, all
obligations are transferred to that new party. In this event, the new owner(s) will be required to submit
all documentation/legal instruments that were required in the original bid/contract. Any change shall be
approved by the Black Horse Pike Regional Board of Education.
The contractor will not assign any interest in the contract and shall not transfer any interest in the same
without the prior written consent of the Black Horse Pike Regional Board of Education.
The Black Horse Pike Regional Board of Education may terminate the contract for convenience by
providing 60 calendar days advanced notice to the contractor.
Payments
18. The Board of Education will make every effort to pay vendors and contractors within thirty (30) to sixty
(60) days provided the district receives the appropriate documentation including but not limited to:
• Signed voucher by vendor;
• Packing Slips; and
• Invoices
Payment will be rendered upon completion of services or delivery of full order to the satisfaction of the
Board of Education, unless otherwise agreed to by written contract or mandated by N.J.S.A. 18A:18A40.1. The Board may, at its discretion make partial payments. All payments are subject to approval by
the Board of Education at a public meeting. Payment may be delayed from time to time depending on
the Board of Education meeting schedule.
Invoices – Should clearly outline the goods received or services rendered and the date(s) of services
rendered.
•
•
•
•
•
•
Invoice must include the full name and address of the company.
Invoice must reference the purchase order number from the Board of Education.
Invoice must include company’s invoice number that may be used as reference.
Invoice must list the goods or services rendered.
Invoice must be submitted to the appropriate department/individual requesting the goods and/or
services.
Invoices must be submitted within thirty (30) days of service.
Bidder Comment Sheet
19. This form is for bidder’s use in offering voluntary alternates or other comments, intended to afford the
Board information or opportunities to improve the quality of the project, without invalidating the bid
proposal. It may not be used to take exception to specific conditions to the project defined in the
contract documents which the bidder does not like. The bid provided must be based upon the plans and
specifications, and all contract conditions, as stated. If these documents or conditions contain some
untenable item, or extremely expensive provision, for example, to which the bidder wishes to raise
objection, this must be done at the prebid meeting, or in writing to the Purchasing Agent through the
question process outlined in the Instructions to Bidders. Such inquiries will have a response issued by
addendum only, and the resulting decision circulated to all bidders of record.
20. Renewal
Successful bidder(s) and the respective school district covenant agree that this contract may be renewed
under the same terms and conditions of this contract at the option of each district for a period of one year
up to four additional times after the initial contract, for a total period not to exceed five years.
(REVISED 4/10)
EXHIBIT A
MANDATORY EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE
N.J.S.A. 10:5-31 et seq. (P.L. 1975, C. 127)
N.J.A.C. 17:27
GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS
During the performance of this contract, the contractor agrees as follows:
The contractor or subcontractor, where applicable, will not discriminate against any employee or applicant for employment
because of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or
expression, disability, nationality or sex. Except with respect to affectional or sexual orientation and gender identity or expression, the
contractor will ensure that equal employment opportunity is afforded to such applicants in recruitment and employment, and that
employees are treated during employment, without regard to their age, race, creed, color, national origin, ancestry, marital status,
affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Such equal employment opportunity
shall include, but not be limited to the following: employment, upgrading, demotion, or transfer; recruitment or recruitment
advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship.
The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by
the Public Agency Compliance Officer setting forth provisions of this nondiscrimination clause.
The contractor or subcontractor, where applicable will, in all solicitations or advertisements for employees placed by or on
behalf of the contractor, state that all qualified applicants will receive consideration for employment without regard to age, race, creed,
color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or
sex.
The contractor or subcontractor will send to each labor union, with which it has a collective bargaining agreement, a notice,
to be provided by the agency contracting officer, advising the labor union of the contractor's commitments under this chapter and shall
post copies of the notice in conspicuous places available to employees and applicants for employment.
The contractor or subcontractor, where applicable, agrees to comply with any regulations promulgated by the Treasurer
pursuant to N.J.S.A. 10:5-31 et seq., as amended and supplemented from time to time and the Americans with Disabilities Act.
The contractor or subcontractor agrees to make good faith efforts to meet targeted county employment goals established in
accordance with N.J.A.C. l7:27 5.2.
The contractor or subcontractor agrees to inform in writing its appropriate recruitment agencies including, but not limited to,
employment agencies, placement bureaus, colleges, universities, and labor unions, that it does not discriminate on the basis of age,
race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability,
nationality or sex, and that it will discontinue the use of any recruitment agency which engages in direct or indirect discriminatory
practices.
The contractor or subcontractor agrees to revise any of its testing procedures, if necessary, to assure that all personnel testing
conforms with the principles of job related testing, as established by the statutes and court decisions of the State of New Jersey and as
established by applicable Federal law and applicable Federal court decisions.
In conforming with the targeted employment goals, the contractor or subcontractor agrees to review all procedures relating to
transfer, upgrading, downgrading and layoff to ensure that all such actions are taken without regard to age, race, creed, color, national
origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, consistent
with the statutes and court decisions of the State of New Jersey, and applicable Federal law and applicable Federal court decisions.
The contractor shall submit to the public agency, after notification of award but prior to execution of a goods and services
contract, one of the following three documents:
Letter of Federal Affirmative Action Plan Approval
Certificate of Employee Information Report
Employee Information Report Form AA302 (electronically provided by the Division and distributed to the public agency
through the Division’s website at www.state.nj.us/treasury/contract_compliance)
The contractor and its subcontractors shall furnish such reports or other documents to the Division of Public Contracts Equal
Employment Opportunity Compliance as may be requested by the office from time to time in order to carry out the purposes of these
regulations, and public agencies shall furnish such information as may be requested by the Division of Public Contracts Equal
Employment Opportunity Compliance for conducting a compliance investigation pursuant to Subchapter 10 of the Administrative
Code at N.J.A.C. 17:27.
TO BE RETURNED
Non-Collusion Affidavit
Milk – Bid #C1-12/13
STATE OF NEW JERSEY)
:ss:
COUNTY OF
)
I,
of the City of
(Name of Affiant)
(Name of Municipality)
in the county of
and the State of
of full age, being duly sworn according to law on my oath depose and say that:
I am
of the firm of
(Title or Position)
and the bidder making the Proposal for the above names contract, and that I executed the said Proposal with full authority so to do;
that I have not, directly or indirectly, entered into any agreement, participated in any collusion, discussed any or all parts of this
proposal with any potential bidders, or otherwise taken any action in restraint of free, competitive bidding in connection with the
above named bid, and that all statements contained in said Proposal and in this affidavit are true and correct, and made with full
knowledge that the Board of Education of the Black Horse Pike Regional School District relies upon the truth of the statements
contained in said Proposal and in the statements contained in this affidavit in awarding the contract for the said bid.
I further warrant that no person or selling agency has been employed or retained to solicit or secure such contract upon an agreement
or understanding for a commission, percentage, brokerage or contingent fee, except bona fide employees of bona fide established
commercial or selling agencies maintained by
(Print Name of Contractor/Vendor)
Subscribed and sworn to:
Before me this
day of
,
(Month)
(NOTARY PUBLIC SIGNATURE)
My Commission expires
APPENDIX A
(Print Name of Notary Public)
,
(Month)
.
(Year)
,
(Day)
.
(Year)
AMERICANS WITH DISABILITIES ACT OF 1990
Equal Opportunity for Individuals with Disability
The contractor and the Black Horse Pike Regional Board of Education (hereafter "owner") do hereby agree that the
provisions of Title 11 of the Americans With Disabilities Act of 1990 (the "Act") (42 U.S.C. S121 01 et seq.), which
prohibits discrimination on the basis of disability by public entities in all services, programs, and activities provided or made
available by public entities, and the rules and regulations promulgated pursuant there unto, are made a part of this contract. In
providing any aid, benefit, or service on behalf of the owner pursuant to this contract, the contractor agrees that the
performance shall be in strict compliance with the Act. In the event that the contractor, its agents, servants, employees, or
subcontractors violate or are alleged to have violated the Act during the performance of this contract, the contractor shall
defend the owner in any action or administrative proceeding commenced pursuant to this Act. The contractor shall
indemnify, protect, and save harmless the owner, its agents, servants, and employees from and against any and all suits,
claims, losses, demands, or damages, of whatever kind or nature arising out of or claimed to arise out of the alleged violation.
The contractor shall, at its own expense, appear, defend, and pay any and all charges for legal services and any and all costs
and other expenses arising from such action or administrative proceeding or incurred in connection therewith. In any and all
complaints brought pursuant to the owner's grievance procedure, the contractor agrees to abide by any decision of the owner
which is rendered pursuant to said grievance procedure. If any action or administrative proceeding results in an award of
damages against the owner, or if the owner incurs any expense to cure a violation of the ADA which has been brought
pursuant to its grievance procedure, the contractor shall satisfy and discharge the same at its own expense.
¬
The owner shall, as soon as practicable after a claim has been made against it, give written notice thereof to the contractor
along with full and complete particulars of the claim, If any action or administrative proceeding is brought against the owner
or any of its agents, servants, and employees, the owner shall expeditiously forward or have forwarded to the contractor every
demand, complaint, notice, summons, pleading, or other process received by the owner or its representatives.
It is expressly agreed and understood that any approval by the owner of the services provided by the contractor pursuant to
this contract will not relieve the contractor of the obligation to comply with the Act and to defend, indemnify, protect, and
save harmless the owner pursuant to this paragraph.
It is further agreed and understood that the owner assumes no obligation to indemnify or save harmless the contractor, its
agents, servants, employees and subcontractors for any claim which may arise out of their performance of this Agreement.
Furthermore, the contractor expressly understands and agrees that the provisions of this indemnification clause shall in no
way limit the contractor's obligations assumed in this Agreement, nor shall they be construed to relieve the contractor from
any liability, nor preclude the owner from taking any other actions available to it under any other provisions of the
Agreement or otherwise at law.
ETHICS IN PURCHASING
Statement to Vendors
School District Responsibility
Recommendation of Purchases
It is the desire of the Black Horse Pike Regional Board of Education to have all Board employees and officials practice exemplary
ethical behavior in the procurement of goods, materials, supplies, and services.
School district officials and employees who recommend purchases shall not extend any favoritism to any vendor. Each recommended
purchase should be based upon quality of the items, service, price, delivery, and other applicable factors in full compliance with
N.J.S.A. 18A:18A-1 et.seq.
Solicitation/Receipt of Gifts – Prohibited
School district officials and employees are prohibited from soliciting and receiving funds, gifts, materials, goods, services, favors, and
any other items of value from vendors doing business with the Black Horse Pike Regional Board of Education or anyone proposing to
do business with the Black Horse Pike Regional School District.
Vendor Responsibility
Offer of Gifts, Gratuities -- Prohibited
Any vendor doing business or proposing to do business with the Black Horse Pike Regional School District, shall neither pay, offer to
pay, either directly or indirectly, any fee, commission, or compensation, nor offer any gift, gratuity, or other thing of value of any kind
to any official or employee of the Black Horse Pike Regional School District or to any member of the official’s or employee’s
immediate family.
Vendor Influence -- Prohibited
No vendor shall cause to influence or attempt to cause to influence, any official or employee of the Black Horse Pike Regional School
District, in any manner which might tend to impair the objectivity or independence of judgment of said official or employee.
Vendor Certification
Vendors or potential vendors will be asked to certify that no official or employee of the Black Horse Pike Regional Board of
Education or immediate family members are directly or indirectly interested in this request or have any interest in any portions of
profits thereof. The vendor participating in this request must be an independent vendor and not an official or employee of the Black
Horse Pike Regional Board of Education.
Mrs. Jean Grubb
Business Administrator
Board Secretary
Purchasing Agent
BLACK HORSE PIKE REGIONAL BOARD OF EDUCATION
580 Erial Road
Blackwood, New Jersey 08012
DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN
RFP: ____________________ Name of Company: ____________________________________________
Pursuant to Public Law 2012, c.25, any person or entity that submits a bid or proposal or otherwise proposes to enter into or renew a contract
must complete the certification below to attest, under penalty of perjury, that the person or entity, or one of the person or entity’s parents,
subsidiaries, or affiliates, is not identified on a list created and maintained by the Department of the Treasury as a person or entity engaging
investment activities in Iran. If the Director finds a person or entity to be in violation of the principles which are the subject of this law, s/he shall
take action as may be appropriate and provided by law, rule or contract, including but not limited to, imposing sanctions, seeking compliance,
recovering damages, declaring the party in default and seeking debarment or suspension of the person or entity.
I certify, pursuant to Public Law 2012, c.25, that the person or entity listed above for which I am authorized to bid/renew:
 is not providing goods or services of $20,000,000 or more in the energy sector of Iran, including a person or entity that provides oil or
liquefied natural gas tankers, or products used to construct or maintain pipelines used to transport oil or liquefied natural gas for the energy
sector of Iran, AND
 is not a financial institution that extends $20,000,000 or more in credit to another person or entity, for 45 days or more, if that person or
entity will use the credit to provide goods or services in the energy sector in Iran.
In the event that a person or entity is unable to make the above certification because it or one of its parents, subsidiaries, or affiliates has
engaged in the above-referenced activities, a detailed, accurate and precise description of the activities must be provided in part 2 below to the
Black Horse Pike Regional Board of Education under penalty of perjury. Failure to provide such will result in the proposal being rendered as nonresponsive and appropriate penalties, fines and/or sanctions will be assessed as provided by law.
PART 2 – ONLY COMPLETE IF ENGAGING IN INVESTMENT ACTIVITIES IN IRAN
Part 2: Please provide further information related to investment activities in Iran
You must provide a detailed, accurate and precise description of the activities of the bidding person/entity, or one of its parents, subsidiaries or
affiliates, engaging in the investment activities in Iran outlined above by completing the box below.
Name: _____________________________________ Relationship to Bidder/Offeror ______________________________
Description of Activities _______________________________________________________________________________
__________________________________________________________________________________________________
Duration of Engagement ___________________________ Anticipated Cessation Date ____________________________
Bidder/Offeror Contact Name _______________________ Contact Phone Number _______________________________
Certification: I, being duly sworn upon my oath, hereby represent and state that the foregoing information and any attachments thereto to the
best of my knowledge are true and complete. I attest that I am authorized to execute this certification on behalf of the above-referenced person
or entity. I acknowledge that the State of New Jersey is relying on the information contained herein and thereby acknowledge that I am under a
continuing obligation from the date of this certification through the completion of any contracts with the State to notify the State in writing of any
changes to the answers of information contained herein. I acknowledge that I am aware that it is a criminal offense to make a false statement or
misrepresentation in this certification, and if I do so, I recognize that I am subject to criminal prosecution under the law and that it will also
constitute a material breach of my agreement(s) with the State of New Jersey and that the State at its option may declare any contract(s)
resulting from this certification void and unenforceable.
Full Name (Print):___________________________________ Signature __________________________________________
Title: _____________________________________________ Date: _____________________________________________
Name of Company: __________________________________ City/State/Zip: ______________________________________
Contractor/Vendor Questionnaire/Certification
Name of Company _____________________________________________________________
Street Address ________________________________________ PO Box ________________
City, State, Zip ________________________________________________________________
Business Phone Number (____)_________________________ Ext. ___________________
Emergency Phone Number (_____)______________________________________________
FAX No. (____)________________________ E-Mail _________________________________
FEIN No. ______________________________
Years in Business
Number of Employees __________________
References – Work previously done for School Systems in New Jersey
Name of District
Address
Contact Person/Title
Phone
1.
2.
3.
Vendor Certification
Direct/Indirect Interests
I declare and certify that no member of the Passaic Board of Education, nor any officer or employee or person whose salary is
payable in whole or in part by said Board of Education or their immediate family members are directly or indirectly interested in this
bid or in the supplies, materials, equipment, work or services to which it relates, or in any portion of profits thereof. If a situation so
exists where a Board member, employee, officer of the board has an interest in the bid, etc., then please attach a letter of
explanation to this document, duly signed by the president of the firm or company.
I certify that I am not an official or employee of the Passaic Board of Education.
Gifts; Gratuities; Compensation
I declare and certify that no person from my firm, business, corporation, association or partnership offered or paid any fee,
commission or compensation, or offered any gift, gratuity or other thing of value to any school official, board member or employee of
the Passaic Board of Education.
Vendor Contributions
I declare and certify that I fully understand N.J.A.C. 6A:23A-6.3(a1-4) concerning vendor contributions to school board members.
I further certify that I understand that it is a crime in the second degree in New Jersey to knowingly make a material representation
that is false in connection with the negotiation, award or performance of a government contract.
__________________________________
President or Authorized Agent (Print)
________________________________________
SIGNATURE