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REQUEST FOR QUOTATION STATE OF ARIZONA ARIZONA DEPARTMENT OF TRANSPORTATION 1739 W. Jackson Street, Suite A Phoenix, AZ 85007 SOLICITATION NUMBER: ADOT16-00005390 DESCRIPTION: In accordance with A.R.S. §41-2535, Request for Quotation the Arizona Department of Transportation invites sealed offers from qualified firms for Concrete Repair at the Meteor Crater Rest Area. This procurement shall not exceed the aggregate dollar amount of $100,000.00. In accordance with A.R.S. §41- 2535 procurements less than $100,000.00 are restricted to small businesses. A small business is one that, including its affiliates, is independently owned and operated, is not dominant in the type of business it conducts, and which employs fewer than 100 full time employees or which has gross receipts of less than $4 million in its last fiscal year. SITE VISIT DATE AND TIME: July 20, 2015 at 9:00 A.M., AZ MST, at the Meteor Crater Rest Area, WB Interstate 40, Milepost 235, Winslow, AZ 86047. BID OPENING DATE AND TIME: Offers shall be received until 3:00 p.m. on July 30, 2015. SUBMITTALS: Offers in response to this solicitation shall be submitted within the State’s e-Procurement system ProcureAZ https://procure.az.gov/bso/login.jsp before the date/time listed in the ‘BID OPENING DATE’ field. Late submittals will not be considered. Offers received by the due date and time will be electronically opened. Offers submitted outside of ProcureAZ, or those that are received after the due date and time shall be rejected. Additional information regarding submittal instructions is located within this document in the following sections: Special Instructions to Offerors and Uniform Instructions to Offerors. QUESTIONS: Inquiries regarding the solicitation are to be submitted online through ProcureAZ using the Q&A Tab. OFFERORS ARE STRONGLY ENCOURAGED TO READ THE ENTIRE SOLICITATION. Christina Jimenez Procurement Officer Phone: (602) 712-4458 Email: [email protected] “An Equal Opportunity Agency” The Arizona Department of Transportation, in accordance with the provisions of Title VI of the Civil Rights Act of 1964 (78 Stat. 252.42 U.S.C. §§ 2000d-4) and the Regulations, hereby notifies all bidders that it will affirmatively ensure that any contract entered into pursuant to this advertisement, disadvantaged business enterprises will be afforded full and fair opportunity to submit bids in response to this invitation and will not be discriminated against on the grounds of race, color, or national origin in consideration for an award.

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Page 1: STATE OF ARIZONA REQUEST FOR QUOTATION ARIZONA … The Arizona Department of Transportation hereinafter referred to as the Department has the need to obtain repair services for existing

REQUEST FOR QUOTATION

STATE OF ARIZONA ARIZONA DEPARTMENT OF TRANSPORTATION

1739 W. Jackson Street, Suite A Phoenix, AZ 85007

SOLICITATION NUMBER: ADOT16-00005390 DESCRIPTION: In accordance with A.R.S. §41-2535, Request for Quotation the Arizona Department of Transportation invites sealed offers from qualified firms for Concrete Repair at the Meteor Crater Rest Area. This procurement shall not exceed the aggregate dollar amount of $100,000.00. In accordance with A.R.S. §41-2535 procurements less than $100,000.00 are restricted to small businesses. A small business is one that, including its affiliates, is independently owned and operated, is not dominant in the type of business it conducts, and which employs fewer than 100 full time employees or which has gross receipts of less than $4 million in its last fiscal year. SITE VISIT DATE AND TIME: July 20, 2015 at 9:00 A.M., AZ MST, at the Meteor Crater Rest Area, WB

Interstate 40, Milepost 235, Winslow, AZ 86047. BID OPENING DATE AND TIME: Offers shall be received until 3:00 p.m. on July 30, 2015. SUBMITTALS: Offers in response to this solicitation shall be submitted within the State’s e-Procurement system ProcureAZ https://procure.az.gov/bso/login.jsp before the date/time listed in the ‘BID OPENING DATE’ field. Late submittals will not be considered. Offers received by the due date and time will be electronically opened. Offers submitted outside of ProcureAZ, or those that are received after the due date and time shall be rejected. Additional information regarding submittal instructions is located within this document in the following sections: Special Instructions to Offerors and Uniform Instructions to Offerors. QUESTIONS: Inquiries regarding the solicitation are to be submitted online through ProcureAZ using the Q&A Tab.

OFFERORS ARE STRONGLY ENCOURAGED TO READ THE ENTIRE SOLICITATION.

Christina Jimenez Procurement Officer Phone: (602) 712-4458 Email: [email protected]

“An Equal Opportunity Agency” The Arizona Department of Transportation, in accordance with the provisions of Title VI of the Civil Rights Act of 1964 (78 Stat. 252.42 U.S.C. §§ 2000d-4) and the Regulations, hereby notifies all bidders that it will affirmatively ensure that any contract entered into pursuant to this advertisement, disadvantaged business enterprises will be afforded full and fair opportunity to submit bids in response to this invitation and will not be discriminated against on the grounds of race, color, or national origin in consideration for an award.

Page 2: STATE OF ARIZONA REQUEST FOR QUOTATION ARIZONA … The Arizona Department of Transportation hereinafter referred to as the Department has the need to obtain repair services for existing

REQUEST FOR QUOTATION

Solicitation No. ADOT16-00005390 Available online at

https://procure.az.gov/bso/ Page 2 of 24

TABLE OF CONTENTS PAGE Title Page 1 Table of Contents 2 Definitions 2 1.0 Statement of Need 2 2.0 Uniform Terms and Conditions 3 3.0 Special Terms and Conditions 3 4.0 Uniform Instructions to Offerors 14 5.0 Special Instructions 14

EXHIBITS 1 - Title VI/Non-Discrimination Assurances Appendix A 17 2 - Title VI/Non-Discrimination Assurances Appendix E 18 ATTACHMENTS 1. Attachment One (1), Offer and Acceptance 19 2. Attachment Two (2), References 20 3. Attachment Three (3),

Designation of Confidential, Trade Secret & Proprietary Information 21 4. Attachment Four (4), Non-Collusion Affidavit 23 5. Attachment Five (5), Subcontractors and Suppliers 24

1.0 DEFINITIONS

Department The Arizona Department of Transportation (ADOT)

Contract Administrator Procurement Officer

Department Contract Representative

The ADOT person responsible for contract work oversight.

Contractor

Firm and/or individual that will perform the work requested in this solicitation.

On-Site Supervisor

Contractor's employee authorized to direct, oversee, or perform work operations, having authority to make day to day decisions concerning the work operations.

1.1 STATEMENT OF NEED

The Arizona Department of Transportation hereinafter referred to as the Department has the need to obtain repair services for existing damaged concrete parking pavement at the Meteor Crater Rest Area, WB Interstate 40, Milepost 235, Winslow, AZ 86047 in accordance with the following scope of work:

1.2 SCOPE OF WORK

3.1. Saw cut damaged concrete parking slab to a depth of approximately ten (10) inches at the existing expansion joints for removal.

3.2. Remove burnt/damaged concrete and dispose of offsite at a legal landfill.

Page 3: STATE OF ARIZONA REQUEST FOR QUOTATION ARIZONA … The Arizona Department of Transportation hereinafter referred to as the Department has the need to obtain repair services for existing

REQUEST FOR QUOTATION

Solicitation No. ADOT16-00005390 Available online at

https://procure.az.gov/bso/ Page 3 of 24

3.3. Saw cut approximately seventy-two (72) linear feet of the seven inch (7”) damaged curbing at existing joints, remove curbing and dispose of offsite at a legal landfill.

3.4. Replace damaged pavement with new PCCP using ADOT Standard Specifications for Road and Bridge Construction and the C standards. No fiber mesh is needed; please stay with the standard mix design.

3.5. Tined finish matching existing pavement. 3.6. Replace damaged curbing with new curbing (to match existing). Apply ADOT standards, Type D on

the bottom and Type A on the top end. 3.7. Re-paint yellow directional parking striping removed with damaged concrete.

1.3 REST AREA WORK LOCATION Meteor Crater Rest Area WB Interstate 40, Milepost 235 Winslow, AZ 86047

2.0 UNIFORM TERMS AND CONDITIONS These are incorporated by reference and are available at:

https://spo.az.gov/sites/default/files/documents/files/Uniform%20Terms%20and%20Conditions%20V9_%28Rev%207-1-2013%29.pdf or you can contact Christina Jimenez at (602) 712-4458.

3.0 SPECIAL TERMS AND CONDITIONS 3.1 TERM OF CONTRACT

The term of any resultant contract shall commence on the effective day of award and shall continue for a period of twelve months (12) thereafter, unless terminated, cancelled or extended as otherwise provided herein. By mutual written contract amendment, any resultant contract may be extended for supplemental periods of up to a maximum of SIX (6) months.

3.2 CHANGES

The Department reserves the right to revise the delivery and schedule and make other changes within the general Scope of Work as may be deemed necessary to best serve the interest of the Department. All changes shall be documented by formal amendments to the contract.

3.3 ELIGIBLE AGENCIES

Any contract resulting from this solicitation shall be for the exclusive use of the Arizona Department of Transportation

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REQUEST FOR QUOTATION

Solicitation No. ADOT16-00005390 Available online at

https://procure.az.gov/bso/ Page 4 of 24

3.4 ACCEPTANCE Work shall be subject to a complete inspection by the Department. Inspection criteria shall include, but

not be limited to, conformity to the specifications, workmanship, quality and materials. Determination of the acceptability of work shall be made by the Department Contract Representative.

Work shall be completed in a responsible and professional manner and in accordance with the scope of work, schedule, and performance and operating standards incorporated in the work scope of work/assignment.

The Department Contract Representative shall address all questions which may arise as to the quality and

acceptability of any work performed under the contract; and provides the final determination in regards to acceptability.

3.5 INVOICING AND PAYMENT

Upon satisfactory inspection and acceptance by Department of the work, an invoice shall be submitted by the Contractor to: Invoices are required for each delivery of service and shall include at a minimum: o Department contract number and purchase order number o Description and listing of quantities or services o Date the service o Price per unit and total per unit o Applicable taxes o Total of invoice Invoices not sent to the proper address, or not containing the necessary and required information may delay payment to the Contractor. A Contractor whose payments are delayed due to improper invoicing shall make no claim against the Department or the State for late or finance charges.

The Department will make every effort to process payment for the purchase of service within thirty (30) calendar days after the Department has conducted the necessary reviews, and inspections as described herein. DELIVERY OF THE SERVICES PROVIDED TO THE DEPARTMENT DOES NOT CONSTITUTE ACCEPTANCE, THEREFORE, ONLY THE DEPARTMENT ACCEPTANCE DATE WILL BE A VALID DATE FOR STARTING THE THIRTY (30) CALENDAR DAY PAYMENT PERIOD. Payment due dates, including discount periods, will be computed from the date of acceptance or date of correct invoice (whichever is later) to the date the Department’s warrant is mailed. If damage caused by the Contractor has to be repaired or replaced by the Department, the cost of the work shall be deducted from the Contractor’s payment. The Contractor shall be paid monthly in arrears, generally within 30 days of receipt of the invoice.

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REQUEST FOR QUOTATION

Solicitation No. ADOT16-00005390 Available online at

https://procure.az.gov/bso/ Page 5 of 24

3.6 VENDOR REGISTRATION Prior to issuance of a Purchase Order and subsequent payment, the Contractor must be registered in the

State of Arizona‘s ProcureAZ on-line system, https://procure.az.gov/bso/. Ensure that the ProcureAZ registration matches the legal name on the Arizona Substitute W9 and that

name matches the name you are registered with at the Internal Revenue Service. 3.7 SAFETY STANDARDS

All items supplied under this contract shall comply with the current applicable Occupational Safety and Health Standards of the State of Arizona Industrial Commission, the National Electric Code, the National Fire Protection Association Standards and the Department of Environmental Quality sand Department of Transportation. Attention is directed to Federal, State and local laws, rules and regulations concerning construction safety and health standards. The Contractor shall not require any workers to work in surroundings or under conditions that are unsanitary, hazardous or dangerous to their health or safety. Safety Requirements The Contractor shall comply with all applicable laws and regulations governing safety, health and sanitation. Attention is directed to Federal, State and local laws, rules and regulations concerning construction safety and health standards. The Department shall be notified immediately of any incidents or conditions relative to public safety or health.

3.8. WARRANTY

The bidder warrants: 1. That all services performed hereunder shall conform to the requirements of this contract and shall be

performed by qualified personnel in accordance with the highest professional standards. 2. That all items furnished hereunder shall conform to the requirements of this contract and shall be

free from defects in design materials and workmanship. 3. The warranty period on workmanship and materials shall be based on a minimum of twelve (12)

months from the time of delivery. All bidders shall indicate on a separate written sheet that is submitted with their bid the exact conditions, limitations and duration of their warranty. As a minimum the warranty provided shall conform to the requirements stated herein.

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REQUEST FOR QUOTATION

Solicitation No. ADOT16-00005390 Available online at

https://procure.az.gov/bso/ Page 6 of 24

3.9. CONTRACT ADMINISTRATION

For information regarding the Uniform and Special Terms and Conditions, and Specifications referenced in this Solicitation contact:

Christina Jimenez, Senior Procurement Officer [email protected] or (602) 712-4458

The contractor shall contact the Procurement Group for guidance or direction in matters of contract interpretation or questions regarding the terms, conditions or scope of the contract. Only the Procurement Officer or authorized designee is authorized to change or amend the specific terms, conditions or provisions of the contract.

3.10 CANCELLATION FOR POSSESSION OF WEAPONS ON ADOT PROPERTY

This contract may be cancelled if Contractor or any subcontractors or others in the employ or under the supervision of the contractor or subcontractors is found to be in possession of weapons.

Possession of weapons (firearms, explosive device, knife or blade of more than three inches, or any other instrument designed for lethal or disabling use) is prohibited on ADOT property pursuant to ADOT Policy, MGT 6.04, "Weapons in the Workplace." Such property includes ADOT owned or leased office building, yards, parking lots, construction sites or state owned vehicles.

Further, if the Contractor or any subcontractors or others in the employ or under the supervision of the Contractors or subcontractors are asked by an ADOT official to leave the ADOT property, they are advised that failure to comply with such a request shall result in cancellation of the contract and anyone who refuses, whether armed or not, is subject to prosecution under A.R.S. §13-1502, "Criminal trespass in the third degree; classification."

3.11. CONFLICT OF INTEREST It should be noted that offerors are hereby advised of the Conflict of Interest Statutes, A.R.S. section §38-501, et seq. Any purchase order for services offered by the Department which may lead to a real or apparent conflict of interest, under the Arizona Revised Statutes, with regard to future State contracts or solicitations, may be refused by the offeror by notifying the Procurement Group in writing within five (5) days of receipt of the purchase order. If such a purchase order is refused, the offeror may be precluded from award of such future contract or solicitation if a real or apparent conflict of interest exists, as determined by the Department.

3.12. REVIEW OF CONTRACTOR’S WORK Work performed by the Contractor shall be subject to periodic reviews and partial acceptance at various stages. The Department reserves the right to make such reviews and pass upon the acceptability of the Contractor’s work. No partial acceptance shall relieve the Contractor’s obligation to correct, without charge, any errors in the work on this contract.

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REQUEST FOR QUOTATION

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https://procure.az.gov/bso/ Page 7 of 24

3.13. ACCURACY OF WORK The Contractor shall be responsible for the accuracy of the work and shall promptly make all the necessary revisions or corrections resulting from errors and omissions on the part of the Contractor without additional compensation. Acceptance of the work by the Department will not relieve the Contractor of the responsibility for subsequent correction of any such errors and clarification of ambiguities.

3.14 INDEMNIFICATION CLAUSE

To the extent allowed by law, Contractor shall defend, indemnify, and hold harmless the State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees (hereinafter referred to as “Indemnitee”) from and against any and all claims, actions, liabilities, damages, losses, or expenses (including court costs, attorneys’ fees, and costs of claim processing, investigation and litigation) (hereinafter referred to as “Claims”) for bodily injury or personal injury (including death), or loss or damage to tangible or intangible property caused, or alleged to be caused, in whole or in part, by the negligent or willful acts or omissions of Contractor or any of its owners, officers, directors, agents, employees or subcontractors. This indemnity includes any claim or amount arising out of, or recovered under, the Workers’ Compensation Law or arising out of the failure of such contractor to conform to any federal, state or local law, statute, ordinance, rule, regulation or court decree. It is the specific intention of the parties that the Indemnitee shall, in all instances, except for Claims arising solely from the negligent or willful acts or omissions of the Indemnitee, be indemnified by Contractor from and against any and all claims. It is agreed that Contractor will be responsible for primary loss investigation, defense and judgment costs where this indemnification is applicable. In consideration of the award of this contract, the Contractor agrees to waive all rights of subrogation against the State of Arizona, its officers, officials, agents and employees for losses arising from the work performed by the Contractor for the State of Arizona. This indemnity shall not apply if the contractor or sub-contractor(s) is/are an agency, board, commission or university of the State of Arizona.

3.15 INSURANCE

The Contractor shall furnish certificates inclusive of the following requirements as stated within to the Department. Certificate(s) shall be received within three (3) calendar days of notification of tentative award by the Procurement Officer and prior to contract execution. Contractor and subcontractors shall procure and maintain until all of their obligations have been discharged, including any warranty periods under this Contract, are satisfied, insurance against claims for injury to persons or damage to property which may arise from or in connection with the performance of the work hereunder by the Contractor, his agents, representatives, employees or subcontractors. The insurance requirements herein are minimum requirements for this Contract and in no way limit the indemnity covenants contained in this Contract. The State of Arizona in no way warrants that the minimum limits contained herein are sufficient to protect the Contractor from liabilities that might arise out of the performance of the work under this contract by the Contractor, its agents,

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REQUEST FOR QUOTATION

Solicitation No. ADOT16-00005390 Available online at

https://procure.az.gov/bso/ Page 8 of 24

representatives, employees or subcontractors, and Contractor is free to purchase additional insurance. A. MINIMUM SCOPE AND LIMITS OF INSURANCE: Contractor shall provide coverage with limits of

liability not less than those stated below.

1. Commercial General Liability – Occurrence Form Policy shall include bodily injury, property damage, personal and advertising injury and broad form contractual liability coverage.

General Aggregate $2,000,000

Products – Completed Operations Aggregate $1,000,000

Personal and Advertising Injury $1,000,000

Damage to Rented Premises $ 50,000

Each Occurrence $1,000,000

a. The policy shall be endorsed (Blanket Endorsements are not acceptable) to include the following additional insured language: “The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees shall be named as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor.” Such additional insured shall be covered to the full limits of liability purchased by the Contractor, even if those limits of liability are in excess of those required by this Contract.

b. Policy shall contain a waiver of subrogation endorsement (Blanket Endorsements are not acceptable) in favor of the “State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees” for losses arising from work performed by or on behalf of the Contractor.

2. Business Automobile Liability

Bodily Injury and Property Damage for any owned, hired, and/or non-owned vehicles used in the performance of this Contract.

Combined Single Limit (CSL) $1,000,000

a. The policy shall be endorsed (Blanket Endorsements are not acceptable) to include the following additional insured language: “The State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees shall be named as additional insureds with respect to liability arising out of the activities performed by or on behalf of the Contractor, involving automobiles owned, leased, hired or borrowed by the Contractor.” Such additional insured shall be covered to the full limits of liability purchased by the Contractor, even if those limits of liability are in excess of those required by this Contract.

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b. Policy shall contain a waiver of subrogation endorsement (Blanket Endorsements are not acceptable) in favor of the “State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees” for losses arising from work performed by or on behalf of the Contractor.

c. Policy shall contain a severability of interest provision.

3. Worker's Compensation and Employers' Liability

Workers' Compensation Statutory

Employers' Liability Each Accident $1,000,000 Disease – Each Employee $1,000,000 Disease – Policy Limit $1,000,000

a. Policy shall contain a waiver of subrogation endorsement (Blanket Endorsements are not acceptable) in favor of the “State of Arizona, and its departments, agencies, boards, commissions, universities, officers, officials, agents, and employees” for losses arising from work performed by or on behalf of the Contractor.

b. This requirement shall not apply to: Separately, EACH contractor or subcontractors exempt under A.R.S. § 23-901, and when such contractor or subcontractor executes the appropriate waiver (Sole Proprietor/Independent Contractor) form.

B. ADDITIONAL INSURANCE REQUIREMENTS: The policies shall include, or be endorsed (Blanket

Endorsements are not acceptable) to include, the following provisions: 1. The Contractor's policies shall stipulate that the insurance afforded the Contractor shall be

primary insurance and that any insurance carried by the Department, its agents, officials, employees or the State of Arizona shall be excess and not contributory insurance, as provided by A.R.S. § 41-621 (E).

2. Coverage provided by the Contractor shall not be limited to the liability assumed under the indemnification provisions of this Contract.

C. NOTICE OF CANCELLATION: With the exception of (10) day notice of cancellation for non-

payment of premium, any changes material to compliance with this contract in the insurance policies above shall require (30) days written notice to the State of Arizona. Such notice shall be sent directly to the Department and shall be sent by certified mail, return receipt requested.

D. ACCEPTABILITY OF INSURERS: Contractors insurance shall be placed with companies licensed in

the State of Arizona or hold approved non-admitted status on the Arizona Department of Insurance List of Qualified Unauthorized Insurers. Insurers shall have an “A.M. Best” rating of not less than A- VII. The State of Arizona in no way warrants that the above-required minimum insurer rating is sufficient to protect the Contractor from potential insurer insolvency.

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https://procure.az.gov/bso/ Page 10 of 24

E. VERIFICATION OF COVERAGE: Contractor shall furnish the State of Arizona with certificates of

insurance (ACORD form or equivalent approved by the State of Arizona) as required by this Contract. The certificates for each insurance policy are to be signed by an authorized representative.

All certificates and endorsements (Blanket Endorsements are not acceptable) are to be received and approved by the State of Arizona before work commences. Each insurance policy required by this Contract must be in effect at or prior to commencement of work under this Contract and remain in effect for the duration of the project. Failure to maintain the insurance policies as required by this Contract, or to provide evidence of renewal, is a material breach of contract. All certificates required by this Contract shall be sent directly to the Department. The State of Arizona project/contract number and project description shall be noted on the certificate of insurance. The State of Arizona reserves the right to require complete copies of all insurance policies required by this Contract at any time.

F. SUBCONTRACTORS: Contractors’ certificate(s) shall include all subcontractors as insureds under

its policies or Contractor shall furnish to the State of Arizona separate certificates and endorsements for each subcontractor. All coverages for subcontractors shall be subject to the minimum requirements identified above.

G. APPROVAL: Any modification or variation from the insurance requirements in this Contract shall

be made by the contracting agency in consultation with the Department of Administration, Risk Management Division. Such action will not require a formal Contract amendment, but may be made by administrative action.

H. EXCEPTIONS: In the event the Contractor or sub-contractor(s) is/are a public entity, then the Insurance Requirements shall not apply. Such public entity shall provide a Certificate of Self-insurance. If the contractor or sub-contractor(s) is/are a State of Arizona agency, board, commission, or university, none of the above shall apply.

3.16 KEY PERSONNEL

It is essential that the Contractor provides adequate experienced personnel, capable of and devoted to the successful accomplishment of work to be performed under this contract. The Contractor must agree to assign specific individuals to the key positions. The Contractor agrees that, once assigned to work under this contract, key personnel shall not be removed or replaced without written notice to the Procurement Group. If key personnel are not available for work under this contract for a continuous period or are expected to devote substantially less effort to the work than initially anticipated, the Contractor shall immediately notify the Procurement Group, and shall, subject to the concurrence of the Department, replace such personnel with personnel of substantially equal ability and qualifications.

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3.17 ADDITIONAL CONTRACTOR’S RESPONSIBILITIES

The Contractor shall furnish all necessary labor, tools, equipment/vehicles, parts and supplies to perform the required scope of work services at the designated location. The Contractor shall comply with the Social Security Act, Workers Compensation laws, and Unemployment laws of the State of Arizona as well as all State, Local, and Federal legislation, rules, and regulations associated with all work relevant to the Contractor’s business. The Contractor shall carry on the operation in such a manner that the Contractor does not damage existing grounds, buildings, landscaping, utilities, highway markers, or other structures. In the event damage occurs to Department property or any adjacent property by reason of any operations performed under this contract, the Contractor shall replace or repair the same at no cost to the State and as directed by the Department. If damage caused by the Contractor has to be repaired or replaced by the Department, the cost of such work shall be deducted from the monies due to the Contractor.

Contractor’s Employees The Contractor shall provide mentally alert, physically fit, adequately trained and qualified employees to ensure contracted services progress in a safe, orderly and timely manner. All persons engaged in performance of work under this contract shall be, unless otherwise approved by the Department, direct bona fide employees of the contractor and shall not be leased employees, sub-contractors, or independent Contractors. The Department may require verification of the nature of employment of the employees. This requirement is not intended to preclude the use of sub-contractors for specialty services such as herbicide/pesticide application services. The Contractor’s employees and any approved sub-contractor’s shall be in compliance with all OSHA and other State, Federal and Local regulatory agency requirements. At least one employee on duty shall carry a cell phone or pager for emergency contact by the Department. This employee must be fluent in English in order to be able to communicate with the Department. Employees shall be neat, clean and appropriately dressed in an approved clean uniform with an identification badge or patch that contains the Contractor’s name and employee’s name, at all times while on duty. The identification badge shall be worn on the outer garment. Due to the nature of the work performed, Contractor employees, in a particular sense, will represent the State to the motoring public. Employees shall treat motorists in a friendly, courteous manner. Employees should keep well informed on local road conditions, detours, points of interest, and services available, but shall refrain from recommending any retail service over another. All Contractors’ employees shall take all necessary operational and safety precautions during the performance of services to prevent accidents from occurring. Contractor shall ensure all of its employees are properly licensed to operate Contractor’s equipment and are properly trained in its use.

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Employees and other individuals are prohibited from having firearms or weapons in their possession while on duty or performing the contracted services as state herein. No one except authorized employees of the Contractor is allowed on the premises of the Department buildings. Contractor employees are NOT to be accompanied in their work area by acquaintances, family members, assistants, or any person unless said person is a bona fide employee of the Contractor. Under no circumstances are minor children to be allowed on State property in the course of the Contractor’s work schedule. The Contractor agrees to utilize only experienced responsible and capable people in the performance of the work. The Department may require that the Contractor remove from the job, covered by this contract, employees who endanger person(s) or property or whose continued employment under this contract is inconsistent with the interest of the Department. Removal of Contractor’s Employees:

The Contractor agrees to utilize only experienced, responsible and capable people in the performance of the work. The Department may require that the Contractor remove from the job, covered by this contract, employees who endanger person(s) or property or whose continued employment under this contract is inconsistent with the interest of the Department. Performance Standards The Contractor shall carry on operations in such a manner as to comply with the existing policies of this and other agencies and work and safety requirements of this contract. The Contractor shall perform the work so as to minimize disruption to the normal operation of any household or business at and around the project location. Upon completion of work the Contractor shall be responsible for cleaning and removing from the job site all debris, materials and equipment associated with the work performed. In the event that work performance is unsatisfactory, the Contractor will be notified by the Department and given a stated amount of time to correct the work.

3.18 DEPARTMENT RESPONSIBILITIES The Department shall be responsible for the following: Suspension of Work The Department may suspend operations at any time, when in their judgment, present or impending weather conditions are such that operations cannot be carried out in a safe, effective manner. The Site Coordinator or Site Coordinator’s representative shall immediately suspend operation when work performance is observed in violation of safety rules, regulations or practices. Violation of safety rules, regulations or practices may be considered grounds for termination of the contract.

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Inspection and Work Acceptance The Site Coordinator or Site Coordinator’s representative shall decide all questions, which may arise as to the quality and acceptability of any work performed under the contract. Work shall be completed in a responsible and professional manner and in accordance with the specifications, schedules, test plans or performance and operating standards, which are incorporated in the work assignment. The Department shall notify the Contractor, verbally and in writing, of any deficiencies found within the contract limits.

3.19 LICENSES, PERMITS, CERTIFICATIONS, FEES

Contractor shall be licensed through Arizona Registrar of Contractors for the type of work to be performed. Contractors providing services which are not licensed through Arizona Registrar of Contractors shall be licensed in accordance with the requirements of Arizona Law. Contractor shall at their own expense, possess, and retain in force without any violations, complaints, or suspensions during the term of this contract, all licenses, permits, certifications, or fees which are required by law. They shall comply with all federal, state, local and tribal laws, statutes, ordinances, rules, and regulations and the acts, codes, orders, and decrees of any administrative bodies, councils, or tribunals in any manner affecting the performance of the solicited services herein.

3.20 SUBCONTRACTOR

It is essential that the Contractor provide an adequate staff of experienced personnel capable of and devoted to the successful accomplishment of work to be performed under any resultant contract. The Contractor agrees that substitution of such specified individuals and/or personnel cannot be made without prior written approval by the Department. The Contractor shall bear all expenses incurred for any costs associated with subcontractors performing work under this contract.

3.21 POST AWARD

Prior to commencement of work, the Departments Contract Representative will arrange a meeting with the Contractor to discuss operational plans for execution of the contracted work. At this meeting, the Contractor shall submit the following: a. Personnel List to include the names and telephone numbers of key personnel and On-Site

Supervisor(s) who will be accountable for day to day decisions. b. Proposed Work Schedule to meet details in Specifications, Paragraph 1, Statement of Need. c. Miscellaneous questions regarding work request responsibilities, procedure, processing and other

concerns of the Contractor and Department have shall be addressed.

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REQUEST FOR QUOTATION

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4.0 UNIFORM INSTRUCTIONS TO OFFERORS

These are incorporated by reference and are available at: https://spo.az.gov/sites/default/files/documents/files/Uniform%20Instructions%20to%20Offerors%20%28rev%209-2014%29.pdf or you can contact the Procurement Officer, Christina Jimenez at (602) 712-4458.

5.0 SPECIAL INSTRUCTIONS

Submission of a bid is prima facie evidence that the Bidder has examined the work site, understands all work requirements and is aware of all conditions that might impact work performance.

5.1 OFFER SUBMISSION, DUE DATE and TIME Responses shall be submitted within the State’s e-Procurement system, ProcureAZ at https://procure.az.gov/bso/ . Offers shall be received before the date/time listed in the ‘Bid Opening Date’ field. Offers submitted outside ProcureAZ, or those that are received after the date/time listed shall be rejected. Questions in this regard shall be directed to the ProcureAZ Help Desk at [email protected] or 602 542-7600.

5.2 QUESTIONS

Questions relating to this solicitation shall be submitted within the State's e-Procurement system, ProcureAZ (https://procure.az.gov) by selecting the Q&A tab. Questions will be answered via the State's e-Procurement system, ProcureAZ (https://procure.az.gov) and are due no less than five (5)calendar days prior to the solicitation due date and time.

5.3 PROCUREAZ SUPPORT

To assist Vendors in the submission of a bid/offer, ProcureAZ offers a Help Desk with email ([email protected]) and telephone support (602-542-7600), and a Quick Reference Guide – Responding to Solicitations, http://www.spo.az.gov/ProcureAZ/Vendors/default.asp. Vendors are encouraged to submit any requests for assistance in a timely manner in order to meet the bid due date and time identified on the Notice Page.

5.4 SUBMITTAL OF REQUIRED INFORMATION

The following items shall be submitted on the State Procurement Office website http://procure.az.gov. Failure to provide all of the items and the information requested may result in the offer being rejected. SOLICITATION AMENDMENTS

Acknowledge all Solicitation Amendments issued via the e-Procurement system, ProcureAZ (http://procure.az.gov). Include and submit signature page of the actual solicitation amendment, if applicable.

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Attachment One (1), Offer and Acceptance, Complete and submit all information requested. Attachment Two (2), References, Bidders shall provide, on the References, Attachment 2, references from at least three (3) organizations for whom services or equivalent services of similar size and scope have been provided for the past thirty-six (36) months (for each listed reference). All information requested on Attachment 2, Reference information must be completed and up to date. Attachment Three (3), Designation of Confidential, Trade Secret & Proprietary Information, Complete and submit all information requested on Attachment 3. Attachment Four (4), Non-Collusion Affidavit, Complete, notarize and submit all information requested on Attachment 4. Attachment Five (5), Subcontractors and Suppliers, Complete and submit all information requested.

5.5 Electronic Copy One electronic copy of the bid shall be submitted in the ProcureAZ e-procurement system, on the attached forms and in the acceptable format specified in the solicitation. Acceptable formats include Microsoft Word (XP or 2003), Excel (XP or 2003) and PDF (Adobe Acrobat portable documents formats).

5.6. Confidential, Trade Secret and Proprietary Information

If the Offeror believes a portion of the proposal contains information that should be withheld from public review, the Offeror shall identify in ProcureAZ the document as confidential by clicking on the Confidential Box after the document is added as an Attachment. Additionally, the Offeror shall complete and submit with its offer a Designation of Confidential, Trade Secret & Proprietary Information (SPO Form 204); Attachment 3. The information identified as confidential shall not be disclosed until the Department’s Procurement Administrator makes a written determination. Historically, only information which is patented, copyright protected, or proprietary has been deemed as confidential. Cost will not be considered as confidential. Refer to Uniform Instructions to Offerors D. “Submission of Offer”, 6. “Public Record”.

5.7 Completing and Submitting Required Attachments NOTE: ProcureAZ will not save information entered directly on an Attachment. Use the following instructions to submit required documents: • Open and save the Attachment(s) to your own computer. • Complete the required information; save and re-attach the completed Attachments to ProcureAZ,

adding “Offeror” before the word “Attachment”.

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PRICING INFORMATION

Pricing shall be submitted under the Line Items tab within State's e-Procurement system, ProcureAZ (https://procure.az.gov). Pricing shall include all the work items which are anticipated for this project including all reporting requirements, labor, equipment/vehicles, materials/parts, travel and all other incidentals required to effectively complete the work specified. Pricing shall be in accordance with the unit of measure identified under the Line Items tab within State's e-Procurement system, ProcureAZ (https://procure.az.gov). The entries made by the bidder under the Line Items tab on ProcureAZ, will reflect actual contractual obligations both of the bidder and of the Department. Do not include taxes or utilize the individual drop down box for the tax rate. Taxes will not be used in the evaluation of bids. Bidders shall indicate the tax rate in percentage for services provided under the Question Tab on Procure.AZ (http://procure.az.gov). Travel time to and from the job site should be considered in the unit bid price and shall not be paid for as an extra item.

5.8 EVALUATION

In accordance with the Arizona Procurement Code ARS §41-2535, awards shall be made to the lowest responsible and responsive bidder whose offer conforms in all material respects to the requirements and criteria set forth in this Request for Quote.

5.9 PROMPT PAYMENT DISCOUNT

Prompt payment discounts of thirty (30) days or more set forth in an Offer shall be deducted from the offer for the purposes of evaluating that price. If a prompt payment discount is being offered you must indicate YES on the Questions Tab and proceed to the General Tab within your quote response to indicate the discount.

5.10 LICENSES, PERMITS, CERTIFICATIONS, FEES

Bidders shall be licensed through Arizona Registrar of Contractors for the type of work to be performed. Bidders providing other services which are not licensed through Arizona Registrar of Contractors shall be license in accordance with the requirements of Arizona Law.

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EXHIBIT 1 Title VI/Non-Discrimination Assurances

Appendix A

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During the performance of this contract, the contractor, for itself, its assignees, and successors in interest (hereinafter referred to as the "contractor") agrees as follows: 1. Compliance with Regulations: The contractor (hereinafter includes consultants) will comply with the Acts

and the Regulations relative to Non-discrimination in Federally-assisted programs of the U.S. Department of Transportation, the Federal Highway Administration, as they may be amended from time to time, which are herein incorporated by reference and made a part of this contract.

2. Non-discrimination: The contractor, with regard to the work performance by it during the contract, will not

discriminate on the grounds of race, color, or national origin in the selection and retention of subcontractors, including procurements of materials and leases of equipment. The contractor will not participate directly or indirectly in the discrimination prohibited by the Acts and the Regulations, including employment practices when the contract covers any activity, project, or program set forth in Appendix B of 49 CFR Part 21.

3. Solicitations for Subcontracts, Including Procurements of Materials and Equipment: In all solicitations,

either by competitive bidding, or negotiation made by the contractor for work to be performed under a subcontract, including procurements of materials, or leases of equipment, each potential subcontractor or supplier will be notified by the contractor of the contractor's obligations under this contract and the Acts and Regulations relative to Non-discrimination on the grounds of race, color, or national origin.

4. Information and Reports: The contractor will provide all information and reports required by the Acts, the

Regulations, and directives issued pursuant thereto and will permit access to its books, records, accounts, other sources of information, and its facilities as may be determined by the Recipient or the Federal Highway Administration to be pertinent to ascertain compliance with such Acts, Regulations, and instructions. Where any information required of a contractor is in the exclusive possession of another who fails or refuses to furnish the information, the contractor will so certify to the Recipient or the Federal Highway Administration, as appropriate, and will set forth what efforts it has made to obtain the information.

5. Sanctions for Noncompliance: In the event of a contractor's noncompliance with the Non-discrimination

provisions of this contract, the Recipient will impose such contract sanctions as it or the Federal Highway Administration ,may determine to be appropriate, including, but not limited to: a. withholding payments to the contractor under the contract until the contractor complies; and/or b. cancelling, terminating, or suspending a contract, in whole or in part.

6. Incorporation of Provisions: The contractor will include the provisions of paragraphs one through six in every subcontract, including procurements of materials and leases of equipment, unless exempt by the Acts, the Regulations and directives issued pursuant thereto. The contractor will take action with request to any subcontract or procurement as the Recipient or the Federal Highway Administration may direct as a means of enforcing such provisions including sanctions for noncompliance. Provided, that if the contractor becomes involved in, or is threatened with litigation by a subcontractor or supplier because of such direction, the contractor may request the Recipient to enter into any litigation to protect the interests of the Recipient. In addition, the contractor may request the United States to enter into the litigation to protect the interests of the United States.

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EXHIBIT 1 Title VI/Non-Discrimination Assurances

Appendix E

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During the performance of this contract, the contractor, for itself, its assignees, and successors in interest (hereinafter referred to as the "contractor") agrees to comply with the following non-discrimination statutes and authorities; including but not limited to: Pertinent Non-Discrimination Authorities: • Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq., 78 stat. 252), (prohibits discrimination on the basis of

race, color, national origin): and 49 CFR Part 21. • The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, (42 U.S.C. § 4601), (prohibits

unfair treatment of persons displaced or whose property has been acquired because of Federal or Federal-aid programs and projects);

• Federal-Aid Highway Act of 1973, (23 U.S.C. § 324 etseq.), (prohibits discrimination on the basis of sex); • Section 504 of the Rehabilitation Act of 1973, (29 U.S.C. § 794 et seq.), as amended, (prohibits discrimination on the

basis of disability); and 49 CFR Part 27; • The Age Discrimination Act of 1975, as amended, (42 U.S.C. § 6101 et seq.), (prohibits discrimination on the basis of

age); • Airport and Airway Improvement Act of 1982, (49 USC § 471, Section 47123), as amended, (prohibits discrimination

based on race, creed, color, national origin, or sex); • The Civil Rights Restoration Act of 1987, (PL 100-209), (Broadened the scope, coverage and applicability of Title VI of the

Civil Rights Act of 1964, The Age Discrimination Act of 1975 and Section 504 of the Rehabilitation Act of 1973, by expanding the definition of the terms "programs or activities" to include all of the programs or activities of the Federal-aid recipients, sub-recipients and contractors, whether such programs or activities are Federally funded or not);

• Titles II and III of the Americans with Disabilities Act, which prohibit discrimination on the basis of disability in the

operation of public entities, public and private transportation systems, places of public accommodation, and certain testing entities (42 U.S.C. §§ 12131-12189) as implemented by Department of Transportation regulations at 49 C.F.R. parts 37 and 38;

• The Federal Aviation Administration's Non-discrimination statute (49 U.S.C. § 47123) (prohibits discrimination on the

basis of race, color, national origin, and sex);

• Executive Order 12898, Federal Actions to Address Environmental Justice in Minority Populations and Low- Income Populations, which ensures discrimination against minority populations by discouraging programs, policies, and activities with disproportionately high and adverse human health or environmental effects on minority and low-income populations;

• Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency, and resulting agency

guidance, national origin discrimination includes discrimination because of limited English proficiency (LEP). To ensure compliance with Title VI, you must take reasonable steps to ensure that LEP persons have meaningful access to your programs (70 Fed. Reg. at 74087 to 74100);

• Title IX of the Education Amendments of 1972, as amended, which prohibits you from discriminating because of sex in

education programs or activities (20 U.S.C. 1687 et. seq).

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ATTACHMENT NO. ONE (1) OFFER AND ACCEPTANCE

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OFFER TO THE STATE OF ARIZONA:

The undersigned hereby offers and agrees to perform in compliance with all terms, conditions, specifications and amendments of this solicitation and any written exceptions in the offer. Signature also acknowledges receipt of all pages indicated in the Table of Contents.

Offeror (Company) Name Signature of Person Authorized to Sign Offer

Address Printed Name Date

City State Zip Title

Email Address Phone Number

Company Email Address Fax Number

PROCUREMENTS LESS THAN $100,000.00 ARE RESTRICTED TO SMALL BUSINESSES. A SMALL BUSINESS IS ONE THAT, INCLUDING ITS AFFILIATES, IS INDEPENDENTLY OWNED AND OPERATED, IS NOT DOMINANT IN THE TYPE OF BUSINESS IT CONDUCTS, AND WHICH EMPLOYS FEWER THAN 100 FULL TIME EMPLOYEES OR WHICH HAS GROSS RECEIPTS OF LESS THAN $4 MILLION IN ITS LAST FISCAL YEAR.

ACCEPTANCE OF OFFER (FOR DEPARTMENT USE ONLY)

The Contractor is now bound to perform based upon Contract Number _________________________________including all terms, conditions, specifications, amendments, etc., and the Contractor's offer as accepted by the state.

Concrete Repair at the Meteor Crater Rest Area

The Contractor is hereby cautioned not to commence any billable work or provide any material, service or construction under this contract until contractor receives a purchase order document. State of Arizona Effective this day of 2015 Christina Jimenez Awarded Date As Procurement Officer and not personal

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ATTACHMENT NO. TWO (2) REFERENCES

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Please list the name, address, contact name, e-mail address and telephone number for three (3) organizations for whom your company has provided services of a similar size and scope within the past twenty-four (24) months. These references may be checked, so please make sure all information is accurate and current. DO NOT SUBMIT THE DEPARTMENT, DEPARTMENT CONTRACTS AND/OR PERSONNEL AS REFERENCES.

1. ORGANIZATION:

ADDRESS:

CITY/STATE/ZIP CODE:

CONTACT:

TELEPHONE NUMBER:

E-MAIL ADDRESS:

DATE OF CONTRACT INITIATION:

TYPE OF SERVICES PROVIDED:

PROJECT SIZE FOR SERVICES PROVIDED:

2. ORGANIZATION:

ADDRESS:

CITY/STATE/ZIP CODE:

CONTACT:

TELEPHONE NUMBER:

E-MAIL ADDRESS:

DATE OF CONTRACT INITIATION:

TYPE OF SERVICES PROVIDED:

PROJECT SIZE FOR SERVICES PROVIDED:

3. ORGANIZATION:

ADDRESS:

CITY/STATE/ZIP CODE:

CONTACT:

TELEPHONE NUMBER:

E-MAIL ADDRESS:

DATE OF CONTRACT INITIATION:

TYPE OF SERVICES PROVIDED:

PROJECT SIZE FOR SERVICES PROVIDED:

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ATTACHMENT NO. THREE (3) ADOT CONFIDENTIALITY AND TRADE SECRETS

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All materials submitted as part of a response to a solicitation are subject to Arizona public records law and will be disclosed if there is an appropriate public records request at the time of or after the award of the contract. Recognizing there may be materials included in a solicitation response that is proprietary or a trade secret, a process is set out in A.A.C. R2-7-103 (attached) that will allow qualifying materials to be designated as confidential and excluded from disclosure. For purposes of this process the definition of “trade secret” will be the same as that set out in A.A.C. R2-7-101(52).

This form must be completed and returned with the response to the solicitation and any supporting information to assist the State in making its determination as to whether any of the materials submitted as part of the solicitation response should be designated confidential because the material is proprietary or a trade secret and therefore not subject to disclosure. All offerors must select one of the following: My response does not contain proprietary or trade secret information. I understand that my entire

response will become public record in accordance with A.A.C. R2-7-C317. My response does contain trade secret information because it contains information that:

1. Is a formula, pattern, compilation, program, device, method, technique or process, AND 2. Derives independent economic value, actual or potential, from not being generally known to,

and not being readily ascertainable by proper means by, other persons who can obtain economic value from its disclosure or use; AND

3. Is the subject of efforts by myself or my organization that are reasonable under the circumstances to maintain its secrecy.

Please note that failure to attach an explanation may result in a determination that the information does not meet the statutory trade secret definition. All information that does not meet the definition of trade secret as defined by A.A.C. R2-7-101(52) will become public in accordance with A.A.C. R2-7-C317. The State reserves the right to make its own determination of Proposer’s trade secret materials through a written determination in accordance with A.A.C. R2-7-103. If the State agrees with the proposer’s designation of trade secret or confidentiality and the determination is challenged, the undersigned hereby agrees to cooperate and support the defense of the determination with all interested parties, including legal counsel or other necessary assistance. By submitting this response, proposer agrees that the entire offer, including confidential, trade secret and proprietary information may be shared with an evaluation committee and technical advisors during the evaluation process. Proposer agrees to indemnify and hold the State, its agents and employees, harmless from any claims or causes of action relating to the State’s withholding of information based upon reliance on the above representations, including the payment of all costs and attorney fees incurred by the State in defending such an action.

Company Name Signature of Person Authorized to Sign

Address Printed Name

City State Zip Title

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ATTACHMENT NO. THREE (3) ADOT CONFIDENTIALITY AND TRADE SECRETS

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R2-7-103 Confidential Information A. If a person wants to assert that a person's offer, specification, or protest contains a trade secret or other

proprietary information, a person shall include with the submission a statement supporting this assertion. A person shall clearly designate any trade secret and other proprietary information, using the term "confidential". Contract terms and conditions, pricing, and information generally available to the public are not considered confidential information under this Section.

B. Until a final determination is made under subsection (C), an agency chief procurement officer shall not

disclose information designated as confidential under subsection (A) except to those individuals deemed by an agency chief procurement officer to have a legitimate state interest.

C. Upon receipt of a submission, an agency chief procurement officer shall make one of the following written

determinations: 1. The designated information is confidential and the agency chief procurement officer shall not disclose

the information except to those individuals deemed by the agency chief procurement officer to have a legitimate state interest;

2. The designated information is not confidential; or 3. Additional information is required before a final confidentiality determination can be made.

D. If an agency chief procurement officer determines that information submitted is not confidential, a person

who made the submission shall be notified in writing. The notice shall include a time period for requesting a review of the determination by the state procurement administrator.

E. An agency chief procurement officer may release information designated as confidential under subsection

(A) if: 1. A request for review is not received by the state procurement administrator within the time period

specified in the notice; or 2. The state procurement administrator, after review, makes a written determination that the

designated information is not confidential.

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ATTACHMENT NO. FOUR (4) NON-COLLUSION AFFIDAVIT

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State of Arizona ) ) ss County of )

(Affiant) the

(Title) of

(Contractor) the persons, corporation, or company who makes the accompanying Proposal, having first been duly sworn, deposes and says: That such Proposal is genuine and not sham or collusive, nor made in the interest or behalf of any person not herein named, and that the Bidder has not directly or indirectly induced or solicited any other Bidder to put in a sham bid, or any other person, firm, or corporation to refrain from bidding, and that the Bidder has not in any manner sought by collusion to secure for itself an advantage over any other Bidder.

(Signature)

(Title)

Subscribed and sworn to before me this Day of , 2015 Signature of Notary Public in and for the County of State of

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ATTACHMENT NO. FIVE (5) SUBCONTRACTORS AND SUPPLIERS

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A list of proposed subcontractors and suppliers shall be submitted. After bid submittal there shall be no change of subcontractor(s) or supplier(s) or Manufacturers identified on this Attachment, without prior written approval from the Department. If the Prime Contractor has an “A” license and plans to perform any of the work listed below, enter the company name in the space provided for Name of Subcontractor/Supplier/Manufacturer, for the appropriate activity.

FULL NAME OF TRADE SUBCONTRACTOR/SUPPLIER/MANUFACTURER LICENSE NUMBER

SAFETY

Barricading

SITE WORK

Demolition

Excavation

Seeding

SWPPP/Erosion Control

If multiple Subcontractors/Suppliers will be providing service in the same trade(s) as listed above or if utilizing a trade not listed above, write the Trade, Name of Subcontractor/Supplier, and License No. (if appropriate) below. If necessary, include additional pages.

I CERTIFY THAT: 1. I, as an officer of this organization, or per the attached letter of authorization, am duly authorized to certify

the information requested herein;

2. The contractor(s) and subcontractor(s) being submitted to perform the duties listed retain the proper classification of license to perform said duties, as required by the Arizona Registrar of Contractors, State of Arizona Office of Pest Management or other State, Federal or Municipal, Councils, or Tribunals licensing authority.

Printed or Typed Name Title

Signature Date