- FIRM INFORMATION (required) —
- Organizational Information
- Firm, related and affiliated entities, Firm ownership and history, including ownership changes in last 5 years, and Firm classification and regulatory bodies, if any
- Individual completing the Response: name and contact information of Authorized Firm Representative and confirmation Representative is authorized to represent and bind the Firm and sign Agreement
- Fidelity bond and fiduciary liability insurance
- Information, if any, distinguishing Firm from competitors
- Service History and Performance
- History of Firm’s offering of proposed service
- Representative client list for proposed service
- Changes in last 5 years: Describe and explain Services, Contracts, or Facilities no longer serviced in last 5 years, and percentage of type lost and gained
- Benchmarks, if any: Describe benchmarks used and how Firm tracks, monitors, and controls performance and deviation from benchmarks, if any
- Firm Personnel
- Firm size and personnel information, e.g., number of employees, managers, client service personnel, and other relevant functions, qualifications, average years of experience, average years tenure, and other relevant information
- Customer service capacity via staffing, hours, methods of contact, proposed key performance indicators regarding payment services and complaint/issue resolution.
- Management and Operating Philosophy
- Describe management and operating philosophy, process, methods, and style, including any information unique to Firm
- Governance
- Firm’s internal control and governance structure
- Potential conflicts of interest Firm, affiliates, related parties, and personnel may have or be perceived to have with this mandate and how such conflicts will be addressed
- Firm’s Code of Ethics and Standards of Conduct, if any
- Process: how Firm manages, measures, monitors, and controls risk
- Succession, Crisis, Disaster Recovery and Business Continuity Plans
- Compliance
- Proof that Firm and assigned personnel are licensed and registered to operate in Pennsylvania
- Identity, title, and biography of chief compliance officer, if any, and to whom she/he reports, and personnel responsible for risk and quality management
- Firm’s registration and proof of compliant corporate standing
- Most recent regulatory inspection report and follow-ups, if any
- Compliance process including methods, frequency, and other relevant information
- Last compliance assessment report, if any
- 5-year history of orders, sanctions, formal investigations, litigation, threatened litigation and administrative proceedings involving Firm, affiliates, or principals
- Technology
- Technology, software, back-up, and redundancy services used by Firm
- Third Party Relations and Fee Arrangements
- Firm’s approach to and use of fee or cost sharing arrangements, including direct or indirect recapture, rebate, referral, selection, retention, discount, performance, or other fee or cost sharing arrangements with affiliated parties, vendors, suppliers, service providers, brokers, or third parties. Provide details including information re entities, arrangements, revenue significance, conflict and disclosure policy, and impact on proposed service costs
- References
- 3 references, preferably from representative client list, with contact information and length of relationship
- Firm must certify that it and any person affiliated with the Firm who is or may be involved with the Proposal, contract execution, and proposed services, have no actual, potential or reasonably perceivable conflict of interest with the City of York or any of its component units, affiliates, elected officials, officers, employees, contractors or sub-contractors, and that any person so affiliated with the Firm has not had an affiliation with the City of York or been a City officer, elected or appointed City official or family member thereof, for a period of two (2) years prior to the RFP Issue Date. Exceptions should be noted. Responders may consult the City Conflict of Interest Policy
- BID (required) —
Bidder hereby agrees to provide the services outline in this Invitation To Bid at the unit price per item in the enclosed schedule, all prices FOB at the plant and as specified.
All applicable permit fees shall be included in the bid price and are to be taken care of by the bidder.
All prices shall be held firm for sixty-days (60) after the bid opening date. Please pay special attention to the Instruction to Bidders.
No conditional bids shall be accepted.
Read Proposal, Instruction to Bidders and Specifications carefully.
Bidders shall be bound by all terms of the Proposal, Instructions to Bidders and Specifications.
The City reserves the right to accept or reject any, all, or parts (units) of bids as may be deemed to be in the best interest of the City.
Bidder shall certify this statement below under penalty of perjury.
- SEALED COST PROPOSAL (required) —
A separate Sealed Cost Proposal shall be signed by Authorized Firm Representative and contain the following:
PROPOSED FEES AND FEE STRUCTURE
- If Proposal to Manage and Operate, provide complete fee structure and schedule for proposed service, billing frequency, and payment method. If Proposal to Rent, provide proposed rent or rent calculation.
- Include all fees and other forms of compensation accruing to or benefitting Firm, related entities, or employees, including direct or indirect recapture, rebate, referral, selection, retention, discount, performance, or other fee or cost sharing arrangements with affiliated parties, vendors, suppliers, service providers, brokers, or third parties, related to proposed services
- All other fees or costs that may be charged to City.
- PROPOSAL AND CONTRACT AND SPECIAL PROVISIONS TO CONTRACT (required) —
Please download the below documents, complete, and upload.
- AMERICANS WITH DISABILITIES ACT COMPLIANCE STATEMENT (required) —
During the term of this contract, the Contractor agrees as follows:
- Pursuant to federal regulations promulgated under the authority of The Americans With Disabilities Act, 28 C.F.R. Section 35.101 et seq., the Contractor understands and agrees that no individual with a disability shall, on the basis of the disability, be excluded from participation in this contract or from activities provided for under this contract. As a condition of accepting and executing this contract, the Contractor agrees to comply with the “General Prohibitions Against Discrimination”, 28 C.F.R. Section 35.130, and all other regulations promulgated under Title II of The Americans with Disabilities Act which are applicable to the benefits, services, programs and activities provided by the City of York through contracts with outside contractors.
- The Contractor shall be responsible for and agrees to indemnify and hold harmless the City of York from all losses, damages, expenses claims, demands, suits and actions brought by any party against the City of York as a result of the Contractor’s failure to comply with the provisions of paragraph A, above.
- CONFLICT OF INTEREST DISCLOSURE (required) —
Please respond to each paragraph individually, attaching additional information as needed.
- Provide the names and titles of all individuals providing professional services to the City of including advisors and subcontractors, if any. After each name, please provide the responsibilities of that person with regard to the professional services provided to the City.
- List the names of any of the above individuals who are current or former officials or employees of the City and their position; and
- List the names of any of the above individuals who has been a registered federal or state lobbyist and the date of the most recent renewal/registration.
- Within the last 10 years, have any of the individuals identified above been employed by the City. If yes, please identify the individual’s name, position with the City, and dates of employment.
- Within the last 10 years, has the Respondent employed or paid compensation to a third party intermediary, agent, or lobbyist to directly or indirectly communicate with any City official in connection with any transaction or investment involving the Respondent and the City. This question does not apply to any officer or employee of the Respondent who is acting within the scope of the Respondent’s standard professional duties on behalf of the Respondent including the actual provision of legal, accounting, engineering, real estate, or other professional advice, services, or assistance pursuant to its professional services contract with the City.
- Within the last 10 years, has any agent, officer, director, or employee of the Respondent solicited a third party to make a political contribution to any City official; any candidate for municipal office in the City; any local, county, or district political party of such official or candidate; or any political committee of such official or candidate. If yes, please identify the agent, officer, director, or employee who made the solicitation; the individual or individuals who were solicited; and the municipal officers, candidates, political party, or political committee for whom the solicitation was made.
- Within the last 10 years, has the Respondent made any contribution to a City official or candidate for municipal office in the City. If yes, please identify the recipient, the amount, and the date of the contribution.
- Does the Respondent have a direct financial, commercial, or business relationships with any City official. With regard to every City official for which the answer is yes, identify that individual and provide a detailed written description of that relationship.
- Within the last 10 years, has the Respondent conferred any gift of more than nominal value to any City official. A gift includes money, services, loans, travel, and entertainment, at value or discounted value. With regard to every City official for which the answer is yes, identify the recipient, the gift, and the date it was conferred.
- Did the Respondent make political contributions the meet all of the following four criteria:
- The contribution was made within the last 10 years;
- The contribution was made by an officer, director, executive-level employee, or owner of at least five percent (5%) of the Respondent;
- The amount of the contribution was at least $500.00 in the form of either a single contribution by an officer, director, executive-level employee, or owner of at least five percent (5%) or the aggregate of all contributions by all officers, directors, executive-level employees, and owners of at least five percent (5%); and
- The contribution was made to a candidate for any public office of the City, or County, or of a district within or containing the City; to an individual who holds such office; or to a political committee of such candidate or office-holder. If yes, then the Respondent shall provide the following information: the name and address of the contributor, the contributor’s relationship to the Respondent, the name and office or position of each recipient, the amount of the contribution, and the date of the contribution.
- Regarding the provision of professional services to the City, are you aware of any conflicts of interest, whether apparent, potential, or actual, with respect to any officer, director, or employee of the Respondent and officials or employees of the City. If yes, please provide a detailed written explanation of the circumstances which you believe provide a basis to conclude that an apparent, potential, or actual conflict of interest may exist.
- Please provide the name(s) and person(s) completing this form. At least one of the individuals identified by the Respondent in the first paragraph must participate in completing this form and must sign the verification statement below.
VERIFICATION
I, ___________________________, hereby state that I am ______________________ for _____________________________, and am authorized to make this verification.
I verify that the facts set forth in the foregoing Act 44 Disclosure Form for entities providing professional services to the City, and any relating attachments, are true and correct to the best of my knowledge, information, and belief. I understand that false statements herein are made subject to penalties of 18 P.A.C.S section 4904 relating to unsworn falsification to authorities.
Signed: ______________________________ Date:__________________________
- GOOD STANDING (required) —
Your firm must be following Federal, State, County and local units of government; which specifically includes good tax payment status and good corporate registration status.
- PROVIDER’S CERTIFICATION OF NON-INDEBTEDNESS TO THE CITY OF YORK (required) —
Provider hereby certifies and represents that Provider and Provider’s parent company(ies) and subsidiary(ies) are not currently indebted to the City of York (the “City”), and will not at any time during the term of this Contract (including any extensions or renewals thereof) be indebted to the City, for or on account of any delinquent taxes, liens, judgments, fees or other debts for which no written agreement or payment plan satisfactory to the City has been established. In addition to any other rights or remedies available to the City at law or in equity, Provider acknowledges that any breach or failure to conform to this certification may, at the option of the City, result in the withholding of payments otherwise due to Provider and, if such breach or failure is not resolved to the City’s satisfaction within a reasonable time frame specified by the City in writing, may result in the offset of any such indebtedness against said payments and/or the termination of this Contract for default (in which case Provider shall be liable for all excess costs and other damages resulting from the termination).
- PUBLIC RECORDS (required) —
Bidder acknowledges by submitting a proposal that all information may be subject to the Public Records law of Pennsylvania. Submit all questions, inquiries, or requests for clarification about the project in writing to Courtney Harlacher, Department of Business Administration, Finance Office, 101 South George Street, York PA 17401.
- NON-DISCRIMINATION STATEMENT (required) —
During the term of this contract, Contractor agrees as follows:
- Contractor shall not discriminate against any employee, applicant for employment, independent contractor or any other person because of race, color, religious creed, ancestry, national origin, age, handicap, familial status, or sex.
- Contractor shall take affirmative action to ensure that applicants are employed and that employees or agents are treated during employment without regard to their race, color, religious creed, ancestry, national origin, age, handicap, familial status, or sex. Such affirmative action shall include, but is not 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.
- Contractor shall post in conspicuous places, available to employees, agents, applicants for employment and other persons, a notice to be provided by the contracting agency setting forth the provisions of this non-discrimination clause.
- Contractor shall, in advertisement or requests for employment placed by it or on its behalf, state all qualified applicants will receive consideration for employment without regard to race, color, religious creed, ancestry, national origin, age or sex.
- Contractor shall send each labor union or workers’ representative with which it has a collective bargaining agreement or other contract or understanding, a notice advising said labor union or workers’ representative of its commitment to this non-discrimination clause. Similar notice shall be sent to every source of recruitment regularly used by Contractor.
- It shall be no defense to finding of noncompliance with the Contract Compliance Regulations issued by the Pennsylvania Human Relations Commission or this non-discrimination clause that Contractor had delegated some of its employment practice to any union, training program or other source of recruitment which prevents it from meeting its obligations. However, if the evidence indicates that the Contractor was not on notice of the third-party discrimination or made a good faith effort to correct it, such factor shall be considered in mitigation in determining appropriate sanctions.
- Where the practices of a union or of any training program or other source of recruitment will result in the exclusion of minority group persons, so that Contractor will be unable to meet its obligations under the Contract Compliance Regulations of the Pennsylvania Human Relations Commissions, 16 Pa. Code Chapter 49 and with all laws prohibiting discrimination in hiring or employment opportunities. In the event of Contractor’s noncompliance with the non discrimination clause of this contract or with any such laws, this contract may after hearing and adjudication, be terminated or suspended, in whole or in part, and Contractor may be declared temporarily ineligible for further Commonwealth contracts, and such other sanctions may be imposed and remedies invoked as provided by the Contract Compliance Regulations.
- NON-COLLUSION DECLARATION (required) —
The Respondent hereby states that I am authorized to make this verification.
The Respondent hereby states that the facts set forth in the foregoing Non-Collusion Declaration, pursuant to 62 P.A.C.S. section 4507 and other applicable laws, are true and correct to the best of my knowledge, information, and belief. I understand that false statements herein are made subject to penalties of 18 P.A.C.S section 4904 relating to unsworn falsification to authorities.
- The Respondent hereby represents that they are fully informed respecting the preparation and contents of the attached Response and of all pertinent circumstances respecting such Response; and
- Such Response is genuine and is not a collusive or sham Response; and
- Neither the Respondent nor any of its officers, partners, owners, agents, representatives, employees, or parties in interest, including this affiant, has in any way colluded, conspired, connived, or agreed, directly or indirectly, with any other Respondent, firm, or person to submit a collusive or sham Response in connection with the Contract for which the attached Response has been submitted or to refrain from responding in connection with such Contract, or has in any manner, directly or indirectly, sought by agreement or collision or communication or conference with any other Respondent, or to Respondent, or to secure through any collusion, conspiracy, connivance, or unlawful agreement any advantage against the City or any person interested in the proposed Contract; and
- The price or prices quoted in the attached Response are fair and proper and are not tainted by any collusion, conspiracy, connivance, or unlawful agreement on the part of the Respondent or any of its agents, representatives, owners, employees, or parties in interest, including this Respondent; and
- Respondent hereby represents that:
- ANTI COLLUSION AFFIDAVIT (required) —
Please download the below documents, complete, and upload.
- BID BOND (required) —
Please download the below documents, complete, and upload.
- EVP FORM (required) —
Please download the below documents, complete, and upload.
- SIGNATURE OF AUTHORIZED REPRESENTATIVE (required) —
Service Proposal signed by Authorized Firm Representative certifying information in Service and Sealed Cost Proposals is complete, accurate, and binds Firm.
- SMALL BUSINESS ENTERPRISE PARTICIPATION —
Upload SBE certification, if applicable.
- AFFIRMATIVE ACTION CERTIFICATION (required) —
During the term of this contract, Respondent agrees as follows:
- Respondent shall not discriminate against any employee, applicant for employment, independent contractor or any other person because of race, color, religious creed, ancestry, national origin, age, sex, or handicap. Respondent shall take affirmative action to insure that applicants are employed, and that employees or agents are treated during employment, without regard to their race, color, religious creed, ancestry, national origin, age, sex or handicap. Such affirmative action shall include, but is not limited to the following: employment, upgrading, demotion or transfer; recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training. Respondent shall post in conspicuous places, available to employees, agents, applicants for employment, and other persons, a notice to be provided by the contracting agency setting forth the provision of this affirmative action certification.
- Respondent shall, in advertisements or requests for employment placed by it or on its behalf, state all qualified applicants will receive consideration for employment without regard to race, color, religious creed, ancestry, national origin, age, sex, or handicap.
- Respondent shall send each labor union or workers’ representative with which it has a collective bargaining agreement to other contract or understanding, a notice advising said labor union or worker’s representative of its commitment to this affirmative action certification. Similar notice shall be sent to every other source of recruitment regularly utilized by Respondent.
- It shall be no defense to a finding of noncompliance with this affirmative action certification that Respondent has delegated some of its employment practices to any union, training program, or other source of recruitment which prevents it from meeting its obligations. However, if the evidence indicates that the Respondent was not on notice of the third-party discrimination or made a good faith effort to correct it, such a factor shall be considered in mitigation in determining appropriate sanctions.
- Where the practices of a union or of any training program or other source of recruitment will result in the exclusion of minority group persons, so Respondent will be unable to meet its obligations under this affirmative action certification, Respondent shall then employ and fill vacancies through other affirmative action employment procedures.
- Respondent shall comply with all state and federal laws prohibiting discrimination in hiring or employment opportunities. In the event of Respondent’s noncompliance with affirmative action certification of this contract or with any such laws, this contract may be terminated or suspended, in whole or in part, and Respondent may be declared temporarily ineligible for further City contracts, and other sanctions may be imposed, and remedies invoked.
- Respondent shall furnish all necessary employment documents and records to, and permit access to its books, records, and accounts by, the City Department of Business Administration, for purposes of investigation to ascertain Compliance with the provision of this certification. If Respondent does not possess documents or records reflecting the necessary information requested, it shall furnish such information on reporting forms supplied by the City Department of Business Administration.
- Respondent shall actively recruit minority subcontractors or subcontractors with substantial minority representation among their employees.
- Respondent shall include the provisions of this affirmative action certification in every subcontract, so that such provisions will be binding upon each subcontractor.
- Respondent’s obligations under this clause are limited to the Respondent’s facilities within Pennsylvania, or where the contract id for purchase of goods manufactured outside of Pennsylvania, the facilities at which such goods are actually produces.
- CERTIFICATE OF NON-SEGREGATED FACILITIES (required) —
The Respondent certifies that he does not maintain or provide for his employees and segregated facilities at any of his establishments, and that he does not permit his employees to perform their services at any location under his control where segregated facilities are maintained. The Respondent certifies further that he will not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does not permit his employees to perform their services at any location under his control where segregated facilities are maintained. The Respondent agrees that a breach of this certification will be a violation of the Equal opportunity clause in any contract resulting from acceptance of his bid. As used in this certification, the term “segregated Facilities,” means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing directive or are in fact segregated on the basis of race, color, religion, or national origin, because of habit, local custom, or otherwise. The Respondent agrees that (except where he has obtained identical certifications from subcontractors for specific time periods) he will obtain identical certifications from proposed subcontractors prior to the award of sub-contracts exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause, and that he will retain such certification in his files.
NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. §1001.
- BYRD ANTI-LOBBYING CERTIFICATION (required) —
(To be submitted with each bid or offer exceeding $100,000)
The undersigned, Respondent, the company submitting this response (the “Company”) hereby certifies, to the best of his or her knowledge, that:
- No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.
- If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.
- The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
The Company certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. § 3801 et seq., apply to this certification and disclosure, if any.
- DAVIS-BACON PREVAILING WAGE CERTIFICATION (required) —
Davis-Bacon Prevailing Wage
The Company acknowledges that the decision to award this Contract is conditioned upon Company’s acceptance of the wage determination, and upon continuing compliance with the Davis–Bacon Act (40 U.S.C. 3141–3144, and 3146–3148) as supplemented by Department of Labor regulations (29 CFR Part 5, “Labor Standards Provisions Applicable to Contracts Covering Federally Financed and Assisted Construction”). Pursuant to the Davis-Bacon Act, Company’s must be required to pay wages to laborers and mechanics at a rate not less than the prevailing wages specified in the Secretary of Labor’s wage determinations, incorporated into this Contract. Company further acknowledges and understands that Company shall be required to pay wages not less than once a week.
Davis-Bacon Prevailing Wage Certification
Company certifies that Company and all subcontractors shall provide certified payroll affidavits verifying compliance with G.L. c.149 §§ 26–27H, the federal Davis Bacon Act, and other related acts.
In the event of any inconsistency between the Davis-Bacon Wage Rates and any prevailing wage rates published by the Commonwealth of Pennsylvania and applicable to this
Contract, the higher of the two wages shall apply.
- ADDENDA ACKNOWLEDGEMENT (required) —
Bidder acknowledged all addenda issued. If no addenda are issued, write "None." (Enter Addendum Date and Number)
- BUSINESS RELATIONSHIP DECLARATION
- BUSINESS RELATIONSHIP DECLARATION PART 1 (required) —
This Declaration is submitted by an Authorized Representative of Responder, as a part of this Proposal. The undersigned, of lawful age and duly sworn, affirms and states that the Responder is fully knowledgeable of Responder’s business relationships and associations, and further states that the nature of any corporation, company, partnership, joint venture, or other business relationship presently in effect or which existed within one (1) year prior to the date of this statement between Responder and the Mayor, Members of City Council, any Trustee, Trust, or Authority of or benefiting the City, entities or parties affiliated with such individuals, significant known City contractors, or other parties, consultants, or employees engaged to further this project, is as follows:
(If none of the above Business Relationships exists, Responder shall state ‘NONE’ or otherwise indicate the absence of such Business Relationships. IF ABOVE IS BLANK, PROPOSAL WILL BE REJECTED.)
- BUSINESS RELATIONSHIP DECLARATION PART 2 (required) —
Responder further states that any such Business Relationship presently in effect or which existed within one (1) year prior to the date of this statement between any officer, agent, employee, partner or director of the Responder and any officer or director, agent, employee, or partner of the above entities or individuals is as follows:
(If none of the above Business Relationships exists, Responder shall state ‘NONE’ or otherwise indicate the absence of such Business Relationships. IF ABOVE IS BLANK, PROPOSAL WILL BE REJECTED.)
- BUSINESS RELATIONSHIP DECLARATION PART 3 (required) —
The names and positions of all persons having any such Business Relationships are as follows:
(If none of the above Business Relationships exists, Responder shall state ‘NONE’ or otherwise indicate the absence of such Business Relationships. IF ABOVE IS BLANK, PROPOSAL WILL BE REJECTED.)
- Basis for Award (required)
- Will This Project Require Line Item Pricing? (required)
- Funding Source(s) (required)
- Name the funding source (required) —
(update below accordingly)
- Is This a Construction Project That Will Exceed $2,000? (required)
- Will Project Exceed $100,000? (required)