Bidder Submission Form
Solicitation
Bid/Proposal Amount
$
Bidder Information
Legal Business Name
Doing Business As Name
Business Street Address
Address Line 2
City
State
Zip Code
Authorized Representative Name
Authorized Representative Title
Email
Phone Number
Unique Entity Identifier (UEI)
SAM.gov Registration Expiration Date
SAM.gov Entity Record or Registration Evidence
Classification
Check any socioeconomic classifications that apply (voluntary):
HUBZone: Historically Underutilized Business Zone
MBE: Minority Business Enterprise
SBE
:
Small Business Enterprise
WBE: Women's Business Enterprise
VOSB: Veteran-Owned Small Business
Service Disabled Veteran Owned
Labor Surplus Area Firm
Other
If Other, please provide a description:
Eligibility
Is the entity actively registered in SAM.gov and does it have no active exclusions?
Yes
No
By selecting
No
, this blocks the submission for automatic qualification and form cannot be submitted.
Is the organization, any principal, or proposed subcontractor presently debarred, suspended,
proposed for
debarment, excluded, or otherwise ineligible for federal awards?
Yes
No
By selecting
Yes
, this blocks the submission for automatic qualification and form cannot be submitted.
Has the organization
identified
any federal criminal law violation involving fraud, bribery, or gratuity potentially affecting a federal award that requires disclosure under 2 CFR 200.113?
Yes
No
By selecting
Yes
, please upload written explanation and evidence of timely disclosure in the Attachments section.
Does the organization have any actual, potential, or
apparent
personal or organizational conflict of interest involving this procurement or a parent, affiliate, or subsidiary?
Yes
No
By selecting
Yes
, please upload any disclosure and mitigation documentation in the Attachments section.
Can the organization obtain and
maintain
all licenses, certifications, insurance, and bonding required by the solicitation?
Yes
No
By selecting
No
, this blocks the submission for automatic qualification and form cannot be submitted.
Does the bidder certify that it maintains a drug-free workplace policy in compliance with federal guidelines?
Yes
No
WARN Terms
Will the bidder comply with all applicable WARN, DOE, BIL, and 2 CFR Part 200 and Part 910 contracting requirements?
Yes
No
Will 100% of direct labor cost charged to the WARN project, including applicable lower tier labor, be incurred in the United States?
Yes
No
Will the bidder
comply with
applicable NEPA limitations and refrain from beginning or changing federally funded activities or locations without required written authorization?
Yes
No
By selecting
No
, this blocks the submission for automatic qualification and form cannot be submitted.
Will the bidder
comply with
applicable Buy America requirements for articles, materials, and supplies incorporated into covered public infrastructure, subject to approved waivers?
Yes
No
Not Applicable
By selecting
No
, this blocks the submission for automatic qualification and form cannot be submitted.
Will the bidder
comply with
Davis Bacon and Copeland requirements, including prevailing wages, weekly certified payrolls, records, postings, and
required
electronic payroll submission?
Yes
No
Not Applicable
By selecting
No
, this blocks the submission for automatic qualification and form cannot be submitted.
Will the bidder
comply with
the Contract Work Hours and Safety Standards Act requirements when the contract exceeds $100,000 and employs mechanics or laborers?
Yes
No
Not Applicable
Will the bidder certify compliance with the Byrd Anti Lobbying Amendment and
submit
Standard Form LLL if lobbying with nonfederal funds must be
disclosed
?
Yes
No
Not Applicable
Will the bidder
comply with
applicable Clean Air Act and Federal Water Pollution Control Act requirements?
Yes
No
Not Applicable
Will the bidder
comply with
recovered materials requirements under 2 CFR 200.323 when applicable?
Yes
No
Not Applicable
By selecting
No
, this blocks the submission for automatic qualification and form cannot be submitted.
Will the bidder
comply with
the prohibition on covered telecommunications and video surveillance equipment or services under 2 CFR 200.216?
Yes
No
By selecting
No
, this blocks the submission for automatic qualification and form cannot be submitted.
Will the bidder provide required records, audit access, site access, and record retention, including certified payroll retention when applicable?
Yes
No
By selecting
No
, this blocks the submission for automatic qualification and form cannot be submitted.
Will the bidder protect lawful reporting of waste, fraud, or abuse and avoid prohibited nondisclosure restrictions?
Yes
No
By selecting
No
, this blocks the submission for automatic qualification and form cannot be submitted.
Does the proposed work involve foreign nationals, foreign collaborations, foreign
ownership
or control concerns,
export controlled
activity, or equipment connected to a foreign country of risk?
Yes
No
Will the bidder report potentially duplicative federal funding and keep WARN costs separately identifiable?
Yes
No
By selecting
No
, this blocks the submission for automatic qualification and form cannot be submitted.
Will the bidder flow all applicable WARN, DOE, BIL, 2 CFR Part 200 and Part 910 requirements to subcontractors and lower tier entities?
Yes
No
By selecting
No
, this blocks the submission for automatic qualification and form cannot be submitted.
Attachments
Please upload any documentation required based on the previous questions.
File Upload #1
File Upload #2
File Upload #3
File Upload #4
File Upload #5
File Upload #6
File Upload #7
File Upload #8
File Upload #9
File Upload #10
Certification
First Name
Last Name
Bidder Signature
Title
Date
(MM/DD/YYYY)
Salesforce Required Fields