CFOPD-16-D-048

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AMENDMENT OF SOLICITATION /

MODIFICATION OF CONTRACT

1. Solicitation Number Page of Pages

1 Attachments

2. Amendment/Modification Number

3. Effective Date 4. Requisition/Purchase Request No.

5. Solicitation Caption

Amendment No. 1

See Box 16C

IT Staffing Services

6. Issued by: Code 7. Administered by (If other than line 6)

Office of the Chief Financial Officer

Office of Contracts

1100 4

th

_{Street SW Suite E610}

Washington, DC 20024

Office of Finance and Treasury

Government of the District of Columbia

1101 4th Street, SW, 8th Floor

Washington, DC 20024

8. Name and Address of Contractor (No. street, city, county, state and zip code)

ALL POTENTIAL OFFERORS

X

9A. Amendment of Solicitation No.

CFOPD-16-D-048

9B. Dated (See Item 11)

July 18, 2016

10A. Modification of Contract/Order No.

Code Facility

10B. Dated (See Item 13)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

The above numbered solicitation is amended as set forth in item 14. The hour and date specified for receipt of Offers is extended.

is not extended.

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods: (a) By completing Items 8 and 15, and returning a _1__ written copy of the amendment: (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) BY separate letter or fax which includes a reference to the solicitation and amendment number. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such may be made by letter or fax, provided each letter or telegram makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. Accounting and Appropriation Data (If Required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS , IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14 A. This change order is issued pursuant to (Specify Authority):

B. The above numbered contract/order is modified to reflect the administrative changes. C. This supplemental agreement is entered into pursuant to authority of:

D. Other (Specify type of modification and authority) Administrative

E. IMPORTANT:

Contractor is not

is required to sign this document and return 1 copy to the issuing office.

14. Description of Amendment/Modification (Organized by UCF Section headings, including solicitation/contract subject matter where feasible.)

The above referenced solicitation to provide IT Staffing Services is hereby amended to reflect the following changes

(Attachment A) and response to inquiries received (Attachment B).

ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED

Except as provided herein, all terms and conditions of the document is referenced in Item 9A or 10A remain unchanged and in full force and effect. 15A. Name and Title of Signer (Type or print) 16A. Name of Contracting Officer

Drakus Wiggins

15B. Name of Contractor

(Signature of person authorized to sign)

15C. Date Signed 16B. District of Columbia

(Signature of Contracting Officer)

16C. Date Signed

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Solicitation CFOPD-16-D-048

IT Staffing Services

Amendment No. 1

Attachment A

The following changes are hereby incorporated into the solicitation.

1. Delete section 7 and replace with:

7. BID SUBMISSION DATE

The due date for receipt of bids is August 2, 2016 2:00 p.m.

2. The following attachments are enclosed herein to correct their omission

at the time of issuance of the solicitation:

a)

Attachment A: Bidder Offeror Certification Form

b)

Attachment B: Tax Affidavit Form

c)

Attachment C: Section K

d)

Attachment D: Past Performance Form

3. Adding Section 15 as follows:

15 METHOD OF AWARD

15.1 EVALUATION FOR AWARD

15.1.1 The District anticipates contract award will be made to the responsive, responsible lowest

bid or the lowest evaluated bid, whichever is applicable.

15.2 EVALUATION OF OPTION YEARS

15.2.1 The District will evaluate bids for award purposes by evaluating the total price for all

options as well as the base year. Evaluation of options shall not obligate the District to

exercise them. The total District’s requirements may change during the option years.

Quantities to be awarded will be determined at the time each option is exercised.

15.3 EVALUATION OF CONTRACT LINE ITEM NUMBERS

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Solicitation CFOPD-16-D-048

IT Staffing Services

Amendment No. 1

15.4 PREFERENCES FOR CERTIFIED BUSINESS ENTERPRISES

Under the provisions of the “Small, Local, and Disadvantaged Business Enterprise

Development and Assistance Act of 2005”, as amended, D.C. Official Code §2-218.01

et

seq

. (the Act), the District shall apply preferences in evaluating bids or proposals from

businesses that are small, local, disadvantaged, resident-owned, longtime resident,

veteran-owned, local manufacturing or local with a principal office located in an enterprise zone of

the District of Columbia.

15.4.1 APPLICATION OF PREFERENCES

For evaluation purposes, the allowable preferences for Certified Business Enterprises

under the Act for are as follows:

15.4 .

1.1 Three percent reduction in the bid price in the case of an Invitation for Bids (IFB)

or the addition of three points on a 100-point scale in the case of a Request for

Proposals (RFP) for a small business enterprise (SBE) certified by the Department

of Small and Local Business Development (DSLBD), as applicable;

15.4 .

1.2 Five percent reduction in the bid price in the case of an IFB or the addition of five

points on a 100-point scale in the case of an RFP for a resident-owned business

enterprise (ROB) certified by the DSLBD, as applicable;

15.4 .

1.3 Ten percent reduction in the bid price in the case of an IFB or the addition of five

points on a 100-point scale in the case of an RFP for a longtime resident business

(LRB) certified by the DSLBD, as applicable;

15.4 .

1.4 Two percent reduction in the bid price in the case of an IFB or the addition of two

points on a 100-point scale in the case of an RFP for a local business enterprise

(LBE) certified by the DSLBD, as applicable;

15.4 .

1.5 Two percent reduction in the bid price in the case of an IFB or the addition of two

points on a 100-point scale in the case of an RFP for a local business enterprise

with its principal office located in an enterprise zone (DZE) and certified by the

DSLBD, as applicable;

15.4 .

1.6 Two percent reduction in the bid price in the case of an IFB or the addition of two

points on a 100-point scale in the case of an RFP for a disadvantaged business

enterprise (DBE) certified by the DSLBD, as applicable;

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Solicitation CFOPD-16-D-048

IT Staffing Services

Amendment No. 1

15.4.1.8 Two percent reduction in the bid price in the case of an IFB or the addition of two

points on a 100-point scale in the case of an RFP for local manufacturing business

enterprise (LME) certified by the DSLBD, as applicable.

15.4.2 MAXIMUM PREFERENCE AWARDED

Notwithstanding the availability of the preceding preferences, the maximum total

preference to which a certified business enterprise is entitled under the Act is twelve

percent (12%) for bids submitted in response to an IFB or the equivalent of twelve (12)

points on a 100-point scale for proposals submitted in response to an RFP. There will be

no preference awarded for subcontracting by the prime contractor with certified business

enterprises.

15.4.3 PREFERENCES FOR CERTIFIED JOINT VENTURES

When the DSLBD, as applicable, certifies a joint venture, the certified joint venture will

receive preferences for categories in which the joint venture and the joint venture partner

are certified, subject to the maximum preference limitation set forth in the preceding

paragraph.

15.4.4 OFFEROR’S SUBMISSION FOR PREFERENCES

15.4.4.1 Any Offeror seeking to receive preferences on this solicitation must submit at the

time of, and as part of its bid or proposal, the following documentation, as

applicable to the preference being sought:

15.4.4.1.1 Evidence of the contractor’s or joint venture’s certification by the DSLBD as a

CBE, to include a copy of the certification from the DSLBD.

15.4.4.2 Any contractor seeking certification in order to receive preferences under this

solicitation must contact the:

DC Department of Small and Local Business Development

ATTN: LSDBE Certification Program

441 Fourth Street, N.W., Suite 970N

Washington, DC 20001

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Solicitation CFOPD-16-D-048

IT Staffing Services

Amendment No. 1

Attachment B

The following are responses to inquiries received.

Question 1.

The cover page mentions the due date as August 2nd and Section 7 mentions it as

July 29th. Which is the correct due date?

Response 1.

The due date is August 02, 2016. See Attachment A, Item 1.

Question 2.

The solicitation requires a Section K for compliance forms. What is included in

Section K?

Response 2.

Refer to Attachment A, Item 2.

Question 3.

May we know the incumbent vendor for the contract?

Response 3.

OCFO does not have a predecessor contract. The current resources are contracted

through ITSA, OCTO’s contract with OST.

Question 4.

Does this solicitation require a technical proposal in addition to the price schedule

on section 3?

Question 5.

No. Refer to section 1 of the solicitation for the documents to be submitted.

Question 6.

Is there a contract ceiling amount or a not to exceed maximum contract value?

Response 6.

The Not to exceed amount will be determined upon award based on the awardee’s

total estimated price.

Question 7.

What is the basis for contract award?

Response 7.

See Attachment A, Item 3.

Question 8.

What is the proposal due date? The cover page states the due date as August

2nd. Section 7 has the submission date as July 29th.

Response 8.

Refer to Attachment A, Item 1.

Question 9.

Is there an annual contract ceiling amount – now for the “current contractor”?

Response 9.

OCFO does not have a current contract therefore this information is not available.

Question 10.

Does OCFO intend to make a single award or award multiple contracts to DC

Supply Schedule holders?

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Solicitation CFOPD-16-D-048

IT Staffing Services

Amendment No. 1

Question 11.

Per Sections 2. BACKGROUND - The OCIO employs contracted staff necessary

to perform tasks and work on projects, augmenting the IT Full Time Employee

(FTE) staff. The OCIO currently employs approximately 25 contract staff via the

current contractor. The OCIO has a continued need for augmented IT staff. - Who

is the "current contractor"?

Response 11.

Refer to Answer 3.

Question 12.

Is the current contractor a CBE and Supply Schedule Holder; and eligible to bid

this solicitation?

Response 12.

This solicitation is restricted to DC Supply Schedule contractors. The current

contractor’s CBE and DC Supply Schedule contract status is unknown at this time

by the OCFO.

Question 13.

Is OCFO happy with the performance of the current contractor?

Response 13.

OCFO is satisfied with the current staff.

Question 14.

Will the 25 contract staff remain with the current contractor, post new contract(s)

award(s)?

Response 14.

This information is not known to the OCFO.

Question 15.

Per Section 4.3 REQUIREMENTS - The Contractor shall ensure that a minimum

of three (3) Candidate resumes for each IT resource per labor category are

submitted to the COTR for review and approval prior to assigning any IT resource

to the OCIO. - Is this a requirement for proposal submission on August 2nd, or a

requirement for resulting Task order submissions, following contract(s) award(s)?

Response 15.

This requirement will be enforced upon award of the task order.

Question 16.

Please confirm that OCFO does not require resumes to be submitted to this

solicitation response.

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Page 1 of 5 (Draft last updated: July 2011)

Telephone # and ext.: Fax #:

Name: EIN: Status:

OFFICE OF CONTRACTS

PART 1: BIDDER/OFFEROR INFORMATION

BIDDER/OFFEROR CERTIFICATION FORM

SECTION I. BIDDER/OFFEROR RESPONSIBILITY CERTIFICATION

Joint Venture Date of Organization:

COMPLETION

The person(s) completing this form must be knowledgeable about the bidder's/offeror's business and operations.

GENERAL INSTRUCTIONS

This form contains four (4) sections. Section I concerns the bidder's/offeror's responsibility; Section II includes additional required certifications; Section III relates to the Buy American Act (if applicable); and Section IV requires the bidder's/offeror's signature.

RESPONSES

Every question must be answered. Each response must provide all relevant information that can be obtained within the limits of the law. Individuals and sole proprietors may use a Social Security number but are encouraged to obtain and use a federal Employer Identification Number (EIN). Provide any explanation at the end of the section or attach additional sheets with numbered responses. Include the bidder's/offeror's name at the top of each attached page.

Additional Legal Business Entity Identities: If applicable, list any other DBA, Trade Name, Former Name, Other Identity and EIN used in the last five (5) years and the status (active or inactive).

Type: Email Address:

Legal Business Entity Name: Solicitation #:

Address of the Principal Place of Business (street, city, state, zip code)

Website:

Instructions for Section I: Section I contains eight (8) parts. Part 1 requests information concerning the bidder's/offeror's business entity. Part 2 inquires about current or former owners, partners, directors, officers or principals. Part 3 relates to the responsibility of the bidder's/offeror's business. Part 4 concerns the bidder's/offeror's business certificates and licenses. Part 5 inquires about legal proceedings. Part 6 relates to the bidder's/offeror's financial and organizational status. Part 7 requires the bidder/offeror to agree to update the information provided. Part 8 relates to disclosures under the District of Columbia Freedom of Information Act (FOIA).

1.1 Business Type (Please check the appropriate box and provide additional information if necessary.):

Limited Liability Company (LLC or PLLC)

Partnership (including LLP, LP or General)

Corporation (including PC) Date of Incorporation:

Date of Organization:

Date of Registration or Establishment:

Other Date established?:

Sole Proprietor How many years in business?: Nonprofit Organization Date of Organization:

If "Other," please explain:

1.2 Was the bidder's/offeror's business formed or incorporated in the District of Columbia?

If "No" to Subpart 1.2, provide the jurisdiction where the bidder's/offeror's business was formed or incorporated. Attach a Certificate or Letter of Good Standing from the applicable jurisdiction and a certified Application for Authority from the District of Columbia, or provide an explanation if the documents are not available.

State _____________________________________ Country __________________________________

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2.3 Been proposed for suspension or debarment?

3.8 Been suspended, cancelled or terminated for cause on any government contract including, but not limited to, a non-responsibility finding?

4.2 Please provide a copy of the bidder's/offeror's District of Columbia Office of Tax and Revenue Tax Certification Affidavit.

PART 5: LEGAL PROCEEDINGS

Please provide an explanation for each "Yes" or "Other" in Part 3. (b) Explain its exemption from the requirement.

Please provide an explanation for "Yes" in Subpart 4.1.

PART 4: CERTIFICATES AND LICENSES

3.6 Been denied a contract award or had a bid or proposal rejected based upon a non-responsibility finding by a government entity?

(a) Any business-related activity; or

3.4 Been charged with a misdemeanor or felony, indicted, granted immunity, convicted of a crime, or subject to a judgment or plea bargain for:

3.5 Been disqualified on any government permit or license?

Within the past five (5) years, has the bidder/offeror:

2.2 Been under suspension, debarment, voluntary exclusion or determined ineligible under any federal, District or state statutes?

3.1 Been under suspension, debarment, voluntary exclusion or determined ineligible under any federal, District or state statutes?

4.1 Had a denial, decertification, revocation or forfeiture of District of Columbia certification of Certified Business Enterprise or federal certification of Disadvantaged Business Enterprise status for other than a change of ownership?

Please provide an explanation for each "Yes" or "Other" in Part 2. For each "Other", include an explanation that provides the basis for not definitively responding "Yes" or "No".

3.3 Been the subject of an investigation, whether open or closed, by any government entity for a civil or criminal violation for any business-related conduct?

(a) Any business-related activity; or

PART 3: BUSINESS RESPONSIBILITY

(b) Any crime the underlying conduct of which was related to truthfulness?

3.7 Had a low bid or proposal rejected on a government contract for failing to make good faith efforts on any Certified Business Enterprise goal or statutory affirmative action requirements on a previously held contract?

(b) Any crime the underlying conduct of which was related to truthfulness?

PART 2: INDIVIDUAL RESPONSIBILITY

Additional Instructions for Section I, Parts 2 through 8: Provide an explanation of the issue(s), relevant dates, the government entity involved, any remedial or

corrective action(s) taken and the current status of the issue(s).

(a) Certify its intent to obtain the necessary license, registration or certification prior to contract award; or

Within the past five (5) years, has any current or former owner, partner, director, officer, principal or any person in a position involved in the administration of funds, or currently or formerly having the authority to sign, execute or approve bids, proposals, contracts or supporting documentation on behalf of the bidder/offeror with any government entity:

2.1 Been sanctioned relative to any business or professional permit or license?

1.3 Please provide a copy of each District of Columbia license, registration or certification that the bidder/offeror is required by law to obtain (other than those provided in Subpart 1.2). If the bidder/offeror is not providing a copy of its license, registration or certification to transact business in the District of Columbia, it shall either:

3.2 Been proposed for suspension or debarment?

2.4 Been the subject of an investigation, whether open or closed, by any government entity for a civil or criminal violation for any business-related conduct?

2.6 Been suspended, cancelled or terminated for cause on any government contract including, but not limited to, a non-responsibility finding?

2.5 Been charged with a misdemeanor or felony, indicted, granted immunity, convicted of a crime, or subject to a judgment or a plea bargain for:

Yes No Other

Yes No Other Yes No Other

Yes No Other

Yes No

Yes No Other

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6.8 During the past three (3) years, has the bidder/offeror been audited by any government entity?

PART 7: RESPONSE UPDATE REQUIREMENT

7.1 In accordance with the requirement of Section 302(c) of the Procurement Practices Reform Act of 2010 (D.C. Official Code § 2-353.02), the bidder/offeror shall update any response provided in Section I of this form during the term of this contract:

6.4 During the past three (3) years, has the bidder/offeror failed to file or pay any tax returns required by federal, state, District of Columbia or local laws?

6.3 Within the last seven (7) years, has the bidder/offeror initiated or been the subject of any bankruptcy proceedings, whether or not closed, or is any bankruptcy proceeding pending?

If "Yes" to Subpart 6.4, provide the taxing jurisdiction, the type of tax, the liability year(s), the tax liability amount the bidder/offeror failed to file/pay and the current status of the tax liability.

If "Yes" to Subpart 6.6, provide the years the bidder/offeror failed to comply with the payment agreement, explain the situation and any remedial or corrective action(s) taken and the current status of the issue(s).

(a) If "Yes" to Subpart 6.8, did any audit of the bidder/offeror identify any significant deficiencies in internal controls, fraud or illegal acts; significant violations of provisions of contract or grant agreements; significant abuse; or any material disallowance?

(b) If "Yes" to Subpart 6.8(a), provide an explanation of the issue(s), relevant dates, the government entity involved, any remedial or corrective action(s) taken and the current status of the issue(s).

If "Yes" to Subpart 6.1, provide an explanation of the issue(s), relevant dates, the government entity involved, any remedial or corrective action(s) taken and the current status of the issue(s).

(a) Within sixty (60) days of a material change to a response; and

6.6 During the past three (3) years, has the bidder/offeror complied with any payment agreement with the Internal Revenue Service, the District of Columbia Office of Tax and Revenue and the Department of Employment Services

If "Yes" to Subpart 6.7, provide an explanation of the issue(s), relevant dates, the government entity involved, any remedial or corrective action(s) taken and the current status of the issue(s).

5.3 Received any OSHA citation and Notification of Penalty containing a violation classified as serious or willful?

If "Yes" to Subpart 6.5, provide the years the bidder/offeror failed to file the return or pay the insurance, explain the situation and any remedial or corrective action(s) taken and the current status of the issue(s).

6.5 During the past three (3) years, has the bidder/offeror failed to file a District of Columbia unemployment insurance return or failed to pay District of Columbia unemployment insurance?

PART 6: FINANCIAL AND ORGANIZATIONAL INFORMATION

6.1 Within the past five (5) years, has the bidder/offeror received any formal unsatisfactory performance assessment(s) from any government entity on any contract?

6.2 Within the past five (5) years, has the bidder/offeror had any liquidated damages assessed over $25,000? Please provide an explanation for each "Yes" in Part 5.

If "Yes" to Subpart 6.2, provide an explanation of the issue(s), relevant dates, the government entity involved, the amount assessed and the current status of the issue(s).

If "Yes" to Subpart 5.1, provide an explanation of the issue(s), relevant dates, the Lien Holder or Claimant's name, the amount of the lien(s) and the current status of the issue(s).

If "Yes" to Subpart 6.3, provide the bankruptcy chapter number, the court name and the docket number. Indicate the current status of the proceedings as "initiated," "pending" or "closed".

5.1 Had any liens or judgments (not including UCC filings) over $25,000 filed against it which remain undischarged?

5.2 Had a government entity find a willful violation of District of Columbia compensation or prevailing wage laws, the Service Contract Act or the Davis-Bacon Act?

6.7 Indicate whether any outstanding debt is owed to the federal or District of Columbia government.

Yes No

Yes No Yes No

Yes No

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(c) No attempt has been made or will be made by the bidder/offeror to induce any other concern to submit or not to submit a contract for the purpose of restricting competition.

___ 2.2 Each signature on the bid/proposal is considered to be a certification by the signatory that the signatory:

(a) Is the person in the bidder's/offeror’s organization responsible for determining the prices being offered in the contract;

(b) Has not participated and will not participate in any action contrary to subparagraphs 2.1(a)(i) through (a)(iii) above; or

________________________________________________________________________________________________

(ii) As an agent, has not participated, and will not participate, in any action contrary to subparagraphs 2.1(a)(i) through (a)(iii) above. (ii) The intention to submit a bid/proposal; or

(iii) The methods or factors used to calculate the prices in the contract.

(b) The prices in this contract have not been and will not be knowingly disclosed by the bidder/offeror, directly or indirectly, to any other bidder/offeror or competitor before bid/proposal opening unless otherwise required by law; and

(a) The contract prices have been arrived at independently without, for the purpose of restricting competition, any consultation, communication or agreement with any bidder/offeror or competitor related to:

PART 8: FREEDOM OF INFORMATION ACT (FOIA)

PART 2: INDEPENDENT PRICE DETERMINATION REQUIREMENTS

___ 1.2 No person listed in clause 13 of the Standard Contract Provisions, “District Employees Not To Benefit”, will benefit from this contract.

(i) Those prices;

___ 1.3 The following person(s) listed in clause 13 of the Standard Contract Provisions may benefit from this contract. (For each person listed, attach the affidavit required by clause 13.)

(a) ____________________________________________________________________________________

(b) ____________________________________________________________________________________ 8.1 Indicate whether any information provided in response to a question in Section I is believed to be exempt from disclosure under the District of Columbia Freedom of Information Act (FOIA), effective March 25, 1977 (D.C. Law 1-96; D.C. Official Code §§ 2-531, et seq.). Include the question number(s) and explain the basis for the claim. (A determination of whether such information is, in fact, exempt from FOIA will be made at the time of any request for disclosure under FOIA.)

SECTION II. ADDITIONAL REQUIRED BIDDER/OFFEROR CERTIFICATIONS

Instructions for Section II: Section II contains three (3) parts. Part 1 requests information concerning District of Columbia employees. Part 2 applies to the bidder/offeror's pricing. Part 3 relates to equal employment opportunity requirements.

PART 1. DISTRICT EMPLOYEES NOT TO BENEFIT

(b) Prior to the exercise of an option year contract.

[Insert full name of person(s) in the organization responsible for determining the prices offered in this contract and the title of his or her position in the bidder's/offeror’s organization]

(i) As an authorized agent, certifies that the principal named in subparagraph 2.2(c) above has not participated, and will not participate, in any action contrary to subparagraphs 2.1(a)(i) through (a)(iii) above; and

___ 2.3 If the bidder/offeror deletes or modifies subparagraph 2.1(b) above, the bidder/offeror must furnish with its bid a signed statement setting forth in detail the circumstances of the disclosure.

SECTION III. BUY AMERICAN ACT CERTIFICATION

By checking the applicable line, the bidder/offeror certifies that:

Instructions for Section III: Section III contains one (1) part which should only be completed if goods are being provided that are subject to the requirements of

the Buy American Act.

(c) Has been authorized, in writing, to act as an agent for the following principal in certifying that the principal has not participated, and will not participate, in any action contrary to subparagraphs 2.1(a)(i) through (a)(iii) above:

___ 2.1 Each signature of the bidder/offeror is considered to be a certification by the signatory that:

PART 3: EQUAL OPPORTUNITY OBLIGATIONS

___ 3.1 I hereby certify that I am fully aware of the contents of Mayor's Order 85-85 and the Office of Human Rights' regulations in Chapter 11 of the DCMR, and agree to comply with them while performing under this contract.

PART 1: BUY AMERICAN ACT COMPLIANCE

By checking the applicable line, the bidder/offeror certifies that:

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Telephone #: Fax #:

Title: Email Address:

Instruction for Section IV: This section must be completed by all bidder/offerors.

Name:

The District of Columbia government is hereby authorized to verify the above information with appropriate government authorities. Penalty for making false statements is a fine of not more than $1,000.00, imprisonment for not more than one year, or both, as prescribed in D.C. Official Code § 22-2514. Penalty for false

swearing is a fine of not more than $2,500.00, imprisonment for not more than three (3) years, or both, as prescribed in D.C. Official Code § 22-2513.

I, [ ], as the person authorized to sign this bid/proposal, hereby certify that the information provided in this form is true and accurate.

SECTION IV. CERTIFICATION

___ 1.1 Each end product, except the end products listed below, is a domestic end product (as defined in Paragraph 23 of the Standard Contract Provisions, "Buy American Act"), and that components of unknown origin are considered to have been mined, produced or manufactured outside the United States.

______________________________________________________ EXCLUDED END PRODUCTS

______________________________________________________ COUNTRY OF ORIGIN

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GOVERNMENT OF THE DISTRICT OF COLUMBIA

Office of the Chief Financial Officer

Office of Tax and Revenue

Name of Organization/Entity

Business Address (include zip code)

Business Phone Number(s)

"I hereby authorize the District of Columbia, Office of the Chief Financial Officer, Office of Tax and Revenue;

consent to release my tax information to an authorized representative of the District of Columbia agency from

which I am seeking to enter into a contractual relationship. I understand that the information released under this

consent will be limited to whether or not I am in compliance with the District of Columbia tax laws and regulations

as of the date found on the government request. I understand that this information is to be used solely for the

purpose of determining my eligibility to enter into a contractual relationship with a District of Columbia agency. I

further authorize that this consent be valid for one year from the date of this authorization."

I hereby certify that I am in compliance with the applicable tax filing and payment requirements of the District of

Columbia.

The Office of Tax and Revenue is hereby authorized to verify the above information with the appropriate

government authorities. The penalty for making false statements is a fine not to exceed $5,000.00, imprisonment

for not more than 180 days, or both, as prescribed by D.C. Official Code § 47-4106.

TAX CERTIFICATION AFFIDAVIT

Date

________________________________________________________________________________

Office of Tax and Revenue, PO Box 37559, Washington, DC 20013

THIS AFFIDAVIT IS TO BE COMPLETED ONLY BY THOSE WHO ARE REGISTERED TO CONDUCT BUSINESS IN

THE DISTRICT OF COLUMBIA.

Principal Officer Name and Title

Square and Lot Information

Federal Identification Number

Contract Number

Unemployment Insurance Account No.

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SECTION K

REPRESENTATIONS, CERTIFICATIONS AND OTHER STATEMENTS OF

OFFERORS

K.1 AUTHORIZED OFFICERS

The Contractor shall list the names of persons authorized to negotiate on the Contractor’s

behalf in connection with this solicitation (list names, titles, and telephone numbers of the

authorized negotiators):

____________________________________________________________________

K.2 PENDING LEGAL CLAIMS AGAINST THE DISTRICT

The Offeror must disclose any pending legal claims against the District. Pending legal

claims includes, but is not limited to, Federal and District court litigation, administrative

actions such as contract appeals or protests, claims for money damages from the District,

and any other type of action (court or administrative) against the District. Offerors with

pending legal claims against the District are not automatically precluded from contract

award. If Offerors does not have any pending legal claims against the District, please

indicate this below.

____________________________________________________________________

The Contractor hereby certifies that the information provided above is true, correct and

complete.

Signature

Date

Title

K.3 TERMS AND CONDITIONS CERTIFICATION

The Contractor hereby certifies that it has read, understands, acknowledges and agrees to

comply with the terms and conditions as set forth in this solicitation/contract/resultant

contract,

without exception

.

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District of Columbia

Office of the Chief Financial Officer

Office of Contracts

CONTRACTOR PERFORMANCE EVALUATION FORM

(Check appropriate box)

Performance

Elements

Excellent

Good

Acceptable

Poor

Unacceptable

Quality of Services/

Work

Timeliness of

Performance

Cost Control

Business

Relations

Customer

Satisfaction

1. NAME & TITLE OF EVALUATOR /(COTR):_______________________________________________

2. SIGNATURE OF EVALUATOR/(COTR):_________________________ DATE:_

3. NAME OF AGENCY: ____________________________________________________

4. TELEPHONE NUMBER OF EVALUATOR/(COTR):_________________________________________

5. NAME OF FIRM BEING EVALUATED _____________________________________________

6. Type of service received: ___________________________________________________

7. Contract Number, Amount and period of Performance ____________________________

____________________________________________________________________________

8. Remarks on Excellent Performance: Provide data supporting this observation.

(Continue on separate sheet if needed)

9. Remarks on Poor and Unacceptable Performance: Provide data supporting this observation.

(Continue on separate sheet if needed)

(15)

RATING GUIDELINES

Summarize Contractor performance in each of the rating areas. Assign each area a rating of 0 (Unacceptable), 1 (Poor), 2

(Acceptable), 3 (Good), 4(Excellent), or ++ (Plus). Use the following instructions as guidance in making these evaluations.

Quality Timeliness Business

Product/Service Cost Control of Performance Relations

-Compliance with -Within budget (over/ -Meet interim milestones -Effective management

contract requirements under target costs) -Reliable -Business-like correspondence

-Accuracy of reports -Current, accurate, and -Responsive to technical -Responsive to contract

-Appropriateness of complete billings directions requirements

personnel -Relationship of negated -Completed on time, -Prompt notification of contract

-Technical excellence costs to actual including wrap-up and problems

-Cost efficiencies contract administration -Reasonable/cooperative

-Change order issue -No liquidated damages -Flexible

assessed -Pro-active

-Effective contractor recommended solutions -Effective small/small disadvantaged business Subcontracting program

0. Zero Nonconformances are compromising Cost issues are compromising Delays are compromising Response to inquiries,

the achievement of contract performance of contract the achievement of contract technical/service

requirements, despite use of requirements. requirements, despite use /administrative issues is

Agency resources. of Agency resources. not effective and

responsive.

1.Unacceptable Nonconformances require major Cost issues require major Delays require major Response to inquiries,

agency resources to ensure agency resources to ensure agency resources to ensure technical/service

achievement of contract achievement of contract achievement of contract /administrative issues is

requirements. requirements. requirements. marginally effective and

responsive.

2. Poor Nonconformances require minor Cost issues require minor Delays require minor Response to inquiries,

agency resources to ensure agency resources to ensure agency resources to ensure technical/service

achievement of contract achievement of contract achievement of contract /administrative issues is

requirements. requirements. requirements. somewhat effective and

responsive.

3. Acceptable Nonconformances do not impact Cost issues do not impact Delays do not impact Response to inquiries,

the achievement of contract achievement of contract the achievement of contract technical/service

requirements. requirements. requirements. /administrative issues is

usually effective and responsive.

4. Good There are no quality problems. There are no cost issues. There are no delays. Responses to inquiries,

technical/service/ administrative issues is effective and

responsive.

5. Excellent

Th

e contractor has demonstrated an exceptional performance level in some or all of the above categories.