Fillable - NP TIO Application (2) (1) (Town of North Providence)

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NAME

STREET ADDRESS

TOWN, STATE, ZIP CODE

LEGAL NAME OF BUSINESS

Doing Business As, if different from legal name

WORK NUMBER

CELL NUMBER

WEBSITE

RHODE ISLAND Commerce Corp. has awarded the Town funding, Take It Outside (TIO), in a

statewide effort to encourage residents to have increased outdoor activities to reduce the transmission

rate of COVID-19. Eligible expenses, associated with the expansion of businesses to outdoors, public

spaces, parking lots and sidewalks, include: chairs, tables, heat lamps, tents, outdoor igloos, outdoor

greenhouses, outdoor WiFi systems, masks, hand sanitizer, security, insurance costs related to specific

outdoor activities, lighting, power sources, relevant signage, bike racks, decks and other costs affiliated

with the expansion to outdoors. The Department of Treasury in its guidance, FAQ#55, has identified

ineligible expenses are: workforce bonuses, severance pay and legal settlements. Funds will be

distributed on a first-come, first-serve basis. For more information, Brent Wiegand, Director of

Planning, 2000 Smith Street, No Providence Ri 02911, planning@northprovidenceri.gov,

401-233-0900 ext. 227

Take-It-Outside Initiative

Celebrate North Providence

___

Provide a brief summary of your proposed project to

Take It Outside

Proposed Hours of Operation

Has the applicant received other Federal coronavirus funds, disclose the

amount and source. Detail how these funds will be spent differently.

Total Request

_____________________________ ____________________

Signature DATE

REQUEST FOR PROPOSAL

For: Grants Under The “Take it Outside” Initiative

The Rhode Island Commerce Corporation (“Corporation”) seeks proposals from eligible entities,

as identified herein (“Eligible Entities”), to receive grants under the “Take it Outside” initiative

(“TIO Initiative”), a statewide effort designed to encourage and increase outdoor activities for all

Rhode Islanders in an effort to reduce the transmission rate of COVID-19.

Expert agencies such as the World Health Organization believe that the coronavirus may linger in

the air in crowded indoor spaces, spreading from one person to the next. A recent Japanese study

of 100 cases found that the odds of catching the coronavirus is nearly 20 times higher indoors than

outdoors. Outdoor gatherings lower the risk of catching the coronavirus because wind disperses

viral droplets and sunlight can kills some of the virus. The Centers for Disease Control and

Prevention has stated that indoor spaces are more risky than outdoor spaces where it might be

harder to keep people apart and there is less ventilation.

In addition to the State making State-owned land available for fitness classes, outdoor meetings,

recreational activities, and outdoor office spaces equipped with WiFi internet, the TIO Initiative

will provide $1 million in total grants, which will be in an amount of up to $150,000, to Eligible

Entities to fund the cost of eligible expenses, as defined herein (“Eligible Expenses”), associated

with the expansion of businesses to outdoor, public spaces—such as closed streets, sidewalks, and

parking lots—in an effort to reduce the transmission rate of COVID-19 while increasing economic

activity. Additional information on the TIO Initiative can be found at www.takeitoutsideri.com.

This document constitutes a Request for Proposal (“RFP”), in a competitive format, from Eligible

Entities. This request is an offer by the Corporation to provide grants to the Eligible Entities, in

accordance with the terms and conditions of this RFP, to fund the costs of Eligible Expenses.

Eligible Entities are encouraged to provide a response to this RFP, providing the Corporation with

proposals on how they will either (1) use the grant to directly fund Eligible Expenses associated

with increasing the Eligible Entity’s outdoor expansion to accommodate for public health

measures adopted in response to COVID-19; or (2) act an intermediary by using the grant to

purchase items that constitute Eligible Expenses to distribute to Eligible Entities to increase those

entities’ outdoor expansion to accommodate for public health measures adopted in response to

COVID-19, such as heat lamps to enable indoor activities to be conducted outdoors.

Eligible Entities and Eligible Expenses

Eligible Entities includes nonprofit organizations, chambers of commerce, municipalities,

merchant associations, downtown improvement districts, tourism regions, arts/cultural institutions,

or other intermediaries that are either:

1. Registered with the Rhode Island Secretary of State, conduct operations within the State of

Rhode Island, and have a location that can reasonably accommodate outdoor expansion

opportunities;

2. Proposing, under this RFP, to serve as an intermediary to purchase items that qualify as

Eligible Expenses and provide those items to other businesses or organizations.

Eligible Expenses must be consistent with the uses permitted under the Coronavirus Relief Fund

(CRF) as defined in guidance and FAQs issued by the U.S. Department of Treasury and updated

from time to time.

Eligible Entities must familiarize themselves with this guidance and adhere to

it.

Eligible Expenses may include the cost affiliated with purchasing, obtaining, delivering, installing,

or otherwise enabling the use of the following between September 28, 2020 and December 18,

2020: chairs, tables, heat lamps, tents, outdoor WiFi systems, masks, hand sanitizer, staffing,

security, insurance costs related to specific outdoor activities, lighting, power sources, relevant

signage, bike racks, and other costs affiliated with purchasing or obtaining good or services that,

in the Corporation’s sole discretion, were necessary to increase the proposer’s outdoor

opportunities. Eligible Expenses can be made after the grant is awarded and a grant agreement

with the Corporation is executed.

Eligible expenses do not include damages covered by insurance; expenses that have been or will

be reimbursed under any federal program; reimbursement to donors for donated items or services;

workforce bonuses other than hazard pay or overtime; severance pay; legal settlements; and other

expenses identified by the Department of Treasury in its Guidance.

Grant Timeline

The successful proposers will enter into a grant agreement with the Corporation, which will be in

a form, and contain provisions and conditions, as the Corporation deems necessary in its sole

discretion. The duration of the initial grant agreement between the Corporation and the successful

proposers—and the time period for the successful proposers to make Eligible Expenses, or an

intermediary to provide items that constitute Eligible Expenses to other business and organizations,

as applicable—is expected to begin upon the effective date of the grant agreement and end on or

before December 18, 2020.

Budget

As applicable, proposers shall either (1) provide a proposed line-item budget for the Eligible

Expenses that are necessary for the expansion of the proposer’s outdoor expansion to

Treasury’s Guidance is available at: https://home.treasury.gov/system/files/136/Coronavirus-

Relief-Fund-Guidance-for-State-Territorial-Local-and-Tribal-Governments.pdf

Treasury FAQs on the Guidance are available at:

https://home.treasury.gov/system/files/136/Coronavirus-Relief-Fund-Frequently-Asked-

Questions.pdf

accommodate for public health measures adopted in response to COVID-19, such as heat lamps to

enable indoor activities to be conducted outdoors; or (2) if the proposer is proposing to be an

intermediary, provide a line-item budget for the purchase and anticipated distribution of items that

constitute Eligible Expenses to businesses and organizations. Each line item must be accompanied

with a narrative description explaining why the purchase complies with the Treasury Guidance.

Municipalities or other government entities applying for this grant must demonstrate that costs

were not budgeted as that concept is explained in the Treasury Guidance

(non-governmental

applicants do not need to satisfy this criteria), and may not use any grant funds for payroll costs or

expenses.

If the applicant has received other federal coronavirus funding, it must disclose the amount and

source of that funding in the budget and detail how these funds would be spent differently or meet

the needs unaddressed by the prior allocation. If the applicant has not received any other federal

coronavirus funding, it must state that in its application.

Applicants may not charge indirect cost rate or an administrative fee. Administrative costs are

only allowable if they are direct and allocable to the specific project. More specifically, only direct

costs are allowable, and only if:

• They are necessary expenditures incurred due to the COVID-19 public health emergency.

• They were incurred during the time period beginning at the start of the period of

performance and ending December 18, 2020.

• For purposes of this grant funding announcement, expenditures must be direct and

allocable to the specific proposed project.

Eligible Expenses may include the cost affiliated with purchasing, obtaining, delivering, installing,

or otherwise enabling the use of the following between September 28, 2020 and December 18,

2020: chairs, tables, heat lamps, tents, outdoor WiFi systems, masks, hand sanitizer, staffing,

security, insurance costs related to specific outdoor activities, lighting, power sources, relevant

signage, bike racks, and other costs affiliated with purchasing or obtaining good or services that,

in the Corporation’s sole discretion, were necessary to increase the proposer’s outdoor

opportunities. Eligible Expenses can be made after the grant is awarded and a grant agreement

with the Corporation is executed.

Proposal Requirements

The Treasury Guidance and FAQ (FAQ #55 in particular) address the unbudgeted requirement

in detail. A cost meets this requirement if either (a) the cost cannot lawfully be funded using a line

item, allotment, or allocation within the budget enacted as of March 27, 2020 or (b) the cost is for

a substantially different use from any expected use of funds in such a line item, allotment, or

allocation. Many governmental entities may have entered a new budget year since March 27,

2020. To determine whether a cost is “unbudgeted” in this new budget year, U.S. Treasury has

provided the following guidance: “the budget most recently approved as of March 27, 2020,

provides the spending baseline against which expenditures should be compared for purposes of

determining whether they may be covered using payments from the Fund. This spending baseline

will carry forward to a subsequent budget year if a Fund recipient enters a different budget year

between March 27, 2020 and December 30, 2020. The spending baseline may be carried forward

without adjustment for inflation.” Governmental entities must demonstrate in their applicants that

any Eligible Expenses satisfy this requirement that the cost be unbudgeted.

In order to be considered responsive, a proposal must at a minimum contain the following:

1. One of the following, as applicable:

a. A description of the proposer’s entity, the location of the organization, the a

description of how the equipment is required or assists the proposer to expand to

an outdoor activity; the proposer’s anticipated expansion of its outdoor

opportunities; the Eligible Expenses that must be incurred in connection with such

expansion; and the number of locations that the grant funds would be used to assist.

b. A description of the proposer’s entity; its ability to purchase items that constitute

Eligible Expenses and the proposed distribution of those items to businesses and

organizations; its prior experience in as an intermediary; its capability to provide

the staffing and infrastructure necessary to consider applications for items that

constitute Eligible Expenses; and the intended amount of distributions of items that

constitute Eligible Expenses that the entity anticipates to make; the industry sectors

of the recipients of those distributions, and the items that constitute Eligible

Expenses that the entity proposes to distribute.

2. A budget, as discussed in the section entitled “Budget,” including the narrative justification

for each expenditure.

3. Evidence that the proposer is an Eligible Entity, including documentation of the

information set forth in the section entitled “Eligible Entities and Eligible Expenses,” if

applicable.

4. Person who will be the primary point of contact with the Rhode Island Commerce

Corporation.

5. A description of the outcome monitoring and evaluation plan including a list of tools to

track process, output and outcome measures for each component of the application.

6. A W-9 form, unless the Eligible Entity does not have an EIN.

Criteria for Selection and Evaluation Criteria

Responsive proposals for this RFP will be evaluated according to the Evaluation Criteria outlined

below. Designated Corporation staff or selected advisors will evaluate the written proposals. The

Corporation may at any time during the evaluation process seek clarification from Proposers

regarding any information contained within their submission. Final scores for each Proposer will

reflect a consensus of the evaluations.

Points

OVERALL EXPERIENCE OF PROPOSER & DEMONSTRATED

RESULTS

Our evaluation will include an assessment of the history of your company, your

experience as it relates to the requirements within this RFP, evidence of past

performance, quality and relevance of past work, references, and related items.

QUALIFICATIONS OF PERSONNEL

Our evaluation will include an assessment of the qualifications and experience of

your managerial team, staff, subcontractors, and related items.

STRATEGIC THINKING/PLANNING APPROACH

Overall approach and strategy described/outlined in the proposal and firm

capacity to perform the engagement within the specified timeframe (prior

experience of the firm in meeting timelines will be factored in here)

BUDGET APPROACH/COST EFFECTIVENESS

Effective and efficient delivery of quality services is demonstrated in relation to

the budget allocation. The allocation is reasonable and appropriate.

Total

100

MBE/WBE/DisBE Participation (additional potential points)

6 pts

NOTE: Designated Corporation staff or selected advisors will evaluate the written proposals.

The Corporation may at any time during the evaluation process seek clarification from Proposers

regarding any information contained within their proposal. Final scores for each respondent will

reflect a consensus of the evaluations. Any attempt by a Proposer to contact a member of

Corporation staff or selected advisors outside the RFP process, in an attempt to gain knowledge

or an advantage, may result in disqualification of Proposer.

1. ISBE Participation Evaluation (see below for scoring)

a. The Rhode Island Commerce Corporation encourages MBE/WBE/DisBE

participation in this Request. In accordance with Title 37, Chapter 14.1, and Title

37, Chapter 2.2 of the Rhode Island General laws, the Corporation reserves the

right to apply additional consideration to MBE/WBE/DisBE up to six (6)

additional points in the scoring evaluation as provided below:

b. Calculation of ISBE Participation Rate

i. ISBE Participation Rate for Non-ISBE Vendors. The ISBE participation

rate for nonISBE vendors shall be expressed as a percentage and shall be

calculated by dividing the amount of non-ISBE vendor’s total contract

price that will be subcontracted to ISBEs by the non-ISBE vendor’s total

contract price. For example, if the non-ISBE’s total contract price is

$100,000.00 and it subcontracts a total of $12,000.00 to ISBEs, the non-

ISBE’s ISBE participation rate would be 12%.

ii. ISBE Participation Rate for ISBE Vendors. The ISBE participation rate

for ISBE vendors shall be expressed as a percentage and shall be calculated

by dividing the amount of the ISBE vendor’s total contract price that will

be subcontracted to ISBEs and the amount that will be self-performed by

the ISBE vendor by the ISBE vendor’s total contract price. For example,

if the ISBE vendor’s total contract price is $100,000.00 and it subcontracts

a total of $12,000.00 to ISBEs and will perform a total of $8,000.00 of the

work itself, the ISBE vendor’s ISBE participation rate would be 20%.

c. Points for ISBE Participation Rate:

i. The vendor with the highest ISBE participation rate shall receive the

maximum ISBE participation points. All other vendors shall receive ISBE

participation points by applying the following formula:

(Vendor’s ISBE participation rate ÷ Highest ISBE participation rate X Maximum ISBE

participation points)

For example, assuming the weight given by the RFP to ISBE participation is 6 points, if Vendor

A has the highest ISBE participation rate at 20% and Vendor B’s ISBE participation rate is 12%,

Vendor A will receive the maximum 6 points and Vendor B will receive (12% ÷ 20%) x 6 which

equals 3.6 points.

See Appendix A for information and the MBE, WBE, and/or Disability Business Enterprise

Participation Plan form(s). Bidders are required to complete, sign and submit these forms with

their overall proposal in a sealed envelope. Please complete separate forms for each MBE, WBE

and/or Disability Business Enterprise subcontractor/supplier to be utilized on the solicitation

Instructions and Notifications to Proposers

1. Potential proposers are advised to review all sections of this RFP carefully and to

follow instructions completely, as failure to make a complete submission as described elsewhere

herein may result in rejection of the proposal.

2. Alternative approaches and/or methodologies to accomplish the desired or intended

results of this procurement are solicited. However, proposals that depart from or materially alter

the terms, requirements, or scope of work defined by this RFP will be rejected as being non-

responsive.

3. All costs associated with developing or submitting a proposal in response to this

RFP, or to provide oral or written clarification of its content, shall be borne by the proposer. The

Corporation assumes no responsibility for such costs.

4. Proposals are considered to be irrevocable for a period of not less than 120 days

following the date set for submission of proposals.

5. All pricing submitted will be considered to be firm and fixed unless otherwise

indicated herein.

6. Proposals misdirected to other locations, or that are otherwise not present at the

Rhode Island Commerce Corporation by the submission deadline for any cause will be determined

to be late and will not be considered. For the purposes of this requirement, the official time and

date shall be that of the time clock in the reception area of the Rhode Island Commerce

Corporation.

7. All proposals should identify the proposed team of professionals, including those

employed by subcontractors, if any, along with respective areas of expertise and relevant

credentials. Proposer should also provide a delineation of the portion of the scope of work for

which each of these professionals will be responsible.

8. All proposals should include the proposer’s FEIN or Social Security number as

evidenced by a W9, downloadable from https://www.irs.gov/pub/irs-pdf/fw9.pdf, to the extent

applicable.

9. All proposals should include a completed RFP Response Certification Cover Form,

included in this document.

10. The purchase of services under an award made pursuant to this RFP will be

contingent on the availability of CARES Act funds and made at the discretion of the Corporation.

11. Awarding this RFP is based on the Evaluation Criteria set forth in this RFP.

Vendors are advised, however, that all materials and ideas submitted as part of this proposal and

during the performance of any award shall be the property of and owned by the Corporation, which

may use any such materials and ideas.

12. Interested parties are instructed to peruse the Corporation’s website

(www.commerceri.com) on a regular basis, as additional information relating to this solicitation

may be released in the form of an addendum to this RFP. Addenda will also be posted to the

Rhode Island State Division of Purchases’ website at www.purchasing.ri.gov.

13. Equal Employment Opportunity (R.I. Gen. Laws § 28-5.1-1, et seq.) – § 28-5.1-1

Declaration of policy – (a) Equal opportunity and affirmative action toward its achievement is the

policy of all units of Rhode Island state government, including all public and quasi-public

agencies, commissions, boards and authorities, and in the classified, unclassified, and non-

classified services of state employment. This policy applies to all areas where State dollars are

spent, in employment, public services, grants and financial assistance, and in state licensing and

regulation.

14. In accordance with Title 7, Chapter 1.2 of the General Laws of Rhode Island, no

corporation organized under the laws of another state or country shall have the right to transact

business in Rhode Island until it shall have procured a Certificate of Authority to do so from the

Rhode Island Secretary of State (401-222-3040). This is a requirement only of the successful

bidder.

15. The Corporation reserves the right to award to one or more Proposers.

Proposal Submission

Responses to this RFP will be accepted in two rounds.

The first round of proposals are due on September 22, 2020 by 5:00 pm. One (1) electronic (PDF)

version must be emailed by that time to john.snider@commerce.ri.gov with the subject line

“Grants Under The “Take it Outside” Initiative RFP.” Three (3) printed copies of the complete

proposal must be mailed and post-marked no later than September 24, 2020. The Corporation

reserves the right to make all awards in the first round of proposals. Therefore, the Corporation

encourages all interested proposers to make their submission in the first round of proposals. The

second round of proposals are subject to available funding and subject to all awards not being

made to the proposers who submitted their proposals during the first round of proposals.

The second round of proposals are due on October 1, 2020 by 2:00: pm. One (1) electronic (PDF)

version must be emailed by that time to john.snider@commerce.ri.gov with the subject line

“Grants Under The “Take it Outside” Initiative RFP.” Three (3) printed copies of the complete

proposal must be mailed and post-marked no later than October5, 2020.

Paper copies should be sent to the following address:

Rhode Island Commerce Corporation

Attention: Grants Under The “Take it Outside” Initiative RFP

315 Iron Horse Way, Suite 101

Providence, RI 02908

Note: No phone calls and late responses will be accepted and responses received via

electronic submission only will be disqualified.

Questions, interpretations, or clarifications concerning this RFP should be directed by e-mail to

john.snider@commerce.ri.gov. Questions for the first round should be sent no later than 5:00 pm

on September 20, 2020. Responses to questions, interpretations, or clarifications concerning the

first round of this RFP will be posted online via addendum at www.commerceri.com and

www.ridop.ri.gov on September 21, 2020 to ensure equal awareness of important facts and details.

Questions for the second round should be sent no later than 5:00 pm on September 29, 2020.

Responses to questions, interpretations, or clarifications concerning the second round of this RFP

will be posted online via addendum at www.commerceri.com and www.ridop.ri.gov on September

30, 2020 to ensure equal awareness of important facts and details.

The Rhode Island Commerce Corporation reserves the right to terminate this solicitation prior to

entering into any agreement with any qualified firm pursuant to this Request for Proposal, and by

responding hereto, no firms are vested with any rights in any way whatsoever.

The Rhode Island Commerce Corporation reserves the right to reject any or all proposals for not

complying with the terms of this RFP.

APPENDIX A

PROPOSER ISBE RESPONSIBILITIES AND MBE, WBE, AND/OR DISABILITY

BUSINESS ENTERPRISE PARTICIPATION FORM

A. Proposer’s ISBE Responsibilities (from 150-RICR-90-10-1.7.E)

1. Proposal of ISBE Participation Rate. Unless otherwise indicated in the RFP, a Proposer

must submit its proposed ISBE Participation Rate in a sealed envelope or via sealed

electronic submission at the time it submits its proposed total contract price. The Proposer

shall be responsible for completing and submitting all standard forms adopted pursuant to

105-RICR-90-10-1.9 and submitting all substantiating documentation as reasonably

requested by either the Using Agency’s MBE/WBE Coordinator, Division, ODEO, or

Governor’s Commission on Disabilities including but not limited to the names and contact

information of all proposed subcontractors and the dollar amounts that correspond with

each proposed subcontract.

2. Failure to Submit ISBE Participation Rate. Any Proposer that fails to submit a proposed

ISBE Participation Rate or any requested substantiating documentation in a timely manner

shall receive zero (0) ISBE participation points.

3. Execution of Proposed ISBE Participation Rate. Proposers shall be evaluated and scored

based on the amounts and rates submitted in their proposals. If awarded the contract,

Proposers shall be required to achieve their proposed ISBE Participation Rates. During

the life of the contract, the Proposer shall be responsible for submitting all substantiating

documentation as reasonably requested by the Using Agency’s MBE/WBE Coordinator,

Division, ODEO, or Governor’s Commission on Disabilities including but not limited to

copies of purchase orders, subcontracts, and cancelled checks.

4. Change Orders. If during the life of the contract, a change order is issued by the Division,

the Proposer shall notify the ODEO of the change as soon as reasonably possible.

Proposers are required to achieve their proposed ISBE Participation Rates on any change

order amounts.

5. Notice of Change to Proposed ISBE Participation Rate. If during the life of the contract,

the Proposer becomes aware that it will be unable to achieve its proposed ISBE

Participation Rate, it must notify the Division and ODEO as soon as reasonably possible.

The Division, in consultation with ODEO and Governor’s Commission on Disabilities,

and the Proposer may agree to a modified ISBE Participation Rate provided that the

change in circumstances was beyond the control of the Proposer or the direct result of an

unanticipated reduction in the overall total project cost.

B. MBE, WBE, AND/OR Disability Business Enterprise Participation Plan Form:

Attached is the MBE, WBE, and/or Disability Business Enterprise Participation Plan form. Bidders

are required to complete, sign and submit with their overall proposal in a sealed envelope. Please

complete separate forms for each MBE, WBE and/or Disability Business Enterprise

subcontractor/supplier to be utilized on the solicitation.

MBE, WBE, and/or DISABILITY BUSINESS ENTERPRISE PARTICIPATION PLAN

dder's Name:

Bidder's Address:

Point of Contact:

Telephone:

Email:

Solicitation No.:

Project Name:

This form is intended to capture commitments between the prime contractor/vendor and MBE/WBE and/or Disability Business

Enterprise subcontractors and suppliers, including a description of the work to be performed and the percentage of the work as

submitted

to the prime contractor/vendor. Please note that all MBE/WBE subcontractors/suppliers must be certified by the

Office of Diversity, Equity and Opportunity MBE Compliance Office and all Disability Business Enterprises must be certified

by the Governor's

Commission on Disabilities at time of bid, and that MBE/WBE and Disability Business Enterprise

subcontractors must self

perform 100% of the work or subcontract to another RI certified MBE in order to receive participation

credit. Vendors may count 60% of

expenditures for materials and supplies obtained from an MBE certified as a regular

dealer/supplier, and 100% of such expenditures obtained from an MBE certified as a manufacturer. This form must be completed

in its entirety and submitted at time of bid.

Please complete separate forms

for each MBE/WBE or Disability Business

Enterprise subcontractor/supplier to be utilized on the solicitation.

Name of Subcontractor/Supplier:

Type of RI Certification:

□ MBE □ WBE □ Disability Business Enterprise

Address:

Point of Contact:

Telephone:

Email:

Detailed Description of Work To Be

Performed by Subcontractor or

Materials to be Supplied by Supplier:

Total Contract Value ($):

Subcontract

Value ($):

ISBE Participation

Rate (%):

Anticipated Date of Performance:

I certify under penalty of perjury that the forgoing statements are true and correct.

Prime Contractor/Vendor Signature

Title

Date

Subcontractor/Supplier Signature

Title

Date

Rhode Island Commerce Corporation

RFP/RFQ RESPONSE CERTIFICATION COVER FORM

Instruction: To fulfill your RFP/RFQ response, this form must be completed, printed,

signed and included with your submission.

SECTION 1 - RESPONDENT INFORMATION

RFP/RFQ Number:

RFP/RFQ Title:

RFP/RFQ Respondent Name:

Address:

Telephone:

Fax:

Contact Name: Contact Title:

Contact Email:

SECTION 2 —DISCLOSURES

RFP/RFQ Respondents must respond to every statement. RFP/RFQ Responses submitted without a

complete response may be deemed nonresponsive.

Indicate “Y” (Yes) or “N” (No) for Disclosures 1-4, and if “Yes,” provide details below

____ 1. State whether the Respondent, or any officer, director, manager, stockholder, member, partner, or other owner or principal of the

Respondent or any parent, subsidiary, or affiliate has been subject to suspension or debarment by any federal, state, or municipal governmental

authority, or the subject of criminal prosecution, or convicted of a criminal offense within the previous 5 years. If “Yes,” provide details below.

____ 2. State whether the Respondent, or any officer, director, manager, stockholder, member, partner, or other owner or principal of the

Respondent or any parent, subsidiary, or affiliate has had any contracts with a federal, state, or municipal governmental authority terminated for

any reason within the previous 5 years. If “Yes,” provide details below.

____ 3. State whether the Respondent, or any officer, director, manager, stockholder, member, partner, or other owner or principal of the

Respondent or any parent, subsidiary, or affiliate has been fined more than $5000 for violation(s) of any Rhode Island environmental law(s) by

the Rhode Island Department of Environmental Management within the previous 5 years. If “Yes,” provide details below.

____ 4. State whether any officer, director, manager, stockholder, member, partner, or other owner or principal of the Respondent is serving or

has served within the past two calendar years as either an appointed or elected official of any state governmental authority or quasi-public

corporation, including without limitation, any entity created as a legislative body or public or state agency by the general assembly or constitution

of this state.

Disclosure details (continue on additional sheets if necessary):

SECTION 3 —OWNERSHIP DISCLOSURE

Respondents must provide all relevant information. Respondent proposals submitted without a complete response may be

deemed nonresponsive.

If the Respondent is publicly held, the Respondent may provide owner information about only those stockholders, members, partners, or other

owners that hold at least 10% of the record or beneficial equity interests of the Respondent; otherwise, complete ownership disclosure is required.

List each officer, director, manager, stockholder, member, partner, or other owner or principle of the Respondent, and each intermediate parent

company and the ultimate parent company of the Respondent. For each individual, provide his or her name, business address, principal

occupation, position with the Respondent, and the percentage of ownership, if any, he or she holds in the Respondent, and each intermediate

parent company and the ultimate parent company of the Respondent.

SECTION 4 —CERTIFICATIONS

Respondents must respond to every statement. Responses submitted without

a complete response may be deemed nonresponsive.

Indicate “Y” (Yes) or “N” (No), and if “No,” provide details below.

THE RESPONDENT CERTIFIES THAT:

____ 1. The Respondent will immediately disclose, in writing, to the Rhode Island Commerce Corporation any potential conflict of interest which

may occur during the term of any contract awarded pursuant to this solicitation.

____ 2. The Respondent possesses all licenses and anyone who will perform any work will possess all licenses required by applicable federal,

state, and local law necessary to perform the requirements of any contract awarded pursuant to this solicitation and will maintain all required

licenses during the term of any contract awarded pursuant to this solicitation. In the event that any required license shall lapse or be restricted or

suspended, the Respondent shall immediately notify the Rhode Island Commerce Corporation in writing.

____ 3. The Respondent will maintain all required insurance during the term of any contract pursuant to this solicitation. In the event that any

required insurance shall lapse or be canceled, the Respondent will immediately notify the Rhode Island Commerce Corporation in writing.

____ 4. The Respondent understands that falsification of any information in its RFP/RFQ response or failure to notify the Rhode Island

Commerce Corporation of any changes in any disclosures or certifications in this Respondent Certification may be grounds for suspension,

debarment, and/or prosecution for fraud.

____ 5. The Respondent has not paid and will not pay any bonus, commission, fee, gratuity, or other remuneration to any employee or official of

the Rhode Island Commerce Corporation or the State of Rhode Island or any subdivision of the State of Rhode Island or other governmental

authority for the purpose of obtaining an award of a contract pursuant to this solicitation. The Respondent further certifies that no bonus,

commission, fee, gratuity, or other remuneration has been or will be received from any third party or paid to any third party contingent on the

award of a contract pursuant to this solicitation.

___ 6. This RFP/RFQ response is not a collusive RFP/RFQ response. Neither the Respondent, nor any of its owners, stockholders, members,

partners, principals, directors, managers, officers, employees, or agents has in any way colluded, conspired, or agreed, directly or indirectly,

with any other Respondent or person to submit a collusive response to the solicitation or to refrain from submitting response to the solicitation,

or has in any manner, directly or indirectly, sought by agreement or collusion or other communication with any other Respondent or person to

fix the price or prices in the response or the response of any other Respondent, or to fix any overhead, profit, or cost component of the price in

the response or the response of any other Respondent, or to secure through any collusion, conspiracy, or unlawful agreement any advantage

against the Rhode Island Commerce Corporation or the State of Rhode Island or any person with an interest in the contract awarded pursuant

to this solicitation. The price in the response is fair and proper and is not tainted by any collusion, conspiracy, or unlawful agreement on the part

of the Respondent, its owners, stockholders, members, partners, principals, directors, managers, officers, employees, or agents.

____ 7. The Respondent: (i) is not identified on the General Treasurer’s list created pursuant to R.I. Gen. Laws § 37-2.5-3 as a person or entity

engaging in investment activities in Iran described in § 37-2.5-2(b); and (ii) is not engaging in any such investment activities in Iran.

____ 8. The Respondent will comply with all of the laws that are incorporated into and/or applicable to any contract with the Rhode Island

Commerce Corporation.

Certification details (continue on additional sheet if necessary):

Submission by the Respondent of a response pursuant to this solicitation constitutes an offer to contract with

the Rhode Island Commerce Corporation on the terms and conditions contained in this solicitation and the

response. The Respondent certifies that: (1) the Respondent has reviewed this solicitation and agrees to comply

with its terms and conditions; (2) the response is based on this solicitation; and (3) the information submitted in

the response (including this Respondent Certification Cover Form) is accurate and complete. The Respondent

acknowledges that the terms and conditions of this solicitation and the response will be incorporated into any

contract awarded to the Respondent pursuant to this solicitation and the response. The person signing below

represents, under penalty of perjury, that he or she is fully informed regarding the preparation and contents of

this response and has been duly authorized to execute and submit this response on behalf of the Respondent.

RESPONDENT

Date:_________________ ______________________________________________

Name of Respondent

______________________________________________

Signature in ink

______________________________________________

Printed name and title of person signing on behalf of Respondent

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- NP TIO Application (2) (1) (Town of North Providence)

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