Parktakes Magazine: Printing and Mailing Services

Agency:	Fairfax County
State:	Virginia
Type of Government:	State & Local
NAICS Category:	323111 - Commercial Printing (except Screen and Books) 323117 - Books Printing
Posted Date:	Nov 14, 2022
Due Date:	Nov 28, 2022
Solicitation No:	IFB2000003621
Bid Source:	Please Login to View Page
Contact information:	Please Login to View Page
Bid Documents:	Please Login to View Page

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IFB 2000003621

Attachment A1

BIDDER DATA SHEET

Note: The following information is required as part of your response to this solicitation. Failure to complete and provide

this sheet may result in finding your bid nonresponsive.

Qualification: The vendor must have the capability and capacity in all respects to satisfy fully all of the

contractual requirements.

Vendor’s Primary Contact:

Name: __________________________________ Phone: _________________________

Vendor Information:

eVA Vendor ID or DUNS Number: ________________________________

Indicate below a listing of at least three (3) current or recent accounts, either commercial or governmental,

that your company is servicing, has serviced, or has provided similar goods. Include the length of service and

the name, address, and telephone number of the point of contact.

A. Company:________________________________ Contact: _____________________________

Phone:(_____)____________________________ Fax: (_____)__________________________

Project:_______________________________________________________________________

Dates of Service: _________________________________$ Value: _______________________

B. Company_____________________________ Contact: ________________________________

Phone:(_____)_________________________ Fax: (_____)_____________________________

Project:_______________________________________________________________________

Dates of Service: ______________________________$ Value: ________________________

C. Company:____________________________ Contact: ________________________________

Phone:(_____)_________________________ Fax:(_____)____________________________

Project:_____________________________________________________________________

Dates of Service: ______________________________$ Value: ________________________

I certify the accuracy of this information.

Signed: ________________________________Title: _____________________________ Date: _______________

IFB 2000003621

Attachment A2

BUSINESS CLASSIFICATION SCHEDULE

PLEASE CLASSIFY YOUR BUSINESS/ORGANIZATION BY MARKING IN STEP 1. STEP 2 IS OPTIONAL. This designation

is requested of all business/organizations including publicly traded corporations, non-profits, sheltered workshops, government

organizations, partnerships, sole proprietorships, etc. Fairfax County does not certify business classifications nor does it

establish preferences or set-asides for specific classifications.

Examples:

• A small, Asian women-owned business would mark “Small” in Step 1, then “Women-Owned” and “Minority-

Owned” in Step 2

• A small, service-disabled veteran and women-owned business would mark “Small” in Step 1, then “Women-

Owned” and “Service-Disabled Veteran-Owned” in Step 2

• A government agency/public body would ONLY mark “Government Agency/Public Body” in Step 1

NAME OF BUSINESS: _______________________________________________________________

LAST 4 DIGITS OF TIN/EIN: ______________ SIGNATURE: __________________________________

Step 1: Please indicate the classification of your business/organization. Select ONLY one (1) option.

☐ Small

☐ Large

☐ Non-Profit ☐ Government Agency/Public Body ☐ Shelter Workshop

Step 2 (OPTIONAL): Please indicate what type of ownership your business/organization consists of. You may

choose MORE than one (1) option.

☐ Women-Owned

☐ Minority-Owned

☐ Service-Disabled Veteran-Owned

DEFINITIONS

Small Business/Organization - “Small business” means a business that is at least 51% independently owned and controlled

by one or more individuals who are U.S. citizens or legal resident aliens, and together with affiliates, has 250 or fewer employees,

or average annual gross receipts of $10 million or less averaged over the previous three years. One or more of these individual

owners shall control both the management and daily business operations of the small business.

Minority Business - is a business concern that is at least 51% owned by one or more minority individuals or in the case of a

corporation, partnership or limited liability company, or other entity, at least 51% of the equity ownership interest in the

corporation, partnership or limited company or other entity is owned by one or more minority individuals and both the

management and daily business operations are controlled by one or more minority individuals. Such individuals shall include

Asian American, African American, Hispanic American, Native American, Eskimo, or Aleut.

Women-Owned Business - a business concern that is at least 51% owned by one or more women who are U.S. citizens or

legal resident aliens, or in the case of a corporation, partnership or limited company or other entity, at least 51% of the equity

ownership interest is owned by one or more women who are U.S. citizens or legal resident aliens, and both the management

and daily business operations are controlled by one or more women who are U.S. citizens or legal resident aliens.

Service-Disabled Veteran - means a veteran who (i) served on active duty in the United States military ground, naval, or air

service, (ii) was discharged or released under conditions other than dishonorable, and (iii) has a service - connected disability

rating fixed by the United States Department of Veterans Affairs.

Service-Disabled Veteran-Owned Business - is a business that is at least 51 percent owned by one or more service -disabled

veterans or, in the case of a corporation, partnership, or limited liability company or other entity, at least 51 percent of the equity

ownership interest in the corporation, partnership, or limited liability company or other entity is owned by one or more individuals

who are service-disabled veterans and both the management and daily business operations are controlled by one or more

individuals who are service-disabled veterans.

Shelter Workshop - a private non-profit, state, or local government institution that provides employment opportunities for

individuals who are developmentally, physically, or mentally impaired, to prepare for gainful work in the general economy. These

services may include physical rehabilitation, training in basic work and life skills (e.g., how to apply for a job, attendance, personal

grooming, and handling money), training on specific job skills, and providing work experience in the workshop.

IFB 2000003621

Attachment A3

VIRGINIA STATE CORPORATION COMMISSION (SCC)

REGISTRATION INFORMATION

The offeror:

□ is a corporation or other business entity with the following SCC identification number:

________________________________ -OR-

□ is not a corporation, limited liability company, limited partnership, registered limited

liability partnership, or business trust -OR-

□ is an out-of-state business entity that does not regularly and continuously maintain as

part of its ordinary and customary business any employees, agents, offices, facilities, or

inventories in Virginia (not counting any employees or agents in Virginia who merely solicit

orders that require acceptance outside Virginia before they become contracts, and not

counting any incidental presence of the offeror in Virginia that is needed in order to

assemble, maintain, and repair goods in accordance with the contracts by which such

goods were sold and shipped into Virginia from offeror’s out-of-state location) -OR-

□ is an out-of-state business entity that is including with this proposal an opinion of legal

counsel which accurately and completely discloses the undersigned offeror’s current

contacts with Virginia and describes why whose contacts do not constitute the transaction

of business in Virginia within the meaning of § 13.1-757 or other similar provisions in Titles

13.1 or 50 of the Code of Virginia.

□ Please check the following box if you have not checked any of the foregoing options

but currently have pending before the SCC an application for authority to transact

business in the Commonwealth of Virginia and wish to be considered for a waiver to allow

you to submit the SCC identification number after the due date for proposals.

IFB 2000003621

Attachment A4

Certification Regarding Ethics in Public Contracting

In submitting this proposal, and signing below, Bidder/Offeror certifies the following in

connection with a bid, proposal, or contract:

Check one:

1. I have not given any payment, loan, subscription, advance, deposit of

money, services or anything of more than nominal or minimal value to

any public employee or official have official responsibility for a

procurement transaction.

2. I have given a payment, loan, subscription, advance, deposit of money,

services or anything of more than nominal or minimal value to a public

employee or official have official responsibility for a procurement

transaction, but I received consideration in substantially equal or

greater value in exchange.

If 2 is selected, please complete the following:

Recipient:

_____________________________________________________

Date of Gift:

_____________________________________________________

Description of the gift and its value:

______________________________________________________________________

Description of the consideration received in exchange and its value:

______________________________________________________________________

Printed Name of Offeror Representative: _______________________________

Signature/Date: ____________________________________ / _______________

Company Name: _____________________________________________________

Company Address: _____________________________________________________

City/State/Zip:

_____________________________________________________

This certification supplements but does not replace the requirements set forth in paragraph

59 (OFFICIALS NOT TO BENEFIT) of the General Conditions and Instructions to Bidders

included in this solicitation.

IFB 2000003621

Attachment A5

Please provide the following information on your company letter head:

Vendor name:

Doing Business As/(Trade Name):

Corporate Address (Address Listed on W9):

Zip code:

(please include last four digits)

Remittance Address ☐

Zip code:

(please include last four digits)

Contact name:

Email:

Phone:

FAX:

Standard Method of Communication: EMAIL ☐ FAX ☐ MAIL ☐ OTHER ☐

Purchase Order Address ☐

Zip code:

(please include last four digits)

Contact name:

Email:

Phone:

FAX:

Standard Method of Communication: EMAIL ☐ FAX ☐ MAIL ☐ OTHER ☐

Parktakes Magazine: Printing and Mailing Services

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