PROPOSALS RECEIVED AFTER THE SUBMISSION DEADLINE WILL NOT BE CONSIDERED.

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1 Minnesota State Colleges and Universities Request for Proposals for Designer Selection for Winona State University Kryzsko Commons Addition and Renovation To Minnesota Registered Design Professionals: The State of Minnesota, acting through its Board of Trustees of the Minnesota State Colleges and Universities, on behalf of Winona State University, is seeking a designer for the above project. Sealed proposals must be received at the following address by 3:00 pm CST Tuesday, November 6, 2012: Steve Ronkowski Facilities Coordinator Winona State University Facilities Planning and Construction Office 203B 175 West Mark Street Winona, MN PROPOSALS RECEIVED AFTER THE SUBMISSION DEADLINE WILL NOT BE CONSIDERED. Responses received after the deadline will be returned to the Responder unopened. Fax and responses will not be considered. All questions concerning procedures, schedule and those relating to the project are to be referred only to the project contact in Item 1.l. 1

2 1. PROJECT a. PROJECT DESCRIPTION: The State of Minnesota, acting through its Board of Trustees of the Minnesota State Colleges and Universities, on behalf of Winona State University, hereinafter referred to as MnSCU, intends to retain a design team to provide architectural and engineering consulting services for the Kryzsko Commons Phase III Renovation and Addition, located on the main campus of the University. The scope of work includes interior renovation work and construction of a new addition to the east side of the Kryszko Commons Phase III Building. The main goals of this project are to increase space for student study and meeting functions, to increase display and storage space for the bookstore, to add fire protection to the Phase III building, and to reduce deferred maintenance issues throughout the building. Underlying goals include addressing site accessibility issues, updating both the interior and exterior of the building and strengthening the building presence and image amongst the campus. b. SCOPE OF SERVICES: The scope of services includes full architectural and engineering design services through construction document preparation, construction scheduling, bidding, construction procurement, and construction administration services, all in accordance with the AIA Document B101 Standard Form of Agreement Between Architect and Owner as amended by the Minnesota State Colleges and Universities. Complete design services shall include field verification of existing conditions and systems of the building, along with an evaluation of the program needs identified in the predesign report. The Respondent shall also evaluate the project budget and schedule requirements each in terms of the other. Schedule requirements shall include an evaluation and recommendation of staging aspects that minimize the disruption of the occupancy schedule. The Respondent shall clearly communicate design and cost ramifications of the schedule impact to allow the Owner a full understanding of the design and schedule decisions. The final design by the Respondent shall blend in with and complement the existing building and overall campus architecture. All drawings and specifications shall be completed in accordance with the following, as a minimum: 1. Current Minnesota State Colleges and Universities Design Standards 2. All applicable state and local building, life safety, mechanical, electrical and energy codes 3. State of Minnesota Sustainable Building Guidelines (B3) 4. ADA regulations 5. Predesign Report program requirements. 2

3 Prepare all design documents using computer aided design and drafting technology in an electronic data exchange file format acceptable to Minnesota State Colleges and Universities. c. REQUIRED CONSULTANT TEAM: Architectural Services including interiors, furniture, fixtures and equipment design, interior and exterior identification and directional signage, cost estimating (if not provided by internal assets may be provided by consultant, see services listed below), project scheduling that includes assistance with staging concepts for construction and construction administration. Structural Engineer Mechanical Engineer including fire protection engineering and integration with the existing energy management system Electrical Engineer including integration with the existing security and fire detection and alarm systems Telecommunications, data, security Systems Designer Cost Estimating Consultant (unless provided as part of the architectural firm s services) Roofing Consultant - A roof design consultant coordinated with and acceptable to the Minnesota State Colleges and Universities institution and the system office will be an integral part of the consultant s design team. The design consultant s fee shall include the fees and reimbursable expenses of the roof design consultant. d. SERVICES PROVIDED BY OTHERS: The following services may be provided by the Owner under separate contract. Some scheduling and coordination may be required by the Respondent. Asbestos and hazardous materials surveys, design and abatement; Construction observations, construction materials inspection and testing services; Mechanical and electrical systems commissioning services. e. PASS/FAIL REQUIREMENTS: The requirements of this section will be assessed on a pass/fail basis. Responders must pass each of the requirements identified to proceed to the proposal evaluation stage. The respondent s proposal was submitted prior to the deadline. Responders have made affirmative representations of the following on the transmittal form: 1. Original Signature in ink of principal of prime firm 2. A statement that proposal contents are true and accurate to the best knowledge of signatory 3. A statement of commitment to enter into the work promptly, if selected, by engaging the consultants and assigning the persons named in the proposal along with adequate staff to meet requirements of the work. 3

4 4. A statement indicating that the consultants listed have been contacted and have agreed to be a part of the team. 5. A statement indicating that consultants are willing to enter into a contract using the state s contract forms and agreeing to their terms. g. PROJECT BUDGET/FEES: The total estimated project cost is estimated at $4, This cost includes all professional fees and reimbursable expenses, surveys, construction, project management, construction inspection and testing, furniture, fixtures, equipment, contingencies, and inflation factors. Design fees for this project shall be based on the project description described herein and in the Predesign Report, and shall include sub-consultant design fees and all reimbursable expenses according to the AIA Document B101 contract provisions. A copy of the MnSCU 2012 Commissioner s Plan Expense Reimbursement is attached for reference. A final design fee will be negotiated upon selecting the Respondent firm. This design fee is anticipated to be approximately 6-8% of the estimated construction cost. h. PROJECT SCHEDULE: December 2012 January 2013 February 2013 March 2013 April 2013 May 2013 June 2013 July 2013 February 2014 March 2014 Schematic Design Design Development Construction Documents Bidding Construction Owner Occupancy i. PROJECT PRE-DESIGN INFORMATION: The Predesign Report dated May 25,2012 was prepared by Elness Swenson Graham Architects, Inc. An electronic copy of this report is available on the Winona State University Facilities Planning and Construction Website at An electronic copy of this report can also be provided if requested. j. PROJECT INFORMATIONAL MEETING: An informational meeting is scheduled for 2:00 PM, October 29, 2012, in the Facilities Conference Room 202 at Winona State University. This informational meeting will include a walk-through of the proposed project areas and a review of the scope of work. To avoid any possible unfair competitive advantage among responders during the solicitation process this will be the only public meeting for the project. There will be no private tours, meetings or communications outside the provisions in this RFP. 4

5 k. QUESTIONS REGARDING THIS PROJECT: To assure potential responders receive the same information about the Project, only questions submitted by for clarifications about this RFP will be addressed. Responder questions must be ed only to the attention of the project contact, no later than 2:00 pm on October 30, The project contact is the only person authorized to respond to questions regarding the RFP. Other persons are not authorized to discuss RFP requirements before the proposal submission deadline, and Winona State University shall not be bound by and Responders may not rely on information regarding RFP requirements obtained from non-authorized persons. When ing questions, include Kryzsko Commons Addition RFP question from (firm name) in the subject line. The body of the question shall include the name of the questioner, the firm they represent, a contact phone number and a contact address. Anonymous inquiries will not be answered. No member of the proposing firm or its sub-consultants shall discuss this Request for Proposal (RFP) or the project with any member of the requesting agency from the date of publication of this RFP in the State Register, other than the prescribed communication provisions set forth in this RFP. l. PROJECT CONTACTS: Winona State University s agent for purposes of responding to inquiries about the RFP is: Name: Steve Ronkowski, Facilities Coordinator Address: 175 West Mark Street, Winona, MN Phone: (507) sronkowski@winona.edu m. SELECTION SCHEDULE: Monday October 22, 2012 RFP Release Date Monday October 29, 2012 at 2:00 pm Informational Meeting and Building Walk Through Tuesday October 30, 2012 by 2:00 pm RFP Questions to Owner Contact Wednesday October 31, 2012 RFP Questions Answered by Owner Tuesday November 6, 2012 by 3:00 pm Deadline for RFP Submissions November 7 to November 9, 2012 Evaluation and Short Listing Friday November 16, 2012 *Interviews and Selection Monday November 30, 2012 Proposed Design Contract Award *Respondents shall assume that all interviews will be scheduled for Friday, November 16, 2012 at Winona State University. More information on time and location will be provided upon being selected to participate in the interview process. 5

6 n. INTERVIEWS, TEAM CHANGES AND INTERVIEW MATERIALS: Proposers who are short-listed for interviews will be notified by . Interviewed firms may not submit any additional materials to the committee beyond their original proposal with the exception of the following: An addendum to the original proposal regarding a new design team member, consultant firm or firm member may be submitted under the following conditions: o If the team has been awarded another major project since the Request For Proposal due date and the team member is working on the project awarded, resulting in a conflict; o If a team member has left one of the submitting firms since the Request For Proposal due date; o If a team member must be removed due to cause In such cases, the addendum should include a cover letter of no more than one page explaining cause and attach a resume of no more than one page. A copy of the proposer s presentation materials may be distributed during the interview, such as a PowerPoint presentation or presentation boards. Such materials should only include materials covered by the team during the interview. o. SAMPLE CONTRACT: The successful responder will be required to meet all the terms and conditions and execute the current AIA Document B101 Standard form of Agreement between Owner and Architect as amended by Minnesota State Colleges and Universities. A copy of the AIA Document B101 is available at the Minnesota State Colleges and Universities Facilities website, 6

7 2. PROPOSAL FORMAT a. HARD COPIES: The Respondent shall submit eight hard copies of the proposal response. The proposal body shall be submitted in bound 8 ½ "x 11" format, with a font size no smaller than 10 point. The proposal shall be limited to 20 faces maximum, not counting the transmittal cover letter, index/table of contents, section divider sheets (if provided) and attachment forms and certifications. The body of the proposal shall include the items listed in the Proposal Content section, with pages numbered. Additional materials, if any, may be in any format fitting within the 8 ½ "x 11" package and will be at the discretion of the Respondent. Any additional materials included in the proposal will also be judged as part of the proposal submission. All items to be included as part of the RFP Response shall be bound together, leaving to loose items. b. ELECTRONIC COPIES: Provide one electronic copy of the response on CD in.pdf format. The disk shall be labeled with Responder s firm name, date and title of the contents. The file size should be less than 4MB. The document should be password secured against copying text, images and other content. 3. PROPOSAL CONTENTS a. TRANSMITTAL FORM: Firms are required to submit one original copy of the attached transmittal form with their responses. b. COVER LETTER: Include a single faced cover letter that summarizes the Respondent s proposal. c. FIRM INFORMATION: For the prime firm, and each consultant firm, provide a brief description including: Name and location Year established Legal status Ownership Staffing by discipline, total staff, and how many employees are located in Minnesota For firms with multiple offices, briefly summarize which office will be the primary location, which office will do what parts of the project and how many employees in each office will be working on the project For the prime firm - identify if certified as a Targeted Group/Economically Disadvantaged firm 7

8 d. PROJECT TEAM Provide a brief statement of the team s past or present working relationships, including the following for each team member and consultant: Name and position in firm (including home base if in a multi-office firm) Responsibility on this project Years of experience Relevant recent experience (note if experience is with a previous firm) Registration (including specialty if engineer) Specifically address the availability of appropriate personnel and their capacity to accomplish the work within the time constraints e. TEAM ORGANIZATION: If planning or design consultants are a part of the team, explain how they will be utilized (e.g. major role during design, absent during construction, etc). Including a matrix or chart is suggested. f. PROJECT EXPERIENCE: For architectural and/or planning firms, please provide examples of relevant projects recently completed or in currently in progress including: Photographs, sketches and/or plans Name and location Brief description (e.g. size, cost, relevance) Firm of record indicating the role of each proposed team member on the relevant project Completion date or current status For engineering or technical firms, provide examples of relevant projects recently completed or in progress including the above. Photographs, sketches and/or plans are to be for only that portion of the work for which firm was responsible. For example, if the firm designed the mechanical system, then a photo of the mechanical system is appropriate, not an exterior building image (unless relevant to the system design). g. APPROACH/METHODOLOGY: Describe your understanding of the project, significant issues to be addressed and your specific approach to the planning, design and construction process for this project. Address constraints you perceive that may affect this proposed project. 8

9 h. UNIQUE QUALIFICATIONS: Briefly summarize your team s unique qualifications for this project. i. FEE CHART: A list of all State and Minnesota State Colleges and Universities (MnSCU) and University of Minnesota current and past projects and studies awarded to the prime firm(s) responding to this request for proposal during the four years immediately preceding the date of this request for proposal. Projects and studies shall be defined as those projects and studies (1) funded by the state legislature, by state/user agencies, MnSCU or University of Minnesota operating funds, or by funding raised from the private sector or individuals by state/user agencies, MnSCU or the University of Minnesota; (2) awarded as a result of the State Designer Selection Board process or awarded directly by state/user agencies, MnSCU or the University of Minnesota without employing the State Designer Selection Board process; or (3) related to design-bid-build or design/build project delivery systems, including owner s representative fees. The prime firm(s) shall list and total all gross fees associated with the above projects and studies, whether the fees have been received or are anticipated. In addition, the prime firm(s) shall indicate the amount of fees listed which were paid, or are anticipated to be paid, to engineering or other specialty consultants employed, or anticipated to be employed, on the projects and studies listed pursuant to the above. The prime firm(s) shall subtract consultant fees from gross fees to determine total net fees using the format below. PROJECT (A) GROSS FEES (B) SUBDESIGNERS PORTION (C) NET TOTAL PROJECT FEE TOTAL The total shown in column (A) shall equal the sum of those shown in columns (B) and (C). j. ADDITIONAL FORMS: One (1) copy of the following forms must be included with the proposal submitted: Affidavit of Noncollusion form is completed, signed, and notarized. Location of Service Disclosure and Certification form is complete and signed. The information on the Affirmative Action Certification is complete and signed. A statement regarding Organizational Conflicts of Interest If applicable, Veteran Owned/Service Disabled Veteran-Owned Firm form is completed. 9

10 4. SELECTION CRITERIA In making its selection of designers, the committee will consider and score each proposal response using the criteria listed below, assigning points for each section. Respondents receiving high evaluation scores will be selected for interviews. The committee will re-evaluate interviewed designers using the same criteria, to select one final designer for contract award. a. QUALIFICATIONS, COMPETENCE AND PRIOR PERFORMANCE 25 POINTS: The Respondent shall provide descriptive narratives of its general problem-solving methods, management and control of project scope, schedule and budget, and knowledge and use of technology. Highlight any services which can be proven by the Respondent to have been carried out successfully on other similar projects. Demonstrate successes of life cycle costing during the design process, including, but not limited to, energy efficiency, sustainability, and the maintainability of design, materials, and equipment. The Respondent shall provide a summary of its experience with design of projects of similar nature and scope to this project. Specifically state the project description, scale and complexity, project work dates and geographic location of each. Demonstrate the team s history of constructability, meeting schedule deadlines, accurate cost estimating and designing within a project budget. Quality control and complete, accurate and fully coordinated contract documents are an important element of the selected design team's services. Provide a change order history of recent past projects and how the team proposes to address this issue shall be provided as part of their submittal. The prime firm(s) shall list the project name and type (new, renovation, and/or remodeling), contract construction budget, bid award amount, total change orders (amount and percentage of overall budget), and total change orders initiated by owner (amount and percentage of overall budget) for projects listed in the proposal, in the matrix format provided below: A B C D E E/C F F/C Project Name Project Type (New, Renovation and/or Remodeling Contract Construction Budget Bid Award Amount Total Change Orders Total Change Orders (Amount and Percentage of Overall Budget) Total Change Orders Initiated by Owner (Amount) Owner Initiated Change Orders (Percentage of Overall Budget) [Note: Unsatisfactory performance must be documented in writing from the Commissioner of Administration, the University of Minnesota or Minnesota State Colleges and Universities based on criteria set forth in Minnesota Statutes 16B.33 Subd 4(f).] 10

11 b. LEADERSHIP, INTEGRATION AND COHESIVENESS OF THE PROPOSED TEAM 25 POINTS: The Respondent shall list the members of its team that will be assigned to this specific project work, their planned responsibilities on this project, and the anticipated percentage of the time of each to be used during specific portions of the project period. The Respondent shall include summary resumes of key team members, indicating education, and years of experience with their company, as well as qualifications and special expertise, including specific experience with projects similar to the one that is the subject of this RFP. All proposed consultants shall be identified as part of your design team. Include descriptions of the firms experience, past performance, availability to the project, and a brief summary of the working relationship between the primary firm and the consultant. c. DESIGN ABILITY AND AESTHETICS 15 POINTS: This is demonstrated by the experience of the proposed team on similar projects. d. PROJECT UNDERSTANDING AND APPROACH/METHODOLOGY 20 POINTS: Demonstrate the proposed team's project understanding and approach/methodology as it applies to this project, including the constraints and issues affecting this proposed project. Detail your approach to ensuring the project documents are coordinated and internally consistent within all disciplines and between all consultants. This is demonstrated by the team's proposal and discussion in the interview. e. UNIQUE QUALIFICATIONS 15 POINTS: This is demonstrated by any unique qualifications of the proposed design team as they relate to this project, or as they can be demonstrated to be a benefit to the Owner. These unique qualifications may include the primary firm or any consultant s geographic location to the project site. f. OTHER UP TO (6) BONUS POINTS: 1. If certified as a Targeted Group/Economically Disadvantaged firm. For information regarding certification, contact the Materials Management Helpline at , or you may reach the Helpline by at mmd.help.line@state.mn.us. For TTY/TDD communications, contact the Helpline through the Minnesota Relay Services at If certified by the U.S. Department of Veterans Affairs prior to the solicitation opening date and time as a Veteran-owned/Service Disabled Veteran-Owned firm. Information regarding certification by the United States Department of Veterans Affairs may be found at 11

12 5. RIGHTS RESERVED This RFP does not obligate the Minnesota State Colleges and Universities (MnSCU) system, its Board of Trustees or Winona State University to award a contract or complete the proposed project. Notwithstanding anything to the contrary, the State reserves the right to: 1. Reject any and all Proposals received in response to this RFP; 2. Disqualify any Responder whose conduct or Proposal fails to conform to the requirements of this RFP; 3. Have unlimited rights to duplicate all materials submitted for purposes of RFP evaluation, and duplicate all public information in response to data requests regarding the Proposal; 4. Select for contract or for negotiations a Proposal other than that with the lowest cost or the highest evaluation score; 5. At its sole discretion, reserve the right to waive any non-material deviations from the requirements and procedures of this RFP and waive informalities contained in the RFP; 6. Negotiate as to any aspect of the Proposal with the selected Responder including asking for a Responder s Best and Final offer; 7. Extend the contract for up to an additional three years, in increments determined by the State, not to exceed a total contract term of five (5) years; and 8. Cancel the Request for Proposal at any time with no cost or penalty to the State All costs incurred in responding to this RFP will be borne by the responder. This RFP does not obligate the State to award a contract or complete the project, and the State reserves the right to cancel the solicitation if it is considered to be in its best interest. 6. CONTRACT REQUIREMENTS a. AFFIDAVIT OF NONCOLLUSION Each responder must complete the Affidavit of Noncollusion form, which is attached to this Request for Proposal. b. CONFLICTS OF INTEREST Responder must provide a list of all entities with which it has relationships that create, or appear to create, a conflict of interest with the work that is contemplated in this request for proposals. The list should indicate the name of the entity, the relationship, and a discussion of the conflict. c. ORGANIZATIONAL CONFLICTS OF INTEREST The responder must include in their proposal a statement warranting that, to the best of its knowledge and belief, and except as otherwise disclosed, there are no relevant facts or circumstances that could give rise to organizational conflicts of interest. An organizational conflict of interest exists when, because of existing or 12

13 planned activities or because of relationships with other persons, the responder is unable or potentially unable to render impartial assistance or advice to the State, or the responder s objectivity in performing the contract work is or might be otherwise impaired, or the responder has an unfair competitive advantage. The responder agrees that, if after award, an organizational conflict of interest is discovered, an immediate and full disclosure in writing must be made to Scott Ellinghuysen, Interim Vice President of Finance and Administration, Winona State University, 107A Somsen Hall, Winona, MN which must include a description of the action which the contractor has taken or proposes to take to avoid or mitigate such conflicts. If an organization conflict of interest is determined to exist, the State may, at its discretion, cancel the contract. In the event the responder was aware of an organizational conflict of interest prior to the award of the contract and did not disclose the conflict to the contracting officer, the State may terminate the contract for default. The provisions of this clause must be included in all subcontracts for work to be performed similar to the service provided by the prime contractor (consultant), and the terms contract, contractor (consultant), and contracting officer modified appropriately to preserve the State s rights. d. DISPOSITION OF RESPONSES All materials in response to this RFP will become the property of the State and will become public record in accordance with Minnesota Statutes after the evaluation process is complete. Pursuant to the statute, completion of the evaluation process occurs when the government entity has completed negotiating the contract with the selected vendor. If the responder submits information in response to this RFP that it believes to be trade secret materials, as defined by the Minnesota Government Data Practices Act, Minn. Stat , the responder must: clearly mark all trade secret materials in its response at the time the response is submitted, include a statement with its response justifying the trade secret designation for each item, and defend any action seeking release of the materials it believes to be trade secret, and indemnify and hold harmless the State, its agents and employees, from any judgments or damages awarded against the State in favor of the party requesting the materials, and any and all costs connected with that defense. This indemnification survives the State s award of a contract. In submitting a response to this RFP, the responder agrees that this indemnification survives as long as the trade secret materials are in possession of the State. Winona State University will not consider the prices submitted by the responder to be proprietary or trade secret materials. Notwithstanding the above, if the State contracting party is a part of the judicial branch, the release of data shall be in accordance with the Rules of Public Access to Records of the Judicial Branch promulgated by the Minnesota Supreme Court as the same may be amended from time to time. 13

14 e. CONTINGENCY FEES PROHIBITED Pursuant to Minnesota Statutes Section 10A.06, no person may act as or employ a lobbyist for compensation that is dependent upon the result or outcome of any legislation or administrative action. f. HUMAN RIGHTS REQUIREMENTS For all contracts estimated to be in excess of $100,000, responders are required to complete the Affirmative Action Data page and return it with the response. The form is attached to this Request for Proposal. As required by Minn. R , It is hereby agreed between the parties that Minn. Stat. 363A.36 and Minn. R are incorporated into any contract between these parties based upon this specification or any modification of it. A copy of Minn. Stat and Minn. R are available on the website g. WORKERS COMPENSATION AND OTHER INSURANCE By submission of a proposal, responder certifies that it is in compliance with all insurance requirements specified in MnSCU s current AIA Document B101 Standard form of Agreement between Owner and Architect as amended by Minnesota State Colleges and Universities. A copy of the AIA Document B101 is available at the Minnesota State Colleges and Universities Facilities website, h. LOCATION OF SERVICE CERTIFICATION AND DISCLOSURE The location of where the proposed work will be performed by the vendor must be disclosed using the Location of Service Certification and Disclosure form attached to this Request for Proposal. i. VETERAN-OWNED/SERVICE DISABLED VETERAN-OWNED FIRM If certified by the U.S. Department of Veterans Affairs prior to the solicitation opening date and time as a Veteran owned/service Disabled Veteran-Owned firm, complete Veteran Preference form found at "Veteran Preference Forms." 14

15 Date: Firm Name: Firm Address: Firm Phone Number: Firm Address: Winona State University Kryzsko Commons Addition and Renovation Transmittal Form [company name] Contact Person: Contact Person Phone Number: Contact Person Address: Firm Fax Number: Response includes: Transmittal Sheet - this page with the following attached to it: Affidavit of Non-Collusion Location of Service Form Organizational Conflict of Interest Cover Letter (no more than one page) Affirmative Action Certification Veteran Owned/Service Disabled Veteran Owned Preference Form (if applicable) (8) Copies of Proposal: (each proposal is no more than twenty pages and includes:) Cover Letter Information on Firms Project Team Team Organization Project Experience Fee Chart (or statement of no fees in last four years) Project Approach/Methodology Unique Qualifications All pages are numbered Portrait format and bound Proposer certifies that no member of the proposing firm or its sub-consultants has discussed this Request for Proposal (RFP) or the project with any member of the requesting agency from the date of publication of this RFP in the State Register, other than the prescribed communication provisions set forth in the RFP. Proposer further certifies that no member of the proposing firm or its sub-contractors will have any discussions regarding this RFP or project with any member of the requesting agency until after the completion of interviews for this project. Proposer understands that its proposal will be disqualified if discussions occur with the requesting agency outside the prescribed communications provisions set forth in the RFP. By signing below, (Name of Firm) agrees: 1. The proposal contents are accurate to the best knowledge of the undersigned. 2. (Name of Firm) is committed to entering into the work promptly, if selected, by engaging the consultants and assigning the persons named in the proposal along with adequate staff to meet the requirements of the work. 3. The consultants listed in this proposal have been contacted and have agreed to be part of the team. 4. The undersigned has read and agrees to the terms of the (State s/mnscu s) contract terms, and is willing to sign the contract should it be offered to our firm. Signature: Dated: 15

16 STATE OF MINNESOTA AFFIDAVIT OF NONCOLLUSION I swear (or affirm) under the penalty of perjury: 1. That I am the Responder (if the Responder is an individual), a partner in the company (if the Responder is a partnership), or an officer or employee of the responding corporation having authority to sign on its behalf (if the Responder is a corporation); 2. That the attached proposal submitted in response to the Request for Proposals has been arrived at by the Responder independently and has been submitted without collusion with and without any agreement, understanding or planned common course of action with, any other Responder of materials, supplies, equipment or services described in the Request for Proposal, designed to limit fair and open competition; 3. That the contents of the proposal have not been communicated by the Responder or its employees or agents to any person not an employee or agent of the Responder and will not be communicated to any such persons prior to the official opening of the proposals; and 4. That I am fully informed regarding the accuracy of the statements made in this affidavit. Responder s Firm Name: Authorized Representative (Please Print) Authorized Signature: Date: Subscribed and sworn to me this day of Notary Public My commission expires: 16

17 Check all that apply: STATE OF MINNESOTA LOCATION OF SERVICE DISCLOSURE AND CERTIFICATION LOCATION OF SERVICE DISCLOSURE The services to be performed under the anticipated contract as specified in our proposal will be performed ENTIRELY within the State of Minnesota. The services to be performed under the anticipated contract as specified in our proposal entail work ENTIRELY within another state within the United States. The services to be performed under the anticipated contract as specified in our proposal will be performed in part within Minnesota and in part within another state or states within the United States. The services to be performed under the anticipated contract as specified in our proposal DO involve work outside the United States. Below (or attached) is a description of (1) the identity of the company (identify if subcontractor) performing services outside the United States; (2) the location where services under the contract will be performed; (3) the percentage of work (in dollars) as compared to the whole that will be conducted in each identified foreign location. Attachment enclosed at (state where): CERTIFICATION By signing this statement, I certify that the information provided above is accurate and that the location where services have been indicated to be performed will not change during the course of the contract without prior, written approval from the State of Minnesota. Name of Company: Authorized Signature: Printed Name: Title: Date: Telephone Number: 17

18 State Of Minnesota Affirmative Action Certification If your response to this solicitation is or could be in excess of $100,000, complete the information requested below to determine whether you are subject to the Minnesota Human Rights Act (Minnesota Statutes 363A.36) certification requirement, and to provide documentation of compliance if necessary. It is your sole responsibility to provide this information and if required to apply for Human Rights certification prior to the due date and time of the bid or proposal and to obtain Human Rights certification prior to the execution of the contract. The State of Minnesota is under no obligation to delay proceeding with a contract until a company receives Human Rights certification. BOX A For companies which have employed more than 40 full-time employees within Minnesota on any single working day during the previous 12 months. All other companies proceed to BOX B. Your response will be rejected unless your business: has a current Certificate of Compliance issued by the Minnesota Department of Human Rights (MDHR) -orhas submitted an affirmative action plan to the MDHR, which the Department received prior to the date and time the responses are due. Check one of the following statements if you have employed more than 40 full-time employees in Minnesota on any single working day during the previous 12 months: We have a current Certificate of Compliance issued by the MDHR. Proceed to BOX C. Include a copy of your certificate with your response. We do not have a current Certificate of Compliance. However, we submitted an Affirmative Action Plan to the MDHR for approval, which the Department received on (date). [If the date is the same as the response due date, indicate the time your plan was received: (time). Proceed to BOX C. We do not have a Certificate of Compliance, nor has the MDHR received an Affirmative Action Plan from our company. We acknowledge that our response will be rejected. Proceed to BOX C. Contact the Minnesota Department of Human Rights for assistance. (See below for contact information.) Please note: Certificates of Compliance must be issued by the Minnesota Department of Human Rights. Affirmative Action Plans approved by the Federal government, a county, or a municipality must still be received, reviewed, and approved by the Minnesota Department of Human Rights before a certificate can be issued. BOX B For those companies not described in BOX A Check below. We have not employed more than 40 full-time employees on any single working day in Minnesota within the previous 12 months. Proceed to BOX C. BOX C For all companies By signing this statement, you certify that the information provided is accurate and that you are authorized to sign on behalf of the responder. You also certify that you are in compliance with federal affirmative action requirements that may apply to your company. (These requirements are generally triggered only by participating as a prime or subcontractor on federal projects or contracts. Contractors are alerted to these requirements by the federal government.) Name of Company: Authorized Signature: Printed Name: Date Telephone number: Title: For assistance with this form, contact: Minnesota Department of Human Rights, Compliance Services Section Mail: 190 East 5 th St., Suite 700 St. Paul, MN TC Metro: (651) Toll Free: Web: Fax: (651) TTY:

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