INVITATION TO BID NO. 18-0010 ORLEANS PARISH SCHOOL BOARD PURCHASING DEPARTMENT 3520 General DeGaulle Drive, Room 5055 New Orleans, Louisiana 70114 Telephone: (504) 304-5639 Fax (504) 309-2879 SPECIFICATIONS FOR WATER FILTRATION SYSTEMS INVITATION TO BID OPENING: MONDAY, AUGUST 28, 2017 AT 2:00 P.M. NOTE: Bid response to be provided as original and one (1) copy on CD or flash drive. BIDDER: _____________________________________ SIGNATURE: _________________________________ NAME: _______________________________________ (Print or Type) ADDRESS: ___________________________________ CITY, STATE, ZIP: ____________________________ PHONE: ______________________________________ FAX NUMBER: ________________________________ E-MAIL ADDRESS:_____________________________ TERMS: ______________________________________ INVITATION TO BID NO. 18-0010 ORLEANS PARISH SCHOOL BOARD PURCHASING DEPARTMENT 3520 General De Gaulle Drive, Fifth Floor, Room 5078 New Orleans, Louisiana 70114 ADVERTISEMENT INVITATION TO BID NO. 18-0010 WATER FILTRATION SYSTEMS Sealed bids relative to the above will be received in the Purchasing Department for the Orleans Parish School Board at 3520 General De Gaulle Drive, Fifth Floor, Room 5055, New Orleans, Louisiana 70114 until 2:00 P.M. on Monday, August 28, 2017. Specifications and proposal documents may be obtained upon request from the OPSB Purchasing Department in writing, by email; or lynn_dillon@opsb.us or by calling (504)304-5639 or by visiting the web site www.opsb.us/solicitations. The OPSB reserves the right to reject any or all proposals whenever such rejection is in its best interest in accordance with law. The provisions and requirements of this advertisement shall not be waived. ORLEANS PARISH SCHOOL BOARD BY: FIRST INSERTION DATE: SECOND INSERTION DATE: THIRD INSERTION DATE: Lynn Dillon Senior Buyer WEDNESDAY, JULY 26, 2017 WEDNESDAY, AUGUST 9, 2017 WEDNESDAY, AUGUST 23, 2017 Page 2 of 18 DO NOT DETACH THIS PAGE INVITATION TO BID NO. 18-0010 ORLEANS PARISH SCHOOL BOARD PURCHASING DEPARTMENT 3520 General De Gaulle Drive, Fifth Floor, Room 5055 New Orleans, Louisiana 70114 INSTRUCTIONS TO BIDDERS Sealed bids will be received by the Orleans Parish School Board in the Purchasing Department, 3520 General De Gaulle Drive, Fifth Floor, Room 5055, New Orleans, Louisiana 70114, until 2:00 P.M. on MONDAY, AUGUST 28, 2017, for INVITATION TO BID NO. 18-0010 WATER FILTRATION SYSTEMS with the following specifications, at which time and place the bids will be publicly opened. A signed original and one (1) copy on CD or flash drive (If a soft copy cannot be provided, submit one (1) paper copy.) MUST be submitted in a sealed envelope and clearly marked: RESPONSE TO ITB NO. 18-0010 WATER FILTRATION SYSTEMS TO BE OPENED ON MONDAY, AUGUST 28, AT 2:00 P.M., and addressed to the Purchasing Department, Orleans Parish School Board, 3520 General De Gaulle Drive, Fifth Floor, Room 5055, New Orleans, Louisiana 70114. The name and address of the company submitting the bid must appear on the top left corner of the envelope containing the bid document. Hand-carried and express mail proposals may be delivered to the above address ONLY between the hours of 8:00 a.m. and 4:30 p.m. local time, Monday through Friday, excluding holidays observed by the OPSB. The Orleans Parish School Board will not be responsible for the opening of, post-opening of, or failure to open a bid not properly addressed or identified. The Orleans Parish School Board will not assume the responsibility for any delay as a result of failure of the mail to deliver proposals on time. No bid(s) will be accepted after 2:00 P.M. ON MONDAY, AUGUST 28, 2017 under any conditions whatsoever. In order for your company to be provided proof of delivery time, bids should be hand delivered, sent by registered mail, or private carrier only to the Purchasing Department, 3520 General De Gaulle Drive, Fifth Floor, New Orleans, Louisiana 70114. BIDDING DOCUMENTS: A complete set of Bidding Documents MUST be used in preparing bids; neither the Orleans Parish School Board nor its representatives assume any responsibility for errors or misinterpretations resulting from the use of incomplete sets of Bidding Documents. The forms furnished as part of the specifications MUST be used for filing of bid and must be signed by the bidder. No bids will be considered unless made on the forms provided and must not be detached from the bidding document of which it forms a part. Failure to follow these instructions may result in your bid being disqualified. The statement listed on the bottom of each page (DO NOT DETACH THIS PAGE) indicates that ALL of the pages included in the bid document must be submitted. Bids that are submitted with a “NO BID” response MUST be clearly stated on the front of the envelope. (If not responding to bid, package need not be mailed.) Page 3 of 18 DO NOT DETACH THIS PAGE INVITATION TO BID NO. 18-0010 BIDDERS REPRESENTATION: Each Bidder by signing and submitting a bid to the Orleans Parish School Board Represents that: a. The Bidder has read and understands the Bidding Documents and that his bid is made in accordance therewith. b. The Bidder is furnishing the Certificate of Insurance with the Bid, in accordance with the insurance requirements. VENDOR CONTACT: Bidders MUST provide NAME and TELEPHONE NUMBER of respective contact person within the firm through whom orders and/or information will be handled. BID INQUIRY: No contact in any form or manner is to be made with any employee of the District except through the Purchasing Department. Violation of this provision shall be considered grounds for disqualification of the violator employer's bid. CONSIDERATION OF BID: The Board reserves the right to select any part of the bid or the whole bid as well as to reject any and all bids whenever such rejection is in its best interest in accordance with law. All blanks within the Bidding Document shall be filled in by typewriter or manually in ink. When Brand name of item is not filled in, the item specified in the specifications must be delivered. Brand name, unit price and extended price must be quoted. When no brand is indicated in the specifications, Bidder must indicate brand to be provided. Samples must be submitted if requested by the Purchasing Department. The Bidder’s name, complete address, phone number and principals of the company must be furnished. Prices are to include inside delivery and installation a school sites. Samples must be submitted if requested by the Purchasing Department. Bidders are cautioned to insure the unit prices are correct as written/typed. A careless error in the bid preparation or in quoting prices will not relieve the bidders’ responsibility. Per Louisiana Revised Statues Title 38:2221, "NO CONTRACT SHALL BE LET ON A COST-PLUS BASIS". DISCOUNTS FOR PROMPT PAYMENT: Discounts/Terms for prompt payment will not be considered in the evaluation of bids. However, any offered discount will form a part of the award and will be taken if payment is made within the discount period indicated in the proposal by the Bidder. As an alternative to offering a prompt payment discount in conjunction with the bid, Bidders awarded contracts may include prompt payment discounts on individual invoices. LOUISIANA PREFERENCE: In accordance with Act 318 of the 1958 Session of the Legislature: "PREFERENCE IS HEREBY GIVEN TO MATERIALS, SUPPLIES AND PROVISIONS PRODUCED, MANUFACTURED OR GROWN IN LOUISIANA, QUALITY BEING EQUAL TO ARTICLES OFFERED BY COMPETITORS OUTSIDE OF THE STATE". Page 4 of 18 DO NOT DETACH THIS PAGE INVITATION TO BID NO. 18-0010 DELIVERY: In the event of the failure of the Bidder to meet the above requirements or to deliver articles within the time specified elsewhere in these specifications, the Board reserves the right, without prior notice or putting in default but by mere lapse of time, to obtain the articles from any other person or firm at such price as may be charged without competitive bids. The difference between the price paid and the contract price shall be deducted from the following or any subsequent payment to the contractor. CORRECTION OF MISTAKES: Bidders MUST not erase, correct or write over any prices or figures necessary for the completion of the bid. Corrections MUST be made by drawing a line through the unwanted text(s) or number(s) and rewriting the correct text(s) or number(s). If a correction is necessary, the bidder shall initial each correction. Failure to comply with the requirements may cause your bid to be disqualified. No bids shall be altered or amended after the specified time for opening. Negligence on the part of the bidder in preparing his/her bid confers no right of withdrawal or modification of his/her bid after bids have been opened. AWARD: The bid will be awarded to the lowest bidder that meets the specifications as determined by the District. It is appropriate to emphasize that the lowest bidder may not be considered the best. The District reserves the right to enter into a single contract or award more than one contract for all services, whichever is deemed to be in the District’s best interest. OBJECTION TO THE AWARD: If any Bidder who submitted a Bid has an objection to the award of the Low Bidder, the objecting Bidder shall furnish that protest, in writing, to the Purchasing Department within two (2) Business Days of the date of the Bid Opening. The protest shall describe in detail the basis for the protest, and shall request a determination under this section of the Instructions to Bidders. If a protest is filed in a timely fashion, the Purchasing Department will, review the basis for the protest and relevant facts under such terms and conditions, as the Purchasing Department considers proper. Upon completion of the review, the Purchasing Department shall submit its findings and recommendations to the Superintendent and/or OPSB who shall then review the matter under such terms and conditions, as deemed proper. Upon receipt of authority to act from the Superintendent or OPSB, the Purchasing Department will notify those Bidders involved of its decision. The decision shall be final and binding on the objecting Bidder. WITHDRAWAL OF BID: Any bid may be withdrawn if clear and convincing sworn, written evidence of obvious mechanical, clerical or mathematical error is furnished by the bidder to the Purchasing Department within 48 hours of bid opening. SUPPLIER PERFORMANCE AND EVALUATION: The contractor, vendor, service provider and/or supplier performance process will involve evaluating the contractor, vendor, service provider and/or supplier’s overall quality status, as well as evaluating the quality of each material or service the Orleans Parish School Board wishes to purchase from the said contractor, vendor service provider and/or supplier. Prior to the invoice submission, the contractor, vendor, service provider and/or supplier, shall meet with a purchasing representative to discuss and review deliverables and timeline events for said services. By signing the certification statement, the bidder certifies that neither it nor any of its principals (e.g., key employees) have been proposed for debarment, debarred or suspended by a Federal Agency. It is the responsibility of each bidder to sign the attached certification statement and submit it with the bid. Failure to comply with this requirement will cause your bid to be Page 5 of 18 DO NOT DETACH THIS PAGE INVITATION TO BID NO. 18-0010 disqualified, declared non responsive. CONTRACTS OVER $100,000: The Contractor must comply with the applicable standards, orders or requirements issued under Section 306 of the Clean Air Act [(42 USC 1837 (h)], Section 508 of the Clean Water Act (32 USC 1368), Executive Order 11738, and Environmental Protection Agency Regulations (40 CFR, Part 15), which prohibit the use under non-exempt federal contracts, grants or loans of facilities included in the EPA list of violating facilities. Contractor shall report any violations to the Orleans Parish School Board, the Department of Agriculture and to the Environmental Protection Agency Assistant Administrator for enforcement. LAWS AND REQUIREMENTS AFFECTING LABOR: All contractors and subcontractors shall comply and conform to all applicable federal, state, and municipal labor laws and various acts mandatory and supplementary thereto, as well as, all other applicable laws, ordinances and legal requirements regarding the employment of labor to include, if applicable, to contracts which exceed $2,500.00 and which involve the employment of mechanics or laborers, the Contract Work Hours and Safety Standards Act (40 USC 327-330) as supplemented by the Department of Labor Regulations (29 CFR, Part 5). The latter requirements do not apply to the purchase of supplies or materials or articles ordinarily available on the open market. ORLEANS PARISH SCHOOL BOARD Lynn Dillon Senior Buyer Page 6 of 18 DO NOT DETACH THIS PAGE INVITATION TO BID NO. 18-0010 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transactions This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 7 CFR Part 3017, Section 3017.510, Participants' responsibilities. The regulations were published as Part IV of the January 30, 1989, Federal Register (pages 4722-4733). Copies of the regulations may be obtained by contacting the Department of Agriculture agency with which this transaction originated. (BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS THAT FOLLOW) (1) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. (2) Where the prospective lower tier participant is unable to certify any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Organization Name_________________________________________________________________ Name and Title of Authorized Representative_____________________________________________ Signature___________________________________________Date_____________________ Page 7 of 18 DO NOT DETACH THIS PAGE INVITATION TO BID NO. 18-0010 Instructions for Completing Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions (Form AD-1048) NOTE: A School Food Authority must require that each responsive bidder include this certification statement with each bid on each contract equaling or exceeding $100,000, or any contract for audit services regardless of amount. 1. By signing and submitting this form, the prospective lower tier participant providing the certification set out on the above in accordance with these instructions. 2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. 3. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of the U. S. Department of Agriculture regulations 7CFR 3017 implementing Executive Order 12 549. (Contact the person to whom this proposal is submitted for assistance in obtaining a copy of those regulations.) 5. The prospective lower tier participant agrees by submitting this form that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated. 6. The prospective lower tier participant further agrees by submitting this form that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transaction" without modification in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 7. A participant in a covered transaction may rely upon a certification that a prospective participant in a lower tier covered transaction has not been debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless the participant knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List. 8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 9. Except for transactions authorized under Paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment. Page 8 of 18 DO NOT DETACH THIS PAGE INVITATION TO BID NO. 18-0010 CERTIFICATION REGARDING LOBBYING CERTIFICATION FOR CONTRACTS, GRANTS, LOANS, AND COOPERATIVE AGREEMENTS EXCEEDING $100,000 IN FEDERAL FUNDS The undersigned certifies, to the best of his or her knowledge and belief, that: 1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. 2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. 3. The undersigned shall require that the language of this certification be included in the award documents for all sub awards (exceeding $100,000 in Federal funds) at all tiers (including subcontracts, sub grants, and contracts under grants, loans, and cooperative agreements) and that all sub recipients shall certify and disclose accordingly. This certification is a material representation of fact which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. NAME/ADDRESS OF VENDOR______________________________________________________________ TITLE/TITLE OF SUBMITTING OFFICIAL____________________________________________________ SIGNATURE____________________________________________DATE___________________________ Page 9 of 18 DO NOT DETACH THIS PAGE INVITATION TO BID NO. 18-0010 GENERAL TERMS AND CONDITIONS 1. The Orleans Parish School Board (OPSB) is soliciting bids to furnish WATER FILTRATION SYSTEMS 2. All items must be new. (Used or reconditioned items will not be accepted). The bidder must guarantee that the items requested are delivered free from defects in design and construction and that they are the manufacturer’s standard design. 3. Unit Price(s) to reflect inside delivery, assembly, set-up, installation, debris removal, service and training. 4. Bidder must also provide graphics, literature, product code(s) and a list of all deviations from the specifications. Failure to comply may result in disqualification of bid. (Vendor catalog(s) will not be accepted in lieu of specifications.) 5. All bids shall be valid for a minimum of 120 days. Terms understood as net 30 days. 6. Bidders must check price quotations for mathematical and typographical errors before submittal (unit prices will govern in case of error). All corrections must be initialed. Failure to comply may result in disqualification of bid. 7. The Orleans Parish School Board is exempt from all Federal and State taxes. 8. Legal identification of the company and/or organization must be listed on the bid form where indicated, including its corporate name and complete mailing address. 9. Samples of item(s) proposed as “Equal or alternate” may be required prior to bid award. 10. Each bidder must include in its bid the policy for returned equipment. 11. The Orleans Parish School Board reserves the right to select any part of the bid or the entire bid, as well as to reject any and all bids received whenever such selection or rejection is in its best interest in accordance with law. 12. A bid may be withdrawn after the time and date designated for receiving bids if clear and convincing sworn, written evidence of obvious mechanical, clerical or mathematical error is furnished by the bidder within 48 hours of bid opening. Negligence on the part of the bidder in preparing his/her bid confers no right of withdrawal or modification of his/her bid after bids have been opened. 13. All inquiries regarding this solicitation for bids must be in writing addressed to Lynn Dillon, lynn_dillon@opsb.us Page 10 of 18 DO NOT DETACH THIS PAGE INVITATION TO BID NO. 18-0010 SPECIFICATIONS AND BID FORM ORLEANS PARISH SCHOOL BOARD PURCHASING DEPARTMENT 3520 General De Gaulle Drive, Fifth Floor New Orleans, Louisiana 70114 TO: ORLEANS PARISH SCHOOL BOARD This form is to be completed, signed and left attached to the Bidding Documents and delivered to the Orleans Parish School Board by the time and date advertised. DATE: ______________________________ Orleans Parish School Board Purchasing Department 3520 General De Gaulle Drive Fifth Floor, Room 5078 New Orleans, LA 70114 Re: Invitation to Bid No. 18-0010 WATER FILTRATION SYSTEMS Gentlemen: In compliance with the Bidding Documents, the undersigned agrees, if this offer is accepted and awarded within one hundred twenty (120) calendar days from the date for the receipt of the offer specified in the Advertisement for Bids, to furnish any or all items awarded at the unit price offered at the price set opposite each item, delivered at the designated points on the dates specified in the Delivery Schedule and during the time period specified. Acknowledgment of Addenda: Addendum No. ____________ , dated _____________________ Addendum No. ____________ , dated _____________________ Addendum No. ____________ , dated _____________________ Page 11 of 18 DO NOT DETACH THIS PAGE INVITATION TO BID NO. 18-0010 BID SPECIFICATIONS FOR POINT OF USE WATER FILTRATION SYSTEMS INTENT OF SOLICITATION: It is the intention of the Orleans Parish School Board (OPSB) to purchase a point-of-use filtration system for our schools’ drinking water. These filtration systems will be connected to drinking fountains as well as water used in the food service area. We seek a point-of-use system that filters water just before consumption. The awarded company shall provide a system that follows the following listed system requirements and installation process. BACKGROUND: Existing drinking fountains are from a variety of companies and have been installed over a period of multiple years. Existing water connections in food service areas are from a variety of companies and have been installed over a period of multiple years. Respondents may anticipate a minimum of 299 units installed. The proposed system must have been in use at an installation with similar requirements to those described in this solicitation for at least 6 months prior to this bid date. SYSTEM REQUIREMENTS: The system, must remove lead to at least below 15PPB as stated by EPA requirements. The system must produce potable water that can be safely used during boil water advisories. We require the system to be a point-of-use system that attaches directly to the drinking fountain water source and then connects to the existing fountain. A point-of-use system is also required for all water connections in the food service area. This system must be a 3-filter system that removes sediment and solids from water prior to removing lead. This measure allows the lead filter to perform at its optimum best, while maintaining the filter’s lifespan. Filter 1 - Sediment or Pre-Sediment Filter 2 - Sediment or Lead Filter 3 - Lead or Microbiological Company supplying filtration systems must determine best filter configuration for removal of contaminants based on existing water quality and must be on-site during installation and set-up to assure best performance. Systems must have a built-in safety trigger that shuts down water flow-through when filters have reached expiration. System must come in a tamper proof, lockable box with stainless steel braided hose line housing. System must have NSF/ANSI 53 and NSF P231 certification for removal of lead and other contaminants, remove chlorine odor, and deliver great tasting water. Page 12 of 18 DO NOT DETACH THIS PAGE INVITATION TO BID NO. 18-0010 INSTALLATION and SERVICE: Company awarded this Contract will assure the installation and service of the systems to be on a specific schedule as determined by the OPSB. The company shall: Install all systems as per OPSB schedule, using certified installers. Assure that all systems are properly functioning and in working order prior to turnover. Set up a schedule with and train maintenance staff to perform filter replacement every 9 months or at filter expiration. Filter change out specs must be: Filters are easy to remove and replace. All filters are number coded for proper placement. Water will NOT need to be turned off to replace filters. On-site staff can replace filters. Company awarded this contract will be required to be on-site and determine best possible installation process and service schedules. A representative of the awarded company must be available to present point-of-use filtration technology and answer questions as needed to district staff during the purchase process. Description Quantity Water Filtration System Water Filtration System Water Filtration System Water Filtration System 1-299 Per unit price (including delivery and installation) Installation Start Date After Receipt Of Order (period required in weeks) 300-599 600-899 900+ Page 13 of 18 DO NOT DETACH THIS PAGE INVITATION TO BID NO. 18-0010 INDICATE THE WARRANTY PERIOD (CHECK ONE) 90 DAYS______ 1 YEAR______ 30 DAYS______ 60 DAYS______ OTHER______ (If OTHER, specify duration of warranty.) All prices quoted are F.O.B. anywhere within the city limits of the City of New Orleans, Louisiana and do not include city or state sales taxes or federal excise taxes. I have completed the Certificate of Insurance and secured signatures by a duly authorized representative of the company. ______ Initial I have signed the Certificate of Debarment. ______ Initial I have checked my quotations for mathematical and typographical errors. Unit Price(s) will prevail if discrepancy is noted. Unit prices will govern in case of error(s) in extension. _______ Initial I have listed the Principals of the Company. ______ Initial I have completed the Non-Collusion Statement. ______ Initial I (or We) acknowledge and accept the General Terms and Conditions as set forth in this document. ____ NAME OF COMPANY ______ SIGNATURE OF BIDDER Page 14 of 18 DO NOT DETACH THIS PAGE __________ DATE INVITATION TO BID NO. 18-0010 PRINCIPALS OF THE COMPANY PRESIDENT: VICE-PRESIDENT: SECRETARY: TREASURER: BIDDER: SIGNATURE: NAME: (PRINT OR TYPE) ADDRESS: CITY, STATE, and ZIP: _____________________ AREA CODE & PHONE: AREA CODE & FAX: E-MAIL: _________________________________ LIST THE BIDDER’S FEDERAL TAX IDENTIFICATION NUMBER _________________ Bidder is (check one) _____Sole Proprietorship; _____Partnership; _____ Corporation (If corporation, in what state incorporated) _______________________________; or ___ Joint venture. Identify parties: Page 15 of 18 DO NOT DETACH THIS PAGE INVITATION TO BID NO. 18-0010 ORLEANS PARISH SCHOOL BOARD Purchasing Department VENDOR REGISTRATION FORM DATE (MM/DD/YYYY): COMPANY NAME: CONTACT: ADDRESS: CITY, STATE, ZIP: REMIT TO ADDRESS: CITY, STATE, ZIP: PHONE: FAX: E-MAIL ADDRESS: TAX ID NO: DUNS NO. MANUFACTURER DISTRIBUTOR SALES OFFICE SERVICES STATE CONTRACT NO. PLEASE IDENTIFY COMMODITIES AND/OR SERVICES THAT YOUR COMPANY PROVIDES: Page 16 of 18 DO NOT DETACH THIS PAGE INVITATION TO BID NO. 18-0010 In addition to the Vendor Registration form the OPSB requires that each respondent submit a recent W-9 form. The most recent W-9 form, as provided by the Internal Revenue Service, can be accessed at http://www.irs.gov/pub/irs-pdf/fw9.pdf. Page 17 of 18 DO NOT DETACH THIS PAGE INVITATION TO BID NO. 18-0010 NON-COLLUSION STATEMENT State of Louisiana Parish of Orleans ____________________________________________________________________, States that he/she is (a partner of the firm, officer of the corporation, or individual making the foregoing proposal or bid); that said bid is genuine and not collusive or sham; that said bidder has not colluded, conspired, connived or agreed, directly or indirectly, with any bidder or person to put in a sham bid or to refrain from bidding, collusion, or communication or conference, with any person, to fix the bid price or affiant or any other bidder, or to fix any overhead, profit or cost element, or that of any other bidder, or to secure any advantage against any person interested in the proposed contract, and that all statements contained in the said bid or proposal are true. (Signature) Page 18 of 18 DO NOT DETACH THIS PAGE