This is an html version of the draft Request for Proposal presented to Charlottesville City Council at its February 22 meeting. Prepared by Peter T. Kleeman

NOTICE: Proposals submitted in response to this RFP will be accepted by the City until 2:00 p.m. (local time) Thursday, March 31, 2005

Request for Proposals

Engineering Services
for
Meadowcreek Parkway/Route 250 Bypass/McIntire Road Interchange Design
City of Charlottesville, Virginia
(VDOT Project No. 250-104-103, PE101,RW201,C501,B604 UPC 60234)

February 22, 2005

I     PURPOSE AND BACKGROUND

The City of Charlottesville is seeking expressions of interest from consulting engineering firms (Offerors) who wish to be considered to provide professional engineering services to prepare comprehensive interchange design options and construction plans and documents for the Meadowcreek Parkway/Route 250 Bypass/McIntire Road Interchange. This will be a phased contract with Phase I going through Location and Design Public Hearing and Phase II for final design. Phase II will be negotiated upon completion of Phase I.

The purpose of this project is to provide all necessary design documents to allow for a location and design public hearing and subsequent right of way and utilities relocation processes.

Design options must be acceptable to the Virginia Department of Transportation (VDOT). This work is to be accomplished utilizing computerized design and drafting systems compatible with VDOT’s automated design and drafting systems. The VDOT design system is GEOPAK and the drafting system is Microstation. This project will be developed utilizing VDOT’s policies and procedures and FHWA’s guidelines. This Request for Proposal does not commit the City to award a contract, to pay any costs incurred in the preparation of a proposal for this request, or to procure or contract for services. The City reserves the right to accept or reject any or all proposals received as a result of this request, to negotiate with any qualified firm or to modify or cancel in part or in its entirety the Request for Proposal if it is in the best interest of the City to do so.

The City requires that the work proceed with the participation of a Steering Committee appointed by City Council. The charge of the Steering Committee is to provide guidance to the consultant regarding public input and final design documents. The Steering Committee has not yet been created but will be involved in the selection of the consultant for this work.

II     SCOPE OF SERVICES

The scope of work shall consist of providing traffic analysis, complete right of way, roadway construction, structure and bridge plans (Stage I, preparation of preliminary structure plans and estimates; Stage II, preparation of contract structure plans, estimates, special provisions; Stage III, review of shop drawing and consultation during construction) with signs, signals, lighting, pavement markings/markers and ITS elements. The consultant will be required to evaluate the existing signing, signals, pavement markings/markers and lighting at the intersection of McIntire Road and the Route 250 Bypass and be prepared to design any required modifications at these locations.

The scope of work shall consist of providing supplemental ground survey, complete traffic data and analysis of the intersection and adjoining traffic network, geotechnical study, foundation and pavement recommendations, public involvement, conceptual alternates, preliminary and final right of way, roadway construction, structure and bridge and landscape plans. The consultant shall provide a noise analysis in accordance with Virginia Department of Transportation and Federal Highway Administration requirements. The project will be federally funded.

In addition, the scope of work will consist of, but not be limited to, the following:

A.     Interchange Design Options:  Provide multiple interchange options for the junction of the Route 250 Bypass, McIntire Road and the proposed two-lane Meadowcreek Parkway. Geometric roadway design options must be acceptable to VDOT. Preliminary conceptual alternatives have been prepared by Rieley & Associates (see Preliminary Study of Interchange Alternatives – Meadowcreek Parkway, McIntire Road, and Veterans Memorial Boulevard, October 2000). These should be the starting point for this work. Alternative design options will be illustrated on recent aerial base mapping assembled by the Consultant. The City prefers a minimum of three separate options; the final option to be presented at a public hearing after review by City Council.

B.     Environmental:  Conduct an environmental evaluation for each option to determine ability to construct each interchange design. Broad consideration will be given to biological, ecological, historical, archeological, and environmental justice issues. In addition, air and noise impacts should be considered. The consultant will be required to coordinate the acquisition of any required environmental permits associated with this project and will provide all required environmental documentation, permits, and approvals necessary for VDOT design acceptance and funding of the selected option.

C.     Traffic Analysis:  Provide Synchro 5 software output of the operational characteristics of each design option. Results may be presented to City Council. Benefits to traffic movements (costs of delay to motorists) will be considered for build and no-build options; up to date costing mechanisms will be used for this effort. Analysis should examine the project impacts on the Park Street/Locust Avenue interchange at 250 Bypass and on McIntire Road to 5th Street at Cherry Avenue.

D.     Determine each design option cost utilizing the latest VDOT costing spreadsheet.

E.     Sequence of Construction/Traffic Management Plan - Outline a prioritized construction and traffic management plan for construction of the proposed interchange improvements. Construction phasing of improvements and maintenance of traffic shall be considered in evaluating the design alternatives, to minimize disruption during construction.

F.     Review of existing studies/documentation:  The study will require consultant review of relevant existing transportation, traffic, and roadway plans, including plans for the proposed two-lane Meadowcreek Parkway. Specifically the conceptual alternatives prepared by Rieley & Associates should be used as the starting point for this analysis. 

G.     Suggested Development Plan:  Considerable discussion has occurred regarding the progress of this work to date. A recommendation made to City Council (and approved May 2001) from those working on the Meadowcreek Parkway project design includes the following steps;  

This is to be an interchange at the beginning/termini of a parkway. Design alternatives and bridge designs must respect the park-like nature of the area with the appropriate use of materials, design, and aesthetics.  

The city intends for this interchange to serve as a gateway to both McIntire Park and the downtown area. A “typical” interchange is not desired. City Council desires this project to set the tone for one of the most important public spaces in Central Virginia. The aforementioned Rieley & Associates report must be the guide for all designs considered.  

Pedestrian access between the downtown area and McIntire Park, bicycle connections, and reduction of impacts to the Rescue Squad facilities are key design features that must be incorporated into the project.

Site Analysis – Natural Conditions (Hydrology, Geology and Soils, Vegetation), Cultural Conditions (Assemble Mapping and Aerial Photos, Utilities, Property Boundaries, Traffic)

Development of Proposals – Develop three acceptable design options, assemble mapping and aerial photos, develop preliminary traffic layouts to schematic design level, develop preliminary grading plan, develop preliminary designs for grade-separation structure, develop preliminary utilities layout scheme, provide preliminary cost estimates, provide photo-simulation aerial views of each alternative. 

Evaluation of Proposals – Comparative analysis of functionality, environmental impact, aesthetic quality and cost to include comparative analysis of bridge structure design and materials. 

Presentation to City Council – Presentation of all three options with consultant and staff evaluations. 

Selection of Preferred Option – City Council selects preferred option. 

Development of Preferred Option – Detailed grading, resolution of remaining technical issues, including environmental work, and a final cost estimate. Adjustment and resolution of photo-simulation of preferred option.

Prepare Presentation for Public Hearing 


III
     EXPRESSION OF INTEREST 

A. (Reference VDOT Guidelines) Furnish three copies of current GSA Forms 254 for each firm involved and three copies of one combined GSA Form 255 for the project team. The GSA Form 255 must specify the number of personnel by discipline for each office where the work is to be performed. In Section 4 of GSA Form 255, list only the full time employees assigned to the office(s) at the time of this submission. Section 8 of GSA Form 255 is limited to one page with not more than 10 projects total (prime and subconsultants combined) on the one page and should primarily list experience of offices where the work will be performed and of the people shown in the organizational chart. If the experience shown is for a branch office other than where the work will be performed, it should be clearly indicated as such. More detailed descriptions for Section 8b may be expanded into Section 10. In Section 9 of GSA Form 255, references to “Federal agencies” are to be replaced by “Virginia Department of Transportation or transportation agencies of other states.” 

B. If more than one firm will participate in the contract, state the type of arrangement between the firms, the names and addresses of all firms, description of the work that each firm will perform, and the percentage of work to be performed by each in Section 5 and 6 of GSA Form 255. A one page organizational chart showing all firms involved and key personnel assignments and responsibilities is required to be included in Section 10 of GSA Form 255. Indicate office locations at which the work will be performed. 

C. In Section 7 of GSA Form 255, indicate KEY PERSONNEL ONLY who will be assigned to this project and give the experience record of each. Key personnel are defined as those to whom the project will be assigned and who will be performing the actual design/services. The project manager shall have a minimum of five years experience in managing similar type and size projects. In Section 7c, indicate the location of the office where the person is currently working if different from where work is to be performed. In Section 7c, part time personnel, personnel not employed on the date of the form, or personnel used on an “as needed basis” must have their status clearly indicated. Section 7g may be expanded to provide a total of a one page resume per individual. 

D. Section 10 of GSA Form 255 is limited to a maximum of ten pages. This section should describe the organization of the proposed project staff indicating the role of each by individual. If subconsultants are proposed, the role of each subconsultant should be discussed. It should also include statements that are responsive to the attached criteria that will be used to evaluate your submission. This is the ONLY section of the submission which may include pictures or graphics (included in the ten page limit). List any computer and CADD equipment and any specialized computer software packages that you will use on this VDOT project. 

E. It is the policy of the Virginia Department of Transportation that Disadvantaged Business Enterprises (DBEs) as defined in 49 CFR Part 26 shall have the maximum opportunity to participate in the performance of consultant contracts. Consultants are encouraged to take all necessary and reasonable steps to ensure that DBEs have the maximum opportunity to compete for and perform services on the contract, including participation in any subsequent supplemental contracts. If the consultant intends to subcontract a portion of the services on the project, the consultant is encouraged to seek out and consider DBEs as potential subcontractors. The consultant is encouraged to contact DBEs to solicit their interest, capability and qualifications. Any agreement between a consultant and a DBE whereby the DBE promises not to provide services to other consultants is prohibited. The Department feels that these services support 10% DBE participation. 

49 CFR Part 26 requires VDOT to collect certain data about firms attempting to participate in VDOT contracts. This data must be provided on the enclosed Firm Data Sheet. 

If DBE is not certified, the DBE must become certified (with VDOT) prior to your response being submitted. If DBE is the prime consultant, the firm will receive full credit for planned involvement of their own forces, as well as the work that they commit to be performed by DBE subcontractors. DBE prime consultants are encouraged to make the same outreach efforts as other consultants. DBE credit will be awarded only for work actually being performed by DBE themselves. When a DBE prime consultant or subconsultant subcontracts work to another firm, the work counts toward DBE goals only if the other firm is itself a DBE. A DBE must perform or exercise responsibility for at least 30% of the total cost of its contract with its own force. 

DBE certification entitles consultants to participate in VDOT’s DBE program. However, this certification does not guarantee that the firm will obtain VDOT work nor does it attest to the firm’s abilities to perform any particular work. 

5.     In two (2) pages or less, provide information that will indicate your firm’s ability to meet the time schedule for this project. The schedule is as follows: 

        Right of Way Plans – Fall 2006
       Construction Plans – Summer 2008 

7. A project approach discussion is neither required nor desired for this project.

8. In addition to the page restrictions listed above, a maximum of two (2) additional pages may be included in the Expression of Interest. All pages are to be 8 1/2” X 11” and printed on one side with single-spaced type no smaller than 12 pitch. 


IV     EVALUATION CRITERIA
 

Criteria used to evaluate the proposals shall include the following: 

A.     Detail about your firm and statement of qualifications. Experience on similar projects. Describe similar projects and include three references, including names and telephone numbers that may be contacted regarding their satisfaction with comparable work.  

B.     Experience of Project Staff. Describe who will be supervising and conducting the work. Specifically include references to similar projects completed and the individual(s) qualifications. 

C.     Ability to complete the Project/Services within the 30-month time frame. State when the firm is able to begin providing the services and confirm that staff is available to complete the study on the schedule specified. 

D.     Any non-binding cost estimate information that may be provided, including reimbursable expenses. 

E.      Any other relevant information offered or discovered during the course of evaluation and individual discussions. 

F.      Certify types and amounts of insurance carried by the firm or individual, including professional liability insurance. Provide a notarized Certificate of No Collusion (sample attached). 

G.     Experience of firm or team members with the design of parkway projects, roadways in parks, and/or tight urban interchange projects.


V     PROCUREMENT AND THE SELECTION PROCESS

The selected consultant will be expected to meet often with the Steering Committee and the community and may be required to make interim reports to the City Council. A final public process will be determined with the Steering Committee during the negotiation phase of the procurement process based on the consultant’s expertise and the needs of the community.

The following criteria shall be used in selecting a design/development team proposal:

A. Discussion Stage.  Following receipt of proposals, the City shall engage in individual discussions with two or more Offerors deemed fully qualified, responsible and suitable on the basis of initial responses, with emphasis on professional competence, to provide the required services. Repetitive informal interviews shall be permissible. Each Offeror shall be encouraged to elaborate on their qualifications and performance data or staff expertise pertinent to the Project, as well as alternative concepts. At the discussion stage, the City may discuss nonbinding estimates of total project costs, including, but not limited to, life-cycle costing, and, where appropriate, nonbinding estimates of price for the professional services.

B.     Negotiations Stage.  At the conclusion of discussion, on the basis of the Evaluation Criteria specified in this RFP and all information developed in the selection process to this point, the City shall select in the order of preference two or more Offerors whose professional qualifications and proposed services are deemed most meritorious. Negotiations shall then be conducted, beginning with the Offeror ranked first. If a contract satisfactory and advantageous to the public body can be negotiated at a price considered fair and reasonable, the award shall be made to that Offeror. Otherwise, negotiations with the Offeror ranked first shall be formally terminated, and negotiations conducted with the Offeror ranked second, and so on until a contract can be negotiated at a fair and reasonable price. 

C.     Should the City Manager determine in writing, and in its sole discretion, that only one Offeror is fully qualified, or that one Offeror is clearly more highly qualified and suitable than the others under consideration, a contract may be negotiated and awarded to that Offeror.  

D.     Public notice of the City’s decision to award a contract resulting from this RFP, or of the City’s announcement of its decision to award such a contract, shall be by posting such notice on the City’s Bulletin Board located in the Purchasing Division, 325 4th Street, Charlottesville, Virginia, 22903. 

E.      Proprietary information from competing Offerors shall not be disclosed to the public or to competitors during the discussion/negotiations processes. However, prior to, or simultaneously with, submission of any proprietary information, an Offeror must specifically identify the data or other materials to be protected, and state the reason(s) why protection is necessary. If an Offeror fails to invoke this protection prior to or upon submission of any proprietary information, the information or materials sought may be subject to disclosure under the Virginia Freedom of Information Act, the Virginia Public Procurement Act, or the Code of the City of Charlottesville, Chapter 22 (Procurement).  

F.      Any competitive negotiation Offeror, upon request, shall be afforded the opportunity to inspect proposal records, within a reasonable time after the evaluation and negotiations of proposals are completed, but prior to award, except in the event the City decides not to accept any of the proposals received and to reopen the contract. Otherwise, proposal records shall be open to public inspection only after award of the contract.  

G.     The City may cancel this Request for Proposals or reject any proposals received in response thereto.

VI GENERAL CONDITIONS

The following shall be and become terms and conditions of any contract resulting from this procurement: 

A.     No Assignments. The Offeror is prohibited from assigning, transferring, conveying, subletting or otherwise disposing of this agreement or its obligations, rights, interest herein to any other person, company or corporation without the previous consent and approval in writing by the City.  

B.     No Employment Discrimination. During the performance of the contract, the Offeror will not discriminate against any employee or applicant for employment because of race, religion, color, sex, sexual orientation, national origin, age, disability, or any other basis prohibited by state or local law relating to discrimination in employment, except where there is a bona fide occupational qualification reasonably necessary to the normal operation of the Offeror. The Offeror shall post in conspicuous places, available to employees and applicants for employment, notices setting forth the provisions of this nondiscrimination clause. The Offeror, in all solicitations or advertisements for employees placed by or on behalf of the Offeror, shall state that such Offeror is an equal opportunity employer. Notices, advertisements and solicitations placed in accordance with federal law, rule or regulation shall be deemed sufficient for the purpose of meeting the requirements of this section.

C.     Drug-Free Workplace. During the performance of this contract the Offeror agrees as follows: (i) to provide a drug-free workplace for the Offeror’s employees; (ii) to post in conspicuous places, available to employees and applicants for employment, a statement notifying employees that the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana is prohibited in the Offeror’s workplace and specifying the actions that will be taken against employees for violations of such prohibition; and (iii) state in all solicitations or advertisements for employees placed by or on behalf of the Offeror that the Offeror maintains a drug-free workplace. For the purposes of this paragraph, “drug-free workplace” means a site for the performance of work done in connection with the contract awarded to the Offeror in accordance with this procurement transaction, where the Offeror’s employees are prohibited from engaging in the unlawful manufacture, sale distribution, dispensation, possession or use of any controlled substance or marijuana during the performance of services in connection with the contract.

D.     The Offeror will include the provisions of the foregoing in any subcontract or purchase order of over $10,000, so that the provisions will be binding upon each subcontractor or vendor.

E.      Indemnification. The Offeror shall indemnify and hold harmless the City from and against all liability, claims, loss, and costs (including reasonable attorney’s fees and costs of defense) to the extent caused by the Offeror’s negligent acts, errors or omissions in the performance of professional services under this contract and those of its employees, subconsultants and anyone for whom the Offeror is legally liable.

F.      Required Insurance. (i) Professional Liability. The Offeror shall maintain professional liability insurance, in an amount not less than $1,000,000, to cover damages caused by the negligent or wrongful errors and omissions of the Offeror, its employees and agents, and the Offeror shall maintain such insurance at all times this Contract is in effect and for a period of 5 years after final completion of the Project. A Certificate of Insurance outlining the terms and limits of the Offeror’s current Errors and Omissions Insurance shall be submitted to City within ten (10) days of the execution of this contract. The City reserves the right to terminate this agreement in the event the Offeror fails to provide evidence of adequate and current Errors and Omissions insurance. If, during the five year term following completion of the Project in which the Offeror is to maintain in force the errors and omissions policy, the cost of such policy increases by more than fifty percent (50%) over the cost of said policy for the year in which the project is completed, then the Offeror may be entitled to reduce or cancel such insurance, by first giving written notice to the City 45 days in advance. (ii) Worker’s Compensation. The Offeror shall purchase and maintain, at its expense, Worker’s Compensation, Disability Benefit, or similar employee benefit act coverage, and employer’s liability coverage, as required by the law of the Commonwealth of Virginia.

G.     Payment. Each calendar month the Offeror shall submit an invoice requesting payment for services rendered during the preceding calendar month, and for expenses due hereunder. The Offeror’s invoice shall describe with reasonable particularity each service rendered, the date thereof, the time expended, and the person(s) rendering such service. The Architect's invoice shall be accompanied by receipts, invoices or other documentation, as the City may require, establishing the amount of the expenses for which reimbursement or payment is sought. Each invoice shall bear the signature of the Offeror, which signature shall constitute the Offeror’s representation to the City that the services indicated in the invoice have reached the level stated, have been properly and timely performed as required herein, that the expenses included in the invoice have been reasonably incurred in accordance with the Professional Services Contract, that all obligations of the Offeror covered by prior invoices have been paid in full, and that the amount requested is currently due and owing, there being no reason known to the Offeror that payment of any portion thereof should be withheld. Submission of the Offeror’s invoice for final payment shall further constitute the Offeror’s representation to the City that, upon receipt by the City of the amount invoiced, all obligations of the Offeror to others, including its consultants, incurred in connection with the Project, will be paid in full. In the event that any invoice contains a defect or impropriety that would prevent payment by the required payment date, the City shall notify the Offeror in writing of such defect or impropriety.  

H.     In the event that the City becomes credibly informed that any representations of the Offeror as set forth in the paragraph preceding above, are wholly or partially inaccurate, the City may withhold payment of sums then or in the future otherwise due to the Offeror until the inaccuracy, and the cause thereof, is corrected to the City’s satisfaction.

I.        The City shall make payment to the Offeror of all sums properly invoiced under the provisions of this Section, within thirty (30) days of the City's receipt of such invoice.

J.       Interest. Interest shall accrue at the rate of one percent (1%) per month, on any amounts which remain unpaid for thirty (30) days following the date a payment is due. No interest shall accrue when payment is delayed due to a dispute between the City and the Offeror as to the accuracy or completeness of any request for payment received. This exception to the accrual of interest shall apply only to that portion of a delayed payment which is actually the subject of the dispute and shall apply only for the duration of such disagreement.

K.    Appropriations of Public Funding. Payment and performance obligations of the City, beyond the initial fiscal year of this contract, are expressly conditioned upon the availability and appropriation by the City of public funds therefore in each subsequent fiscal year. When public funds are not appropriated or are otherwise unavailable to support continuation of performance by the City in a subsequent fiscal period, this contract and the City’s obligations hereunder shall automatically expire, without liability or penalty to the City. In that event, the Offeror shall be paid for all services rendered prior to the expiration date.

L.      Termination. (i) Either party hereto may terminate this Contract upon giving ten (10) days' written notice to the other in the event that such other party substantially fails to perform its material obligations set forth herein; (ii) This Contract may be terminated by the City for any reason or for no reason upon thirty (30) days' written notice to the Offeror. In the event of such a termination for any reason or for no reason, the City shall pay the Offeror for all services rendered prior to the termination, plus any reasonable expenses incurred and unpaid which would otherwise be payable hereunder. In such event, the Offeror  shall promptly submit to the City its invoice for final payment.

M.   Modification of Contracts. A City contract may include provisions for modification during performance; however, no fixed price contract may be increased by more than ten percent of the amount of the contract without the advance written approval of the City Manager. In no event may the amount of any contract, without adequate consideration, be increased for any purpose, including, but not limited to, relief any Offeror from the consequences of an error in its offer.

N.    Project Records. All records relating in any manner whatsoever to the Project, or any designated portion thereof, which are in the possession of the Offeror or the Offeror’s consultants, shall be made available to the City for inspection and copying upon written request of the City. Additionally, said records shall be made available, upon request by the City, to any local, state, federal or other regulatory authorities and any such authority may review, inspect and copy such records. Said records include, but are not limited to, all plans, specifications, submittals, correspondence, minutes, memoranda, tape recordings, videos, or other writings or things which document the Project, its design, and its construction. Said records expressly include those documents reflecting the time expended by the Offeror and its personnel in performing the obligations of this Contract and the records of expenses incurred by the Offeror in its performance under said Contract. The Offeror shall maintain and protect these records for no less than three (3) years after final completion of the Project, or for any longer period of time as may be required by applicable law or standard architectural practice.  

O.    Applicable Law. This Professional Services Contract shall be deemed to be entered into in the City of Charlottesville, Virginia. This Professional Services Contract shall, in all aspects, be governed by and interpreted under the laws of the Commonwealth of Virginia. 

VII CONTACT AND SUBMITTAL CONDITIONS

A.     Submittals (8 copies) will be received until 2:00 p.m. Thursday, March 31, 2005.

B.     Proposals must be submitted by the date and time indicated above or they will remain unopened. No allowance will be made for postmark or error in delivery to an incorrect address. It is the sole responsibility of the offeror to ensure timely delivery of the submittal.

C.     The City of Charlottesville will assume no responsibility for oral instruction, suggestion or interpretations. The final deadline for all questions and addendum’s will be Thursday, March 10, 2005. Any material change will be submitted to all offerors through issuance of a written addendum. Questions, in writing, should be directed to Angela Tucker, Development Services Manager, Department of Neighborhood Development Services, P.O. Box 911, Charlottesville, VA 22902 Phone (434) 970-3993 Fax (434) 970-3359. 

D.     All proposals must be valid for one hundred twenty (120) days from opening date. 

E.      Proposals should be submitted to:  

        Angela Tucker, Development Services Manager
        Department of Neighborhood Development Services/City Hall
        P.O. Box 911
        610 East Market Street
        Charlottesville, VA 22902
        tuckera@charlottesville.org

The face of the container shall be clearly marked with the following:
        Attn: Angela Tucker
        For: Meadowcreek Parkway/Route 250 Bypass/McIntire Road
        Interchange Design RFP
        Department of Neighborhood Development Services
        City of Charlottesville
 

Attachment : Certificate of No Collusion

CERTIFICATION OF NO COLLUSION

The undersigned, acting on behalf of _________________________________________, does hereby certify in connection with the procurement and bid to which this Certification of No Collision is attached that: 

This bid is not the result of, or affected by, any act of collusion with another person engaged in the same line of business or commerce: nor is this bid the result of, or affected by, any act of fraud punishable under Article 1.1 of Chapter 12 of Title 18.2 Code of Virginia, 1950 as amended (&&18.2-498.1 atseq.)

____________________________________
Signature of Company Representative

____________________________________
Name of Company

____________________________________
Date

ACKNOWLEDGEMENT

STATE OF VIRGINIA
CITY OF CHARLOTTESVILLE, to wit:
The foregoing Certification of No Collusion bearing the signature of ______________________ 

and dated _____________________________ was subscribed and sworn to before the 

undersigned notary public by ______________________________ on ____________________. 

____________________________________
Notary Public 

My commission expires:____________________________________ 

CODE OF VIRGINIA 

&18.2-498.4. Duty to provide certified statement.

A.                The Commonwealth, or any department or agency thereof, and any local government or any department or agency thereof, may require that any person seeking, offering or agreeing to transact business or commerce with it, or seeking, offering or agreeing to receive any portion of the public funds or moneys, submit a certification that the offer or agreement or any claim resulting thereon is not the result of, or affected by, any act of collusion with another person engaged in the same line of business or commerce, or any act of fraud punishable under this article.

B. Any person required to submit a certified statement as provided in paragraph A above who knowingly makes a false statement shall be guilty of a Class 6 felony. (1980, c.472)