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RESPONSIBILITY DETERMINATION FORM
Project Name: ____________
Bid Number: ____________
Business Entity Name: ____________
CCB License Number: ____________
Form Submitted By (Contracting Agency):
___________________________
Form Submitted By (Contracting Agency Representative's Name): ____________
Title: ____________
Date: ____________
(The contracting agency must submit this form with attachments, if any, to the Construction Contractors Board within 30 days after the date of contract award.)
The contracting agency has (check all of the following):
[ ] Checked the list created by the Construction Contractors Board under ORS 701.227 for bidders who are not qualified to hold a public improvement contract.
[ ] Determined whether the bidder has met the standards of responsibility. In so doing, the contracting agency has found that the bidder demonstrated that the bidder:
[ ] Has available the appropriate financial, material, equipment, facility and personnel resources and expertise, or the ability to obtain the resources and expertise, necessary to meet all contractual responsibilities.
[ ] Holds current licenses that businesses or service professionals operating in this state must hold in order to undertake or perform the work specified in the contract.
[ ] Is covered by liability insurance and other insurance in amounts required in the solicitation documents.
[ ] Qualifies as a carrier-insured employer or a self-insured employer under ORS 656.407 or has elected coverage under ORS 656.128.
[ ] Has disclosed the bidder's first- tier subcontractors in accordance with ORS 279C. 370.
[ ] Has a satisfactory record of performance.
[ ] Has a satisfactory record of integrity.
[ ] Is legally qualified to contract with the contracting agency.
[ ] Possesses a certificate that the Oregon Department of Administrative Services issued under ORS 279A.167.
[ ] Agrees to be bound by the terms and conditions of a community benefit contract if the public contract is a community benefit contract.
[ ] Has supplied all necessary information in connection with the inquiry concerning responsibility.
[ ] Determined the bidder to be (check one of the following):
[ ] Responsible under ORS 279C. 375 (3) (a) and (b) .
[ ] Not responsible under ORS 279C. 375 (3)(a) and (b).
(Attach documentation if the contracting agency finds the bidder not to be responsible.)
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ORS 279C.375