Public Art Coordination Services

REQUEST FOR PROPOSALS (RFP)

Specification No. 25-11737-C

FOR

Public Art Coordination Services

PROPOSALS WILL NOT BE OPENED AND READ PUBLICLY

Dear Proposer:

The City of Berkeley is soliciting written proposals from qualified firms or individuals Public Art Coordination Services. As a Request for Proposal (RFP) this is not an invitation to bid and although price is very important, other factors will be taken into consideration.

The project scope, content of proposal, and vendor selection process are summarized in the RFP (attached). Proposals must be received no later than 2:00 pm, on Tuesday, December 16, 2025. Proposals are to be sent via email with the “Specification No. 25-11737-C and Public Art Coordination Services” clearly indicated in the subject line of the email. Please submit one (1) PDF of the technical Proposal with the filename saved as, “Proposal: Vendor Name - 25-11737-C, Public Art Coordination Services RFP.” Corresponding pricing proposal shall be submitted as a separate document with the filename saved as, “Pricing: Vendor Name - 25-11737-C, Public Art Coordination Services RFP.”

Email Proposals to:

City of Berkeley

Finance Department/General Services Division

Solicitations@berkeleyca.gov

Proposals will not be accepted after the date and time stated above. Incomplete proposal or proposals that do not conform to the requirements specified herein will not be considered. Issuance of the RFP does not obligate the City to award a contract, nor is the City liable for any costs incurred by the proposer in the preparation and submittal of proposals for the subject work. The City retains the right to award all or parts of this contract to several bidders, to not select any bidders, and/or to re-solicit proposals. The act of submitting a proposal is a declaration that the proposer has read the RFP and understands all the requirements and conditions.

For questions concerning the anticipated work, or scope of the project, please contact Jennifer Lovvorn (Project Manager), Chief Cultural Affairs Officer, via email at jlovvorn@berkeleyca.gov no later than Tuesday, November 18, 2025, by 5 PM. Answers to questions will not be provided by telephone or email. Answers to all questions or any addenda will be posted on the City of Berkeley’s site at Bid & Proposal Opportunities | City of Berkeley (berkeleyca.gov) . It is the vendor’s responsibility to check this site. For general questions concerning the submittal process, contact purchasing at 510-981-7320.

We look forward to receiving and reviewing your proposal.

Sincerely,

Henry Oyekanmi

Finance Director

I. BACKGROUND

The City of Berkeley’s public art enlivens and beautifies its civic buildings, parks, streetscapes, and other public spaces. Since its inception in 1967, Berkeley’s Civic Arts Program has acquired approximately 50 outdoor permanent public artworks, including works of sculpture, integrated design elements, mosaics, tile artworks, and painted murals. Also included in the City’s artwork collection are over 50 small portable, and mostly framed, artworks such as drawings, etchings, paintings, textiles and prints displayed in City buildings.

The City of Berkeley’s Civic Arts Program is responsible for documenting, cataloguing, and maintaining the artwork in this collection. These responsibilities require the Civic Arts Program to install, de-install, transport and store large scale artwork, as well as to frame and install smaller works, provide didactic signage, photograph and video document artworks as installed, and catalogue artwork in the collection. All of the artwork in the collection has been evaluated within the last two years and the Civic Arts Program intends to conserve the artworks in most need of treatment as funding becomes available. In addition to scheduled maintenance, artworks in the collection also occasionally require emergency repair.

The City of Berkeley (“City”) is soliciting proposals from qualified individuals and firms that provide Public Art Coordination Services. Interested parties must be willing to enter into a three-year (3) contract beginning January 21, 2026.

II. SCOPE OF SERVICES

Public Art Coordination Services include the following:

• Coordination of artwork restoration

• Facilitate artist and artwork selection

• Interface with the City of Berkeley on approvals

• Provide expert artwork curation and project management

• Develop and manage artwork fabrication and installation

• Manage art project budgets

• Develop and maintain records management systems related to artwork documentation with individual files for each object in the collection

• Documentation includes information about an artwork’s condition, its identification number, provenance, materials, treatment reports, and its physical location.

• Ensure the completeness of records within an on-line collection data base and corollary paper records.

• Coordinate professional photography of artwork

• Coordinate artwork signage design, production and installation

• Coordinate and develop publicity materials

Services are to be provided at the contractor’s place of business with occasional site meetings at locations throughout Berkeley and coordination meetings with artists, vendors, and City staff at their business locations.

Contractor will coordinate quarterly work plans with the Civic Arts Program’s project manager at the following intervals: January, April, July, and October. Quarterly work plan will describe the anticipated projects and tasks and the number of coordination service hours per week. Contractor shall not perform any work unless approved by Civic Arts Staff. Contractor shall not exceed the approved number of hours of the quarterly work plan. Contractor will bill monthly for services rendered at the contracted rate.

Contractor shall perform work in accordance with sensitivity to the artistic integrity and cultural impact of artwork, and in accordance with any design or Construction Documents relative to the work.

III. SUBMISSION REQUIREMENTS

All proposals shall include the following information, organized as separate sections of the proposal. The proposal should be concise and to the point.

1. Contractor Identification:

Provide the name of the firm, the firm's principal place of business (see section VII, F. – Local Vendor Preference), the name and telephone number of the contact person and company tax identification number.

2. Client References:

Provide a minimum of three (3) client references. References should be California cities or other art sector entities. Provide the designated person's name, title, organization, address, telephone number, and the project(s) that were completed under that client’s direction.

3. Price Proposal:

The proposal shall include pricing for all services. Pricing shall be all inclusive unless indicated otherwise. Pricing proposals shall be a separate document. The Proposal shall itemize all services, including hourly rates for all professional, technical and support personnel, and all other charges related to completion of the work shall be itemized. Evaluation of price proposals are subject to the local vendor business preference (see section VII.F.).

4. Contract Terminations:

If your organization has had a contract terminated in the last five (5) years, describe such incident. Termination for default is defined as notice to stop performance due to the vendor’s non-performance or poor performance and the issue of performance was either (a) not litigated due to inaction on the part of the vendor, or (b) litigated and such litigation determined that the vendor was in default.

Submit full details of the terms for default including the other party’s name, address, and phone number. Present the vendor’s position on the matter. The City will evaluate the facts and may, at its sole discretion, reject the proposal on the grounds of the past experience.

If the firm has not experienced any such termination for default or early termination in the past five (5) years, so indicate.

IV. SELECTION CRITERIA

The following criteria will be considered, although not exclusively, in determining which firm is hired.

1. The Firm’s and staff qualifications and experience (35 points)

2. Project understanding, approach, and ability to follow consultant procedures as described in the Scope of Services (30 points)

3. Costs* (25 points)

4. References (5 points)

5. Completeness of the proposal (5 points)

* Effective 1/1/2022. Local Vendor Preference. For the purposes of comparing pricing as part of this competitive RFP for goods up to $100,000 or non-professional services up to $250,000, 5% shall be deducted from the bid price proposal from any local Berkeley vendor.

A selection panel will be convened of staff to evaluate and score submittals.

V. PAYMENT

Invoices: Invoices must be fully itemized, and provide sufficient information for approving payment and audit. Invoices must be accompanied by receipt for services in order for payment to be processed. Email invoices to Accounts Payable and cc: Jennifer Lovvorn, Civic Arts Program jlovvorn@berkeleyca.gov; (List on invoice, Attn: Project Manager Jennifer Lovvorn, Civic Arts Program, City Manager’s Office) and reference the contract number.

City of Berkeley

Accounts Payable

P.O. Box 700

Berkeley, CA 94710-700

Email: AccountsPayable@berkeleyca.gov

Phone: 510-981-7310

Payments: The City will make payment to the vendor within 30 days of receipt of a correct, approved and complete invoice.

VI. CITY REQUIREMENTS

(Do not modify any part of this section except: Living Wage would not apply if commodities are being purchased and Equal Benefits would not apply if the contract amount will be less than $25,000. If this is the case, do not delete the section just note next to it “Does Not Apply to this Request for Proposal”)

A. Non-Discrimination Requirements:

Ordinance No. 5876-N.S. codified in B.M.C. Chapter 13.26 states that, for contracts worth more than $3,000 bids for supplies or bids or proposals for services shall include a completed Workforce Composition Form. Businesses with fewer than five employees are exempt from submitting this form. (See B.M.C. 13.26.030)

Under B.M.C. section 13.26.060, the City may require any bidder or vendor it believes may have discriminated to submit a Non-Discrimination Program. The Contract Compliance Officer will make this determination. This applies to all contracts and all consultants (contractors). Berkeley Municipal Code section 13.26.070 requires that all contracts with the City contain a non-discrimination clause, in which the contractor agrees not to discriminate and allows the City access to records necessary to monitor compliance. This section also applies to all contracts and all consultants.

Bidders must submit the attached Non-Discrimination Disclosure Form with their proposal.

B. Nuclear Free Berkeley Disclosure Form:

Berkeley Municipal Code section 12.90.070 prohibits the City from granting contracts to companies that knowingly engage in work for nuclear weapons. This contracting prohibition may be waived if the City Council determines that no reasonable alternative exists to doing business with a company that engages in nuclear weapons work. If your company engages in work for nuclear weapons, explain on the Disclosure Form the nature of such work.

Bidders must submit the attached Nuclear Free Disclosure Form with their proposal.

C. Oppressive States:

The City of Berkeley prohibits granting of contracts to firms that knowingly provide personal services to specified Countries. This contracting prohibition may be waived if the City Council determines that no reasonable alternative exists to doing business with a company that is covered by City Council Resolution Nos. 59,853-N.S., 60,382-N.S., and 70,606-N.S. If your company or any subsidiary is covered, explain on the Disclosure Form the nature of such work.

Bidders must submit the attached Oppressive States Disclosure Form with their proposal.

D. Sanctuary City Contracting Ordinance:

Chapter 13.105 of the Berkeley Municipal Code prohibits the City from granting and or retaining contracts with any person or entity that provides Data Broker or Extreme Vetting services to the U.S. Immigration and Customs Enforcement Division of the United States Department of Homeland Security (“ICE”).

Bidders must submit the attached Sanctuary City Compliance Statement with their proposal.

E. Conflict of Interest:

In the sole judgment of the City, any and all proposals are subject to disqualification on the basis of a conflict of interest. The City may not contract with a vendor if the vendor or an employee, officer or director of the proposer's firm, or any immediate family member of the preceding, has served as an elected official, employee, board or commission member of the City who influences the making of the contract or has a direct or indirect interest in the contract.

Furthermore, the City may not contract with any vendor whose income, investment, or real property interest may be affected by the contract. The City, at its sole option, may disqualify any proposal on the basis of such a conflict of interest.

Please identify any person associated with the firm that has a potential conflict of interest.

F. Berkeley Living Wage Ordinance:

Chapter 13.27 of the Berkeley Municipal Code requires that contractors offer all eligible employees with City mandated minimum compensation during the term of any contract that may be awarded by the City. If the Contractor is not currently subject to the Living Wage Ordinance, cumulative contracts with the City within a one-year period may subject Contractor to the requirements under B.M.C. Chapter 13.27. A certification of compliance with this ordinance will be required upon execution of a contract. The current Living Wage rate can be found here: Information for Vendors | City of Berkeley (berkeleyca.gov) . The Living Wage rate is adjusted automatically effective June 30th of each year commensurate with the corresponding increase in the Consumer Price Index published in April of each year. If the Living Wage rate is adjusted during the term of your agreement, you must pay the new adjusted rate to all eligible employees, regardless of what the rate was when the contract was executed.

G. Berkeley Equal Benefits Ordinance:

Chapter 13.29 of the Berkeley Municipal Code requires that contractors offer domestic partners the same access to benefits that are available to spouses. A certification of compliance with this ordinance will be required upon execution of a contract.

H. Statement of Economic Interest:

The City’s Conflict of Interest Code designates “consultants” as a category of persons who must complete Form 700, Statement of Economic Interest, at the beginning of the contract period and again at the termination of the contract. The selected contractor will be required to complete the Form 700 before work may begin.

VII. OTHER REQUIREMENTS

A. Insurance

The selected contractor will be required to maintain general liability insurance in the minimum amount of $2,000,000, automobile liability insurance in the minimum amount of $1,000,000 and a professional liability insurance policy in the amount of $2,000,000 to cover any claims arising out of the performance of the contract. The general liability and automobile insurance must name the City, its officers, agents, volunteers and employees as additional insured.

B. Worker’s Compensation Insurance:

A selected contractor who employs any person shall maintain workers' compensation insurance in accordance with state requirements. Sole proprietors with no employees are not required to carry Worker’s Compensation Insurance.

C. Business License

Virtually every contractor that does business with the City must obtain a City business license as mandated by B.M.C. Ch. 9.04. The business license requirement applies whether or not the contractor has an office within the City limits. However, a "casual" or "isolated" business transaction (B.M.C. section 9.04.010) does not subject the contractor to the license tax. Warehousing businesses and charitable organizations are the only entities specifically exempted in the code from the license requirement (see B.M.C. sections, 9.04.295 and 9.04.300). Non-profit organizations are granted partial exemptions (see B.M.C. section 9.04.305). Persons who, by reason of physical infirmity, unavoidable misfortune, or unavoidable poverty, may be granted an exemption of one annual free license at the discretion of the Director of Finance. (See B.M.C. sections 9.04.290).

Vendor must apply for a City business license and show proof of application to Purchasing Manager within seven days of being selected as intended contractor.

The Customer Service Division of the Finance Department located at 1947 Center Street, Berkeley, CA 94704, issues business licenses. Contractors should contact this division for questions and/or information on obtaining a City business license, in person, or by calling 510-981-7200.

D. Recycled Paper

Any printed reports for the City required during the performance of the work shall be on 100% recycled paper, and shall be printed on both sides of the page whenever practical.

E. State Prevailing Wage:

Certain labor categories under this project may be subject to prevailing wages as identified in the State of California Labor Code commencing in Section 1770 et seq. These labor categories, when employed for any “work performed during the design and preconstruction phases of construction including, but not limited to, inspection and land surveying work,” constitute a “Public Work” within the definition of Section 1720(a)(1) of the California Labor Code requiring payment of prevailing wages.

Wage information is available through the California Division of Industrial Relations web site at:

http://www.dir.ca.gov/OPRL/statistics_and_databases.html

F. Local Vendor Preference

City of Berkeley applies a local vendor preference for comparing pricing submittals in RFP responses (City Council Resolution No. 69,890-N.S.)

A local business is defined as “a business firm with fixed offices or distribution points located within the City of Berkeley boundaries and listed in the Permits and License Tax paid file, with a Berkeley business street address.”

Competing for non-professional services

For the purposes of comparing pricing as part of this competitive RFP for non-professional services up to $250,000, 5% shall be deducted from the bid price proposal from any local Berkeley vendor in order to assign evaluation points to the pricing section.

VIII. SCHEDULE (Dates are subject to change)

◊ Issue RFP to Potential Bidders: 12/5/2025

◊ Questions Due 12/12/2025, by 5 PM

◊ Proposals Due from Potential Bidders 12/16/2025, by 2 PM

◊ Complete Selection Process 01/6/2026

◊ Council Approval of Contract (over $50k) 1/20/2026

◊ Award of Contract 1/21/2026

◊ Sign and Process Contract 2/4/2026

◊ Notice to Proceed 2/5/2026

Thank you for your interest in working with the City of Berkeley for this service. We look forward to receiving your proposal.

Attachments:

• Check List of Required items for Submittal Attachment A

• Non-Discrimination/Workforce Composition Form Attachment B

• Nuclear Free Disclosure Form Attachment C

• Oppressive States Form Attachment D

• Sanctuary City Compliance Statement Attachment E

• Living Wage Form Attachment F

• Equal Benefits Certification of Compliance Attachment G

• Right to Audit Form Attachment H

• Insurance Endorsement Attachment I

ATTACHMENT A

CHECKLIST

◊ Proposal describing service (one (1) PDF of proposal)

◊ Contractor Identification and Company Information

◊ Client References

◊ Costs proposal by task, type of service & personnel (as a separate document from the proposal). Please include hourly rate.

◊ The following forms, completed and signed in blue ink (attached):

o Non-Discrimination/Workforce Composition Form Attachment B

o Nuclear Free Disclosure Form Attachment C

o Oppressive States Form Attachment D

o Sanctuary City Compliance Statement Attachment E

o Living Wage Form (may be optional) Attachment F

o Equal Benefits Certification (EBO-1) (may be optional) Attachment G

ADDITIONAL SUBMITTALS REQUIRED FROM SELECTED VENDOR AFTER COUNCIL APPROVAL TO AWARD CONTRACT.

◊ Provide original-signed in blue ink Evidence of Insurance

o Auto

o Liability

o Worker’s Compensation

◊ Right to Audit Form Attachment H

◊ Commercial General & Automobile Liability Endorsement Form Attachment I

◊ Berkeley Business License (Current Year Certificate)

For informational purposes only, see the Sample of Personal Services Contract .

NON-DISCRIMINATION/WORKFORCE COMPOSITION FORM FOR NON-CONSTRUCTION CONTRACTS

To assist the City of Berkeley in implementing its Non-Discrimination policy, it is requested that you furnish information regarding your personnel as requested below and return it to the City Department handling your contract: Organization: _____________________________________________________________________________________ Address: _______________________________________________________________ Business Lic. #: ___________

Occupational Category: __________________________ (See reverse side for explanation of terms)

Total Employees

White Employees

Black Employees

Asian Employees

Hispanic Employees

Other Employees

Female

Male

Female

Male

Female

Male

Female

Male

Female

Male

Female

Male

Official/Administrators

Professionals

Technicians

Protective Service Workers

Para-Professionals

Office/Clerical

Skilled Craft Workers

Service/Maintenance

Other (specify)

Totals:

Is your business MBE/WBE/DBE certified? Yes: _____ No: _____ If yes, by what agency? _______________________

If yes, please specify: Male: _____ Female: _____ Indicate ethnic identifications: ___________________________

Do you have a Non-Discrimination policy? Yes: _____ No: _____

Signed: ________________________________________________________________ Date: __________________

Verified by: _____________________________________________________________ Date: __________________

City of Berkeley Contract Compliance Officer

Contract Description/Specification No: 25-11737-C Public Art Coordination Services Attachment B (page 1)

Occupational Categories

Officials and Administrators - Occupations in which employees set broad policies, exercise overall responsibility for execution of these policies, or provide specialized consultation on a regional, district or area basis. Includes: department heads, bureau chiefs, division chiefs, directors, deputy superintendents, unit supervisors and kindred workers.

Professionals - Occupations that require specialized and theoretical knowledge that is usually acquired through college training or through work experience and other training that provides comparable knowledge. Includes: personnel and labor relations workers, social workers, doctors, psychologists, registered nurses, economists, dietitians, lawyers, systems analysts, accountants, engineers, employment and vocational rehabilitation counselors, teachers or instructors, and kindred workers.

Technicians - Occupations that require a combination of basic scientific or technical knowledge and manual skill that can be obtained through specialized post-secondary school education or through equivalent on-the-job training. Includes: computer programmers and operators, technical illustrators, highway technicians, technicians (medical, dental, electronic, physical sciences) and kindred workers.

Protective Service Workers - Occupations in which workers are entrusted with public safety, security and protection from destructive forces. Includes: police officers, fire fighters, guards, sheriffs, bailiffs, correctional officers, detectives, marshals, harbor patrol officers, and kindred workers.

Para-Professionals - Occupations in which workers perform some of the duties of a professional or technician in a supportive role, which usually requires less formal training and/or experience normally required for professional or technical status. Such positions may fall within an identified pattern of a staff development and promotion under a "New Transporters" concept. Includes: library assistants, research assistants, medical aides, child support workers, police auxiliary, welfare service aides, recreation assistants, homemaker aides, home health aides, and kindred workers.

Office and Clerical - Occupations in which workers are responsible for internal and external communication, recording and retrieval of data and/or information and other paperwork required in an office. Includes: bookkeepers, messengers, office machine operators, clerk-typists, stenographers, court transcribers, hearings reporters, statistical clerks, dispatchers, license distributors, payroll clerks, and kindred workers.

Skilled Craft Workers - Occupations in which workers perform jobs which require special manual skill and a thorough and comprehensive knowledge of the processes involved in the work which is acquired through on-the-job training and experience or through apprenticeship or other formal training programs. Includes: mechanics and repairpersons, electricians, heavy equipment operators, stationary engineers, skilled machining occupations, carpenters, compositors and typesetters, and kindred workers.

Service/Maintenance - Occupations in which workers perform duties which result in or contribute to the comfort, convenience, hygiene or safety of the general public or which contribute to the upkeep and care of buildings, facilities or grounds of public property. Workers in this group may operate machinery. Includes: chauffeurs, laundry and dry-cleaning operatives, truck drivers, bus drivers, garage laborers, custodial personnel, gardeners and groundskeepers, refuse collectors, and construction laborers.

Contract Description/Specification No: 25-11737-C Public Art Coordination Services Attachment B (page 2)

CITY OF BERKELEY

Nuclear Free Zone Disclosure Form

I (we) certify that:

1. I am (we are) fully cognizant of any and all contracts held, products made or otherwise handled by this business entity, and of any such that are anticipated to be entered into, produced or handled for the duration of its contract(s) with the City of Berkeley. (To this end, more than one individual may sign this disclosure form, if a description of which type of contracts each individual is cognizant is attached.)

2. I (we) understand that Section 12.90.070 of the Nuclear Free Berkeley Act (Berkeley Municipal Code Ch. 12.90; Ordinance No. 5784-N.S.) prohibits the City of Berkeley from contracting with any person or business that knowingly engages in work for nuclear weapons.

3. I (we) understand the meaning of the following terms as set forth in Berkeley Municipal Code Section 12.90.130:

"Work for nuclear weapons" is any work the purpose of which is the development, testing, production, maintenance or storage of nuclear weapons or the components of nuclear weapons; or any secret or classified research or evaluation of nuclear weapons; or any operation, management or administration of such work.

"Nuclear weapon" is any device, the intended explosion of which results from the energy released by reactions involving atomic nuclei, either fission or fusion or both. This definition of nuclear weapons includes the means of transporting, guiding, propelling or triggering the weapon if and only if such means is destroyed or rendered useless in the normal propelling, triggering, or detonation of the weapon.

"Component of a nuclear weapon" is any device, radioactive or non-radioactive, the primary intended function of which is to contribute to the operation of a nuclear weapon (or be a part of a nuclear weapon).

4. Neither this business entity nor its parent nor any of its subsidiaries engages in work for nuclear weapons or anticipates entering into such work for the duration of its contract(s) with the City of Berkeley.

Based on the foregoing, the undersigned declares under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Printed Name: ___________________________________ Title: ____________________________________

Signature: _______________________________________Date: ____________________________________

Business Entity: ___________________________________________________________________________

Contract Description/Specification No: 25-11737-C Public Art Coordination Services Attachment C

CITY OF BERKELEY

Oppressive States Compliance Statement

The undersigned, an authorized agent of_________________________________________________ (hereafter "Vendor"), has had an opportunity to review the requirements of Berkeley City Council Resolution Nos. 59,853-N.S., 60,382-N.S., and 70,606-N.S., (hereafter "Resolutions"). Vendor understands and agrees that the City may choose with whom it will maintain business relations and may refrain from contracting with those Business Entities which maintain business relationships with morally repugnant regimes. Vendor understands the meaning of the following terms used in the Resolution:

"Business Entity" means "any individual, firm, partnership, corporation, association or any other commercial organization, including parent-entities and wholly-owned subsidiaries" (to the extent that their operations are related to the purpose of the contract with the City).

"Oppressive State" means: Tibet Autonomous Region and the Provinces of Ado, Kham and U-Tsang; and Burma (Myanmar)

“Personal Services” means “the performance of any work or labor and shall also include acting as an independent contractor or providing any consulting advice or assistance, or otherwise acting as an agent pursuant to a contractual relationship.”

Contractor understands that it is not eligible to receive or retain a City contract if at the time the contract is executed, or at any time during the term of the contract it provides Personal Services to:

a. The governing regime in any Oppressive State.

b. Any business or corporation organized under the authority of the governing regime of any Oppressive State.

c. Any person for the express purpose of assisting in business operations or trading with any public or private entity located in any Oppressive State.

Vendor further understands and agrees that Vendor's failure to comply with the Resolution shall constitute a default of the contract and the City Manager may terminate the contract and bar Vendor from bidding on future contracts with the City for five (5) years from the effective date of the contract termination.

The undersigned is familiar with, or has made a reasonable effort to become familiar with, Vendor's business structure and the geographic extent of its operations. By executing the Statement, Vendor certifies that it complies with the requirements of the Resolution and that if any time during the term of the contract it ceases to comply, Vendor will promptly notify the City Manager in writing.

Based on the foregoing, the undersigned declares under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Printed Name: ____________________________________ Title: _______________________________________

Signature: ________________________________________ Date: ______________________________________

Business Entity: ____________________________________________________________________________________

Contract Description/Specification No: Project Name/XX-XXXXX

I am unable to execute this Statement; however, Vendor is exempt under Section VII of the Resolution. I have attached a separate statement explaining the reason(s) Vendor cannot comply and the basis for any requested exemption.

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