Okaloosa County BOCC — November 4, 2012 — DRC Contract — reading text

Okaloosa County and its consultants and other indemnities of the Contractor under all the foregoing policies of insurance. Umbrella Insurance The Contractor shall have the right to meet the liability insurance requirements with the purchase of an umbrella insurance policy. In all instances, the combination of primary and umbrella liability coverage must equal or exceed the minimum liability insurance limits stated in this agreement. Last Revised — 04/10/2007 18 INDEMNIFICATION AND HOLD HARMLESS To the fullest extent permitted by law, CONTRACTOR shall indemnify and hold harmless COUNTY, its officers and employees from liabilities, damages, losses, and costs including but not limited to reasonable attorney fees, to the extent caused by the negligence, recklessness, or intentional wrongful conduct of the CONTRACTOR and other persons employed or utilized by the CONTRACTOR in the performance of this Agreement. DEC EMERGENCY SERVICES, LLOE Mit. fl —_— Bidder’s Company Name \ Authorized Signature — Manual TYo museum pee , Mobice AL Mare STafee2O Physical Address ' BwbdYX Authorized Signature — Typed SAm Ee CHER OPERATING OFFICER Mailing Address Title 5 |-243-S564_ 95\-343-358\ Phone Number ~ FAX Number 504-415 FT45 Sot¢-4IS-1VI4S Cellular Number After-Hours Number(s) 4 |atfot DATE § (REVISED: JANUARY 12, 2001) Last Revised - 06/12/2007 19 CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all bidders/proposers, must disclose if any Okaloosa Board of County Commissioner, employee(s), elected officials(s), of if any of its agencies is also an owner, corporate officer, agency, employee, etc., of their business. Indicate either “yes” (a county employee, elected official, or agency is also associated with your business), or “no”. If yes, give person(s) name(s) and position(s) with your business. YES NO. xX XN NAME(S) POSITION(S) FIRM NAME: DRC EmeERGcEN ol SERVICES BY (PRINTED): MA€e STAFFORD BY (SIGNATURE): | TITLE: Chree OPERATING OF FICE ADDRESS: TWYo museum DRIVE MOBILE. At 308 PHONE NO. a5 1-3 43-358 | Last Revised — 06/12/2007 20 DRUG-FREE WORKPLACE CERTIFICATION THE BELOW SIGNED BIDDER CERTIFIES that it has implemented a drug-free workplace program. In order to have a drug-free workplace program, a business shall: 1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations. 3. Give each employee engaged in providing the commodities or contractual services that are under quote a copy of the statement specified in subsection 1. 4. In the statement specified in subsection 1, notify the employees that, as a condition of working on the commodities or contractual services that are under quote, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction. 5. Impose a sanction on, or require the satisfactory participation in, drug abuse assistance or rehabilitation program if such is available in employee’s community, by any employee who is convicted. 6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section. As the person authorized to sign this statement, I certify that this firm complies fully with the above requirements. DATE: £ | [Lot SIGNATURE: Mut COMPANY: DRC En€eckroy SERucesS NAME: MARE STAF ORD (Typed or Printed) TITLE: CLLEF OPERATING OFF CER ADDRESS: A4O MUSEUM De MOBILE ; Au 3,608 PHONENO.: 251 7343-3 53 Last Revised — 06/12/2007 21 RECYCLED CONTENT FORM RECYCLED CONTENTINFORMATION \\ 4. 1. Is the material in the above: Virgin or Recycled (Check the applicable blank). If recycled, what percentage %. Product Description: 2. Is your product packaged and/or shipped in material containing recycled content? Yes No Specify: 3. Is your product recyclable after it has reached its intended end use? Yes No Specify: The above is not applicable if there is only a personal service involved with no product involvement. Name of Bidder; __ HRT EMERGENCY SERVviIces jpLLe Last Revised — 06/12/2007 22 LOCAL PREFERENCE DATA SHEET Refer to Special Bid Condition SEE ATIACHED Does the state, county, municipality or political subdivision in which your firm is located offer a preference to their local bidders? (If your firm is located in Okaloosa County, you will check “NO.”) If “YES,” list below the extent of such preference. YES NO x Cihree OPERATING OF ICER_ Mat = | Bidder’s Company Name Authorized Signature — Manual BE MARK sinfroeD Authorized Signature — Typed 23 Last Revised — 06/12/2007 EVALUATION SHEET RANKING OF DEBRIS REMOVAL OKALOOSA COUNTY, FLORIDA BOARD OF COUNTY COMMISSIONERS CRITERIA FOR RANKING: B. C. EXPERIENCES A. PROFESSIONAL W/SIMILAR D. LOCATION - F, KNOWLEDGE EXPERTISE PROJECTS AVAILABILITY | E. FEES REFERENCES | TOTALS FIRM 0-10 0-10 0-10 0-40 0-40 0-10 To avoid duplication, the Project Manager or Designee will contact and rank references. Signature of Rater: Print Name: Date: Last Revised — 04/10/2007 24