Okaloosa County BOCC — March 18, 2014 — R&E Farms Contract — reading text

violation of this policy shall result in disqualification of my proposal/submittal. Last Revised- 2/6/13 Page 13  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 X NAME(S) POSITION(S) FIRM NAME: LL BY (PRINTED): ; ii R_ et V BY (SIGNATURE): X~~~ TITLE: C___ () f1 E/" ADDRESS: 5+ 4t- 3Y/ 1(_ 54-10 ' PHONE NO. Last Revised- 12/6/13 Page 14  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: 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 contender 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. 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: COMPANY: J 7 I LI P E Pa/ji't c1 L L C, SIGNATURE: NAME: Z _______ (Typed or Printed) ADDRESS: 25 /9ttva'ct 5+ TITLE: 4L. 31 PHONE NO.: 33 53L/. Last Revised - 06/24/2013 Page 19  RECYCLED CONTENT FORM RECYCLED CONTENT INFORMATION 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: (N 4 ) R Fai r— Last Revised - 12/6/13 Page 20  LOCAL PREFERENCE DATA SHEET Okoloosa County grants a preference to in-county bidders only when bids are received from firms located in states, municipalities or other political subdivisions which offer preference to bidders located in such political subdivisions. The amount of preference given to local bidders will be the same as that given by the state, county, municipality or other political subdivisions in which the out-of-county bidder is located. If the political subdivision in which a bidder is located offers a preference to its local firms, that bidder must plainly state the extent of such preference to include the amount and type preference offered. Any bidder failing to indicate such preference will be removed from the County bid list and any and all bids from that firm will be rejected. Does the state, county, municipality or political subdivision in which your firm is located offer a preference to their local bidders? If "YES," list below the extend of such preference. (If your firm is located in Okaloosa County, you will check 'YES-reciprocal only.) YES NO If yes, you must identify how you confirmed this information or who you spoke with within your area of business location below: Bidder's Company Name Authorized Signature - Manual /), Jf t; ueftba/k Printed Name - 7-/ Date Last Revised - 12/6/13 Page 21  INDEMNIFICATION AND HOLD HARMLESS To the fullest extent permitted by law, CONTRACTOR shallindemnify 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. Bidder's Company Name Atpu/ Authorized Signature - Manual 62. S Si 1):/1 Riiiev.bauA' Physical Address Authorized Signature - Typed C/pvtV Mailing Address Title 11- S3q-///, p,te& Phone Number P,n/ FAXNumbe' 95c 2o'?- (0f7o 33 1[53 Lf_//f , Cellular Number After-Hours Number(s) DATE (REVISED: JANUARY 12, 2001) Last Revised - 2/6/13 Page 22  BID SHEET BID #: #WS21-14 BID ITEM: WATER & SEWER BIOSOLIDS REMOVAL & TRANSPORTATION 1 PRICE PER CUBIC YARD TO INCLUDE ALL TRANSPORTATION/PICKUP & DISPOSAL COSTS 2. PRICE PER CUBIC YARD WITHOUT TRANSPORTATION COSTS (DISPOSAL ONLY & SITE LOCATED IN FLORIDA) $75 DISPOSAL SITE ADDRESS 32/3 3. PRICE PER CUBIC YARD WITHOUT TRANSPORTATION COSTS (DISPOSAL ONLY & SITE LOCATED IN ALABAMA) DISPOSAL SITE ADDRESS 3cc A 3 f 5 kl Ftoi, /1. 3C2- Note: It is not necessary to submit a bid on all three line items. The County reserves the right to perform a financial analysis on all line items of all bids and take into consideration distance to the disposal site (in which County expenses/resources would be incurred by transporting biosolids), in order to award the bid to the contractor(s) which produce the overall lowest expenses to the County. Remarks: ANTI-COLLUSION STATEMENT: The below signed bidder has not divulged to, discussed or compared his bid with other bidders and has not colluded with any other bidder or parties to bid whatever. (Note: No premiums, rebates, or gratuities permitted either with, prior to, or after any delivery of materials. Any such violation will result in the cancellation and/or return of material (as applicable) and the removal from bid list(s). Last Revised - 12/6/13 Page 25  R 6v vv,5, Bidder's Company Name' Z~4 ___ Authorized Signature - - "// Manual s1 /y, ii 4 ,vCIi(' Authorized Signature - Typed /B1ack' 4L 3,31( c4 tec' Address Title 33L/ 53qJJ/4 Phone # Fax# E'vt4 I 20- /781322_ Federal ID # or SS # Last Revised - 12/6/13 Page 26