Fort Walton Beach Council agenda — 02-26-13--regular — reading text

IA4Ir { I I Lt I i IIV Yn tYP. yl 11I 1011 M1IIAG 11, 1 1, OpC 1, 11 11, 141 1, A "" II' M", SECTION 23 REFERENCES —ITB 13- 013 o_ Bidder shall submit as a part of the bid package, four ( 4) business references with name of the business, address, contact person, and telephone number. All references shall be for similar work that has been performed within the last five (5) years.. y ..^^ REGARDING PROPOSER / BIDDER: 04AIr IV JJ r, M c 111, < Name: Name: nkt s C F F.• to Contact: Contact Address: Address: 32 Jcl- Or; ,. e c .+ . r Telephone: Telephone: Facsimile: Facsimile x Nance: Name: 1- tS F•... G14. Cfl Contact, Contact: n Address: Address: 00 r— acr Ms. 1 C acjc Telephone: Telephone: g' o YS7- Yzvz so - Yz- i 76 Facsimile: Facsimile 79 Yr) 1 Page 7 of 28  Oulpue, M=l in „ ood Bu llslx3 ;o luawaneldaa Et0-EL 811 ZOZZ) 4anS N s3oal7 1718 £ t0-£ t auawyaallV a( Mu a 111VVILVI. SECTION 2. 4 " NYUG1 UVAI OUCh I(` p"'" A" I' LA] NO BID" RESPONSE TO INVITATION TO BID UI16 J0. M1 IO L I am y a IF YOU ARE NOT SUBMITTING A BID, PLEASE PROVIDE THE INFORMATION BELOW AND RETURN THIS FORM BEFORE THE SCHEDULED BID OPENING DATE TO: Purchasing Agent City Of Fort Walton Beach 105 Miracle Strip Parkway SW Fort Walton Beach, FI 32548 Or by fax to (950) 833 -9643 FAILURE TO RESPOND TO THREE (3) CONSECUTIVE BIDS MAY RESULT IN YOUR COMPANY BEING DELETED FROM THE CITY' S BIDDER' S LIST. We have received your invitation to bid for ITB# 13 -013 — REPLACEMENT OF EXISTING BOAT DOCK. AT FORT WALTON LANDING, opening at 2: 30 PM, CST on February 12, 2013. Reason for not bidding lxcr, f I(, i i ( k Ira ( tnxt-; 1r . Company Name itt3 Date Page 8 of 28  6u, pue- I M3 to yno0 Bupsorg to moumoeidaa ELO- EL 911: ZOZZ) gonS N WeO - (3113 Et0-£ L : luawgoeliv u mw air arn IIH If t, `,' I Of h11SI1 \,' f111., 1111Ch ' MM" I', IO \ I. 1101. 1• ...... SECTION 2. 5 DRUG -FREE WORKPLACE FORM ti The undersigned vendor, on rfb i If' Statutus, —. 2013, in accordance with Section that [ business) 287.087, Flora'da certifies 1- 7 fI. Y YdOes: L 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 he taken against employees for violations of such prohibition. 2. Inform employees about the danger; of drug abuse in the workplace, the business's policy of maintaining a drug -free workplace, any available drug counseling, rehabilitation, 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 hid a copy of the statement specified in Paragraph 1. 4. In the statement specified in Paragraph 1, notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction o£, or pies of guilty or nolo comendere 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 a drug assistance or rehabilitation program if such is available in the employee' s community, by any employee who is so convicted. 6. Make a good faith effort to continue to maintain a drug -free workplace through implementation of Paragraphs 1 through 5. Check o As the person authorized to sign this statement, I certify that this firm complies fully with above requirements. As the person authorized to sign this statement, this firm does not comply fully with the above requirements. NAME OF S: -.( iii ` n SuC.1'l BY: SIGNATLIRI!- NAME & TITLE, TYPED OR PRINTED 4';A -V- 41- 4", ti - k l(Jri f Page 9 of 28  Bulpue3 M=l In 1000 Builsl)(3 In lu0ma0eldeN CIO- ft. all : ZOZZ) LlmS N s1080 - ais £Lo-£ I : luawyoelly o thU a arn rM #13 -013 Poplacemrnt of Existing Boat OOck 9 Fort Walton Landing PUBLIC ENTITY CRIME FORM - RFP 13- 013 asUm a SECTION 2. 6 SWORN STATEMENT UNDER SECTION 287. 133 ( 3) ( A) FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS. This swom statement is submitted with Proposal, Proposal or Contract # j TahG This sworn is submitted by CL , tY & LCk Mile e'whose business address is rhJ j•4>; 1tmVif F }- vo ' fit- , and( ifapplicable) Fedeml Employer Identification Number ( FEIN is, _ ( If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement). My name is }-, LL t L Wfte 7 _. tAl and my relationship to the entity named above is -( y= mot -. Cal-[ — Ir I understand that a " public entity crime" as defined in Paragraph 287. 133( a)( g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any proposal or contract for goods or services to be provided to any public entity or any agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.