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

a NF. P1. 1< LIlill tV, 1111. N11I OW, VI PJNIA, 111',, 1 A MIG ' I' lWlUl In,IMI x SECTION 2. 1 BIDDER' S CERTIFICATION - ITB 13 -013 am 1 have carefully examined the Invitation to bid, Instructions to bidders, General and Special Conditions, Vendor' s Notes, Specifications, proposed agreement and any other documents accompanying or made a part of this Invitation. I hereby propose to famish the goods or services specified in the Invitation at the prices or rates quoted in my bid. I agree that my bid will remain firm for a period of up to ninety (901 days in order to allow the City adequate time to evaluate the bids. I certify that all information contained in this bid is truthful to the best of my knowledge and belief. I further certify that I am duly authorized to submit this bid on behalf of the vendor /contractor as its act and deed and that the vendor/ contractor is ready, willing and able to perform if awarded the bid. 1 further certify that this bid is made without prior understanding, agreement, connection, discussion, or collusion with any other person, firm or corporation submitting a bid for the same product or service; no officer, employee or agent of the City of Fort Walton Beach or of any other bidder interested in said bid; and that the undersigned executed this bidder' s Certification with fall knowledge and understanding of the matters therein contained and was duly authorized to do so. NAME OF BU ASS BY: r` ,, Signature - jLckv JYI NAME & TITLE ( type or print) MAILING ADDRESS z CITY, STATE, ZIP CODE . TELEPHONE NUMBER FAX NUMBER DATE Page 5 of 28  Mj to 43oa 6upsixg jo luawaoeldea ELO- EL ell : ZOZZ) uo!LOnjtsuoO 40114S 016 ELO- EL quaw40ti mw M a iA, t ll",:'..,: Pt ' CrIlt" 14 tstsl Ill, Sant till( h t, 111. 1 till tVN. ANDiN,. SECTION 2. 2 ADDENDUM PAGE —ITB 13 -013 a The undersigned acknowledges receipt of the following addenda to the Documents ( Give number and date of each): Addendum No. Addendum No. Addendum No. Addendum No. FAILURE TO SUBMIT ACKNOWLEDGMENT OF ANY ADDENDUM THAT AFFECTS THE BID PRICES IS CONSIDERED A NLXJOR IRREGULARITY AND WILL BE CAUSE FOR REJECTION OF THE BID. NAME OF B SS ( jJ BY: Signature ME & TITLE ( type or print) NAM nt MAILING .ADDRESS CITY, STATE, ZIP CODE TELEPHONE NUMBER FAX NUMBER aYl DATE Page 6 of 28  MA to 4no0 0upslx3 io luowaoeldab £ LO-£ L 811 : ZOZZ) uogonjlsuoo 4ol! 4S ( lie £LO-£ L . luamyoelly/ 0m a an fit: 4 Vi.( ttF ? I OI ITbI SECTION 2.3 i. EtO. V' hO( h Vt 4() S$( Yt UIU` ItAlkii{ REFERENCES —ITB 13 -013 a Y aN 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. REGARDING PROPOSER / BIDDER: J VA--I Name: Name: Contact: Contact: Stz3y t f Address: Adt \ Telephone: Telephone: Facsimile: Facsimile Na Contact: Contact: r4k—_\ U Address: Address: Telephone: Telephone: c. Facsimile: Facsimile Page 7 of 28  Md le gaot7 6ugs1xg jo luawaoeldab £ LO-£ I Sit : ZOZZ) uol3onr1suoD 4o114S 018 £ LO-£ t _ 1mnnf3EI1V w ah m r a L4iIIll CN Willu , t.:: U, VPAtFrnI,", r V, I"'," 0 A I UOCfi VII Oftf," M, 1" In". Y SECTION 2. 5 DRUG -FREE WORKPLACE FORM ° a C The undersigned vendor, on l + x` r"r. s , r, 2013, in accordance with Section. 82087, Florida Statutes, — certifies that [ business] r ea -., 4ro Y - r> aegis: 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, 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 bid 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 terns of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contenders 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 I through 5. Check one: 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 BB ESS: f,• BY: mil SIGNATURE NAME & TITLE, TYPED OR PRNTED: f— z 1 C" r - m t, —, Page 9 of 28  M3 le aooa 6u4s1x310 lueumoeldaa CIO-El. Bit : ZOZZ) uoilonslsuoO 40114S - ale CIO- Et : 1u3w40e9tl a MV a rT RB41" 13 Replvc a0faistmg eoat Dock mFon Wahen lauding Uof a SECTION 2. 6 PUBLIC ENTITY CRIME FORM - RFP 13 -013 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 swum statement is submitted with Proposal, Proposal or Contract # - I- This sworn statement is submitted by ', p( 3 - whose business address is ` g \ - and ( if applicable) Federal Employer Identification Number FIN) (