Okaloosa County BOCC — January 30, 2013 — Proposed SHIP Administrative Services RFQ — reading text

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: _______________________ SIGNATURE: ____________________ COMPANY: _______________________ NAME: _________________________ (Typed or Printed) ADDRESS: _______________________ TITLE: _________________________ _______________________ E-MAIL: ________________________ _______________________ PHONE NO.: _____________________ ___  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. ____________________________ __________________________ Bidder’s Company Name Authorized Signature – Manual ____________________________ __________________________ Physical Address Authorized Signature – Typed ____________________________ __________________________ Mailing Address Title ____________________________ __________________________ Phone Number FAX Number ____________________________ __________________________ Cellular Number After-Hours Number(s) ____________________________ DATE (REVISED: JANUARY 12, 2001)  NOTICE OF AWARD TO: PROJECT DESCRIPTION: The OWNER has considered the BID submitted by you for the above-described WORK in response to its Advertisement for Bids dated __________________ and Information for Bidders. You are hereby notified that your BID has been accepted for items in the amounts of $_________________. You are required by the Instructions to Bidders to execute the Agreement and furnish the required CONTRACTOR’S Certificate of Insurance within fifteen (15) calendar days from the date of this notice to you. If you fail to execute said Agreement and to furnish said certificate within fifteen (15) calendar days from the date of this notice, said OWNER will be entitled to consider all your rights arising out of the OWNER’s acceptance of your BID as abandoned. The OWNER will be entitled to such other rights as may be granted by law. You are required to return an acknowledged copy of this NOTICE OF AWARD to the OWNER: Okaloosa County Purchasing, 602-C North Pearl St., Crestview, FL 32536. If you have any questions, please call John Christopher at 850-689-5960. Dated this ____ day of ____________, 2013. OWNER – OKALOOSA COUNTY BOARD OF COUNTY COMMISSIONERS BY: _________________________ TITLE Purchasing Director Richard L Brannon ACCEPTANCE OF NOTICE Receipt of the above NOTICE OF AWARD is hereby acknowledged. BY: ___________________________________________________ This the ________ day of ___________________, 2013. BY: ___________________________________________________ Title: __________________________________________________  NOTICE TO PROCEED DATE: ________________ TO: PROJECT: ________________________________________________________ You are hereby notified to commence WORK in accordance with the Agreement dated _____________________, 2013. You are required to return an acknowledged copy of this NOTICE TO PROCEED to the OWNER: Okaloosa County Purchasing, 602-C North Pearl St, Crestview, FL 32536. OKALOOSA COUNTY BOARD OF COUNTY COMMISSIONERS OWNER BY:_____________________________ Richard L. Brannon TITLE: Purchasing Director ACCEPTANCE OF NOTICE Receipt of the above NOTICE TO PROCEED is hereby acknowledged. ____________________________________ Company Name This the ________ day of _________________, 2013 ____________________________________ Signature By: _________________________________ Type or Print Name Title: ________________________________  LOCAL PREFERENCE DATA SHEET Refer to Special Bid Condition 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_______________________ ________________________ __________________________________ ________________________ __________________________________ ________________________ __________________________________ ________________________ __________________________________ _____________________________ ______________________________ Bidder’s Company Name Authorized Signature – Manual ______________________________ ______________________________ E-Mail Authorized Signature – Typed