Okaloosa County BOCC — December 18, 2012 — reading text

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 – 01/09/2013 Page 18 Packet Pg. 368  8.5.a.a E-VERIFY COMPLIANCE CERTIFICATION Attachment: Request for Bids (1264 : Approval of Bid - Dune Planting Projects (Okaloosa Island & Western Destin)) In accordance with Okaloosa County Policy and Executive Order Number 11-116 from the office of the Governor of the State of Florida, Bidder hereby certifies that the U.S. Department of Homeland Security’s E-Verify system will be used to verify the employment eligibility of all new employees hired by the contractor during the contract term, and shall expressly require any subcontractors performing work or providing services pursuant to the contract to likewise utilize the U.S. Department of Homeland Security’s E-Verify system to verify the employment eligibility of all new employees hired by the subcontractor during the contract term; and shall provide documentation of such verification to the OWNER upon request. As the person authorized to sign this statement, I certify that this company complies/will comply fully with the above requirements. DATE: _______________________ SIGNATURE: ____________________ COMPANY: _______________________ NAME: _________________________ (Typed or Printed) ADDRESS: _______________________ TITLE: _________________________ _______________________ E-MAIL: ________________________ PHONE NO.: ___________________________ Last Revised – 01/09/2013 Page 19 Packet Pg. 369  8.5.a.a INDEMNIFICATION AND HOLD HARMLESS To the fullest extent permitted by law, CONTRACTOR shall indemnify and hold harmless Attachment: Request for Bids (1264 : Approval of Bid - Dune Planting Projects (Okaloosa Island & Western Destin)) OKALOOSA 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) Last Revised – 01/09/2013 Page 20 Packet Pg. 370  8.5.a.a CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all bidders/proposers, must Attachment: Request for Bids (1264 : Approval of Bid - Dune Planting Projects (Okaloosa Island & Western Destin)) 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______________ NAME(S) POSITION(S) FIRM NAME: _____________________________________ BY (PRINTED): _____________________________________ BY (SIGNATURE): _____________________________________ TITLE: _____________________________________ ADDRESS: _____________________________________ _____________________________________ PHONE NO. _____________________________________ E-MAIL _____________________________________ Last Revised – 01/09/2013 Page 21 Packet Pg. 371  8.5.a.a 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: Attachment: Request for Bids (1264 : Approval of Bid - Dune Planting Projects (Okaloosa Island & Western Destin)) 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: _______________________ SIGNATURE: ____________________ COMPANY: _______________________ NAME: _________________________ (Typed or Printed) ADDRESS: _______________________ TITLE: _________________________ _______________________ E-MAIL: ________________________ _______________________ PHONE NO.: _______________________ Last Revised – 01/09/2013 Page 22 Packet Pg. 372  8.5.a.a RECYCLED CONTENT FORM RECYCLED CONTENT INFORMATION Attachment: Request for Bids (1264 : Approval of Bid - Dune Planting Projects (Okaloosa Island & Western Destin)) 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: ________________________________________________________ E-Mail: Last Revised – 01/09/2013 Page 23 Packet Pg. 373  8.5.a.a LOCAL PREFERENCE DATA SHEET Attachment: Request for Bids (1264 : Approval of Bid - Dune Planting Projects (Okaloosa Island & Western Destin)) 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_______________________ ________________________ __________________________________ ________________________ __________________________________ ________________________ __________________________________