Okaloosa County BOCC — May 4, 2013 — Purchasing Manual-6 (post 3-19-13 meeting) CLEAN COPY — reading text

Address__NA Amount of Bond $__NA NAME AND ADDRESS OF FINANCIAL INSTITUTION MAKING A LOAN FOR THE CONSTRUCTION OF THE ABOVE IMPROVEMENTS Name__NA Address__NA PERSONS WITHIN THE STATE OF FLORIDA DESIGNATED BY OWNER UPON WHOM NOTICES OR OTHER DOCUMENTS MAY BE SERVED AS PROVIDED BY SECTION 713.13(1)(a)7, FLORIDA STATUTES Name Finance Department Contracts & Grants Office Address Clerk of Courts, 1804 Lewis Turner Blvd., Ft. Walton Beach FL 32548 IN ADDITION TO HIMSELF, OWNER DESIGNATES THE FOLLOWING PERSON TO RECEIVE A COPY OF THE LIENOR'S NOTICE AS PROVIDED IN SECTION 713.13(1)(b), FLORIDA STATUTES (FILL IN AT OWNER'S OPTION). Name Purchasing Services Coordinator Address 602-C North Pearl Street, Crestview, FL 32536 EXPIRATION DATE OF NOTICE OF COMMENCEMENT (THE EXPIRATION DATE IS 1 YEAR FROM THE DATE OF RECORDING UNLESS A DIFFERENT DATE IS SPECIFIED). _________________________________________________________________________________________________________ THIS SPACE FOR RECORDER'S USE ONLY I attest to the correctness of the information above. _________________________________________________ Authorized Department Signature The foregoing instrument was acknowledged before me this _____ day of _________________, 20___, by ____________ ______________________, who is personally known to me or who has produced ___________________________ as identification and who did/did not take an oath. _________________________________________________ NOTARY PUBLIC _________________________________________________ MY COMMISSION EXPIRES 55  TASK ORDER APPROVAL FORM CONTRACT #: TASK ORDER #: TASK ORDER AMOUNT: $__________________________ OFFERED BY CONSULTANT: FIRM’S NAME REPRESENTATIVE’S PRINTED NAME SIGNATURE TITLE DATE RECOMMENDED FOR APPROVAL APPROVED BY OKALOOSA COUNTY (Department Director) (Per Purchasing Manual) • $25,000 or less approved by Purchasing Director • Between $25,001 and $50,000 approved by Purchasing Director and County Administrator • In excess of $50,000 approved by the Board. SIGNATURE PURCHASING DIRECTOR TITLE DATE DATE COUNTY ADMINISTRATOR (if applicable) CHAIRMAN (if applicable) DATE DATE 56  CONTRACT/LEASE RENEWAL FORM Date: Company Name Attn: Address City, State, Zip RE: Dear : The Okaloosa County agrees to renew the subject contract/lease, # for an additional term. The contract renewal period will be ____ to . The annual budgeted amount for this contract is $______________. If you are in agreement, please sign below and return this form along with a current Certificate of Insurance listing Okaloosa County as co-insured (if applicable). COUNTY REPRESENTATIVES AUTHORIZED COMPANY REPRESENTATIVE Dept. Director Contractor: ______ Signature: Approved By: Approved By: __________________ (as prescribed below on item 1) Title: Title: Date: Date: County Department Instructions: 1) Obtain signatures from Department Director, authorized Company Representative and then Purchasing Director <$25K and less, County Administrator <$50K and less or Board >$50K, as necessary. If Board approval is required, the Chairman and County Administrator’s signatures are required. Make sure the company provides a current Certificate of Insurance. (If applicable). 2) Keep a copy of this form for your records. 3) Send original to Purchasing Services Coordinator. If you have any questions please contact the Purchasing Director at 850-689-5960, Fax: 850-689-5998. 57  OKALOOSA COUNTY BOARD OF COUNTY COMMISSIONERS COUNTY ISSUED WIRELESS COMMUNICATION DEVICE USAGE AGREEMENT CERTIFICATION COUNTY OFFICIAL/EMPLOYEE CERTIFICATION I hereby certify by my signature that I have read and understand the County policy for Wireless Communication Device; that I understand the requirements contained therein; and that I agree to comply with the requirements of the policy as now written or amended in the future. Printed Name of Authorized User: Signature of Authorized User: Date: _____________ Name of Department: Type of Equipment Requested: CIRCLE ALL THAT APPLY Smart Phone, PDA (Blackberry), Cellular, Push to Talk Radio (Link), Pager, Air Card APPROVED BY: Department Director’s Signature: Date: Information Systems Department: _________________________________ Date: _____________ Requesting Department complete the following information & fax to: Purchasing Dept. @ 850-689-5970 Wireless Communication Device: Mfr Model Serial #: Wireless Telephone #: 58  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), or 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: _____________________________________ DATE: _____________________________________ ADDRESS: _____________________________________ _____________________________________ PHONE NO. _____________________________________ E-MAIL _____________________________________ 59  NO CONTACT CLAUSE The Board has established a solicitation silence policy (No Contact Clause) that prohibits oral and written communication regarding all formal solicitations for goods and services (formal bids, Request for Proposals, Requests for Qualifications) issued by the Board through the County Purchasing Department. The period commences when the procurement document is received and terminates when the Board approves an award. When the solicitation silence period is in effect, no oral or written communication is allowed regarding the solicitation between prospective bidders/proposers and members of the Board, the County Administrator or members of the Board Approved Review Committee. All questions or requests for information regarding the solicitation must be directed to the designated Purchasing Representative listed in the solicitation. Any information thought to affect the committee or staff recommendation submitted after bids are due, should be directed to the Purchasing Director or his appointed representative. It shall be the Purchasing Director’s decision whether to consider this information in the decision process. Any violation of this policy shall be grounds to disqualify the proposer from consideration during the selection process. All proposers must agree to comply with this policy by signing the following statement and including it with their submittal. I representing Signature Company Name on this _____ day of ____________, 20__hereby agree to abide by the County’s “No Contact Clause” and understand violation of this policy shall result in disqualification of my proposal/submittal. 60  SELECTION COMMITTEE MEMBER INSTRUCTIONS You have been selected to serve on a Board-approved Review and Recommendation Committee for services for Okaloosa County. 1. You will be given a copy of all proposals received for this service. 2. You are required to read and review each proposal, make written notes as to the proposal meeting the following criteria: a. Did the response meet the requested format? b. Did the proposal include all required documentation? c. Does this firm seem capable of producing the services requested? 3. Fill out the provided ranking sheet for each firm. 4. At a duly noticed meeting, all Committee Members will discuss the strengths and weaknesses of each firm. No discussion may be conducted between Committee Members related to the proposals except during the duly noticed meeting. 5. All Committee Members will submit their signed ranking sheet to the Committee Chair or the Purchasing representative. 6. A consensus ranking will be prepared for attachment to the Board agenda recommendations to be presented at the next Board meeting. 7. Upon approval by the Board, the Purchasing Director shall notify all firms submitting proposals of the Board action. 8. The Board has adopted a No Contact Clause prohibiting contact by potential bidders/proposers from contacting any committee members effective on the date bids/proposals are due. Committee members shall report any violations to the Purchasing Director. Note: Any questions directed to any Committee Member by a proposer should be directed to the Purchasing Director. 61  SOLE SOURCE PURCHASE DATA SHEET Date: PR No.: Requestor: Phone No.: Department/Division: Item Description: Requesting Department's Suggested Vendor: Vendor's Address: Vendor's Telephone No.: Point of Contact: Sole Source Justification: ___________________________________________ ______________________ Requesting Department Director Signature