Okaloosa County BOCC — November 5, 2013 — reading text

______________________________________________ PHONE NUMBER ______________________________________________ PERSON TO CONTACT ______________________________________________ NAME OF CUSTOMER ______________________________________________ ADDRESS ______________________________________________ PHONE NUMBER ______________________________________________ PERSON TO CONTACT ______________________________________________ Page 22 Packet Pg. 676  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 proposers? (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 Page 23 Packet Pg. 677  CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all 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: _____________________________________ ADDRESS: _____________________________________ _____________________________________ PHONE NO. _____________________________________ E-MAIL _____________________________________ Page 24 Packet Pg. 678  DRUG-FREE WORKPLACE CERTIFICATION THE BELOW SIGNED PROPOSER CERTIFIES that it has implemented a drug-free workplace program. In order to have a drug-free workplace program, a business shall: 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.: _______________________ Page 25 Packet Pg. 679  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 Page 26 Packet Pg. 680  PERFORMANCE BOND KNOW ALL PERSONS BY THESE PRESENTS: that __________________________________________________________________ (Name of Contractor) __________________________________________________________________ (Address of Contractor) a __________________________________________, hereinafter called Principal and (Corporation, Partnership or Individual) __________________________________________________________________ (Name of Surety) __________________________________________________________________ (Address of Surety) hereinafter called Surety, are held and firmly bound unto __________________________________________________________________ (Name of Owner) __________________________________________________________________ (Address of Owner) hereinafter called OWNER in the total aggregate penal sum of ____________________ _____________________________ Dollars ($ _________________________) in lawful money of the United States, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION is such that whereas, the Principal entered into a certain contract with the OWNER, dated the __________ day of _______________, 20 _____, a copy of which is hereto attached and made a part hereof for _____________________________________________________________. NOW, THEREFORE, if the Principal shall well, truly, and faithfully perform its duties, all the undertakings, covenants, terms, conditions, and agreements of said contract during the original term thereof, and any extensions thereof which may be granted by the OWNER, with or without notice to the SURETY and during the one year guaranty period and if the PRINICIPAL shall satisfy all claims and demands incurred under such contract, and shall fully indemnify and save harmless the OWNER from all costs and damages which it may suffer by reason of failure to do so, and shall reimburse and repay the Page 27 Packet Pg. 681 OWNER all outlay and expenses which the OWNER may incur in making good any default, then this obligation shall be void, otherwise to remain in full force and effect. PERFORMANCE BOND PROVIDED, FURTHER, that the said SURETY, for value received hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the contract or to WORK to be performed thereunder or the SPECIFICATIONS accompanying same shall in any way affect its obligation on this BOND, and does hereby waive notice of any change, extension of time, alteration or addition to the terms of the contract or to the WORK or to the SPECIFICATIONS. PROVIDED, FURTHER, that it is expressly agreed that the BOND shall be amended automatically and immediately, without formal and separate amendments hereto, upon amendment to the Contract not increasing the contract price more than twenty percent, so as to bind the PRINCIPAL and the SURETY to the full and faithful performance of the CONTRACT as so amended. The term “Amendment”, wherever used in this BOND, and whether referring to this BOND, or the CONTRACT DOCUMENTS, shall include any alteration, addition, extension or modification of any character whatsoever. PROVIDED, FURTHER, that no final settlement between the OWNER and the PRINCIPAL shall abridge the right of the other beneficiary hereunder, whose claim may be unsatisfied. The OWNER is the only beneficiary hereunder. Page 28 Packet Pg. 682 PERFORMANCE BOND IN WITNESS WHEREOF, this instrument is executed in 3 counterparts, each one of which shall be deemed an original, this the _________ day of _____________, 20 ___. ATTEST ______________________________ ______________________________ (PRINCIPAL) SECRETARY PRINCIPAL (SEAL)