Okaloosa County BOCC — November 4, 2012 — Slavin Management Consultants 3 — reading text

CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all firms, must 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 x NAME(S) POSITION(S) FIRM NAME: Slavin Management Consultants BY (PRINTED): Robert E. Slavin BY (SIGNATURE): Korte A &. Lb TITLE: President ADDRESS: 3040 Holcomb Bridge Rd A1; Norcross, GA 30071 PHONE NO. (770) 449-4656 Page 14 DRUG-FREE WORKPLACE CERTIFICATION THE BELOW SIGNED FIRM 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, | certify that this firm complies fully with the above requirements. DATE: December 11, 2012 SIGNATURE: (CbuAd bbe. COMPANY: _Slavin Management Consultantsyame: Robert E. Slavin . (Typed or Printed) ADDRESS: 3040 Holcomb Bridge Rd A1 Norcross, GA 30071 TITLE: President PHONE NO.: (770) 449-4656 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. Slavin Management Consultants Cast At Firm’s Company Name Authorized Signature — Manual 3040 Holcomb Bridge Rd. A1, Norcross GA, 30071 Robert E. Slavin Physical Address Authorized Signature — Typed Same as Above President Mailing Address Title (770) 449-4656 (770) 416-0848 Phone Number FAX Number (678) 296-2037 Same as Cell Number Cellular Number After-Hours Number(s) December 11, 2012 DATE (REVISED: JANUARY 12, 2001) Last Revised - 02/23/2010