Okaloosa County BOCC — May 4, 2013 — RFP - Tourist Development Legal Services — reading text

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 – 03/20/2013 Page 12  COMPANY DATA Physical Address & Phone #: Proposer’s Company Name: Physical Address: Contact Person (Typed-Printed): Phone #: Cell #: Federal ID or SS #: Proposer’s License #: Fax #: Emergency #’s After Hours, Weekends & Holidays: Last Revised – 03/20/2013 Page 13  LIST OF REFERENCES Refer to Proposal Specification NAME OF CUSTOMER ______________________________________________ ADDRESS ______________________________________________ PHONE NUMBER ______________________________________________ PERSON TO CONTACT ______________________________________________ NAME OF CUSTOMER ______________________________________________ ADDRESS ______________________________________________ PHONE NUMBER ______________________________________________ PERSON TO CONTACT ______________________________________________ NAME OF CUSTOMER ______________________________________________ ADDRESS ______________________________________________ PHONE NUMBER ______________________________________________ PERSON TO CONTACT ______________________________________________ NAME OF CUSTOMER ______________________________________________ ADDRESS ______________________________________________ PHONE NUMBER ______________________________________________ PERSON TO CONTACT ______________________________________________ NAME OF CUSTOMER ______________________________________________ ADDRESS ______________________________________________ PHONE NUMBER ______________________________________________ PERSON TO CONTACT ______________________________________________ Last Revised – 03/20/2013 Page 14  ADDENDUM ACKNOWLEDGEMENT The bidder acknowledges that he/she has received the following addendum: ADDENDUM NO.______________________ DATED__________________________ ADDENDUM NO.______________________ DATED__________________________ ADDENDUM NO.______________________ DATED__________________________ ADDENDUM NO.______________________ DATED__________________________ ADDENDUM NO.______________________ DATED__________________________ Bidder Firm Name: _____________________________________________________ Address: _____________________________________________________ _____________________________________________________ Title: _____________________________________________________ Phone #: _____________________________________________________ FAX No.: _____________________________________________________ Last Revised – 03/20/2013 Page 15  “NO CONTACT CLAUSE” The Okaloosa County Board of County Commissioners have 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 of County Commissioners 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 of County Commissioners, 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 attempt by a vendor/proposer to influence a member or members of the aforementioned 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 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. Last Revised – 03/20/2013 Page 16  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: _____________________________________ ADDRESS: _____________________________________ _____________________________________ PHONE NO. _____________________________________ E-MAIL _____________________________________ DATE Last Revised – 03/20/2013 Page 17  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: 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 proposer complies fully with the above requirements. DATE: _______________________ SIGNATURE: ____________________ COMPANY: _______________________ NAME: _________________________ (Typed or Printed) ADDRESS: _______________________ TITLE: _________________________ _______________________ E-MAIL: ________________________ _______________________ PHONE NO.: _______________________ Last Revised – 03/20/2013 Page 18  LIST OF REPRESENTATIVES CONTRACT ADMINISTRATOR: Jack Allen, Purchasing Services Coordinator Okaloosa County Purchasing 602-C North Pearl St. Crestview FL 32536 850-689-5960 / 850-689-5998 (F) CONTRACTOR’S REPRESENTATIVE: Last Revised – 03/20/2013 Page 19  LOCAL PREFERENCE DATA SHEET Refer to Special Bid Condition Does the state, county, municipality or political subdivision in which your proposer is located offer a preference to their local bidders? (If your proposer 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 Date Last Revised – 03/20/2013 Page 20  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 ____________________________