Fort Walton Beach Council agenda — 08-14-12 regular — reading text

Stated On It Signed Bidder' s Certification Page Addendum Page References Completed Drug Free Workplace Forth Public Entities Crime Form Invitation to Bid Price Schedule, Unit Price and Total Price Columns Completed Bid Envelope Prepared as Specified —Clearly Labeled and Properly Delivered SPECIAL ITEMS ( APPLICABLE TO THIS BID ONLY): XX Bond Requirements ( See Special Conditions- Section 3. 14) XX Insurance ( Sec Special Conditions -Section 3. 15) XX Exceptions to Specifications on company letterhead ( See General Conditions Section 2. 5) NOTE: PLEASE ENSURE THAT ALL DOCUMENTS ARE COMPLETED & SUBMITTED WITH YOUR BID IN ACCORDANCE WITH THIS INSTRUCTION SHEET. FAILURE TO DO SO MAY RESULT IN YOUR BID NOT BEING CONSIDERED FOR AWARD. Page 4 of 55 Packet Pg. M  8. 3. c Smm - I 1115- 1, J1; n I' k13 , II( lu I 1 , I ncdSFv 1; BIDDER' S CERTIFICATION - ITB 12 -020 I have carefully examined the Invitation to Bid, Instructions to bidders, General and Special Conditions, Vendor' s Notes, Specifications, proposed agreement and any other documents accompanying or made a part of this Invitation. I hereby propose to furnish the goods or services specified in the Invitation at the prices or rates quoted in my bid. I agree that my bid will remain firm for a period of up to nine 90 days in order to allow the City adequate time to evaluate the bids. I certify that all information contained in this bid is truthful to the best of my knowledge and belief. I further certify that T am duly authorized to submit this bid on behalf of the vendor /contractor as its act and deed and that the vendor /contractor is ready, willing and able to perform if awarded the bid. I further certify that this bid is made without prior understanding, agreement, connection, discussion, or collusion with any other person, firm or corporation submitting a bid for the same product or service; no officer, employee or agent of the City of Fort Walton Beach or of any other bidder interested in said bid; and that the undersigned executed this bidder's Certification with full knowledge and understanding of the matters therein contained and was duly authorized to do so. NAME OF BUSINESS BY: Signature NAME & TITLE ( type or print) MAILING ADDRESS CITY, STATE, ZIP CODE 1 TELEPHONE NUMBER FAX NUMBER DATE Page 5 of 55 Packet Pg. 45  6. 3. c iII, : C`. i)" I= i3 ( '° lUu ill, e' IV, l 1 p -.. mn, ADDENDUM PAGE ITB 12 -020 The undersigned acknowledges receipt of the following addenda to the Documents ( Give number and date of each): Addendum No. Addendum No. Addendum No. Addendum No. FAILURE TO SUBMIT ACKNOWLEDGMENT OF ANY ADDENDUM THAT AFFECTS THE BID PRICES IS CONSIDERED A MAJOR IRREGULARITY AND WILL BE CAUSE FOR REJECTION OF THE BID. NAME OF BUSINESS BY: Signature NAME & TITLE (type or print) MAILING ADDRESS CITY, STATE, ZIP CODE 1 TELEPHONE NUMBER 1 FAX NUMBER DATE Page 6 of 55 Packet Pg: 46  8. 3.c AH , b ixc. d Wat .. I , I I I I, . l- 020 REFERENCES —ITB 12 -020 Bidder shall submit as a part of the bid package, four ( 4) business references with name of the business, address, contact person, and telephone number. All references shall be for similar product that has been delivered within the last Bve ( 5) years. REGARDING PROPOSER / BIDDER: Name: Name: Contact: Contact: Address: Address: Telephone: Telephone: Facsimile: Facsimile Name: Name: Contact: Contact: Address: Address: Telephone: Telephone: Facsimile: Facsimile Page 7 of 55 Packet Pg. 4T  8. 3. c ITLS - L - I' ii I AUi ^ I Cfa) 1 , d ', s it, DRUG -FREE WORKPLACE FORM ITB 12 -020 The undersigned vendor, on 2012, in accordance with Section 287. 087, Florida Statutes, certifies that [ company] does: 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. Inforrn 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, 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 bid a copy of the statement specified in Paragraph 1. 4. In the statement specified in Paragraph 1, notify the employees that, as a condition of working on the commodities or contractual services that are under bid, 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 eontendere 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 a drug assistance or rehabilitation program if such is available in the employee' s community, by any employee who is so convicted. 6. Make a good faith effort to continue to maintain a drug -free workplace through implementation of Paragraphs 1 through 5. Check one: As the person authorized to sign this statement, I certify that this firm complies fully with above requirements. As the person authorized to sign this statement, this firm does not comply fully with the above requirements. NAME OF BUSINESS BY: SIGNATURE NAME & TITLE, TYPED OR PRINTED Page 8 of 55 Packet Pg 48  P, in - 1: 0 8. 3. e I A o. a 11R— N, „, d : PUBLIC ENTITY CRIME FORM —ITB 12 -020 ( 2 PAGES) SWORN STATEMENT UNDER SECTION 287. 133 ( 3) ( A) FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS. This sworn statement is submitted with Proposal, Proposal or Contract # This sworn statement is submitted by whose business address is and ( if applicable) Federal Employer Identification Number ( FEIN) is ( If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement). My name is and my relationship to the entity named above is I understand that a " public entity crime” as defined in Paragraph 287. 133( a)( g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any proposal or contract for goods or services to be provided to any public entity or any agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. I understand that " convicted' or " conviction" as defined in paragraph 287. 133( a)( b), Florida Statutes, means finding of guilt or a conviction of a public entity crime with or without an adjudication of guilt, in any federal or state trial court of records relating to charges brought by E indictment or information after July 1, 1989, as a result of a jury verdict, non -jury trial, or entry E of a plea of guilty or nolo contendere. 10 I understand that an " affiliate' as defined in Paragraph 287. 133( 1)( a), Florida Statutes, means: A predecessor or successor of a person convicted of a public entity crime ( or) An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term " affiliate' includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one of shares constituting a controlling income among persons when not for fair interest in another person, or a pooling of equipment or income among persons when not for fair market value under a