Okaloosa County BOCC — April 27, 2013 — reading text

financial capability and funds necessary to cover the responsibilities incurred as a result of the deductible or SIR. G. In the event of failure of the CONTRACTOR to furnish and maintain said insurance and to furnish satisfactory evidence thereof, Okaloosa County shall have the right (but not the obligation) to take out and maintain insurance on the project. All costs for the coverage will be paid by CONTRACTOR upon presentation of a bill. General Terms Any type of insurance or increase of limits of liability not described above which the CONTRACTOR required for its own protection or on account of statute shall be its own responsibility and at its own expense. The carrying of the insurance described shall in no way be interpreted as relieving the CONTRACTOR of any responsibility under this contract. Should the CONTRACTOR engage a subcontractor or sub-subcontractor, the same conditions will apply under this agreement to each subcontractor and sub- subcontractor. The CONTRACTOR hereby waives all rights of subrogation against Okaloosa County and its consultants and other indemnities of the CONTRACTOR under all the foregoing policies of insurance. Umbrella Insurance The CONTRACTOR shall have the right to meet the liability insurance 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- 03-07-2013 Page 15 Packet Pg. 659  8.6.a.a COMPANY DATA Physical Address & Phone #: Attachment: RESTORE Act Consulting Draft RFP (1507 : Restore Act Consulting Services RFP & Committee) Proposer’s Company Name: Physical Address: Contact Person (Typed-Printed): Phone #: Cell #: Federal ID or SS #: Proposer’s License #: Fax #: Emergency #’s After House, Weekends & Holidays: Last Revised- 03-07-2013 Page 16 Packet Pg. 660  8.6.a.a LIST OF REFERENCES Refer to Proposal Specification Attachment: RESTORE Act Consulting Draft RFP (1507 : Restore Act Consulting Services RFP & Committee) 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- 03-07-2013 Page 17 Packet Pg. 661  8.6.a.a ADDENDUM ACKNOWLEDGEMENT The proposer acknowledges that he/she has received the following addendum: Attachment: RESTORE Act Consulting Draft RFP (1507 : Restore Act Consulting Services RFP & Committee) 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- 03-07-2013 Page 18 Packet Pg. 662  8.6.a.a CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all proposers, must disclose Attachment: RESTORE Act Consulting Draft RFP (1507 : Restore Act Consulting Services RFP & Committee) 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 _____________________________________ Last Revised- 03-07-2013 Page 19 Packet Pg. 663  8.6.a.a 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: Attachment: RESTORE Act Consulting Draft RFP (1507 : Restore Act Consulting Services RFP & Committee) 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, 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 Florida Statute 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.: _______________________ Last Revised- 03-07-2013 Page 20 Packet Pg. 664  8.6.a.a LIST OF REPRESENTATIVES CONTRACT ADMINISTRATOR: Attachment: RESTORE Act Consulting Draft RFP (1507 : Restore Act Consulting Services RFP & Committee) Jack Allen, Manager Purchasing Services Okaloosa County Purchasing 602-C North Pearl St. Crestview FL 32536 850-689-5960 / 850-689-5998 (F) CONTRACTOR’S REPRESENTATIVE: Last Revised- 03-07-2013 Page 21 Packet Pg. 665  8.6.a.a