Okaloosa County BOCC — April 27, 2013 — reading text

Date: _____________ Name of Department: Type of Equipment Requested: CIRCLE ALL THAT APPLY Smart Phone, PDA (Blackberry), Cellular, Push to Talk Radio (Link), Pager, Air Card APPROVED BY: Department Director’s Signature: Date: Requesting Department complete the following information & fax to: Purchasing Dept. @ 850-689-5970 Wireless Communication Device: Mfr Model Serial #: Wireless Telephone #: 59 Packet Pg. 749  8.6.c.b 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 Attachment: Okaloosa County Purchasing Manual-5 (1517 : Revisions to the Purchasing Manual) 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 _____________________________________ 60 Packet Pg. 750  8.6.c.b NO CONTACT CLAUSE The Board has 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 Attachment: Okaloosa County Purchasing Manual-5 (1517 : Revisions to the Purchasing Manual) 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, 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 violation of this policy 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. 61 Packet Pg. 751  8.6.c.b SELECTION COMMITTEE MEMBER INSTRUCTIONS You have been selected to serve on a Board-approved Review and Recommendation Committee for services for Okaloosa County. 1. You will be given a copy of all proposals received for this service. 2. You are required to read and review each proposal, make written notes as to the proposal meeting the following criteria: a. Did the response meet the requested format? Attachment: Okaloosa County Purchasing Manual-5 (1517 : Revisions to the Purchasing Manual) b. Did the proposal include all required documentation? c. Does this firm seem capable of producing the services requested? 3. Fill out the provided ranking sheet for each firm. 4. At a duly noticed meeting, all Committee Members will discuss the strengths and weaknesses of each firm. No discussion may be conducted between Committee Members related to the proposals except during the duly noticed meeting. 5. All Committee Members will submit their signed ranking sheet to the Committee Chair or the Purchasing representative. 6. A consensus ranking will be prepared for attachment to the Board agenda recommendations to be presented at the next Board meeting. 7. Upon approval by the Board, the Purchasing Director shall notify all firms submitting proposals of the Board action. Note: Any questions directed to any Committee Member by a proposer should be directed to the Purchasing Director. 62 Packet Pg. 752  8.6.c.b SOLE SOURCE PURCHASE DATA SHEET Date: PR No.: Requestor: Phone No.: Department/Division: Item Description: Requesting Department's Suggested Vendor: Vendor's Address: Attachment: Okaloosa County Purchasing Manual-5 (1517 : Revisions to the Purchasing Manual) Vendor's Telephone No.: Point of Contact: Sole Source Justification: ___________________________________________ ______________________ Requesting Department Director Signature Date ------------------------------------------------------------------------------------------------------------ REVIEW BY PURCHASING DEPARTMENT VERIFY IF OTHER SOURCES OF SUPPLY MEETS THIS NEED Vendor #1 Contact: Phone No.: Vendor #2 Contact: Phone No.: Vendor #3 Contact: Phone No.: Buyer Comments: _____________________________________________ _____________________ Signature of Buyer Who Reviewed Date Purchasing Services Coordinator Comments: Purchasing Services Coordinator Signature Date ------------------------------------------------------------------------------------------------------------ PURCHASING MANUAL - SOLE SOURCE DETERMINATION Comments: Approve: Disapprove: Amount of Purchase: Date: __________________________________ _____________________ Purchasing Director Signature Date 63 Packet Pg. 753  8.6.c.b OKALOOSA COUNTY PURCHASING CARD EXPENDITURE REPORT Below is an account of all Purchasing Card expenditures for: Name of Employee/Department _________________________________________________________________________ Purchasing Card Number ________________________________________________________________________________ Attachment: Okaloosa County Purchasing Manual-5 (1517 : Revisions to the Purchasing Manual) For the month of ________________________________________________________________________________________ DESCRIPTION OF ITEMS PURPOSE OF DATE GOODS/ DATE VENDOR PURCHASED AMOUNT DEPT. ACCOUNT TRANSACTION SERVICES RECEIVED NUMBER NUMBER I HEREBY CERTIFY THAT ALL PURCHASES CONTAINED HEREIN WERE FOR OFFICIAL OKALOOSA COUNTY BUSINESS, WERE MADE IN ACCORDANCE WITH RULES AND DIRECTIVES, AND THAT I HAVE REVIEWED THIS LOG AND IT CORRECTLY REFLECTS THE CARD RECEIPTS ENCLOSED. _____________________________________________________ _______________________________________________________________ SIGNATURE OF CARDHOLDER DATE SIGNATURE OF REVIEWER DATE DELIVER TO: OKALOOSA COUNTY COURTHOUSE - FINANCE OFFICE, 302 N. Wilson Street, Suite 203 Crestview FL 32536 64 Packet Pg. 754  8.6.c.b LOST OR STOLEN PURCHASING CARD REPORTING FORM TO: PURCHASING DEPARTMENT FAX: 850-689-5037 Attachment: Okaloosa County Purchasing Manual-5 (1517 : Revisions to the Purchasing Manual) FROM: PHONE: URGENT MESSAGE PLEASE DELIVER THIS FACSIMILE IMMEDIATELY --------------------------------------------------- EMPLOYEE NAME: PURCHASING CARD NO.: DATE CARD WAS LOST/STOLEN: (If unknown, report today’s date) TIME CARD WAS LOST/STOLEN: (If unknown, report time this form was completed)) LAST KNOWN LOCATION OF CARD: LAST KNOWN TIME CARD