Okaloosa County BOCC — February 7, 2017 — RFP BCC 02-17 — reading text

requirements. DATE: SIGNATURE: COMPANY: NAME: (Typed or Printed) ADDRESS: TITLE: E-MAIL: PHONE NO.:  CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all respondents, 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:  FEDERAL E-VERIFY COMPLIANCE CERTIFICATION In accordance with Okaloosa County Policy and Executive Order Number 11-116 from the office of the Governor of the State of Florida, Respondent hereby certifies that the U.S. Department of Homeland Security’s E-Verify system will be used to verify the employment eligibility of all new employees hired by the respondent during the contract term, and shall expressly require any subcontractors performing work or providing services pursuant to the contact to likewise utilize the U.S. Department of Homeland Securities E- Verify system to verify the employment eligibility of all new employees hired by the subcontractor during the contract term; and shall provide documentation such verification to the COUNTY upon request. As the person authorized to sign this statement, I certify that this company complies/will comply fully with the above requirements. DATE: SIGNATURE: COMPANY: NAME: ADDRESS: TITLE: E-MAIL: PHONE NO.:  NO CONTACT CLAUSE The 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 by the County 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 respondents and members of the Board of County Commissioners the County Administrator, county employees 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 Manager or an appointed representative. It shall be the Purchasing Manager’s decision whether to consider this information in the decision process. Any violation of this policy shall be grounds to disqualify the respondent from consideration during the selection process. All respondents must agree to comply with this policy by signing the following statement and including it with their submittal. I representing Signature Company Name On this day of 2017 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.  INDEMNIFICATION AND HOLD HARMLESS To the fullest extent permitted by law, Respondent shall indemnify and hold harmless the 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 Respondent and other persons employed or utilized by the Respondent in the performance of this Agreement. Respondent’s Company Name Authorized Signature – Manual Physical Address Authorized Signature – Typed Mailing Address Title Phone Number FAX Number Cellular Number After-Hours Number(s) Date  COMPANY DATA Respondent’s Company Name: Physical Address & Phone #: Contact Person (Typed-Printed): Phone #: Cell #: Email: Federal ID or SS #: Respondent’s License #: Fax #: Emergency #’s After Hours, Weekends & Holidays:  ADDENDUM ACKNOWLEDGEMENT Acknowledgment is hereby made of the following addenda (identified by number) received since issuance of solicitation: ADDENDUM NO. DATE NOTE: Prior to submitting the response to this solicitation, it is the responsibility of the respondent to confirm if any addenda have been issued. If such addenda have been issued, acknowledge receipt by noting number(s) and date(s) above.  LOBBYING - 31 U.S.C. 1352, 49 CFR Part 19, 49 CFR Part 20 APPENDIX A, 49 CFR PART 20--CERTIFICATION REGARDING LOBBYING Certification for Contracts, Grants, Loans, and Cooperative Agreements (To be submitted with each bid or offer exceeding $100,000) The undersigned [Contractor] certifies, to the best of his or her knowledge and belief, that: 1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. 2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for making lobbying contacts to an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form--LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions [as amended by "Government wide Guidance for New Restrictions on Lobbying," 61 Fed. Reg. 1413 (1/19/96). Note: Language in paragraph (2) herein has been modified in accordance with Section 10 of the Lobbying Disclosure Act of 1995 (P.L. 104-65, to be codified at 2 U.S.C. 1601, et seq .)] 3. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995). Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. [Note: Pursuant to 31 U.S.C. § 1352(c)(1)-(2)(A), any person who makes a prohibited expenditure or fails to file or amend a required certification or disclosure form shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such expenditure or failure.] The Contractor, ___________________, certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. A 3801, et seq., apply to this certification and disclosure, if any. __________________________ Signature of Contractor's Authorized Official __________________________ Name and Title of Contractor's Authorized Official ___________________________ Date  RECYCLED CONTENT FORM RECYCLED CONTENT INFORMATION 1. Is the material in the above: Virgin or Recycled (Check the applicable blank). If recycled, what percentage %. Product Description: 2. Is your product packaged and/or shipped in material containing recycled content? Yes No Specify: 3. Is your product recyclable after it has reached its intended end use? Yes No Specify: The above is not applicable if there is only a personal service involved with no product involvement. Name of Respondent: E-Mail:  PROPOSAL SHEET Date Submitted: PROPOSAL#: RFP BCC 02-17 PROPOSAL TITLE: COMMERICAL REALTOR SERVICES Vendor Ability of proposer to meet or exceed the requirements defined in this RFP (20%) Experience, Qualifications and References (20%) Knowledge of local real estate market (15%) Fee Schedule (30%) Completeness of Response to RFP (15%) Total (100 pts. Max) Do you possess a State of Florida Real Estate Broker License? __________ Do you have 5 plus years experience working as a Broker? ___________