Okaloosa County BOCC — December 4, 2012 — reading text

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 18 Packet Pg. 405  9.2.a.a 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. Attachment: Internal Auditing Services (1292 : Internal Auditing Services) 19 Packet Pg. 406  9.2.a.a LIST OF SUBCONTRACTORS (Appendix B) The BIDDER expressly agrees that: 1. If awarded the contract as a result of the proposal, the subcontractors used in the prosecution of the work will be those listed below. 2. The following list includes all subcontractors who will perform work on this project. 3. The subcontractors listed below are financially responsible and are qualified to do the work required. Attachment: Internal Auditing Services (1292 : Internal Auditing Services) 4. Use of any of the subcontractors is subject to the approval of the County and Engineer. CATEGORY NAME OF SUBCONTRACTOR ADDRESS ________________________________ ________________________________ CONTRACTOR'S NAME AUTHORIZED SIGNATURE ________________________________ TITLE 20 Packet Pg. 407  9.2.a.a COMPANY DATA (Appendix C) Physical Address & Phone #: Proposer’s Company Name: Attachment: Internal Auditing Services (1292 : Internal Auditing Services) Physical Address: Contact Person (Typed-Printed): Phone #: Cell #: Federal ID or SS #: Proposer’s License #: Fax #: Emergency #’s After Hours, Weekends & Holidays: 21 Packet Pg. 408  9.2.a.a INDEMNIFICATION AND HOLD HARMLESS (Appendix D) 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 Attachment: Internal Auditing Services (1292 : Internal Auditing Services) CONTRACTOR in the performance of this Agreement. ____________________________ __________________________ Bidder’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 22 Packet Pg. 409  9.2.a.a CONFLICT OF INTEREST DISCLOSURE FORM (Appendix E) 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. Attachment: Internal Auditing Services (1292 : Internal Auditing Services) YES______________ NO______________ NAME(S) POSITION(S) FIRM NAME: _____________________________________ BY (PRINTED): _____________________________________ BY (SIGNATURE): _____________________________________ TITLE: _____________________________________ ADDRESS: _____________________________________ _____________________________________ PHONE NO. _____________________________________ E-MAIL _____________________________________ 23 Packet Pg. 410  9.2.a.a DRUG-FREE WORKPLACE CERTIFICATION (Appendix F) 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 Attachment: Internal Auditing Services (1292 : Internal Auditing Services) 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 firm complies fully with the above requirements. DATE: _______________________ SIGNATURE: ____________________ COMPANY: _______________________ NAME: _________________________ (Typed or Printed) ADDRESS: _______________________ TITLE: _________________________ _______________________ E-MAIL: ________________________ _______________________ PHONE NO.: _______________________ 24 Packet Pg. 411  9.2.a.a LOCAL PREFERENCE DATA SHEET (Appendix G) Refer to Special Bid Condition Attachment: Internal Auditing Services (1292 : Internal Auditing Services) Does the state, county, municipality or political subdivision in which your firm is located offer a preference to their local bidders? (If your firm 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