Fort Walton Beach Council agenda — 01-24-12 regular — reading text

83. i rn - r >. - cnrs c. moo r. rd v " I R ADDENDUM PAGE FFB 12 -008 The undersigned acknowledges receipt of the following addenda to the Documents ( Give number and date of each): N00 El d0y Addendum No. c_ 0 Addendum No. ama Addendum No. a O Addendum No. m 00N FAILURE TO SUBMIT ACKNOWLEDGMENT OF ANY ADDENDUM THAT AFFECTS m THE BID PRICES IS CONSIDERED A MAJOR IRREGULARITY AND WILL BE CAUSE FOR REJECTION OF TI {E BID. aN E moot-, L wdr( 4- '< Ms s C, NAME OF BUSINESS By &, 7 Signature fi NAME & TITLE ( type or print) n I i8 tU F Ce trAa4 k& MAILING ADDRESS mr 694 CITY, STATE, ZIP CODE 04N 6- V I 126 z- 3/ 611, TELEPHONE NUMBER 9 Z` jo% tUE tb'l!- y a FAXNUMBER i- AfVa DATE Page 6 of 27 - Packet Pg. 83  8. 3. c D_,_, r__ IZli ^ L - 0U€ REFERENCES —ITB 12 -008 NO Bidder shall submit as a pan of the bid package, four ( 4) business references with name of the 0 business, address, contact person, and telephone number. All references shall be for similar product that has been delivered within the last five ( 5) years. / 4d1 T REGARDING PROPOSER / BIDDER: / rJr iL ((% L f7n-t lfrf5 S Co Name: Name: - 0Cavry Aa t sev C'o' s cu Contact: - n Contact$ ,/ r 6 /C ,t %( j S 1r 1 Jo. L o Address: Addxfss: 4G4 Sk,tp er Q, v- YEi o IgGI m a a, f ny Telephone: Telephone: a3 5- V A 03• x131 BSp. g 3• t 8 Facsimile: Facsimile N 8toa sa99 Aso- B. a 49c N Name: Name: 0 Contact: Contact: R Sfl Ve- JC "O 1\L 1 rJ N Pr Address:,- Address: 0 LL ao I 3 a Ja 0 R Telephone: Telephone: a- yes yt> trsv _ 13 6 K a Facsimile: Facsimile M 0 QtYREu. Page 7 of 27 ` Paekat Pg.>M.  8. 3. c I II - I` ws r_ u, i, yl0ibcad tilixl It ti" nrsrc._ _. _ Drug -Free Workplace Form —ITB 12 -008 The undersigned vendor, on / Z ` i Z — 201 I, ' yn accordance with section 287. 087. Florida Statutes, certifies that tbusinessl r r- , t AI L 12- G. d4S Cn_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. 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 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 N abide by the terms of the statement and will notify the employer of any conviction of or plea of guilty or nolo contendere m, any violation of Chapter 843 or of any controlled NN 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. ca 5. Impose a sanction on, or require the satisfactory participation in a drug assistance or m3 rehabilitation program if such is available in the employee' s community, by any employee who is so convicted. r0L Ja 6. Make a good faith effort to continue to maintain a drug -free workplace through 0 implementation of Paragraphs I through 5. O Ka Check oye: As the person authorized to sign this statement, I certify that this firm complies