Okaloosa County BOCC — September 1, 2015 — RFQ PS 70-15rev (draft) — reading text

knowledge that an alien is being employed. Respondent’s failure to take such steps as are necessary to terminate the employment of any said alien within 24 RFQ PS 70-15 GSC - 6 OKALOOSA COUNTY  hours of notification or actual knowledge that an alien is being employed shall be grounds for immediate termination of the contract. Respondent shall take all commercially reasonable precautions to ensure that it and its subcontractors do not employ persons who are not authorized to work by the immigration laws. 30. The following documents are to be submitted with the qualifications packet: A. Drug-Free Workplace Certification Form B. Conflict of Interest C. Federal E-Verify D. No Contact Clause Form E. Indemnification and Hold Harmless F. Company Data G. Addendum Acknowledgement H. Ranking Sheet I. Certification Regarding Lobbying RFQ PS 70-15 GSC - 7 OKALOOSA COUNTY  DRUG-FREE WORKPLACE CERTIFICATION THE BELOW SIGNED RESPONDENT 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 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, Florida Statutes, 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.: _______________________ RFQ PS 70-15 Form - A OKALOOSA COUNTY  CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all respondents/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. YES______________ NO______________ NAME(S) POSITION(S) FIRM NAME: _____________________________________ BY (PRINTED): _____________________________________ BY (SIGNATURE): _____________________________________ TITLE: _____________________________________ ADDRESS: _____________________________________ _____________________________________ PHONE NO. _____________________________________ E-MAIL _____________________________________ DATE _____________________________________ RFQ PS 70-15 Form - B OKALOOSA COUNTY  FEDERAL E-VERIFY COMPLIANCE CERTIFICATION In accordance with Okaloosa County Policy and Executive Order Number 11-116 from the office of the Governor if the State of Florida, Proposer 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.: ____________________________ RFQ PS 70-15 Form - C OKALOOSA COUNTY  NO CONTACT CLAUSE The Board of County Commissioners has established a solicitation silence policy (No Contact Clause) that prohibits oral and written communication regarding all formal solicitations for goods and services (formal proposals, 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 Respondent 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/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 proposals are due, should be directed to the Purchasing Manager or an appointed representative. It shall be the Purchasing Manager 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 2015 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. RFQ PS 70-15 Form - D OKALOOSA COUNTY  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 RFQ PS 70-15 Form - E OKALOOSA COUNTY  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: RFQ PS 70-15 Form - F OKALOOSA COUNTY  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. RFQ PS 70-15 Form - G OKALOOSA COUNTY Ranking Sheet RFQ PS 70-15 REQUEST FOR QUALIFICATIONS RFQ PS 70-15 COMPANY NAME Qualifications Experience (0-25) Availability of Facilities and Vehicles (0-25) Staffing (0-15) Veterinarian Services (0-15) Animal