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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 CONTRACTOR in the performance of this Agreement.
Certificate of Insurance
A. Certificates of insurance, in duplicate, indicating the job site and evidencing all
required coverage must be submitted to and approved by Okaloosa County
prior to the commencement of any of the work. The certificate holder(s) shall be
as follows:
Okaloosa County
602-C North Pearl Street
Crestview, Florida 32536
B. All policies shall expressly require 30 days written notice to Okaloosa County at
the address set out above, or the cancellations of material alterations of such
policies, and the Certificates of Insurance, shall so provide.
C. All certificates shall be subject to Okaloosa County’s approval of adequacy of
protection and the satisfactory character of the Insurer.
D. The Certificates of Insurance shall disclose any and all deductibles or self-insured
retentions (SIRs). County requests that all deductibles or SIRs be no greater than
$10,000. However, CONTRACTORS having insurance with higher deductibles may
submit a proposal without penalty reflecting the pricing for their deductible
provided that CONTRACTOR also submits a brief company financial statement.
E. In no way will the entities listed as Additional Insured be responsible for, pay for,
be damaged by, or limited to coverage required by this schedule due to the
existence of a deductible or SIR. Specific written approval from Okaloosa County
will only be provided upon demonstration that the CONTRACTOR has the financial
capability and funds necessary to cover the responsibilities incurred as a result of
the deductible or SIR.
F. In the event of failure of the CONTRACTOR to furnish and maintain said insurance
and to furnish satisfactory evidence thereof, Okaloosa County shall have the right
(but not the obligation) to take out and maintain insurance on the project. All
Last Revised – 10/17/2011 Page 13
costs for the coverage will be paid by CONTRACTOR upon presentation of a bill.
General Terms
Any type of insurance or increase of limits of liability not described above which the
CONTRACTOR required for its own protection or on account of 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
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.
Last Revised – 10/17/2011 Page 14
CONFLICT OF INTEREST DISCLOSURE FORM
For purposes of determining any possible conflict of interest, all 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 _____________________________________
Last Revised – 10/17/2011 Page 15
DRUG-FREE WORKPLACE CERTIFICATION
THE BELOW SIGNED PROPOER 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 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.: _______________________
Last Revised – 10/17/2011 Page 16
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 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
On this ______ day of __________, 2013 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.
Last Revised – 10/17/2011 Page 17
INDEMNIFICATION AND HOLD HARMLESS
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 CONTRACTOR in the performance of this Agreement.
____________________________ __________________________
Proposer’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
Last Revised – 10/17/2011 Page 18
NOTICE TO PROCEED
DATE: ________________
TO:
PROJECT: ________________________________________________________
You are hereby notified to commence WORK in accordance with the Agreement dated
_____________________, 2013, on or before _____________________, and you are to complete the
WORK within __________________________________. The date of completion of
