Okaloosa County BOCC — May 4, 2013 — reading text

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 – 03/20/2013 Page 12 Packet Pg. 446  9.1.c.c COMPANY DATA Physical Address & Phone #: Attachment: RFP - Tourist Development Legal Services [Revision 1] (1563 : Legal Services Informational Update) Proposer’s Company Name: Physical Address: Contact Person (Typed-Printed): Phone #: Cell #: Federal ID or SS #: Proposer’s License #: Fax #: Emergency #’s After Hours, Weekends & Holidays: Last Revised – 03/20/2013 Page 13 Packet Pg. 447  9.1.c.c LIST OF REFERENCES Refer to Proposal Specification Attachment: RFP - Tourist Development Legal Services [Revision 1] (1563 : Legal Services Informational Update) NAME OF CUSTOMER ______________________________________________ ADDRESS ______________________________________________ PHONE NUMBER ______________________________________________ PERSON TO CONTACT ______________________________________________ NAME OF CUSTOMER ______________________________________________ ADDRESS ______________________________________________ PHONE NUMBER ______________________________________________ PERSON TO CONTACT ______________________________________________ NAME OF CUSTOMER ______________________________________________ ADDRESS ______________________________________________ PHONE NUMBER ______________________________________________ PERSON TO CONTACT ______________________________________________ NAME OF CUSTOMER ______________________________________________ ADDRESS ______________________________________________ PHONE NUMBER ______________________________________________ PERSON TO CONTACT ______________________________________________ NAME OF CUSTOMER ______________________________________________ ADDRESS ______________________________________________ PHONE NUMBER ______________________________________________ PERSON TO CONTACT ______________________________________________ Last Revised – 03/20/2013 Page 14 Packet Pg. 448  9.1.c.c ADDENDUM ACKNOWLEDGEMENT Attachment: RFP - Tourist Development Legal Services [Revision 1] (1563 : Legal Services Informational Update) The bidder acknowledges that he/she has received the following addendum: ADDENDUM NO.______________________ DATED__________________________ ADDENDUM NO.______________________ DATED__________________________ ADDENDUM NO.______________________ DATED__________________________ ADDENDUM NO.______________________ DATED__________________________ ADDENDUM NO.______________________ DATED__________________________ Bidder Firm Name: _____________________________________________________ Address: _____________________________________________________ _____________________________________________________ Title: _____________________________________________________ Phone #: _____________________________________________________ FAX No.: _____________________________________________________ Last Revised – 03/20/2013 Page 15 Packet Pg. 449  9.1.c.c “NO CONTACT CLAUSE” The Okaloosa County Board of County Commissioners have established a solicitation silence policy (No Contact Clause) that prohibits oral and written communication regarding all formal Attachment: RFP - Tourist Development Legal Services [Revision 1] (1563 : Legal Services Informational Update) 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 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 bidders/proposers and members of the Board of County Commissioners, 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 attempt by a vendor/proposer to influence a member or members of the aforementioned 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 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 – 03/20/2013 Page 16 Packet Pg. 450  9.1.c.c CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all bidders/proposers, must disclose if any Okaloosa Board of County Commissioner, employee(s), elected Attachment: RFP - Tourist Development Legal Services [Revision 1] (1563 : Legal Services Informational Update) 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 Last Revised – 03/20/2013 Page 17 Packet Pg. 451  9.1.c.c DRUG-FREE WORKPLACE CERTIFICATION 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: Attachment: RFP - Tourist Development Legal Services [Revision 1] (1563 : Legal Services Informational Update) 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 proposer complies fully with the above requirements. DATE: _______________________ SIGNATURE: ____________________ COMPANY: _______________________ NAME: _________________________ (Typed or Printed) ADDRESS: _______________________ TITLE: _________________________ _______________________ E-MAIL: