Okaloosa County BOCC — May 4, 2013 — reading text

9.10.c.b NOTICE OF COMMENCEMENT STATE OF FLORIDA COUNTY OF OKALOOSA The undersigned hereby informs all concerned that improvements will be made to certain real property and, in accordance with Section 713.13 of the Florida Statutes; the following information is stated in this NOTICE OF COMMENCEMENT: LEGAL DESCRIPTION OF PROPERTY TO BE IMPROVED (If lengthy, attach copy) ___________________________________________________________________________________________ _____ Street Address (if any) ___ ____ __ Attachment: Purchasing Manual-6 (post 3-19-13 meeting) (1553 : Revisions to the Purchasing Manual) General Description of Improvements___ _________________________________________________________ Owner Okaloosa County Board of County Commissioners Owner's Interest__100%___ Address__302 N. Wilson St., Crestview, Florida 32536 ______________ Fee Simple Title Holder (If other than Owner)__NA Address__NA GENERAL CONTRACTOR Name__ Address__ Surety Bond__NA Address__NA Amount of Bond $__NA NAME AND ADDRESS OF FINANCIAL INSTITUTION MAKING A LOAN FOR THE CONSTRUCTION OF THE ABOVE IMPROVEMENTS Name__NA Address__NA PERSONS WITHIN THE STATE OF FLORIDA DESIGNATED BY OWNER UPON WHOM NOTICES OR OTHER DOCUMENTS MAY BE SERVED AS PROVIDED BY SECTION 713.13(1)(a)7, FLORIDA STATUTES Name Finance Department Contracts & Grants Office Address Clerk of Courts, 1804 Lewis Turner Blvd., Ft. Walton Beach FL 32548 IN ADDITION TO HIMSELF, OWNER DESIGNATES THE FOLLOWING PERSON TO RECEIVE A COPY OF THE LIENOR'S NOTICE AS PROVIDED IN SECTION 713.13(1)(b), FLORIDA STATUTES (FILL IN AT OWNER'S OPTION). Name Purchasing Services Coordinator Address 602-C North Pearl Street, Crestview, FL 32536 EXPIRATION DATE OF NOTICE OF COMMENCEMENT (THE EXPIRATION DATE IS 1 YEAR FROM THE DATE OF RECORDING UNLESS A DIFFERENT DATE IS SPECIFIED). _________________________________________________________________________________________________________ THIS SPACE FOR RECORDER'S USE ONLY I attest to the correctness of the information above. _________________________________________________ Authorized Department Signature The foregoing instrument was acknowledged before me this _____ day of _________________, 20___, by ____________ ______________________, who is personally known to me or who has produced ___________________________ as identification and who did/did not take an oath. _________________________________________________ NOTARY PUBLIC _________________________________________________ MY COMMISSION EXPIRES 70 Packet Pg. 683  9.10.c.b TASK ORDER APPROVAL FORM CONTRACT #: TASK ORDER #: TASK ORDER AMOUNT: $__________________________ Attachment: Purchasing Manual-6 (post 3-19-13 meeting) (1553 : Revisions to the Purchasing Manual) OFFERED BY CONSULTANT: FIRM’S NAME REPRESENTATIVE’S PRINTED NAME SIGNATURE TITLE DATE RECOMMENDED FOR APPROVAL APPROVED BY OKALOOSA COUNTY (Department Director) (Per Purchasing Manual) • $25,000 or less approved by Purchasing Director • Between $25,001 and $50,000 approved by Purchasing Director and County Administrator) • In excess of $50,000 approved by the Board. SIGNATURE SIGNATUREPURCHASING DIRECTOR TITLE TITLEDATE DATE DATE COUNTY ADMINISTRATOR (if applicable) CHAIRMAN (if applicable) DATE DATE 71 Packet Pg. 684  9.10.c.b CONTRACT/LEASE RENEWAL FORM Date: Company Name Attachment: Purchasing Manual-6 (post 3-19-13 meeting) (1553 : Revisions to the Purchasing Manual) Attn: Address City, State, Zip RE: Dear : The Okaloosa County agrees to renew the subject contract/lease, # for an additional term. The contract renewal period will be ____ to . The annual budgeted amount for this contract is $______________. If you are in agreement, please sign below and return this form along with a current Certificate of Insurance listing Okaloosa County as co-insured (if applicable). COUNTY REPRESENTATIVES AUTHORIZED COMPANY REPRESENTATIVE Dept. Director Contractor: ______ Signature: Approved By: Approved By: __________________ (as prescribed below on item 1) Title: Title: Date: Date: County Department Instructions: 1) Obtain signatures from Department Director, authorized Company Representative and then Purchasing Director <$25K and less, County Administrator <$50K and less or Board >$50K, as necessary. If Board approval is required, the Chairman and County Administrator’s signatures are required. Make sure the company provides a current Certificate of Insurance. (If applicable). 2) Keep a copy of this form for your records. 3) Send original to Purchasing Services Coordinator. If you have any questions please contact the Purchasing Director at 850-689-5960, Fax: 850-689-5998. 72 Packet Pg. 685  9.10.c.b OKALOOSA COUNTY BOARD OF COUNTY COMMISSIONERS COUNTY ISSUED WIRELESS COMMUNICATION DEVICE USAGE AGREEMENT CERTIFICATION COUNTY OFFICIAL/EMPLOYEE CERTIFICATION Attachment: Purchasing Manual-6 (post 3-19-13 meeting) (1553 : Revisions to the Purchasing Manual) I hereby certify by my signature that I have been provided a copy ofread and understand the County policy for Wireless Communication Device; that I have read andthat I understand the requirements contained therein; and that I agree to comply with the requirements of the policy as now written or amended in the future. Printed Name of Authorized User: Signature of Authorized User: Date: _____________ Name of Department: Type of Equipment Requested: CIRCLE ALL THAT APPLY Smart Phone, PDA (Blackberry), Cellular, Push to Talk Radio (Link), Pager, Air Card APPROVED BY: Department Director’s Signature: Date: Information Systems Department: _________________________________ Date: _____________ Requesting Department complete the following information & fax to: Purchasing Dept. @ 850-689-5970 Wireless Communication Device: Mfr Model Serial #: Wireless Telephone #: 73 Packet Pg. 686  9.10.c.b 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 officials(s), or if any of its agencies is also an owner, corporate officer, agency, employee, etc., of their business. Attachment: Purchasing Manual-6 (post 3-19-13 meeting) (1553 : Revisions to the Purchasing Manual) 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: _____________________________________ DATE: _____________________________________ ADDRESS: _____________________________________ _____________________________________ PHONE NO. _____________________________________ E-MAIL _____________________________________ 74 Packet Pg. 687  9.10.c.b 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. Attachment: Purchasing Manual-6 (post 3-19-13 meeting) (1553 : Revisions to the Purchasing Manual) 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