Okaloosa County BOCC — November 4, 2012 — Bob Murray 6

CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all firms, must disclose if any Okaloosa Board of County Commissioner, employee(s), elected officials(s), of 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______________ X NO______________ NAME(S) POSITION(S) FIRM NAME: Bob Murray & Associates _____________________________________ BY (PRINTED): S. Renee Narloch _____________________________________ BY (SIGNATURE): _____________________________________ TITLE: Vice President _____________________________________ ADDRESS: 2910 Kerry Forest Parkway, D4-242 _____________________________________ Tallahassee, FL 32309-6892 _____________________________________ PHONE NO. (850) 391-0000 _____________________________________ Page 14  DRUG-FREE WORKPLACE CERTIFICATION THE BELOW SIGNED FIRM 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: December 6, 2012 _______________________ SIGNATURE: _______________________ COMPANY: Bob Murray & Associates _______________________ S. Renee Narloch NAME: _____________________________ (Typed or Printed) ADDRESS: 2910 Kerry Forest Parkway _______________________ Vice President TITLE: _____________________________ D4-242 _______________________ Tallahassee, FL 32309-6892 _______________________ PHONE NO.: (850) 391-0000 _______________________ Page 15  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. Bob Murray & Associates ____________________________ __________________________ Firm’s Company Name Authorized Signature – Manual 2910 Kerry Forest Parkway, D4-242 ____________________________ S. Renee Narloch __________________________ Physical Address Authorized Signature – Typed 2910 Kerry Forest Parkway, D4-242 ____________________________ Vice President __________________________ Mailing Address Title (850) 391-0000 ____________________________ (916) 735-2402 __________________________ Phone Number FAX Number (850)391-0006 ____________________________ (850) 391-0006 __________________________ Cellular Number After-Hours Number(s) December 6, 2012 ____________________________ DATE (REVISED: JANUARY 12, 2001) Last Revised – 02/23/2010 Page 16