Okaloosa County BOCC — March 18, 2014 — reading text

NAME: Z _______ (Typed or Printed) ADDRESS: 25 /9ttva'ct 5+ TITLE: 4L. 31 PHONE NO.: 33 53L/. Last Revised - 06/24/2013 Page 19 Packet Pg. 370  RECYCLED CONTENT FORM RECYCLED CONTENT INFORMATION 1. Is the material in the above: Virgin or Recycled________ (Check the applicable blank). If recycled, what percentage __%. Product Description: 2. Is your product packaged and/or shipped in material containing recycled content? Yes No Specify: 3. Is your product recyclable after it has reached its intended end use? Yes No_________ Specify: The above is not applicable if there is only a personal service involved with no product involvement. Name of Bidder: (N 4 ) R Fai r— Last Revised - 12/6/13 Page 20 Packet Pg. 371  LOCAL PREFERENCE DATA SHEET Okoloosa County grants a preference to in-county bidders only when bids are received from firms located in states, municipalities or other political subdivisions which offer preference to bidders located in such political subdivisions. The amount of preference given to local bidders will be the same as that given by the state, county, municipality or other political subdivisions in which the out-of-county bidder is located. If the political subdivision in which a bidder is located offers a preference to its local firms, that bidder must plainly state the extent of such preference to include the amount and type preference offered. Any bidder failing to indicate such preference will be removed from the County bid list and any and all bids from that firm will be rejected. Does the state, county, municipality or political subdivision in which your firm is located offer a preference to their local bidders? If "YES," list below the extend of such preference. (If your firm is located in Okaloosa County, you will check 'YES-reciprocal only.) YES NO If yes, you must identify how you confirmed this information or who you spoke with within your area of business location below: Bidder's Company Name Authorized Signature - Manual /), Jf t; ueftba/k Printed Name - 7-/ Date Last Revised - 12/6/13 Page 21 Packet Pg. 372  INDEMNIFICATION AND HOLD HARMLESS To the fullest extent permitted by law, CONTRACTOR shallindemnify 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. Bidder's Company Name Atpu/ Authorized Signature - Manual 62. S Si 1):/1 Riiiev.bauA' Physical Address Authorized Signature - Typed C/pvtV Mailing Address Title 11- S3q-///, p,te& Phone Number P,n/ FAXNumbe' 95c 2o'?- (0f7o 33 1[53 Lf_//f , Cellular Number After-Hours Number(s) DATE (REVISED: JANUARY 12, 2001) Last Revised - 2/6/13 Page 22 Packet Pg. 373  BID SHEET BID #: #WS21-14 BID ITEM: WATER & SEWER BIOSOLIDS REMOVAL & TRANSPORTATION 1 PRICE PER CUBIC YARD TO INCLUDE ALL TRANSPORTATION/PICKUP & DISPOSAL COSTS 2. PRICE PER CUBIC YARD WITHOUT TRANSPORTATION COSTS (DISPOSAL ONLY & SITE LOCATED IN FLORIDA) $75 DISPOSAL SITE ADDRESS 32/3 3. PRICE PER CUBIC YARD WITHOUT TRANSPORTATION COSTS (DISPOSAL ONLY & SITE LOCATED IN ALABAMA) DISPOSAL SITE ADDRESS 3cc A 3 f 5 kl Ftoi, /1. 3C2- Note: It is not necessary to submit a bid on all three line items. The County reserves the right to perform a financial analysis on all line items of all bids and take into consideration distance to the disposal site (in which County expenses/resources would be incurred by transporting biosolids), in order to award the bid to the contractor(s) which produce the overall lowest expenses to the County. Remarks: ANTI-COLLUSION STATEMENT: The below signed bidder has not divulged to, discussed or compared his bid with other bidders and has not colluded with any other bidder or parties to bid whatever. (Note: No premiums, rebates, or gratuities permitted either with, prior to, or after any delivery of materials. Any such violation will result in the cancellation and/or return of material (as applicable) and the removal from bid list(s). Last Revised - 12/6/13 Page 25 Packet Pg. 374  R 6v vv,5, Bidder's Company Name' Z~4 ___ Authorized Signature - - "// Manual s1 /y, ii 4 ,vCIi(' Authorized Signature - Typed /B1ack' 4L 3,31( c4 tec' Address Title 33L/ 53qJJ/4 Phone # Fax# E'vt4 I 20- /781322_ Federal ID # or SS # Last Revised - 12/6/13 Page 26 Packet Pg. 375  R&EFA-1 OP ID: JB I4WRL CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I DATE (MMIDDfYYYY) CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate _holder _in_lieu_of such_endorsement(s). PRODUCER CONTACT SanBuck, Inc. PHONE FAX P.O. Box 311650 (AC, No. Ext): (NC, No): Enterprise, AL 36331-1650 E-MAIL John Milton Buck INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: ROCKHILL INS. Co INSURED R & E Farms, LLC INSURER B: Canal Insurance Co William Rivenbark INSURER C. ROCKHILL INS CO 625 Burnt St Black, AL 36314 INSURER D: INSURER E: I INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ABBL)US1. POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD!YYYY) (MM/DD/YYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE 1,000,000 $ DAMAGE TO A X COMMERCIAL GENERAL LIABILITY ENVP005290-01 08116/2013 08/16/2014 PREMISES EIn) $ 100,001 CLAIMS-MADE OCCUR MED EXP (Any one person) $