Okaloosa County BOCC — February 18, 2014 — GCS Systems — reading text

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. f\, 4, ‘| f j representing GSC Systems, Inc. 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 submittal. 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), 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 Co) NAME(S) POSITION(S) FIRM NAME: GSC Systems, Inc. BY (PRINTED): Caralee M. Gibson A, BY (SIGNATURE): ( ny all ) if } \ “ne V\ TITLE: President | ADDRESS: 15 Industrial Street NW Fort Walton Beach, FL 32548-4813 PHONE NO. (850) 243-8812 E-MAIL c.gibson-15@gscsystems.net DATE 4 December 2013 DRUG-FREE WORKPLACE CERTIFICATION THE BELOW SIGNED PROPOSER CERTIFIES that it has implemented a drug-free workplace program. In order to have a drug-free workplace program, a business shall: li 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. 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. Give each employee engaged in providing the commodities or contractual services that are under quote a copy of the statement specified in subsection 1. 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. 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. 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: 4 December 2013 SIGNATURE: | 4 \ ( MW \ 4 l\ We fn ‘| COMPANY: GSC Systems, Inc. NAME: Caralee M. Gibson ‘ (Typed or Printed) ADDRESS: 15 Industrial Street NW TITLE: President Fort Walton Beach, FL 32548 E-MAIL: c.gibson-15@gscsystems.net PHONE NO.: (850) 243-8812 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. \ /\ /\ ) whi ‘N | Vy Mn AY \ As GSC Systems, Inc. ! DAD Wii v4 if ARON" Proposer’s Company Name Authorized Signature — Manual 15 Industrial Street NW Fort Walton Beach, FL 32548-4813 Caralee M. Gibson Physical Address Authorized Signature — Typed SAME President Mailing Address Title (850) 243-8812 (850) 244-2530 Phone Number FAX Number (850) 259-2616 (850) 243-8812 Cellular Number After-Hours Number(s) 4 December 2013 DATE (REVISED: JANUARY 12, 2001) FEDERAL E-VERIFY COMPLIANCE CERTIFICATION In accordance with Okaloosa County Policy and Executive Order Number 11-116 from the office of the Governor of the State of Florida, Proposer hereby certifies that the U.S. Department of Homeland Security’s E-Verify system will be used to verify the employment eligibility of all new employees hired by the contractor during the contract term, and shall expressly require any subcontractors performing work or providing services pursuant to the contract to likewise utilize the U.S. Department of Homeland Security’s E-Verify system to verify the employment eligibility of all new employees hired by the subcontractor during the contract term; and shall provide documentation of such verification to the COUNTY upon request. As the person authorized to sign this statement, I certify that this company complies/will comply fully with the above requirements. . } DATE: 4 December 2013 SIGNATURE: _| yi 00 v4) UK aN | COMPANY: _GSC Systems, Inc. NAME: Calsiey Mi, Sean (Typed or Printed) ADDRESS: 15 Industrial Street NW TITLE: President Fort Walton Beach, FL 32548-4813 E-MAIL: c.gibson-15@gscsystems.net PHONE NO.: (850) 243-8812 BID SHEET Bid #: IS 17-14 BID ITEM: NETWORK CABLING & REPAIR BID PRICE PER HOUR: $_48.25 CATEGORY 5e: $_ 48.25 CATEGORY 6 OR BETTER: $ 48.25 FIBER OPTIC: $ 48.25 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). / . /) i) GSC Systems, Inc. ( Vy havoy A) ( | Wow = Bidder’s Company Name Authorized Signature — Manual 15 Industrial Street NW Caralee M. Gibson Authorized Signature — Typed Fort Walton Beach, FL 32548-4813 President Address Title (850) 243-8812 (850) 244-2530 Phone # Fax # 59-2914136 Federal ID # or SS # ) @ ACCORD _ CERTIFICATE OF LIABILITY INSURANCE DATE (MMW/DD/YYYY) 12/4/2013 REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. THIS CERTIFICATE iS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 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 certificate holder in tieu of such endorsement(s). 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 PRODUCER J Kevin Campbell Agency GONTACT Janie Freeman PHONE. (800) 508-9126 FAX oy: (877) 234-6089 P O Box 9435 EMAL... jfreeman@workcompspecialists.com INSURER(S) AFFORDING COVERAGE NAIC # Panama City Beach FL 32417 INSURER A:Retail First Insurance Company [10700 INSURED INSURER B : GSC Systems, Inc. INSURER C : 15 Industrial St NW INSURER D : INSURER E : Ft Walton Beach FL 32548 INSURER F : COVERAGES CERTIFICATE NUMBERC1L138707066 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 ADDL} POLICY EFF | POLICY EXP LTR TYPE OF INSURANCE INSR LwyD POLICY NUMBER (MM/DD/YYYY) | (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ | DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) | $ CLAIMS-MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADVINJURY | $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG | $ POLICY THO. LOC $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea aocdent) $ ANY AUTO BODILY INJURY (Per person) | $ AL OWNED SCHEDULED BODILY INJURY (Per accident) | $ r NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB occur EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I | RETENTION $ $ A | WORKERS COMPENSATION Y X | WC STATU- OTH AND EMPLOYERS’ LIABILITY YIN 1s. EA ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? [| N/A (Mandatory in NH) 0520-42628 7/26/2013 (7/26/2014 | & 1 piseaSE - EA EMPLOYEH $ 1,000,000 if yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT | $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Blanket waiver of subrogation applies for workers' comp only. CERTIFICATE HOLDER CANCELLATION Okaloosa County 602-A North Pearl Street Crestview, FL 32536 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE OP. AR ot Ee engge BOQ Kevin Campbell/JANIE ACORD 25 (2010/05) INS025 ronionss nt © 1988-2010 ACORD CORPORATION. All rights reserved. The ASORN nama and nan are ranietarad marke nt ACORN i | ; GSCSYST-01 CLINDNER ASOR] CERTIFICATE OF LIABILITY INSURANCE —_! CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the the terms and conditions of the policy, certificate holder in lieu of such endorsement(s). certain policies may require an endorsement. A statement on this policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to certificate does not confer rights to the PRODUCER CONTACT fcentria, Inc - Panama City Office (ale Wo, Exy: (850) 257-2990 | fae, No}: (850) 257-2991 Panama City, FL 32401 EMAL os: INSURER(S) AFFORDING COVERAGE NAIC # iNsuRER A: Everest Indemnity Ins Co 10851 INSURED insurer B: Westfield Insurance Company 24112 GSC Systems, Inc. INSURER C : 15 Industrial Street NW INSURER D: Fort Walton Beach, FL 32548 INSURERE: INSURER FE: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS iS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW H INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORD! AVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO