Okaloosa County BOCC — March 18, 2013 — reading text

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 _____________________________________ Last Revised- 02-18-2013 Page 19 Packet Pg. 169  6.2.a.a 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: 1. Publish a statement notifying employees that the unlawful manufacture, distribution, Attachment: RFP- BCC Restore Act Mgmt (02-18-2013) (1423 : Restore Act Consulting Services RFP) 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: _______________________ SIGNATURE: ____________________ COMPANY: _______________________ NAME: _________________________ (Typed or Printed) ADDRESS: _______________________ TITLE: _________________________ _______________________ E-MAIL: ________________________ _______________________ PHONE NO.: _______________________ Last Revised- 02-18-2013 Page 20 Packet Pg. 170  6.2.a.a LIST OF REPRESENTATIVES CONTRACT ADMINISTRATOR: Jack Allen, Manager Purchasing Services Attachment: RFP- BCC Restore Act Mgmt (02-18-2013) (1423 : Restore Act Consulting Services RFP) Okaloosa County Purchasing 602-C North Pearl St. Crestview FL 32536 850-689-5960 / 850-689-5998 (F) CONTRACTOR’S REPRESENTATIVE: Last Revised- 02-18-2013 Page 21 Packet Pg. 171  6.2.a.a LIST OF SUBCONTRACTORS The PROPOSER expressly agrees that: 1. If awarded the contract as a result of the proposal, the subcontractors used in the Attachment: RFP- BCC Restore Act Mgmt (02-18-2013) (1423 : Restore Act Consulting Services RFP) prosecution of the work will be those listed below. 2. The following list includes all subcontractors who will perform work on this project. 3. The subcontractors listed below are financially responsible and are qualified to do the work required. 4. Use of any of the subcontractors is subject to the approval of the County and Engineer. CATEGORY NAME OF SUBCONTRACTOR ADDRESS ________________________________ ________________________________ CONTRACTOR'S NAME AUTHORIZED SIGNATURE ________________________________ TITLE Last Revised- 02-18-2013 Page 22 Packet Pg. 172  6.2.a.a LOCAL PREFERENCE DATA SHEET Refer to Special Bid Condition Attachment: RFP- BCC Restore Act Mgmt (02-18-2013) (1423 : Restore Act Consulting Services RFP) Does the state, county, municipality or political subdivision in which your firm is located offer a preference to their local proposers? (If your firm is located in Okaloosa County, you will check “NO.”) If “YES,” list below the extent of such preference. YES____________________ NO_______________________ ________________________ __________________________________ ________________________ __________________________________ ________________________ __________________________________ ________________________ __________________________________ _____________________________ _______________________________ Bidder’s Company Name Authorized Signature – Manual ______________________________ _______________________________ E-Mail Authorized Signature – Typed Last Revised- 02-18-2013 Page 23 Packet Pg. 173  6.2.a.a INDEMNIFICATION AND HOLD HARMLESS To the fullest extent permitted by law, CONTRACTOR shall indemnify and hold harmless Attachment: RFP- BCC Restore Act Mgmt (02-18-2013) (1423 : Restore Act Consulting Services RFP) 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 Authorized Signature – Manual ____________________________ __________________________ Physical Address Authorized Signature – Typed ____________________________ __________________________ Mailing Address Title ____________________________ __________________________ Phone Number FAX Number ____________________________ __________________________ Cellular Number After-Hours Number(s) ____________________________ DATE Last Revised- 02-18-2013 Page 24 Packet Pg. 174  6.2.a.a CONTRACT This agreement, executed in Crestview, Florida this _____ day of ___________________________ 2013 between the County of Okaloosa, Florida, the Owner, hereinafter called the Party of the First Part, and ______________________________ or its successors, executors, administrators and assigns, hereinafter called the Party of the Second Part. Attachment: RFP- BCC Restore Act Mgmt (02-18-2013) (1423 : Restore Act Consulting Services RFP) WITNESSETH: That for and in consideration of payments, hereinafter mentioned, to be made by the Party of the First Part, the Party of the Second Part agrees to furnish all equipment, machinery, tools and labor; to furnish and deliver all materials required to be furnished and delivered in and about the improvement and to do and perform all work related to providing Restore Act Management Consulting Services for the Okaloosa County Board of County Commissioners per the attached proposal for an approximate total price of $ in strict conformity with the provisions of this Contract, the Notice to Contractors, the Specifications and the Plans approved by the Owner. The said Notice to Contractors, and the Proposal are hereby made a part of this agreement as fully and to the same effect as if the same had been set forth at length in the body of this agreement. In consideration of the foregoing promises, the Party of the First Part agrees to pay to the Party of the Second Part such unit prices for the work actually done as are set out in the accompanying proposal in the manner provided in the said Specifications. The Contractor shall be prepared to begin work to be performed under the contract as he set forth in his proposal, but will not proceed until he receives official notice to begin.