Fort Walton Beach Council agenda — 03-12-13--regular — reading text

V a_ D NAME & TITLE ( type or print) m ac 8812 Grow Dr MAILING ADDRESS Pensacola, FL 32514 NaOo` CITY, STATE, ZIP CODE 00 r7 8$ 0 476 - 7600 aLL TELEPHONE NUMBER c I. 41LLILLI: I: I.S zaE m DATE Packet Pg. 199  P. 05 FES - 04 - 2013 15: 25 PSV PNS 15.2. h ro . t.. dm So,. d s FP * 1 1a 10 REFERENCES RFP 13 -010 Bidder shall submit as a part of the bid package, four ( 4) Customer references with name of the customer, address, contact person, and telephone number. REGARDING PROPOSER: Pro Sound & Video Name: Name: New World Symphony Gateway Church Contact: Contact: David Leuschner Howard Herring Address: Address: 541 Lincoln Road 700 Blessed Way Southlake, TX 76092 Miami Beach, FL 33139 Telephone: Telephone: 305) 673 - 3330 817) 328 - 1000 Facsimile: Facsimile a0m Name: Turner Construction Name: University of Florida ac0an Contact: Contact: Bob Grace Gregory McGarity ti0a` Address: Address: PO Box 14485 00 250 W. Court St. Suite 30OW of Cincinnati, OH 45202 Gainesville, FL 32604 fYnLL c Telephone: Telephone: 513) 721 - 4224 E 352) 375 - 4683 x6049 UM Facsimile: Facsimile a 2 E22  P. 06 FEB - 04 - 2013 15: 25 PSV PNS F5.2 h Fort Walt Landing Sound S ct RFP# 13 - 010 DRUG -FREE WORKPLACE FORM RFP 13 -010 The undersigned vendor, on February 4 2013, in accordance with Section 287. 087, Florida Statutes, certifies that [ company] Pro Sound & Video does: 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 betaken against employees forviolations 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, 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 bid a copy of the statement specified in Paragraph 1. 4. In the statement specified in Paragraph 1, notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terns of the statement and will notify the employer ofany 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. 0 N 5. Impose a sanction on, or require the satisfactory participation in a drug assistance or N rehabilitation program if such is available in the employee's community, by any employee who is so convicted. aO0 D 6. Make a good faith effort to continue to maintain a drug -free workplace through m implementation of Paragraphs I through 5. c Check one: As the person authorized to sign this statement, I certify that this rn0a` 0 firm complies fully with above requirements. 0 of As the person authorized to sign this statement, this firm does not a LL comply fully with the above requirements. NAME OF US Pro Sound & video caE ury BY: S GNA Brian Smith, Regional Manager NAME & TITLE, TYPED OR PRINTED ofza  P. 07 FEB - 04 ' 2013 15: 25 FSV PNS 15. 2. h Fort Walmn Lendine Sound Svsrom UP #13- 010 PUBLIC ENTITY CRIME FORM —RFP 13. 010 SWORN STATEMENT UNDER SECTION 287. 133 ( 3) ( A) FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES THIS FORM MUST HE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS. This sworn statement is submitted with Proposal, Proposal or Contract # RFP 13 - 010 This swom statement is submitted by Brian Smith whose business address is 8812 Grow Dr. Pensacola, FL 32514 and ( if