Okaloosa County BOCC — July 30, 2015 — I. e. Colleen Marine contract — reading text

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.: _______________________ RFB Form-I OKALOOSA COUNTY  CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all respondents, must disclose if any Okaloosa Board of County Commissioner, employee(s), elected officials(s), or 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______________ NO______________ NAME(S) POSITION(S) FIRM NAME: _____________________________________ BY (PRINTED): _____________________________________ BY (SIGNATURE): _____________________________________ TITLE: _____________________________________ ADDRESS: _____________________________________ _____________________________________ PHONE NO. _____________________________________ E-MAIL _____________________________________ DATE _____________________________________ RFB Form-I OKALOOSA COUNTY  FEDERAL E-VERIFY COMPLIANCE CERTIFICATION In accordance with Okaloosa County Policy and Executive Order Number 11-116 from the office of the Governor if the State of Florida, Respondent 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 respondent during the contract term, and shall expressly require any subcontractors performing work or providing services pursuant to the contact to likewise utilize the U.S. Department of Homeland Securities E-Verify system to verify the employment eligibility of all new employees hired by the subcontractor during the contract term; and shall provide documentation 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: ________________________________ SIGNATURE: _______________________________ COMPANY: ____________________________ NAME: ____________________________________ ADDRESS: _____________________________ TITLE: _____________________________________ _____________________________ E-MAIL: _______________________________ PHONE NO.: ____________________________ RFB Form-I OKALOOSA COUNTY  NO CONTACT CLAUSE The Board of County Commissioners have established a solicitation silence policy (No Contact Clause) that prohibits oral and written communication regarding all formal solicitations for goods and services (formal bids, Request for Proposals, Requests for Qualifications) issued by the Board through the County Purchasing Department. The period commences when the procurement document is received and terminates when the Board of County Commissioners approves an award. When the solicitation silence period is in effect, no oral or written communication is allowed regarding the solicitation between prospective respondents and members of the Board of County Commissioners the County Administrator 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 Manager or an appointed representative. It shall be the Purchasing Manager decision whether to consider this information in the decision process. Any violation of this policy shall be grounds to disqualify the respondent from consideration during the selection process. All respondents must agree to comply with this policy by signing the following statement and including it with their submittal. I representing Signature Company Name On this day of 2015 hereby agree to abide by the County’s “No Contact Clause” and understand violation of this policy shall result in disqualification of my proposal/submittal. RFB Form-I OKALOOSA COUNTY  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 Respondent: ________________________________________________________ E-Mail: RFB Form-I OKALOOSA COUNTY  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. ____________________________ __________________________ Respondent’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 RFB Form-I OKALOOSA COUNTY  COMPANY DATA Physical Address & Phone #: Respondent’s Company Name: Physical Address: Contact Person (Typed-Printed): Phone #: Cell #: Federal ID or SS #: Respondent’s License #: Fax #: Emergency #’s After Hours, Weekends & Holidays: RFB Form-I OKALOOSA COUNTY  ADDENDUM ACKNOWLEDGEMENT Acknowledgment is hereby made of the following addenda (identified by number) received since issuance of solicitation: ADDENDUM NO. DATE _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ NOTE: Prior to submitting the response to this solicitation, it is the responsibility of the respondent to confirm if any addenda have been issued. If such addenda have been issued, acknowledge receipt by noting number(s) and date(s) above. RFB Form-I OKALOOSA COUNTY  BID SHEET Date Submitted: BID#: RFB TDD 47-15 BID TITLE: Okaloosa County Artificial Reef Construction Project PART I. Bid submitted by: Company: _____________________________________________________________________ Address: ______________________________________________________________________ City & State: _______________________________________ Zip Code: __________ Telephone: ( ) __________________ Fax: ( ) __________________ Number of Years in Business: _____________ PART II. Bidding RFB TDD 47-15 – Okaloosa County Artificial Reef Construction Project: All bid items shall include all costs for furnishing to the Owner all labor, materials, equipment, tools, machinery, utilities, insurance, supplies, permits, and all costs incurred in providing all work shown on the Construction Drawings and outlined in the Contract Specifications and all other Contract Documents. BID SCHEDULE Bid Description Units Quantity Unit Cost Bid Item Cost Item Artificial Reef U.S. Ton 1 $ $ Construction (2,000 lbs) Total Cost Bid Item 1: $ Total Cost Bid Item 1 (Written): Bidder shall sign below that they have read and understood all addenda, if any, related to this project. Failure to acknowledge any addendum issued shall disqualify the Bidder. Addendum No.: Date of Receipt: Addendum No.: Date of Receipt: Addendum No.: Date of Receipt: Notice to All Bidders: 1.