ATTACHED FORMS. Drug-Free Workplace Program Certification (Form ) MBE Planned Utilization (Form )

Transcription

1 ATTACHED FORMS Drug-Free Workplace Program Certification (Form ) MBE Planned Utilization (Form ) Performance Bond (Form ) Bid Opportunity List (From ) 1

2 DRUG-FREE WORKPLACE PROGRAM CERTIFICATION FORM / Preference to businesses with drug-free workplace programs. --Whenever two or more bids, proposals, or replies that are equal with respect to price, quality, and service are received by the state or by any political subdivision for the procurement of commodities or contractual services, a bid, proposal, or reply received from a business that certifies that it has implemented a drug-free workplace program shall be given preference in the award process. In order to have a drug-free workplace program, a business shall: (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 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 bid 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 bid, 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 5 days after such conviction. (5) Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community by, any employee who is so convicted. (6) Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section. Does the individual responding to this solicitation certify that their firm has implemented a drug-free workplace program in accordance with the provision of Section , Florida Statues, as stated above? YES NO Name of Business: 2

3 MBE PLANNED UTILIZATION Procurement 12/09 Procurement Number: Financial Project Number: Description: District Four, Materials Lab Restroom Renovation. I,, (Name) (Title) of plan to subcontract at least % (percent) of the project costs on the above reference project to Certified Minority Business Enterprises. If I have indicated above that a portion of the project costs will be subcontracted to certified MBE(s), the firms considered as proposed subconsultants/contractors and the types of services or commodities to be subcontracted are as follows: MBE SubConsultants / Contractors Types of Services / Commodities I understand that I will need to submit Minority Business Enterprises (MBE) payment certification forms to the Department for reporting purposes only. Signed: Title: Date: 3

4 PERFORMANCE BOND "Attached Forms" OGC - 10/04 KNOW ALL MEN BY THESE PRESENTS: That we, (name) (hereinafter called Vendor) of (address) and (hereinafter called Surety) of (name), (address) duly authorized to do business in the State of Florida, are held and firmly bound unto the State of Florida in the full and just sum of FULL BID AMOUNT Dollars ($ ), lawful money of the United States of America, to be paid to the Florida Department of Transportation (hereinafter called the Department), to which payment will and truly to be made we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally and firmly by these presents; WHEREAS, the above Vendor has subscribed to an agreement with the Department to bear the date of, for contractual services agreement in connection with District Four, Materials Lab Restroom Renovation. in Broward particularly known as (hereinafter called the Agreement), upon certain terms and conditions in said Agreement more particularly mentioned; and County(ies), NOW, THEREFORE, The condition of this obligation is such that if the above Vendor in all respects will comply with the terms and conditions of said Agreement, and its obligations thereunder, including the Scope of Services, Specifications, General Conditions, Special Conditions, Bid Blank therein referred to and made a part thereof, and such alterations as may be made in said conditions and specifications, as therein provided for; and, further, if such Vendor will promptly make payment to all persons supplying labor, material, equipment and supplies, used directly or indirectly by the said Vendor or any subcontractor(s) in the prosecution of the work provided for in said Agreement, and promptly will pay all State Workers' Compensation and Unemployment Compensation taxes incurred in the performance of the said Agreement and will pay to the Department any amount in money or property, the Department may lose or be overcharged or otherwise defrauded of, by reason of any wrongful or criminal act of the Vendor, its agents, or employees, then this obligation is to be void; otherwise, to be and remain in full force and virtue in law. WITNESS the signature of the Vendor and the signature of the Surety by its (Agent or Attorney-in-Fact, or otherwise) with seals of said Vendor and Surety hereunto affixed this day of,. Surety Vendor TITLE: Signature Attorney-in-Fact/Agent (Surety Seal) TITLE: ATTEST: Authorized Signature(s) Secretary/Notary Name/Telephone #: Address: Signature NOTE: Attach Power of attorney showing authority of Surety's Agent or Attorney-in-Fact. This bond is not for public works contracts required by Section , Florida Statutes.

5 /07 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION BID OPPORTUNITY LIST FOR PROFESSIONAL CONTRACT SERVICES, AND COMMODITIES & CONTRACTUAL SERVICES Prime Contractor / Prime Consultant: Address / Telephone Number: Procurement Number / Advertisement Number: 49 CFR Part The list is intended to be a listing of all firms that are participating, or attempting to participate, on DOT-assisted contracts. The list must include all firms that bid on prime contracts, or bid or quote subcontracts and supplies materials on DOT-assisted projects, including both DBEs and non- DBEs. For consulting companies this list must include all subconsultants contacting you and expressing an interest in teaming with you on a specific DOT-assisted project. Prime contractors and consultants must provide information for Numbers 1, 2, 3 and 4, and should provide any information they have available on Numbers 5, 6, 7 and 8 for themselves, and their subcontractors and subconsultants. 7. Sub-contractor Between $10 - $15 Million 7. Sub-contractor Between $10 - $15 Million 7. Sub-contractor Between $10-$15 Million AS APPLICABLE, PLEASE SUBMIT THIS FORM WITH YOUR: BID SHEET (Invitation to Bid ITB LETTERS OF RESPONSE (LOR) PRICE PROPOSAL (Request for Proposal RFP) REPLY (Invitation to Negotiate ITN) 4