REQUEST FOR QUALIFICATIONS #2016-XXX

Transcription

1 U N IO N C OU N T Y, N OR T H C A R OL I N A D E P A R TM E N T O F P U B L I C WO R K REQUEST FOR QUALIFICATIONS #2016-XXX PROGRAM MANAGEMENT AND OWNER S REPRESENTATIVE REQUEST FOR QUALIFICATIONS RFQ # Union County Human Services Building Commissioning Due Date: June 13, 2017 Time: 3:00 pm Submittal Location: Union County Government Center Administrative Services Procurement Division, Suite # North Main Street Monroe, NC Procurement Contact Person Name: Erin DeBerardinis Title: Procurement Specialist Erin.DeBerardinis@unioncountync.gov Telephone:

2 1. SUBMITTAL DEADLINE In accordance with Union County (the County) guidelines, submittals for the services specified will be received by Union County at the specified location listed in this RFQ document, until the time and date cited. Submittals received by the correct time shall be considered. Submittals received after the due date and time will not be considered. RFQ submittals are to be received by the Union County, Procurement Division by 3:00pm on June 13, Submittals must be submitted in a sealed envelope/box labeled on the outside RFQ , Union County Human Services Building Commissioning along with the submitter s name and address clearly indicated on the envelope. Instructions for preparing the Request for Qualifications (RFQs) are provided herein. Mail or hand-deliver submission packets to: Union County Government Center Administrative Services, Procurement Division 500 North Main Street, Suite #709 Monroe, NC Attention: Erin DeBerardinis Procurement Specialist Electronic ( ) or facsimile submissions will not be accepted. Pre-submittal: There will be no pre-submittal conference Questions: Submit all questions regarding this Request for Qualifications (RFQ) to Erin DeBerardinis, Procurement Specialist at Erin.DeBerardinis@UnionCountyNC.gov on May 23, Selection criteria are outlined in this document. Union County reserves the right to reject any or all submittals, to waive technicalities and to make such selection deemed in its best interest. With limited response, Union County reserves the right to extend the solicitation opening date as appropriate in order to assure a competitive procurement process. 2. SCOPE OF WORK General Pursuant to G.S , the Union County Department of Public Works ( UCPW ) hereby requests qualified consultants to submit an RFQ for Union County Human Services Building Commissioning. Union County Public Works Facilities Division is committed to commissioning The Union County Human Services Building at the conclusion of the construction phase and warranty period to ensure that all included systems are complete and functioning properly prior to the end of the warranty period. In addition, a requirement is that the Union County Maintenance and Page 2 of 18

3 Operations personnel have adequate system documentation and training. Union County will utilize the Commissioning Authority for the Acceptance and Warranty Phases and will approve the scope of work for each phase individually. General Union County will contract with a commissioning agent, independent of the design and/or construction team that is capable of reviewing design documents, preparing commissioning specifications and inspecting constructed facilities. This will ensure proper Mechanical, Electrical, Plumbing, and miscellaneous building systems commissioning of the facility described in this document. The selected firm will coordinate commissioning efforts with the project architect and the MEP engineering consultants. Provide references from previous commissioning projects your firm has performed. Specific requirements of the commissioning process and responsibilities, duties, and obligations of the Commissioning Authority (CxA) team are described in Section 2 Commissioning Tasks. To accomplish these tasks, the CxA team shall be required to coordinate his or her activities with other entities. The commissioning process does not take away from or reduce the responsibility of the project designers or installing contractor to provide a finished and fully functioning product. It is noted that the services of the Construction Manager (CM), design team, and the General Contractor (GC) and his various subcontractors, are NOT provided under this Scope of Work and the CxA is not responsible for providing their services. The primary role of the CxA team shall be to develop and coordinate the execution of commissioning activities prior to occupancy of the building. The CxA shall not be responsible for design concept, design criteria, compliance with codes, design, or cost estimating. The CxA may assist the design team with problem solving, or the correction of construction non-conformance or deficiencies, but ultimate responsibility for meeting the project objectives and requirements resides with the A/E team and General Contractor. 2.0 Systems to Commission The following is a general description of the systems within the Human Services Building: The building will house the Social Services Department, Public Health Department and Human Services Administration. The new 144,000 square foot facility (Type II-B, Business Occupancy) will be located on a +/- 30 acre site at the intersection of Concord Avenue and Skyway Drive. Taking advantage of the site s natural topography, the 3 story social services wing sits on the lower portion of the site, while the 2 story public health wing is situated at a higher elevation. MEP Systems Types: Mechanical System Description The general HVAC system will consist of main zone VAV air handling units with fan arrays supplying cooling air to variable air volume terminal devices. Page 3 of 18

4 The perimeter and high use areas will have parallel fan powered VAV boxes with hot water reheat coils. The interior areas will be served with single duct VAV boxes with reheat coils. The air handling units contain preheat coils. The air handlers will be provided with chilled water generated within the facility by water cooled chillers. The VAV boxes and AHUs will be provided with heating hot water (HHW) generated within the facility by natural gas boilers. Ventilation air will be supplied to the building through the air handling units which shall be ducted to sidewall louvers. Chilled water and heating water shall be distributed via a variable primary loop system using variable frequency drive (VFD) pumps. Pumps shall be provided with N+1 redundancy. Condenser water pumps shall also be provided with N+1 redundancy. Two cooling towers and two chillers will be provided, each sized for 2/3 of the building load. All components will be controlled via DDC modules and be tied into a central BMS system. Building pressurization will be controlled by two rooftop fans. Plumbing System Description Hot Water is provided to restroom groups and lab areas by tank type, electric water heaters. Some systems incorporate recirculation loops. Fire Protection System Description The building is served by a wet pipe sprinkler system. Electrical system description The lighting system incorporates occupancy sensors and dimming ballasts to maximize lighting efficiency while maintaining user control. Emergency and Standby power will be provided via a new outdoor diesel generator in a sound attenuated enclosure. The generator will provide complete backup of code required emergency systems as defined by Article 700 of the NEC, as well as optional standby systems as designed by Article 702 of the NEC. The standby branch will power various receptacle and mechanical loads throughout the building. Two (2) Automatic Transfer Switches (ATS) with bypass isolation switches located within the building in the Emergency Systems Equipment Room will be provided to serve emergency and standby loads. Technology System Description The server room has a UPS system installed to carry the power load during a loss of power for the period of time that it takes the standby generator to initiate. Page 4 of 18

5 Any Unique/Unusual Spaces: Triage Access B105 & Exam room B106: these areas are to be under negative pressure relative to surrounding spaces. The space is served by a Fan Terminal Unit (FTU) box and exhaust fan w/ Electronically Commutated (EC) motor. The exhaust fan speed will be modulated by the BAS to maintain negative pressure. Proper system operation will need to be verified during functional testing. Emergency Power Sequence The HVAC system is to remain operational while the emergency generator is in operation. One chiller, cooling tower, boiler, associated pumps, AHU-2, and associated FTU boxes will be on emergency power. Proper system operation will need to be verified during functional testing. Server Room The server room cooling system is set up in a hot aisle/cold aisle configuration. The three split systems are designed to operate simultaneously. Proper system operation will need to be verified during functional testing. The CxA shall commission the building systems and other building components, equipment or systems as indicated in this document and based on Construction Documents, plans and specifications, submitted by Perkins & Will Architects, dated 10/16/2015, as well as any revisions, modifications or additions to these documents. Mechanical (Divisions 21, 22 & 23) Building automation systems, including linkages to remote monitoring and control sites (communication with and operation of each component shown to be evaluated during commissioning) Testing of building automation operator workstation graphics (verification of graphics for user friendly monitoring and control modifications) (3) Chilled water, (3) condenser water and (3) hot water pumps, piping, accessories and associated equipment (speed control) Boilers, control valves, combustion air systems, and boiler controls (2) Chillers, chiller controls, control valves (2) Cooling Tower (2 cells) (fans, nozzles, basin heaters, floats, etc.) Preheat/Reheat water systems (control valves) (3 Air Handlers, 20% VAV, 20% Fan Boxes) Computer Room Units (all) Split Systems (all) Building Pressurization Fans (all) Sump Pumps and controllers (all) Air Handling Units (3) (VAV operation) Fan Terminal Units (20% sample) (fans and dampers) VAV Boxes (20% sample) (dampers) Exhaust fans, manifold systems (all) Smoke Control & life safety devices ( see Electrical ) (all) Verify air/water balance (2 chillers, 2 boilers, 3 Air Handlers, 20% Fan Boxes, 20% VAV Boxes) Unit heaters and unit ventilators (all) Domestic hot water tanks and water heaters, pumps, and associated equipment (all) Page 5 of 18

6 Chemical Treatment (CHW/HW/CW ) (all) Water Conservation devices/fixtures (all) Fire Protection Systems (Verify testing by authority having jurisdiction) (all) Electrical (Division 26) Emergency power function test, transfer switch and generator set. Electrical system from the building entrance through the main switchboard, switchgear, and to the distribution panels. Motor Control Centers, Variable Speed Drives, Motor Starters, protective devices. Building lighting and lighting control - Verify sequence of operations, and luminaires for proper operation, lamping and lighting levels. Fire Alarm system verification, verify interlocks with mechanical system Electrical Metering Architectural Systems (Other than and Divs 21, 22, 23 or 26) Automatic/HC door operator electro-mechanical system Elevators (verify testing by authority having jurisdiction) Loading Dock Equipment (verify testing by authority having jurisdiction) 2.2 Final Construction Phase (from selection of Cx Agent through warranty period) Coordinate the commissioning work and, with the construction manager (CM), ensure that commissioning activities are being scheduled into the master schedule. Prepare and distribute the final construction and acceptance phase Cx plan, UCPW Facilities will review and approve plan. Continually update Cx plan and coordination throughout final phase of construction, acceptance and warranty phases with CM, UCPW Facilities, and subcontractors. Submit final commissioning plan for construction with coordination and activities for Union County Public Works Facilities and CM review. Attend a 1 day planning session with CM team to ensure that Cx tasks, and startup issues, corrective action times, and functional testing are included. O&M material will be submitted to the CxA team. Attend monthly owner s and designer s progress meetings with CM team and identify Cx related issues for team. (allow for 5 meetings) Prepare final pre-functional and final functional test procedures for the equipment and systems. Submit test procedures to contractor for comments on appropriate start-up, operations, and systems safety. Coordinating with the contractor to witness start-up of major equipment. Review and comment on submitted TAB execution plan. Maintain a running master issues and deficiency log of items found to be a problem, poorly installed, or discrepancies. Witnessing a sample of checkout, TAB, end-to-end testing, and calibration of controls. Observing first contractor start-up and pre-functional test of each type of system, including mechanical, controls, electrical, and specialty systems. CM will provide adequate coordination and scheduling. ( 5 working days minimum notice) Page 6 of 18

7 Develop a training plan, provide training for operation of the systems listed in this document for the owner and operators as related to design intent of the system, and provide final training documentation. Refer to Specification Section for the UC Human Services Building for clarification of responsibilities of the commissioning agent and the contractor. 2.3 Acceptance Phase The CxA shall complete the following tasks during the acceptance phase: Obtain pre-functional reports from general contractor with sign-offs that the systems have been checked out according to proper manufacturer and pre-functional procedures. Functional Testing o Verify the accuracy of the TAB effort and report. Grilles, terminal devices, and other equipment shall be tested, and documented. All individual systems will be sampled at a 20% rate. o Functionally test 20% of exhaust systems. o Building Pressurization Fans o Functionally test 20 % of terminal VAV units, including controls, airflow, and sequence of operations. Document findings and issue deficiency logs. o Witness performance testing of smoke control and life safety systems, in conjunction with designer and authorities having jurisdiction. o Perform and direct functional testing of each major piece of equipment to demonstrate that each item of equipment and system is operating according to the design intent and contract documents. Functional testing shall include operating the system and components through each of the written sequences of operation. CM will provide coordination and subcontractor support during testing. o Provide troubleshooting to assist in resolving control problems, as they are uncovered. Functional testing shall be performed on all control points within listed samples. o Perform the first of 2 seasonal performance tests (either heating or cooling system, depending on completion schedule and respective season) during acceptance phase. Performance test shall include AHU s, sample terminal units, and exhaust systems as listed. o Check system graphics within sample to assure all graphics are developed and points are mapped to graphics. o Keep a detailed log of testing of each piece of equipment. Notify UCPW Facilities, CM and A/E of unacceptable findings if components fail to perform to the requirements of the contract documents. o Set up/ensure key trends are set up at the completion of successful testing to monitor building performance parameters. All points will be trended by the contractor; CxA will sample trends for completeness. Maintain a deficiency log of any items found to be a problem, poorly installed, or discrepancies. Provide the log and test results to UCPW Facilities, A/E, and CM with recommended actions. Coordinate re-testing as necessary. One re-test of issues will be provided as part of normal functional testing. More than one retest will be considered work outside the normal scope of work. Page 7 of 18

8 Attend weekly meetings while on-site for functional testing. Review O&M documentation for completeness. This review shall be in parallel with the A/E team s review of the O&M documentation for conformance to the project specification. Review, pre-approve, and coordinate training of operating personnel designated by UCPW Facilities by the contractor to coincide with CxA provided systems training. Verify that control point data is correctly mapped and set up in building automation system. Prepare five (5) hard copies and three (3) CD-ROM copies of the re-commissioning management report (final commissioning report). The report shall include an executive summary, list of participants and roles, brief building description, and the following sections: Design intent Basis of design Owner s Project Requirements Pre-functional checklists, complete Functional checklists, complete TAB reports System schematics Control strategies and set-points Deficiency logs Guidelines for Energy Accounting 2.4 Warranty Phase The CxA shall complete the following tasks during the warranty phase: Return to the site at the 10 th month of contractor warranty and meet with facility staff to discuss the current building operation and the condition of outstanding issues related to the original and seasonal commissioning. Identify problems or concerns they have with operating the building as originally intended. Perform second part of seasonal testing checkout of equipment, August-September of cooling systems and January-February of heating systems, depending on acceptance phase test performed prior, and issue/update deficiency log with results. Remotely verify trending set at the 3 month, 6 month, and 9 month operating points during the warranty period. Update logs as to performance variances from the Cx data obtained in acceptance phase. Identify deficiencies that may come under warranty or under the original construction contract. Provide one day of additional training for users and staff in building system operations. Attend up to four on-site meetings to discuss warranty issues. 2.5 Additional Services The CxA shall perform the following additional Commissioning Related Services: A. Schedule The project design and construction is scheduled as follows: Page 8 of 18

9 Develop and coordinate Cx Schedule in conjunction with UCPW Facilities and project team. B. Forms Forms and Items of Responsibility for this submittal are attached at the end of this document. (Signature Form, Addendum and Non-Collusion Affidavit, Iran Divestment Act) C. Test Equipment The installing contractors shall provide all tools or the use of tools required to start, checkout and functional test equipment and systems, except for specified testing with supplemental portable data- loggers, which shall be supplied and installed by the CxA. Data logging equipment, monitoring devices, specialized equipment, and software, not required to be provided by the installing contractor in the Contract Documents, and provided by the CxA to monitor, confirm, or verify the contractor s testing procedures, shall remain the property of the CxA. Equipment provided shall meet the minimum accuracy, calibration and performance standards required by the performance test. 2. RFQ SUBMITTAL REQUIREMENTS Submit, one (1) original and five (5) copies, in printed form and on a non-returnable CD or flash drive. Submittals must be submitted in a sealed envelope/box labeled RFQ# , Union County Human Services Building Commissioning along with the submitter s name and address clearly indicated on the envelope. The original submittal package must have original signatures and must be signed by a person who is authorized to bind the proposing firm. All additional submittals may contain photocopies of the original package. Union County may reject any or all proposals and may waive any immaterial deviation in a submittal package. RFQs should be submitted spiral bound, tabbed for each section outlined below. The total length of the proposal, including cover letter, should be no more than 20 single-sided pages. Font size should be no smaller than Arial Narrow 11pt. Key personnel resumes may also be provided as an appendix to the document and will not count against the page limit. Covers and tabs do not count against the page limit. Please provide the following information in the sequence of the following major headings described below. TAB 1: COVER LETTER The cover letter shall briefly introduce your firm, principal in charge, and area(s) of experience in which your firm is seeking consideration. Specify the location of your office from where project activities will be led; Designate your Project Manager and why they were chosen for this assignment; List the individual with contract signatory to enter into an agreement with Union County; and Page 9 of 18

10 Provide contact information for any follow-up questions regarding this SOQ. TAB 2: FIRM BACKGROUND/EXPERIENCE Provide a general description of the capabilities of your firm, including an overview related to its history, overall size, and experience as it related to commissioning for similar sized governmental projects. Provide references for three (3) similar projects completed in the last five years. List the name of the project, year completed, name of the entity, contact person s name, title, phone number and . TAB 3: PROJECT TEAM Provide a Project Team organizational chart identifying the engineer and/or architect team members proposed for this assignment, their availability, and a brief biography of each team member to include specific experience, project role, and office location. Include staff to be directly involved with this project. TAB 4: PROJECT MANAGEMENT AND QUALITY CONTROL Provide a description of the systems and methods employed by the firm to effectively manage proposed project including a discussion of: goal setting, managing client expectations, communications, quality control, managing project schedule and cost within prescribed budgets and change management. TAB 5: HISTORY OF SIMILAR PROJECTS Provide a minimum of two (2) project examples similar in scope in your firm s response that your firm has completed in the past five (5) years. Provide the following information for each project: Owner s name Owner s contact person name, address, telephone number, and address Title and Description of the project Date of project and in what capacity firm worked. 3. SELECTION PROCESS Maintaining the integrity of the RFQ process is of paramount importance for the County. To this end, please do not contact any members of Union County or its staff regarding the subject matter of this RFQ until a selection has been made, other than the County s designated contact person identified in the introduction to this RFQ. Representatives of Union County will read, review, and evaluate the qualifications independently based on the evaluation criteria. Union County reserves the right to conduct interviews with a shortlist of selected respondents. The following factors will be used in the initial evaluation process. Page 10 of 18

11 REPUTATION, QUALITY, AND EXPERIENCE OF FIRM How substantial is the firm s experience in providing similar services for a State, County, Town, or City of comparable size and complexity? Did all references listed have a favorable experience with the firm? Would they work with them again? How comparable was their project? Does the firm have the depth and breadth of resources necessary to achieve the County s goals in a designated timeframe in order to keep it on schedule? Did the firm demonstrate an understanding of the specific needs of Union County in this effort? Did all projects included in the History of Similar Projects section of the response have a favorable experience with the firm? Did the firm demonstrate an understanding of the specific needs? Would they work with them again? Was the listed project relevant and comparable? Was the project completed within prescribed schedule and budget constraints? PROPOSED PROJECT TEAM Does the proposed project staff appear to have the appropriate experience and capabilities to deliver the requested services? Is the firm proposing to use resources that are accessible to enhance communication with the County s, regulatory agencies, and other interested stakeholders? Does the firm s organizational structure support the project team and project objectives? Is the availability of key team members to participate adequate to support Union County? OVERALL APPROACH AND METHODOLOGY How successfully does the RFQ provide a clear and concise answer to the question Why should UCPW select your firm for these services? Does the RFQ response discuss the approach to project management and what measures will be used to guarantee a successful outcome? Does the firm address its approach to project management with respect to quality control and factors listed in Tab 4? Page 11 of 18

12 4. ADDITIONAL INFORMATION Insurance At Contractor s sole expense, Contractor shall procure and maintain the following minimum insurances with insurers authorized to do business in North Carolina and rated A-VII or better by A.M. Best. A. WORKERS COMPENSATION Statutory limits covering all employees, including Employer s Liability with limits of: $500,000 Each Accident $500,000 Disease - Each Employee $500,000 Disease - Policy Limit B. COMMERCIAL GENERAL LIABILITY Covering Ongoing and Completed Operations involved in this Agreement. $2,000,000 General Aggregate $2,000,000 Products/Completed Operations Aggregate $1,000,000 Each Occurrence $1,000,000 Personal and Advertising Injury Limit $5,000 Medical Expense Limit C. COMMERCIAL AUTOMOBILE LIABILITY $1,000,000 Combined Single Limit - Any Auto D. PROFESSIONAL LIABILITY $1,000,000 Claims Made Contractor shall provide evidence of continuation or renewal of Professional Liability Insurance for a period of two (2) years following termination of the Agreement. Page 12 of 18

13 ADDITIONAL INSURANCE REQUIREMENTS A. The Contractor s General Liability policy shall be endorsed, specifically or generally, to include the following as Additional Insured: UNION COUNTY, ITS OFFICERS, AGENTS AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSURED WITH RESPECTS TO THE GENERAL LIABILITY INSURANCE POLICY. Additional Insured status for Completed Operations shall extend for a period of not less than three (3) years from the date of final payment. B. Before commencement of any work or event, Contractor shall provide a Certificate of Insurance in satisfactory form as evidence of the insurances required above. C. Contractor shall have no right of recovery or subrogation against Union County (including its officers, agents and employees). D. It is the intention of the parties that the insurance policies afforded by contractor shall protect both parties and be primary and non-contributory coverage for any and all losses covered by the above-described insurance. E. Union County shall have no liability with respect to Contractor s personal property whether insured or not insured. Any deductible or self-insured retention is the sole responsibility of Contractor. F. Notwithstanding the notification requirements of the Insurer, Contractor hereby agrees to notify County s Risk Manager at 500 N. Main Street # 130, Monroe, NC 28112, within two (2) days of the cancellation or substantive change of any insurance policy set out herein. Union, in its sole discretion, may deem failure to provide such notice as a breach of this Agreement. G. The Certificate of Insurance should note in the Description of Operations the following: Department: Contract #: H. Insurance procured by Contractor shall not reduce nor limit Contractor s contractual obligation to indemnify, save harmless and defend Union County for claims made or suits brought which result from or are in connection with the performance of this Agreement. I. Certificate Holder shall be listed as follows: Union County Page 13 of 18

14 Attention: Keith A. Richards, Risk Manager 500 N. Main Street, Suite #130 Monroe, NC J. If Contractor is authorized to assign or subcontract any of its rights or duties hereunder and in fact does so, Contractor shall ensure that the assignee or subcontractor satisfies all requirements of this Agreement, including, but not limited to, maintenance of the required insurances coverage and provision of certificate(s) of insurance and additional insured endorsement(s), in proper form prior to commencement of services. Indemnification The Firm agrees to protect, defend, indemnify and hold Union County, its officers, employees and agents free and harmless from and against any and all losses, penalties, damages, settlements, costs, charges, professional fees or other expenses or liabilities of every kind and character arising out of or relating to any and all claims, liens, demands, obligations, actions, proceedings, or causes of action of every kind in connection with or arising out of this Agreement and/or the performance hereof that are due, in whole or in part, to the negligence of the Firm, its officers, employees, subcontractors or agents. The Firm further agrees to investigate, handle, respond to, provide defense for, and defend the same at its sole expense and agrees to bear all other costs and expenses related thereto. Minority and Small Business Participation Outreach Plan Good Faith Effort In an effort to encourage Good Faith Effort Outreach, Union County encourages certified Historically Underutilized Businesses ( HUB ), MBE/WBE s to participate in the solicitation process for this RFQ. Review Union County s Minority and Small Business Guidelines and Outreach Plan at, (click Procurement, then Minority Outreach tab). Iran Divestment Act The Iran Divestment Act of 2015 (N.C.G.S formerly known as N.C.G.S. 143C-6A- 1 to 6A-9) was signed by the Governor of North Carolina on June 29, Effective February 26, 2016, the Act prohibits: The North Carolina Retirement Systems or the Department of State Treasurer from investing funds with individuals or companies engaging in certain defined investment activities in Iran. State agencies, local government units, and other political subdivisions of the State from contracting with individuals or companies on the Department of State Treasurer s Final Divestment List. UNION COUNTY RESERVES THE RIGHT TO REJECT ANY AND/OR ALL QUALIFICATIONS AND TO WAIVE ANY AND ALL TECHNICALITIES. Page 14 of 18

15 5. SCHEDULE It is anticipated that the review of qualifications will be completed in June Interviews may or may not be conducted after that time. All firms submitting an RFQ will be notified of the results of the selection process. Page 15 of 18

16 Signature Form RFQ Union County Human Services Building Commissioning Qualification Package Submitted by: Company Full Legal Name: Contact Person for RFQ Process: Address: City/State/Zip Telephone Number: Fax Number: Address: Submission of a response to this RFQ constitutes certification that the Firm and all proposed team members are not currently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this Project by any State or Federal department or agency. Submission is also agreement that the County will be notified of any change in this status. The information contained in this Statement of Qualifications package, including its forms and other documents, delivered or to be delivered to the County, is true, accurate, and complete. This Statement of Qualifications package includes all information necessary to ensure that the statements therein do not in whole or in part mislead the County as to any material facts. Represented and Warranted by (Signature): Printed Name and Title: Date Signed: Page 16 of 18

17 Addendum and Non-Collusion Affidavit RFQ # Union County Human Services Building Commissioning Please acknowledge receipt of all addenda by including this form with your Proposal. Any questions or changes received will be posted as an addendum on and It is your responsibility to check these sites for this information. ADDENDUM #: DATE ADDENDUM DOWNLOADED I certify that this submittal is made in good faith and without collusion with any other proposer or officer or employee of Union County. Company Name (Please Print Name) Date Authorized Signature and Title Address Page 17 of 18

18 UNION COUNTY ADMINISTRATIVE SERVICES PROCUREMENT DIVISION 500 North Main Street, Suite 709, Monroe, NC Phone: (704) Fax: (704) RFQ Number (if applicable): Name of Vendor or Bidder: IRAN DIVESTMENT ACT CERTIFICATION REQUIRED BY N.C.G.S. 143C-6A-5(a) As of the date listed below, the vendor or bidder listed above is not listed on the Final Divestment List created by the State Treasurer pursuant to N.C.G.S A-4. The undersigned hereby certifies that he or she is authorized by the vendor or bidder listed above to make the foregoing statement. Signature Date Printed Name Title Notes to persons signing this form: N.C.G.S. 143C-6A-5(a) requires this certification for bids or contracts with the State of North Carolina, a North Carolina local government, or any other political subdivision of the State of North Carolina. The certification is required at the following times: When a bid is submitted When a contract is entered into (if the certification was not already made when the vendor made its bid) When a contract is renewed or assigned N.C.G.S. 143C-6A-5(b) requires that contractors with the State, a North Carolina local government, or any other political subdivision of the State of North Carolina must not utilize any subcontractor found on the State Treasurer s Final Divestment List. The State Treasurer s Final Divestment List can be found on the State Treasurer s website at the address and will be updated every 180 days. Page 18 of 18