If Applicable Bidder acknowledges, by initialing, receipt of the following Addendums:

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1 ATTACHMENT A COVER SHEET FOR PROPOSAL Proposals must include this cover sheet (or this sheet reproduced on company letterhead) or PAGE 1 of the proposal. This attachment is provided as a fillable form.pdf document for all required attachments. Vendors may also complete all required attachments as a stand-alone response (written or typed). [ ] an individual, [ ] a corporation (please mark appropriate box), duly organized under the laws of the State of. The undersigned, having carefully read and considered the request in the manner described and subject to the terms and conditions set forth in the attached proposal, including, by reference here, the County s RFP document. Proposals must be signed by an official authorized to bind the provider to its provisions for at least a period of 90 days. By submission of a response, the Bidder agrees that at the time of submittal, he/she: (1) has no interest (including financial benefit, commission, finder s fee, or any other remuneration) and shall not acquire any interest, either direct or indirect, that would conflict in any manner or degree with the performance of Bidder s services, or (2) benefit from an award resulting in a Conflict of Interest. A Conflict of Interest shall include holding or retaining membership, or employment, on a board, elected office, department, division or bureau, or committee sanctioned by and/or governed by the County. Bidders shall identify any interests, and the individuals involved, on separate paper with the response and shall understand that the County, at its discretion may reject their proposal. By submission of a proposal the Bidder certifies, under civil penalty for false certification, that it is fully eligible to do so under law and that it is not an Iran linked business, as defined in the Michigan Economic Sanctions Act, 2012 P.A The Bidder affirms that he/she is duly authorized to execute this proposal, that this company, corporation, firm, partnership or individual has not prepared this proposal in collusion with any other bidder and that the contents of this proposal as to prices, terms or conditions have not been communicated by the undersigned, nor by any employee or agent, to any competitor, and will not be, prior to the award and the bidder has full authority to execute any resulting contract awarded as the result of, or on the basis of the proposal. If Applicable Bidder acknowledges, by initialing, receipt of the following Addendums: Addendum No. 1: Addendum No. 2: Addendum No. 3:

2 ATTACHMENT A COVER SHEET FOR PROPOSAL, continued The submission of a proposal hereunder shall be considered evidence that the bidder is satisfied with respect to the conditions to be encountered and the character, quantity and quality of the work to be performed. BY: (Signature of Authorized Representative) (Printed Name and Title of Authorized Representative) PRINCIPAL OFFICE INFORMATION / ADDRESS: Individual / Company Name: Street Address City State Zip Code Telephone Fax Taxpayer Identification Number

3 ATTACHMENT B VENDOR INFORMATION Responses to the following questions must be submitted in the proposal and signed by an authorized Company Representative This RFP document is provided as a fillable form.pdf document for all required attachments. Vendors may also complete all required attachments as a stand-alone response (written or typed). 1. COMPANY EXPERIENCE - How many years has the company been providing the requested services? Please describe your experience. How many employees does the company employ (FT/PT, temporary). Discuss any instances within the last five years when your company or any of its subconsultants/subcontractors been involved in any litigation, as applicable. 2. PROJECT MANAGEMENT Identify by name the Contractor representative to be assigned to the County. Provide a summary of your project management methodology for the purchase and supply of materials, floor preparation and flooring installation. Include consideration for quality assurance, delivery, storage and handling, staffing, scheduling and work conditions. 3. SUBCONTRACTORS - Will sub-consultants/subcontractors be used? If yes, identify the subconsultants/subcontractors, their experience as well as the scope of their responsibility as it relates to this project. 4. CARPET SPECIFICATIONS - The County will consider any manufacturer of plank carpet tiles with Antron 6/6 Nylon fiber system and coordinating carpet base of 4-1/4 H. Describe performance characteristics of proposed material(s) and include a full specification sheet that identifies product type, face weight, loop construction, pile height average, gauge, stitch/inch, primary backing, dye method, and soil/stain protection, etcetera.

4 ATTACHMENT B VENDOR INFORMATION continued 5. WARRANTY Provide copy of Manufacturer s standard form in which manufacturer agrees to repair/replace components of carpet installation that fail in materials/workmanship within specified warranty period. Describe the company s Warranty management process, procedures and all applicable terms. 6. RECYCLING Describe the company s recycling process and identify the recycling center used for existing carpet. 7. Other Information Include any other information that would be helpful to the County. Authorized Representative s Printed Name and Title Company Name (and Legal Name) for Business

5 ATTACHMENT C - AUTHORIZATION FOR REFERENCE CHECK The undersigned hereby authorizes the County to obtain all information that said recipient may have concerning the undersigned s contract performance history. The undersigned further authorizes any person contacted to give the County any and all information concerning the undersigned s (and the employees of the undersigned) education, work experience, and character which they may have, personal or otherwise, and releases all parties from all liability for any damage that may result from furnishing the same to the County. A photocopy of this authorization shall be deemed equivalent to the original. Authorized Representative s Printed Name and Title Company Name (and Legal Name) for Business

6 ATTACHMENT D VENDOR REFERENCE INFORMATION List three (3) references for PROJECT successfully completed in the last five (5) years. Type of Project(s): Company Name: Address: County, State, Zip Code: Contact Person: Telephone Number: (s) of Service: Type of Project(s): Company Name: Address: County, State, Zip Code: Contact Person: Telephone Number: (s) of Service: Type of Project(s): Company Name: Address: County, State, Zip Code: Contact Person: Telephone Number: (s) of Service:

7 ATTACHMENT E - CERTIFICATION FOR INSURANCE AND INDEMNITY REQUIREMENTS Potential Vendors must understand and agree that financial responsibility for claims or damages to any person or to companies and agents shall rest with the Vendor. The Vendor must affect and maintain any and all insurance coverage, including, but not limited to, Worker s Compensation, Employer s Liability and General, Contractual and Professional Liability, to support such financial obligations. The indemnification obligation, however, shall not be reduced in any way by existence or non existence, limitation, amount or type of damages, compensation or benefits payable under Worker s Compensation laws or other insurance. Compliance with Government Requirements the Vendor shall evidence satisfactory compliance for Unemployment Compensation and Social Security reporting as required by federal and state laws. Evidence of Insurance Evidence of Workers Compensation and Employers Liability, Commercial General Liability and Automobile (if applicable) and Professional Liability (if applicable) Insurances shall be provided to Ottawa County. The successful Bidder shall purchase and maintain policies of insurance and proof of financial responsibility to cover costs as may arrive from claims of tort, statutes, and benefits under Worker s Compensation laws, as respects damages to persons or property and third parties in such coverages and amounts as required and approved by Ottawa County. Acceptable proof of such coverage s shall be furnished to Ottawa County prior to service under the contract. The Bidder is indemnifying and holding harmless the County, its employees, agents and volunteers against and from all claims, judgments, losses, damages, payments, costs and expenses of every nature and description including attorney s fees arising out of or resulting from the Bidder s performance or nonperformance of the work described. Types of Coverage and Limits of Liability The Vendor shall provide evidence of the following coverages and minimum amounts prior to the implementation of services. Vendor(s) must maintain the following insurance during the term of the contract: Worker s Compensation and Employers Liability Workers Compensation Limits Employers Liability Limits Michigan Statutory $500,000 Each Accident $500,000 Each Employee, Injury by Disease $500,000 Policy Limit, Injury by Disease Commercial General Liability- There shall be no Products/Completed Operations or Contractual Liability exclusion. The General Aggregate limit shall apply separately per location or project. Each Occurrence $1,000,000 Personal & Advertising Injury $1,000,000 General Aggregate $2,000,000 Products/Completed Operations Aggregate $2,000,000

8 ATTACHMENT E - CERTIFICATION FOR INSURANCE AND INDEMNITY REQUIREMENTS - continued Automobile (if applicable) Residual Liability Limit $1,000,000 Each Accident Personal Injury Protection Michigan Statutory Property Protection Insurance Michigan Statutory Coverage shall apply to any auto, including owned, non-owned, and hired. There shall be no Contractual Liability exclusion. Professional Liability (if applicable) Limit of Liability $2,500,000 Aggregate Limit A certificate of insurance detailing your coverage which meets the above requirements may be requested as a part of this RFP. The certificate must indicate that insurers will provide us written notice thirty (30) days prior to terminating any policy. Additional Insured Endorsement to the Commercial General Liability policy must accompany the certificate, OR the Certificate must state that the General Liability policy includes a blanket additional insured provision on the primary basis for any entity required by contract or agreement to be an additional insured. A certificate of insurance shall be submitted for review to the County for each successive period of coverage for the duration of this agreement. The undersigned certifies and represents an understanding of the County s Insurance and Indemnification requirements. The undersigned acknowledges that the County is, in part, relying on the information contained in this proposal in order to evaluate and compare the response to the RFP. Authorized Representative s Printed Name and Title Company Name (and Legal Name) for Business Name (and Legal Name) for Business

9 ATTACHMENT F DEBARMENT AND SUSPENSION The Bidder certifies to the best of its knowledge and belief, that the corporation, LLC, partnership, or sole proprietor, and/or its principals, owners, officers, shareholders, key employees, directors and member partners: (1) are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (2) have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (3) are not presently indicted for or otherwise criminally charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in (2) of this certification; and, (4) have not within a three-year period preceding this proposal had one or more public transactions (Federal, State or local) terminated for cause or default. Authorized Representative s Printed Name and Title Company Name (and Legal Name) for Business Name (and Legal Name) for Business

10 ATTACHMENT G CERTIFICATION OF NON-COLLUSION The undersigned certifies and represents that the Vendor: 1) has not colluded, conspired, connived or agreed, directly or indirectly, with any other bidder or person to submit a proposal which is a sham, 2) has not in any manner agreed with any other persons or businesses to fix the proposed price, overhead, profit, or any cost element of the submitted proposal, 3) has not attempted to secure any advantage against any other bidders through collusion with any other bidder or employee(s) or representative of Ottawa County, 4) has not directly or indirectly submitted or disclosed its proposal or its contents or divulged information or relative data to any association or to any member or agent of any other bidder to this proposal. Authorized Representative s Printed Name and Title Company Name (and Legal Name) for Business

11 ATTACHMENT H - PROPOSAL PRICING FORM The undersigned hereby agrees to perform all work in accordance with the specifications, terms, and conditions of the County Request for Proposal 19-14, as described herein. The fees proposed shall be considered firm and cannot be altered after receipt of the proposal by the County per the terms of this RFP. All costs must be identified in proposer s response. PROPOSAL PRICING Please provide pricing for each of the following items for the flooring project to take place at the Ottawa County Department of Public Health located at James St., Holland, MI 49424: ITEM Carpet Materials (tile and base): Provide Manufacturer Name, Product Name, and Item Number Sq. footage*: Material Cost: $ DESCRIPTION Labor Costs Standard Prep Work / Standard Work (hours 7am 4pm) Additional Labor Cost for excessive prep work (describe): Labor Costs Non-Standard Work Hours (nights and weekends): Comments: $ $ $ *Measurements: It is the responsibility of the Vendor to field verify for accuracy, all critical dimensions as related to square yardage of project material. Ottawa County is not responsible for accuracy of square yardage estimates provided for pricing purposes. Authorized Representative s Printed Name, Company Name (and Legal Name) for Business