REQUEST FOR PROPOSAL-FS FOR TWO (2) NEW CUSTOM FIRE PUMPER APPARATUS

Transcription

1 REQUEST FOR PROPOSAL-FS FOR TWO (2) NEW CUSTOM FIRE PUMPER APPARATUS Purpose: The City of Palm Coast is Notice is hereby given that the City of Palm Coast, Florida is accepting sealed proposals to be received NO LATER THAN 2:00 p.m., May 30, 2006, to purchase (2) New Fire Custom Apparatus (Pumper) to used as part of the City of Palm Coast fleet. Instructions to Bidders: Submittal: Any firms desiring to provide the required services must submit their bid in a sealed envelope marked: RFP-FS Invitation to Bid-FS Custom Fire Pumper Apparatus Fire Services on the outside of the envelope. The proposals will be received until 2:00 PM on Monday, May 30, Mail or deliver all proposals to Brian Rothwell, Purchasing Manager, City of Palm Coast, 2 Commerce Blvd. Palm Coast, FL Proposals received after the date and time specified will be returned unopened. The City will not be responsible for late deliveries due to mail or other delays. Questions regarding the Proposals: Questions related to the proposals should be directed to Brian Rothwell, Purchasing Manager, City of Palm Coast, 2 Commerce Blvd., Palm Coast, FL Inquiries related to the work scope, clarification or correction must be in writing by fax, mail, etc. and received no later than close of business on May 23, 2006, to allow adequate time for response and/or addendum. Please do not contact any other staff member of the City, except the above, with regard to this RFP. All inquiries will be routed to the appropriate staff member for response. 1

2 Terms and Conditions: 1. The City reserves the right to reject any and all proposals, with or without cause, to waive technical errors and waive informalities and make award to / negotiate with the firm whose bid best serves the interest(s) of the City. 2. The City reserves the right to clarification of information and to request additional information from one or more Bidders. 3. Any bid may be withdrawn until the date and time set above for the submission of the proposals. Any bid not so withdrawn shall constitute an irrevocable offer for a period of ninety (90) days to provide to the City the services set forth in this RFP, or until one or more of the proposals have been awarded. 4. Costs related to the preparation of a response to the RFP are solely those of the Bidder, and the City assumes no responsibility for any such costs incurred by the Bidder. 5. Public Entity Crimes. A person or affiliate who has been placed on the convicted Bidder list following a conviction for a public entity crime may not submit a bid or bid on a contract to provide any goods or services to a public entity, may not submit a bid or bid on a contract with a public entity for the construction or repair of a public building or public work, may not submit proposals or proposals on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Florida Statutes Section , for category two for a period of thirty six (36) months from the date of being placed on the convicted Bidder list. The Bidder shall provide a certification of compliance regarding the public crime requirements. 6. Drug Free Workplace. The Bidder shall certify that the firm has a drug free workplace policy in accordance with Section , Florida Statutes. Failure to submit this certification shall result in the rejection/disqualification of your bid. 7. All forms in the attached Appendix must be completed, signed and returned with the Bidders bid. A. The City shall have the right to terminate its bid without cause with a hundred twenty (120) day written notice to the other party. The City reserves the right to terminate any bid for cause with a five (5) day written notice to the Bidder. Notice shall be served to the parties as specified in the bid. B. Legal Fees: The City shall be entitled to recover any and all legal costs including attorney fees it may incur. C. Escalation Cost: The bid price set forth in this bid has been calculated based on the current prices for the goods and/or services that are the subject of this Bid. However, the market for the goods and/or services that pertain to this Bid may be volatile on the basis of fuel costs 2

3 and sudden and substantial price increases could occur. The CONTRACTOR agrees to use its best efforts to obtain the lowest possible prices from fuel suppliers, but should there be a substantial and prejudicial increase in fuel prices for fuel that is purchased after execution of this Bid which fuel prices directly and materially relate to the pricing of the goods and/or services provided for in this Bid, the CITY agrees, upon written request from the CONTRACTOR, to consider a reasonable adjustment to the prices set forth in this Bid based upon the following index: Engineering News Record, Construction Cost Index, etc.. Any claim by the CONTRACTOR for a price increase, as provided above, shall state, with specificity, the increased cost, the product in question, and the source of supply, and shall be supported by invoices or bills of sale and such other information as may be required by the CITY. Only one (1) such request from the CONTRACTOR will be considered in each calendar year period. The decision of the CITY shall be final. D. Term of Contract: The initial term of the bid shall be for a period of two (2) years. After the two (2) year initial term, the contract shall automatically renew annually for one additional years. The maximum term for the contract and all renewals is a cumulative term of three (3) years. Should the City wish to not have the contract automatically renewed, the City shall provide written notice ninety (90) days prior to the automatic renewal. AWARD Award shall be made to the responsible proposer whose proposal is determined in writing to be the more advantageous to the City taking into consideration price and the evaluation factors set forth in the Request for Proposals. The award of a contract shall be the sole discretion of the City. The award shall be based on the evaluation of all information as the City may request. The City reserves the right to accept or reject any or all proposals in whole or in part and to waive any informality in the RFP. Further, the City reserves the right to enter into a contract deemed to be in its best interest. DEMONSTRATIONS The City reserves the right to require demonstrations, tests and certifications to determine quality or suitability of the apparatus proposed by the proposer. The purchasing agent or a designated City representative shall have the right to conduct such tests as may seem useful and reserves the right to make all evaluations. Such factors which may be brought out through a demonstration as in the City's interest may be considered in the decision to select a proposer. SPECIFICATIONS FOR PUMPER The City of Palm Coast desires proposals from qualified manufacturers of Custom Fire Pumper Apparatus. The City is interested in entering a contract for two (2) such vehicle as outlined in this RFP. The intent of this RFP is in no way to exclude or restrict any one manufacturer, it is instead designed to allow each proposer to show and tell the City of Palm Coast what it can provide. The City will also consider any pumper that is already manufactured and has been used as a demonstration unit as long as it meets the City s minimum requirements listed in this proposal. 3

4 The following conditions must be met and proposals will be rejected without further Consideration unless: 1. The manufacturer s / re-seller s vehicle being proposed meets or exceeds the latest applicable NFPA standards in construction, safety and performance. 2. A clearly marked price and delivery date is set forth in the proposal that will be agreed to in the City s contract. 3. Detailed specifications relating the vehicle being proposed are provided to the City. INTENT OF SPECIFICATIONS It is the intent of the City to receive all information as requested herein to determine which apparatus has the highest safety factors and performance standards available in order to provide the safest and most effective apparatus to the firefighters and citizens of the City consistent with the financial requirements of the City. With a view toward obtaining the best possible results and the most acceptable pumper for service, these specifications cover only the general requirements as to the type of construction and tests to which the pumper must conform. Minor details of construction and materials where not otherwise specified are left to the discretion of the proposer who shall be solely responsible for the design and construction. The City is depending upon the expertise of the proposer to design all the features, characteristics, safety and operational considerations necessary for the intended particular purpose for which it is meant. The apparatus shall conform fully to National Fire Protection Association Standard for Automotive Fire Apparatus #1901 in its most recent edition and in its entirety. Each proposal must to be accompanied by a set of detailed specifications of the apparatus and equipment proposed. Specifications shall include size, location, type, and model of all component parts being furnished. Detailed information shall be provided on the materials used to construct all facets of the apparatus. Any proposer who fails to submit detailed construction specifications, or submits a letter only or generic manufacturer's literature only shall be considered non-responsive and shall have render their proposal ineligible for award. If more than one (1) pumper is proposed, each fire truck shall have it s own complete submittal. A line drawing of the general fire truck being offered shall be supplied. All major components must be built and assembled in the continental United States including the engine, transmission, cab, chassis, pump, body, water tank, and aerial device. EXCEPTIONS TO SPECIFICATIONS In the interest of obtaining the best possible pumper available, and recognizing that the City depends upon the expertise of the proposer to supply that product which best suits the particular purpose intended by the City, exceptions which are substantially equal or better than the specifications will be considered. To be considered the proposer shall provide an attached listing of all exceptions with explanations of the intent. Failure to provide this listing, or of not including all exceptions on this listing may be cause for the rejection of the respective proposal. Proposers shall submit a detailed specification showing complete information on the unit proposed. Failure to do so may be cause for rejection of the proposal. 4

5 The City will not consider exceptions which lower the quality of the pumper. Attempts to become "low proposer" by supplying less expensive components are not acceptable and will be considered "nonresponsive". DELIVERY The proposer shall state the time required for the completed units in calendar days from the date of contract award on the proposal page. The City s contract shall provide for liquidated damages of $ a day for each day the pumper delivery exceeds the delivery stated on the proposer's proposal. The completed unit shall be delivered to the City of Palm Coast over the road under their own power by a qualified delivery engineer. The delivery engineer shall conduct training for the customer to insure the customer is familiar with the unit. Training shall be conducted at the customer's location and shall cover maintenance, care, operation, and safety considerations. The manufacturer / re-seller shall supply, at the time of delivery, complete operation and maintenance manuals covering the completed apparatus as delivered. The pumper shall be completely equipped as per these specifications upon arrival and upon completion of the required tests shall be ready for service. Any and all alterations required at the scene of delivery or testing to meet requirements outlined in the specifications shall be done at the proposer's expense. THE CITY OF PALM COAST WILL CONSIDER THE SPECIFIED DATE OF DELIVERY IN DETERMINING THE AWARD OF CONTRACT. IT IS EXPECTED THAT 270 DAYS FROM AWARD IS MAXIMUM TIME THE CITY WILL CONSIDER UNLESS CIRCUMSTANCES DICTATE OTHERWISE. LIQUIDATED DAMAGES TIME IS OF THE ESSENCE. Failure of the successful proposer to deliver an acceptable and ready to load and use fire truck will result in damages being sustained by the City. Such damages are, and will continue to be, impracticable and extremely difficult to determine. For each consecutive calendar day in excess of the time specified for delivery, the proposer shall pay to the City, or have withheld from monies due it, the sum of $ Submittal of a signed proposal under these specifications shall constitute agreement by the City and the proposer that this amount per day is the minimum value of costs and actual damage caused by the failure of the successful proposer to deliver an acceptable pumper within the allotted time, that such sum is liquidated damages and shall not be construed as a penalty, and that such sum may be deducted from payments due the proposer if such delays occurs. Permitting the successful proposer to continue to work on the pumper or its systems, or parts thereof after the 270 days shall in no way operate as a waiver on the part of the City of any of its rights. Payment of liquidated damages shall not release the proposer from obligations in respect to the fulfillment of the entire contract, nor shall the payment of such liquidated damages constitute a waiver of the City's right to collect any additional damages which may be sustained by failure to the proposer to perform, it being the intent of the parties that said liquidated damages be full and complete payment only for failure of the proposer to deliver on time. 5

6 WARRANTY The warranty or warranties relating to the pumper will be considered in the evaluation of proposals and is important to the City. Please provide complete warranty information including optimal extended warranties available. Warranties, extended warranties, brochures, or other attachments must be identified and attached as part of your submission with the Request For Proposals number, and name of company submitting the proposal. Complete warranty information including any optional extended warranties shall be provided with the proposal. The proposer shall indicate policies, procedures and locations of warranty service facilities. QUALITY OF WORKMANSHIP The design of the pumper must embody the latest approved automotive engineering practices. The workmanship must be of the highest quality in its respective field. Accessibility of the various components which require periodic maintenance, ease of operation (including pumping and driving) is required. Construction shall be rugged and ample safety factors shall be provided to carry the loads specified both on and off road under the conditions set forth under Performance Tests and requirements. GENERAL CONSTRUCTION The pumper shall be designed with due consideration to distribution of load between the front and rear axles. Weight balance and distribution shall be in accordance with the recommendations of the International Association of fire Chiefs and National Fire protection Association. PEFORMANCE TESTS AND REQUIREMENTS A road test shall be conducted with the pumper fully loaded and a continuous run of ten (10) miles or more shall be made under all driving conditions, during which the pumper shall show no loss of power or overheating. The transmission drive shaft(s) and rear axles shall run quietly and shall be free from abnormal vibration or noise throughout the operating range of the pumper. A. The pumper, when fully equipped and loaded, shall not have less than 25% nor more than 45% of the weight on the front axle, and not less than 55% nor more than 75% on the rear axles. B. The pumper must be capable of accelerating to 35 mph from a standing start within 30 seconds on a level concrete highway without exceeding the maximum governed rpm of the engine. C. The service brakes shall be capable of stopping the fully loaded vehicle in 35 feet at 20 mph on a level concrete highway. 6

7 D. The pumper, fully loaded, shall be capable of obtaining a speed of 65 mph on a level concrete highway with the engine not exceeding its governed RPM (full loads). E. Prior to acceptance must meet requirements or certification test in accordance with NFPA Test to be performed by third party company. F. City reserves the right to perform other tests as it seems fit to demonstrate suitability and workmanship. IN-PLANT INSPECTIONS The City reserves the right to inspect the production of the pumper in its various stages during normal working hours at the plant. As many as 4-5 officials may call at various times, usually with some notice to observe, inspect and consult on City preferences. Please include on a separate page, but included in the total price, the expense incurred by the successful proposer on providing airline travel (provided its necessary), at least two nights stay at a hotel, and three days worth of meals for an inspection party of three. The City upon awarding a contract will have at its sole discretion as to whether or not the proposer will pay for the City s traveling expenses. If the City chooses to pay its own expenses then those costs will be subtracted from the total contract price. A. CAB AND CHASSIS CUSTOM PUMPER SPECIFICATIONS Six (6) person full tilt aluminum cab pumper 186 Wheel base Front tow hooks Rear tow loops- heavy duty Anti-lock brakes (ABS) Steel disc wheels 5 hole 50 gallon steel fuel tank Alternator Leece Neville 320 amp minimum Radio compartment Bostrom 915 air driver s seat with SCBA Bostrom tanker seat for officer with SCBA Rear seating 4 SCBA; 2 rear, 2 forward Heater/defroster 57,000 BTU. Two cab defrost fans, dash mounted Air conditioner, minimum 66,000 BTU Tilt and telescoping steering wheel 7

8 Battery charging plug Step and under hood lights Cab and interior dome lights 12V supply I dash Dual Grover air horns/lanyard control Two-tone cab paint Weatherproof outlets, one on each side of rear cab for tripod mounted flood lights Battery charger, conditioner, air compressor, combo unit Cab to have barrier type doors w/tread-plate wells Rear cab wall to have windows on each side Painted bumper 10 high with chevron striping Scotch Lite Yellow. BUMPER TO BE PAINTED RED WITH ANGLED ENDS ALONG WITH THE CHEVRON STRIPING. Michelin tires Chassis to be painted to match job color Top speed to be 75 MPH Additional speedometer for officer Jumper cable studs Fast idle switch B. BODY Rear pick up spotlights; 1 spot, 1 flood Ground lights Hose body with aluminum slats Hose bed partitions, aluminum 3 Pumper body, aluminum construction Air bottle components (4) fender panel w/cast production door Adjustable shelves smooth aluminum Hydraulic ladder rack 8

9 Hose body capacity: ½ ¾ Vertical hinged full height doors on all compartments except those above rear wheels Four (4) roll out trays Adjustable shelf in all compartments Full rear step across entire rear body All compartments to have locks, keyed alike Body to have extended height sides to accommodate high hose loads Two (2) underbody storage compartments behind rear wheels Rear body to be painted red with yellow Scotch Lite chevrons Captive rollers rear body for hose reel Hinged cover over cross lays C. ENGINE AND TRANSMISSION 400 hp Caterpillar C-0 Diesel engine Allison automatic transmission Vertical exhaust All engine hoses to be silicone Engine exhaust brake D. WATER TANK 750 gal T-type tank poly 30 gal Class B Foam Tank Lifetime tank warranties 9

10 E. PUMP 1250 gallon per minute Hale single stage pump 54 side control pump stand Dry type gauges Large flow gauges to be FRC Insight Ultimate deluge and 3 ½ discharge FRC Pump Boss for CAT engines Stainless steel for ALL plumbing except flex hose, where applicable One (1) 3 deluge riser with TFT 18 Extend-A-Gun Four (4) 2 ½ discharges; 2 LH side, 1 RH side, 1 left rear body One (1) 3 ½ discharge RH side with 5 Storz One (1) 1 ½ discharge front bumper with 90 degree swivel One (1) Booster reel 200, 1 rear compartment with captive rollers Two (2) cross-lays capable of ¾ Two (2) 6 short intakes, 1 on each side One (1) 2 ½ gated intake, LH side One (1) 2 ½ rear direct fill to booster tank, RH rear body, no valve just plug Two (2) hose trays at pump stand; 1 RH side, 1 LH side Fuel gauge at pump panel Air horn push button at pump panel Pump panel to be color coded Pump packing to be adjustable type 2 tank fill Foam Pro 2002 Class B foam system FRC Tank Vision water tank gauge FRC Tank Vision foam tank gauge 10

11 F. LIGHTING AND SIRENS Wiring diagram FRC STYLE M w, 120v Floodlights, WITH FC570 top mount brackets to be installed, one on each side of body above center compartment individual switches for left and right floodlights to be installed both in cab and on pump panel. FRC style M w, 120v floodlights on FC600 Telescoping Tripods, to be mounted on each rear side of cab with FC603-Quick Release tripod mounting bracket set. Whelen NFPA LED warning light package FN72QLED 72 (1)/60R00FRR(6) All running lights to be Whelen LED Federal Q siren to be pedestal mounted to LH front bumper Federal CP100 to be mounted on RH side of bumper Air horns to be recess mounted in front bumper, 1 each side Compartment lights LED stop/tail/directional front and rear Under hood lights Electronic siren Siren brake button for officer and driver Q Siren emergency disconnect switch in cab in case of stuck siren Whelen LED arrow stick recess mounted rear body One (1) 12 circuit Square D circuit breaker box One (1) FRC M10 brow light mounted over center windshield Two (2) L520R receptacles; 1 mounted LH wheel area, 1 mounted rear body One (1) Harrison 6.0 MCR hydraulic generator One (1) ECR cord reel mounted RH side in area over pump 12/3 cable for cord reel connected to 2 50 lengths Cord reel to have captive rollers for cord deployment One (1) cable stoop for cord One (1) junction box 11

12 G. EXTRA EQUIPMENT Two (2) Maintenance manuals Two (2) Parts manuals Approval drawings Duo-Safety #585A, 8 aluminum folding ladder Duo-Safety #775A, 14 aluminum roof ladder Duo-Safety #900A 24 2 section aluminum extension ladder 6 Pike pole w/fiberglass handle Zico collapsible aluminum wheel chocks Mud flaps front and rear booster hose Minimum 10 year structural cab and body warranty Minimum 10 year corrosion perforation warranty Minimum 10 year pain warranty Pump test and certification Delivery to City of Palm Coast Fire Department Delivery Representative, or appointee, to be in Palm Coast for 3 consecutive days of training SUBMITTALS Proposers shall submit one original and six copies of their bound proposals addressing the following: 1. Description of firm and statement of qualifications. This statement must also include any associated firms that would be involved in the manufacturing of the apparatus. 2. Detailed description of the pumper and equipment proposed. Specifications must meet latest NFPA standards (1901) in construction, safety, and performance. 3. Reference list of at least (5) Municipalities that have purchased similar pumpers, to the pumper being proposed. Names, addresses, and telephone numbers are required. 4. Detailed statement showing the commitment of delivery, training, and any after sale service, which might be necessary. 12

13 5. Prices submitted shall be clearly stated so that the City fully understands what will be supplied for at a given figure. Any optional add-on's must be clearly stated in the proposal with prices and clearly marked "OPTIONAL". 6. Warranties of all truck parts and systems. Any optional warranties must be written and prices available. 7. The proposer should discuss discount option to the contract. EVALUATION CRITERIA Evaluation of the proposer shall be based on the following criteria which are listed in the ORDER OF IMPORTANCE: 1. Design of the pumper and the firm's commitment to a delivery schedule. 2. Quality control used by the firm during design and production. 3. Manufacturers demonstrated capabilities and qualifications. 4. Price. 5. References. 6. Warranties. 7. Completeness and clarity of Proposal. During the evaluation period, the City reserves the right to require the proposer to submit such evidence of their qualifications as necessary above and beyond the published proposal requirements. 13

14 REQUEST FOR PROPOSAL-FS FOR TWO (2) NEW CUSTOM FIRE PUMPER APPARATUS Bid Reply - BID NUMBER: RFP-FS City of Palm Coast Financial Services Department Attn: Brian Rothwell 2 Commerce Blvd. Palm Coast, FL The City of Palm Coast reserves the right to reject any and all proposals, to waive informalities, and to accept any proposal as the City, in its sole discretion, determines to be in the best of the City. I hereby certify that I have read and understand the requirements of this Request for Proposal RFP-FS and that I as the bidder, will comply with all requirements, and that I am duly authorized to execute this bid/offer document and any contract(s) and other transactions required by award of this Bid. Company: Address: Telephone: ( ) Fax: ( ) Name: (Typed or Printed in Ink) Signature: Title: Addendum Acknowledgment: 14

15 The proposer acknowledges that the following addenda have been received and are included in this proposal: Addenda Number Date 15

16 APPENDIX FORMS Public Entities Crime Certification Form Conflict of Interest Statement Disputes Disclosure Form Drug Free Workplace Form Statement of Insurance Compliance Form 16

17 SWORN STATEMENT UNDER SECTION (3)(a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS. 1. This sworn statement is submitted to (print name of public entity) by (print individual s name and title) for (print name of entity submitting sworn statement) whose business address is and (if applicable) its Federal Employer Identification Number (FEIN) is (if the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement:.) 2. I understand that a public entity crime as defined in Paragraph (1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any business with any public entity or with an agency or political subdivision of any other state or of the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 3. I understand that convicted or conviction as defined in Paragraph (1)(b), Florida Statutes means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere. 4. I understand that an affiliate as defined in Paragraph (1)(a), Florida Statutes, means: 1. A predecessor or successor of a person convicted of a public entity crime; or 2. An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term affiliate includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm s length bid, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate. 5. I understand that a person as defined in Paragraph (1)(e) Florida Statutes means any natural person or entity under the laws of any state or of the United States with the legal power to enter into a binding contract and which proposals or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term person includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity. 17

18 6. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (indicate which statement applies) Neither the entity submitting this sworn statement, nor any officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, nor any affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members or agents who are active in the management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of the entity, or an affiliate of the entity has been Charged with and convicted of a public entity crime subsequent to July 1, However, there has been a subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearings and the Final Order entered by the hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list (attach a copy Of the final order) I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE) ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IT IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION , FLORIDA STATUTES FOR CATERGORY TWO OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM (Signature) Sworn to and subscribed before me this day of, 20. Personally known Or Produced identification Notary Public State of My commission expires (Type of Identification) (Printed typed or stamped Commissioned name of Notary Public) 18

19 CONFLICT OF INTEREST STATEMENT STATE OF FLORIDA ) COUNTY OF ) ) ss Before me, the undersigned authority, personally appeared, who was duly sworn, deposes and states: I am the of with a local office in, and principal office in. The above named entity is submitting an Expression of Interest for the City of Palm Coast project described as: RFP-FS Custom Fire Pumper Apparatus 1. Diligent inquiry and provides the information contained in this Affidavit based upon his own knowledge. 2. The Affiant states that only one submittal for the above project is being submitted and that the above named entity has no financial interest in other entities submitting Statement of Qualifications for the same project. 3. Neither the Affiant nor the above named entity has directly or indirectly entered into any bid, participated in any collusion or otherwise taken any action in restraint of free competitive pricing in connection with the entity s submittal for the above project. This statement restricts the discussion of pricing data until the completion of negotiations and execution of an bid for this project. 4. Neither the entity nor its affiliates, nor any one associated with them, is presently suspended or otherwise ineligible from participating in contract lettings by any local, State or Federal agency. 5. Neither the entity, nor its affiliates, nor any one associated with them have any potential conflict of interest due to any other clients, contracts, or property interest for this project. 6. I certify that no member of the entity s ownership, management, or staff has a vested interest in any aspect of or Department of the City of Palm Coast. 7. I certify that no member of the entity s ownership or management is presently applying for an employee position or actively seeking an elected position with City of Palm Coast. 19

20 8. In the event that a conflict of interest is identified in the provision of services, I, on behalf of the above named entity, will immediately notify the City of Palm Coast in writing. DATED this day of, Affiant Typed Name of Affiant Title Sworn to and subscribed before me this, day of, Personally known OR Produced Identification Notary Public State of (Type of identification) My commission expires (Printed, typed or stamped commissioned name Notary Public) This Form Must Be Completed and Returned with your Submittal. 20

21 DISPUTES DISCLOSURE FORM Answer the following questions by placing an X after YES or NO. If you answer YES, please explain in the space provided or via attachment. Has your firm or any of its officers received a reprimand of any nature or been suspended by the Department of Professional Regulation or any other regulatory agency or professional association within the last five (5) years? YES NO Has your firm or any member of your firm been declared in default, terminated or removed from a contract or job related to the services your firm provides in the regular course of business within the last five (5) years? YES NO Has your firm had filed against it or filed any requests for equitable adjustment, contract claims or litigation in the past five (5) years that is related to the services your firm provides in the regular course of business or any project in which your firm was involved. YES NO If yes, state the nature of the request for equitable adjustment, contract claim or litigation, a brief description of the case, the outcome or status of suit and the monetary amounts or extended contract time involved. I hereby certify that all statements made are true and agree and understand that any misstatement or misrepresentation or falsification of facts shall be cause for forfeiture of rights for further consideration of this project: RFP-FS Custom Fire Pumper Apparatus Firm Date Authorized Signature Officer Title Printed of Typed Name This Form Must Be Completed and Returned with your Submittal. 21

22 DRUG-FREE WORKPLACE FORM The undersigned vendor in accordance with Florida Statute hereby certifies that Does: (Name of Business) 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 drugfree 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 proposed 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 five (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. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. Proposers Signature Date This Form Must Be Completed and Returned with your Submittal. 22