REQUEST FOR PROPOSALS 18-005 CONCESSION OPERATION/SERVICES PROPOSALS TO BE RECEIVED NO LATER THAN 2:00 P.M. ON February 22, 2018
CONCESSION OPERATION/SERVICES RFP 18-005 CONTENTS Proposer Acknowledgment form 2 General Conditions 2,3,4,5 A. Description 6 B. Requirements of Submittal 6 C. General Proposal Information 7 D. Accounting/Payment Information 8 E. Evaluation of Proposals 8 F. Proposal Format 9,10,11 G. Conditions of Proposals 11,12 Appendix 13 Statement of Affirmation and Intent 14 W-9 15 Drug-Free Workplace Form 16 Public Entity Crimes Form 17,18 1
SUBMIT RESPONSE TO: CITY OF NEW PORT RICHEY ATTN: CITY CLERK RE: RFP 18-005 5919 MAIN STREET NEW PORT RICHEY, FL 34652 PAGE 1 MAILING DATE: BIDS DUE BY: February 22, 2018 NOTE: PROPOSALS RECEIVED AFTER THE ABOVE DATE AND TIME WILL NOT BE ACCEPTED. Unless specified elsewhere, all prices shall be: a. FIRM-FIXED (not subject to any escalations) REQUEST FOR PROPOSALS PROPOSER ACKNOWLEDGMENT FORM TIME: 2:00 PM PROPOSAL NUMBER: RFP 18-005 PROPOSAL TITLE: CONCESSION OPERATION/SERVICES PROPOSER NAME: MAILING ADDRESS: CITY, STATE, ZIP: IF RETUNING AS A NO BID/PROPOSAL, STATE REASON: PHONE NO: TOLL FREE PHONE NO.: FAX NUMBER: EMAIL: WEBSITE: INCORPORATED IN THE STATE OF: I certify that this bid/proposal is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a bid/proposal for the same contractual service, and is in all respects fair and without collusion or fraud. I agree to abide by all conditions of this proposal for the bidder/proposer. FEDERAL EMPLOYER I.D. NO. OR SOCIAL SECURITY NO: CERTIFIED OR CASHIER S CHECK IS ATTACHED IN THE AMOUNT OF $ (if applicable) X AUTHORIZED SIGNATURE (MANUAL) DATE TYPED NAME TITLE THIS FORM MUST BE COMPLETED AND RETURNED WITH YOUR PROPOSAL/PROPOSAL GENERAL CONDITIONS 1. SEALED BIDS/PROPOSALS: All bids/proposals shall be submitted in a sealed envelope. The proposal/rfp number, title, and opening date shall be clearly displayed on the outside of the sealed envelope. The delivery of bids/proposals to the City of New Port Richey prior to the specified opening date and time is solely and strictly the responsibility of the bidder/proposer. All bids/proposals are subject to the conditions specified herein. Those bids/proposals which do not comply with these conditions are subject to rejection. 2
2. EXECUTION OF BID/PROPOSAL: Proposal must contain a manual signature of authorized representative in the space(s) provided. Bids/proposals must be typed or printed in ink. Use of erasable ink is not permitted. All corrections made by bidder/proposer to any proposal entry must be initialed. The company name and F.E.I.N. shall appear in the space(s) provided. 3. NO BID/PROPOSAL SUBMITTED: If not submitting a proposal, respond by returning only this Proposal Form with the reason for not responding in the space provided above. 4. PRICES, TERMS AND PAYMENT: The price proposed is considered to be a FIRM-FIXED PRICE, shall remain firm for ninety (90) days, and shall be F.O.B. delivered to City Hall, 5919 Main Street, New Port Richey, FL 34652. (a) Taxes: The City is exempt from Federal Excise and Sales taxes. Tax exemption number: Municipal Government # 85-8012621647C-4. (b) Mistakes: Bidders/proposers are expected to examine the RFP document, proposal form, and all other instructions provided herein. Recheck all proposal prices and extensions prior to submittal. Failure to do so will be at the bidder/proposer s risk. If the unit price and the extension price are at variance, the unit price shall prevail and the bidder/proposer s total offer will be corrected accordingly. (c) Invoicing and Payment: Invoices are to be mailed to 6630 Van Buren Street, New Port Richey, FL 34653, and will be reviewed by the appropriate department of the City to verify that the items have been received, are correct, and in good working order. Invoices will then be forwarded to the Finance Department for payment. Invoices must reference the purchase order number or bid/proposal number. 5. QUESTIONS REGARDING SPECIFICATIONS OR PROPOSAL PROCESS: To ensure fair consideration for all bidders/proposers, the City prohibits communication to or with any department, division, or employee during the submission process, except as provided in paragraph b below. Additionally, the City prohibits communication initiated by a bidder/proposer to an elected official, employee, or others evaluating or considering the bids/proposals prior to the time a decision has been made. Any communication between bidder/proposer and the City will be initiated by the appropriate City official or employee in order to obtain information or clarification needed to develop a proper accurate evaluation of the proposal. Such communication initiated by a bidder/proposer may be grounds for disqualification of the offending bidder/proposer from consideration of award for the bid/proposal under evaluation and/or any future bid/proposal depending on severity of the infraction. (a) Any questions relative to interpretation of specifications or the bid/proposal process shall be addressed in writing to the Department Head, with a copy to the Recreation Manager in ample time before the period set for the receipt and opening of bids/proposals. Inquiries received within ten (10) days prior to the date set for the receipt of bids/proposals will not be given consideration. Any interpretation made to prospective bidders/proposers will be expressed in the form of an addendum to the specifications which, if issued, will be conveyed to all prospective bidders/proposers no later than five (5) days before the date set for receipt of bids/proposals. Oral interpretations will not be provided. 3
(b) It will be the responsibility of the bidder/proposer to contact the Department Head prior to submitting a bid/proposal to ascertain if any addenda have been issued, to obtain all such addenda, and return executed addenda or acknowledgment thereof with the proposal. (c) Direct inquiries shall be submitted to the Assistant Parks and Recreation Director, Recreation & Aquatic Center, 6630 Van Buren Street, New Port Richey, FL 34653 or by e-mail to bornflethc@cityofnewportrichey.org. 6. CONFLICT OF INTEREST: The award hereunder is subject to the provisions of Chapter 112, Florida Statutes. Bidders/proposers must disclose the name of any officer, director, or agent who is also an employee of the City. Further, all bidders/proposers must disclose with their submission the name of any City employee who owns, directly or indirectly, an interest of five percent (5%) or more in the bidder/proposer s firm or any of its branches. In accordance with Chapter 287, Florida Statutes, no person or firm receiving a contract that has not been procured pursuant to Section 287.057(2) or (3) to perform a feasibility study of the potential implementation of a subsequent contract participating in the drafting of an invitation of bids, request for proposals, or developing a program for future implementation shall be eligible to contract with the City for any other contracts dealing with that specific subject matter, and bidder/proposer must disclose with their proposal any such conflict of interest. 7. INTENT: Once the review and evaluation process is complete and staff has developed a recommendation for award, the bidders will be notified a minimum of 5 (five) calendar days prior to the item being considered by the City Council. The only exception is in the event that the bid/proposal was identified as an emergency and wherein the intent period is not practical. 8. AWARD: The purchase order/contract will be awarded to the lowest, most responsive, most responsible bidder/proposer complying with all the provisions of the Request for Proposals/Invitation to Bid, provided the proposal price is reasonable, financially feasible, and is in the best interest of the City. Final approval and award shall be made by the City Council at a scheduled public meeting. The bidder/proposer understands that this Request for Proposals/Invitation to Bid does not constitute an agreement or a contract with bidder/proposer. A contract/agreement is not considered binding until it is officially approved by the City Council and fully executed by both parties. The City reserves the right to accept or reject any or all bids/proposals and to waive any informalities. The City also reserves the right to re-advertise and solicit new bids/proposals or to abandon the project in its entirety. 9. DISPUTES: Bid/proposal award challenges shall be posted in writing (no e-mail) with the Department Head who is the administrative head of purchasing. The Department Head will gather evidence, and discern facts, and present their recommendations to the governing body that will make the final decision on the matter. All decisions of the governing body are final. A written notice of protest must be filed with the Parks & Recreation director, whose address is 6630 Van Buren Street, New Port Richey, FL 34653, within seventy-two (72) hours after the intent to award is posted. The nature of protest must be followed within ten (10) calendar days of filing by a formal written notice fully detailing all elements which promulgated the protest. 4
10. CERTIFICATION OF INDEPENDENT PRICE DETERMINATION: The bidder/proposer certifies that the prices submitted in response to this Request for Proposals have been arrived at independently and without - for the purpose of restricting competition - any consultation, communication, or agreement with any other bidder/proposer or competitor relating to those prices, the intention to submit a proposal, or the methods or factors to calculate the prices provided. 11. DEFAULT: Should the awarded bidder/proposer fail to deliver services in accordance with the contract terms and conditions, the City may procure the services from other sources and hold the bidder/proposer responsible for any resulting additional purchase and administrative costs. The remedy shall be in addition to any other remedies that the City may pursue. 12. APPLICABLE LAWS: The bidder/proposer shall comply with all applicable federal, state, and local laws and regulations bearing on the conduct of work. The contract shall be governed in all respects by the laws of the State of Florida, and any litigation with respect thereto shall be brought in the courts of Pasco County. 13. LEGAL REQUIREMENTS: Applicable provisions of all federal, state, county and local laws and of all ordinances and evaluation of all bids/proposals received in response hereto shall govern any and all claims and disputes which may arise between person(s) submitting a proposal response hereto and the City by and through its officers, employees and authorized representatives, or any other person, natural or otherwise, and lack of knowledge by any bidder/proposer shall not constitute a cognizable defense against the legal effect thereof. 14. ADVERTISING: In submitting a proposal, bidder/proposer agrees not to use the results wherefrom as a part of any commercial advertising. 15. ASSIGNMENT: The awarded bidder/proposer shall not assign, transfer, convey, sublet, or otherwise dispose of any award or any or all of its rights, title, or interest herein, without prior written consent of the City. 16. INDEMNIFICATION: The bidder/proposer covenants to save, defend, keep harmless, and indemnify the City of New Port Richey, its officers, agents and employees from and against all claims, loss, damage, injury, fines, penalties, and costs resulting from, arising out of, or in any way connected with the bidder/ proposer s negligent performance or nonperformance of the terms of the resulting contract. NOTE: ANY ADDITIONAL CONDITIONS OR SPECIFICATIONS ATTACHED HERE TO WHICH VARY FROM THESE GENERAL CONDITIONS SHALL HAVE PRECEDENCE 5
CITY OF NEW PORT RICHEY REQUEST FOR PROPOSAL RFP 18-005 CONCESSION OPERATION/SERVICES A. DESCRIPTON The City of New Port Richey is soliciting the services of a vendor to provide refreshments at the City owned concession stand located inside the New Port Richey Recreation and Aquatic Center. The Recreation and Aquatic Center has a 408 square foot concession stand with air conditioning, stainless steel sinks, commercial grill, fryer, 2 vending windows with pool deck view/access, large 120 Sq. Ft. storage and sink area, Stainless professional grade refrigerators and freezers. The Park is centrally located in New Port Richey. B. REQUIREMENTS OF SUBMITTAL Separate sealed proposals for concessionaires will be accepted by the City until 2:00 P.M. local time on February 22, 2018, at New Port Richey City Hall, 5919 Main Street, New Port Richey, FL 34652. Late proposals will not be opened or considered. IF MAILING PROPOSAL, MAIL TO: ATT: City Clerk City of New Port Richey, City Hall 5919 Main Street New Port Richey, FL 34652 IF DELIVERING PROPOSAL IN PERSON, DELIVER TO: NEW PORT RICHEY, CITY HALL ATT: CITY CLERK 5919 MAIN STREET NEW PORT RICHEY, FL 34652 Each proposal shall be submitted in a sealed envelope containing one (1) original and three (3) copies. The company name of the proposer shall be clearly shown on the outside of the sealed envelope with the designation RFP 18-005 CONCESSION OPERATION/SERVICES. 6
C. GENERAL PROPOSAL INFORMATION The concession facilities shall be available for inspection by prospective vendors by appointment only, during the hours of 9:00 A.M. until 3:00 P.M., Monday through Friday. Contact Elaine Smith, Parks and Recreation Director at (727) 841-4560, or Chris Bornfleth, Assistant Parks and Recreation Director at (727) 841-4560 for an appointment. The City of New Port Richey participates in the Healthy Weight Community Champion Program which requires healthy food and beverage options in their concession stands in order to qualify for this program. Prospective vendors must submit a list of healthy food and refreshment items for sale which may include, but not limited to juices, bottled water, sports drinks, snacks and various other items including corresponding prices. The price of concession items and rentals will remain unchanged during the contract period unless approved in writing by the Department Head. The menu of each venue may vary depending on the season and other factors. Preferred Operation of the Recreation and Aquatic Center concession will be open a minimum of seven days per week with minimum hours of operation from 11 A.M. to 4 P.M. (times may expand). The schedule can be adjusted with written approval from the Department Head if the public need is apparent. All required permits, insurance and licenses, including but not limited to workers compensation, general liability, and local business tax receipt (formerly occupational license) will be at the expense of the concessionaire. The vendor must meet all local, state and/or federal government health standards and codes. It will be the responsibility of the concessionaire to bring the concession facility within compliance of all required codes and standards for the service provided. All costs involved, including minor repairs, construction and otherwise, will be the concessionaire s responsibility. The Proposer shall obtain and keep up to date all necessary City, County and State licenses and pay all required taxes, if any, and abides by all applicable City, County, State and Federal Laws. The City shall be responsible for providing all paper and soap products for the rest rooms and all necessary building and fixture maintenance. The concessionaire will be responsible for the daily collection of litter, discarded cups and wrappers, etc. at the Recreation and Aquatic Center. The City will provide an adequate number of trash containers in the designated park area and will remove the trash as the need determines. Any and all signage must be permitted and comply with the City of New Port Richey Code of Ordinances. This City pays for all utilities with the exception of grease disposal. The concessionaire will be responsible for obtaining, maintaining and paying for proper grease disposal. 7
D. ACCOUNTING/PAYMENT INFORMATION Concessionaire shall be required to maintain a method of accounting for the concession which shall correctly and accurately reflect the gross receipts and disbursements received or made by concessionaire from the operation of the concession. The method of accounting, including bank accounts, established for the concession shall be separate from the accounting systems used for any other business operated by concessionaire or for recording concessionaire s personal financial affairs. The concessionaire shall maintain adequate records to justify all charges, expenses and costs incurred in performing the services hereunder for at least three (3) years from the date of final payment. The City shall have access to such books, records, and documents for the purpose of inspection or audit during normal business hours at a place convenient and agreeable to the concessionaire and the City. The concessionaire will need to specify in their proposal a recommended percentage to be paid to the City (minimum shall be 10% of net profits or $650 per month, whichever is greater). Such payment will be made no later than the 15 th of the subsequent month which represents the reporting period. Late payments shall bear interest at a rate of five percent (5%) per month. All payments must be accompanied by a monthly expense and revenue report as well as the State Sales Tax report broken down by location. All payments must be made payable to City of New Port Richey. Payment is to be mailed to: City of New Port Richey Attn: Parks and Recreation Department 6630 Van Buren Street New Port Richey, FL 34653 The City of New Port Richey shall enter into an agreement with the selected vendor for a period of no more than three (3) years with possible renewal for two (2) additional one (1) year periods. E. EVALUATION OF PROPOSALS Proposals will be evaluated using a method to ascertain which proposer best meets the needs of the City. Evaluation criteria will include, but not necessarily be limited to: Responsiveness of the proposal in clearly stating an understanding of the work to be performed. Experience and creativity of the vendor, including track record for generating bottom-line results. Current licenses, certificates of insurance, etc. Proposed products, services and pricing. Proposed profit sharing, percentages and/or fee guarantees to the City. 8
F. PROPOSAL FORMAT In order to ensure a uniform review process and to obtain the maximum degree of comparability, it is required that the proposals be organized in the manner specified. Tab 1) Required Submittals Title Page & Proposer Acknowledgement Form: Name of Proposer s Vendor/corporation, address, telephone number, fax number, e-mail address, name of person which will handle City s account, date, and the subject RFP# CONCESSION OPERATION/SERVICES. Letter of Transmittal: Limit to one or two pages. Briefly state the Proposer s positive commitment and understanding of the work to be performed. Please include any similar operation(s) which you own/oversee and their location(s). Type of Business and Financial Responsibility: Identify the type of business entity involved (e.g. sole proprietorship, partnership, corporation, joint venture, etc.). Indicate whether the business entity is incorporated in Florida, another state, or a foreign country. Indicate years in business, any changes in ownership and list the number of employees. If the Proposer is a corporation, provide a copy of the certification from the Florida Secretary of State verifying Proposer s corporate status and good standing, and in the case of out-of-state corporation, evidence of authority to do business in Florida. The Proposer may be requested to furnish latest financial statement for review. FEIN: Provide the Federal Employer Identification Number of the Proposer. In the case of a sole proprietorship or partnership, provide the Social Security numbers for all owners/partners. Submit a completed W-9 (attached). Acknowledgement of Addenda: If applicable, include signed and dated copies of addenda issued by the City. Drug-Free Workplace: If applicable, provide a statement concerning the Proposer s status as a Drug-Free Work Place. See enclosed Drug Free Workplace Form. NOTE: Whenever the City for the procurement of commodities or contractual services receives two or more proposals which are equal with respect to price, quality and service, a proposal received from a business that certifies that it has implemented a drug-free workplace program shall be given preference in the award process. Conflict Of Interest Statement: See Statement of Affirmation and intent included in this package. Public Entity Crime Information Form: See Statement of Public Entity Crimes form included in this appendix. 9
Insurance: Except as otherwise specified in this contract, the Contractor will be required (at their own expense) to maintain in effect at all times during the performance of the work, insurance coverage with limits not less than those set forth below with insurers and other forms of policies satisfactory to the City. It shall be the responsibility of the Contractor to maintain required insurance coverage at all times. Failure of the Contractor to maintain adequate coverage shall not relieve him/her of any contractual responsibility or obligation. All insurance coverage furnished under this contract, except for Workers Compensation and Employer s Liability, shall include the City of New Port Richey as additional insured. Proposers must submit with their proposal proof of insurance meeting or exceeding the following requirements. (a) Worker s Compensation Coverage is to apply for all employees for statutory limits in compliance with the applicable state and federal laws. The policy must include Employer s Liability with a limit of $500,000 each accident, $500,000 with employee, $500,000 policy limit for disease. (b) Commercial General Liability (Occurrence Form required) Contractor shall maintain Commercial General Liability (CGL) insurance with a limit of not less than $300,000 each occurrence. If such CGL insurance contains a general aggregate limit, it shall apply separately to this location/project in the amount of $600,000. CGL insurance shall be written on an occurrence form and shall include bodily injury and property damage liability for premises, operations, independent contractors, products and completed operation, contractual liability, broad form property damage and property damage resulting from explosion, collapse or underground exposures, personal injury and advertising injury. Damage to rented premises shall be included at $100,000. (c) Commercial Automobile Liability Insurance Contractor shall maintain automobile liability insurance with a limit of not less than $300,000 each accident for bodily injury and property damage liability. Such insurance shall cover liability arising out of any auto (including owned, hired and now-owned autos). The policy shall be endorsed to provide contractual liability coverage. (d) Evidence of Insurance The Contractor shall furnish the City with all applicable Certificates of Insurance. The Certificates are to be signed by a person authorized by that insurer to bind coverage on its behalf. The City of New Port Richey is to be specifically included as an additional insured on all policies except Workers Compensation. In the event of the insurance coverage expiring prior to the completion of the project, a renewal certificate shall be issued thirty (30) days prior to said expiration date. The policy shall provide a thirtyday (30-day) notification clause in the event of cancellation or modification to the policy. All certificates of insurance must be on file with and approved by the City before the commencement of any work activities. 10
Tab 2) Qualifications Information related to the Proposer s qualifications and resources including the following: (a) Description of the history of the company including how long it has been in business in Florida. (b) Description of the company s size (number of locations and number of staff). (c) Narrative of experience of the company in providing food and beverage service for day-to-day operations and special events. (d) List of additional services or creative thoughts offered by the company that may be of interest to the City. Tab 3) List of Items/Services Provide a complete list of items and services to be provided at each venue along with corresponding prices. Tab 4) Proposed Fees/Profit Sharing List proposed profit sharing, percentages and/or fee guarantees to the City. (See section D. Accounting & Payment Information for more detail) G. CONDITIONS OF PROPOSALS To ensure fair consideration for all proposers, the City prohibits communication of the subject of the Request for Proposals with any employee or official of the City except as specified herein. Such contact may be cause for disqualification. Any information relative to interpretation of specifications or the proposal process shall be directed in writing to: City of New Port Richey Attn: Chris Bornfleth 6630 Van Buren St. New Port Richey, FL 34653 Or by email to bornflethc@cityofnewportrichey.org To be answered, inquiries must be received no later than five (5) business days before the date set for the opening of the proposals. Answers will be provided in written form to all prospective proposers. Oral answers will not be binding. The City of New Port Richey will not be liable for any costs incurred in the preparation of any proposal. By submitting a proposal, the proposer accepts responsibility for full knowledge of the scope, nature, quantity, and quality of the work to be performed, the requirements of the specifications, and the conditions under which the work is to be performed. The proposer shall furnish the City such additional information as the City may reasonably require. 11
The City of New Port Richey reserves the right to conduct background checks and personal interviews with any or all proposers prior to selection, and will not be liable for any costs incurred by proposers in connection with such an interview (travel, accommodations, etc.). By submitting a proposal, the proposer agrees to not sublet, assign or encumber any interest under this proposal or contract. By submitting a proposal, the proposer agrees to offer products from quality suppliers with current food liability insurance coverage. The City of New Port Richey reserves the right to conduct pre-contract discussions/ negotiations with any and all proposers. Proposals that do not include all information required by this RFP may be rejected by the City without consideration of any other factors. All proposals shall be binding for ninety (90) calendar days following the opening date. After the sixty (60) day period, proposers may select to continue the binding for a period of one (1) year for the purpose of secondary selection should the selected contractor default. Notwithstanding any criteria or evaluation methods stated in this RFP, the City will award the contract in accordance with its purchasing procedures. 12
APPENDIX REQUEST FOR PROPOSALS 18-005 CONCESSION OPERATION/SERVICES PROPOSALS TO BE RECEIVED NO LATER THAN 2:00 P.M. ON February 22, 2018 13
CITY OF NEW PORT RICHEY REQUEST FOR PROPOSALS RFP NUMBER 18-005 CONCESSION OPERATION/SERVICES RECREATION and AQUATIC CENTER STATEMENT OF AFFIRMATION AND INTENT Business Name: Address: The undersigned, hereinafter called the Proposer, declares that the only persons or parties interested in their proposal are those named herein, that this proposal is, in all respects, fair and without fraud, and that it is made without collusion with any other vendor or official of the City of New Port Richey. Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, 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 the Agreement for this project. The Respondent certifies that no City Council member, other City officer or City employee directly or indirectly owns assets or capital stock of the bidding entity, nor will directly or indirectly benefit by the profits or emoluments of the proposal. (For purposes of this paragraph, indirect ownership or benefit does not include ownership or benefit by a spouse or minor child.) The Proposer certifies that no member of the entity s ownership or management is presently applying for an employee position or actively seeking an elected position with the City. In the event that a conflict of interest is identified in the provision of services, the Proposer agrees to immediately notify the City in writing. The Proposer further declares that he has carefully examined the scope of services, instructions, terms and conditions of the RFP and that their proposal is made according to the provisions of the Request for Proposals and that he/she will meet or exceed the scope of services, requirements, and standards contained in the Request for Proposals. Proposer agrees to abide by all conditions of the negotiation process. In conducting negotiations with the City, Proposer offers and agrees that if this negotiation is accepted, the Proposer will convey, sell, assign, or transfer to the City all rights, title, and interest in and to all causes of action it may now or hereafter acquire under the Anti-trust laws of the United States and State of Florida for price fixing relating to the particular commodities or services purchased or acquired by the City. At the City s discretion, such assignment shall be made and become effective at the time the City tenders final payment to the Proposer. The proposal constitutes a firm and binding offer by the Proposer to perform the services as stated. Signature of Authorized Representative Telephone Number Date Printed Name and Title 14
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DRUG-FREE WORKPLACE Florida Statutes on Drug-Free Workplace Programs: In case of tie bids, preference must be given to vendors submitting a certification with their bid/proposal certifying they have a drug-free workplace in accordance with Section 287.087, Florida Statutes. The drug free certification form below must be signed and returned with your bid. DRUG-FREE WORKPLACE CERTIFICATION In order to have a drug-free workplace program, a business shall: 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. 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. Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in the first paragraph. In the statement specified in the first paragraph, 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. 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. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section. VENDOR NAME: BID NO: As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. VENDOR S SIGNATURE: STATE OF: COUNTY OF: PERSONALLY APPEARED BEFORE ME, the undersigned authority, who, after first being sworn by me, affixed his/her signature in the space provided above on this day of, 20 Notary Public: (Affix Seal) My Commission Expires: 16
SWORN STATEMENT UNDER SECTION 287.133(3)(a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS. 1. This sworn statement is submitted with Bid, Proposal or Contract No. for 2. This sworn statement is submitted by whose business address is (name or entity, submitting sworn statement) and (if applicable) it s Federal Employer Identification Number (FEIN) is (If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement): 3. My name is and my relationship to the entity named above is 4. I understand that a "public entity crime" as defined in Paragraph 287.133(l)(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 public entity or with an agency or political subdivision of any other state or with the United Suites, 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. 5. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(l)(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, nonjuring trial, or entry of a plea of guilty or nolo contendere. 6. I understand that an "affiliate" as defined in Paragraph 287.133(l)(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 agreement, 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. 17
7. I understand that a "person" as defined in Paragraph 287.133(l)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids 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. 8. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (Please 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 management of the entity, nor any affiliate of the entity have been charged with and convicted of a public entity crime subsequent to July 1, 1989. The entity submitting this sworn statement, or one or more of the officers, directors, executives, partners, shareholders, employees, members or agents who are active in 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, 1989 AND ( Please indicate which additional statement applies. ) There has been a proceeding concerning the conviction before a hearing officer of the State of Florida, Division of Administrative Hearings. The final order entered by the hearing officer did not place the person or affiliate on the convicted vendor list. (Please attach a copy of the final order.) The person or affiliate was placed on the convicted vendor list. There has been a subsequent proceeding before a hearing officer of the State of Florida, Division of Administrative Hearings. The final order entered by the hearing officer determined that it was in the public interest to remove the person or affiliate from the convicted vendor list. (Please attach a copy of the final order.) The person or affiliate has not been placed in the convicted vendor list. (Please describe any action taken by or pending with the Department of General Services.) By: (signature) Date: STATE OF COUNTY OF PERSONALLY APPEARED BEFORE ME, the undersigned authority, (name of individual signing) who, after first being sworn by me, affixed his/her signature in the space provided above on this day of, 20. NOTARY PUBLIC My commission expires: 18