CITY OF TITUSVILLE, FLORIDA

RFQ #: 15-Q-055 Due Date: August 7, 2015 @ 3:00 pm Mail Date: July 21, 2015 Buyer: Jesus M. Vieiro 321-567-3733 Respond: 555 South Washington Avenue (PO Box 2806) Titusville, Florida 32796 (32781-2806) RFQ: Project Briefing: July 28, 2015 at 2:00 PM RFQ Title/Name: Professional Fire Protection Engineering Services for LNG Plant Project CITY OF TITUSVILLE, FLORIDA REQUEST FOR QUALIFICATIONS (RFQ) Professional Fire Protection Engineering Services for LNG Plant Project July 2014

REQUEST FOR QUALIFICATIONS RFQ FLORIDA LICENSED ENGINEER (S) PURSUANT TO THE CONSULTANTS COMPETITIVE NEGOTIATIONS ACT (CCNA), FLORIDA STATUTE 287.055, THE CITY OF TITUSVILLE HEREBY INVITES INTERESTED FLORIDA LICENSED PROFESSIONAL ENGINEERS TO PRESENT THEIR QUALIFICATIONS PERTAINING TO PROVIDING FIRE PROTECTION ENGINEERING CONSULTING SERVICES REQUIRED FOR LNG PLANT PROJECT TO BE CONSTRUCTED IN TITUSVILLE. QUALIFICATIONS WILL BE ACCEPTED AT CITY HALL BY PURCHASING AND CONTRACTING ADMINISTRATION, 555 S. WASHINGTON AVENUE, TITUSVILLE, FLORIDA 32796, UNTIL 3:00 P.M. ON AUGUST 7, 2015. SEALED ENVELOPES ARE TO BE MARKED AS FOLLOWS: RFQ: FIRE PROTECTION ENGINEERING SERVICES FOR LNG PROJECT OPEN: AUGUST 7, 2015 @ _3:00 P.M. Qualified Firms interested in responding to this Request for Qualifications may pick up or request a general information package, which contains details relevant to this RFQ, from the Purchasing and Contracting Administration office 321-567-3733 located at the above indicated address in City Hall. Your attention is directed to F.S. Section 287.133 (2) (A) Public Entity Crime, which prohibits certain persons or affiliates who have been convicted of a public entity crime from responding to this invitation. A form is included in the information package for your execution and submission. A Drug Free Workplace Form is included in the information package for your execution and submission. Failure to execute and submit the above forms will subject your response to disqualification. Firms interested in submitting a response to this RFQ agree not to contact (lobby) City Council Members or any employee or agent of the City at any time during the solicitation period and selection process. All oral or written inquires must be directed to the Purchasing and Contracting Administrator. Any other contact with the owner will be considered inappropriate and subject your response to rejection/disqualification. A non-mandatory project briefing will be held on July 28, 2015 at 2:00 PM in the City Council Chamber, City Hall located at 555 S. Washington Avenue, Titusville FL 32796. Questions concerning this RFQ should be directed in writing to Jesus M. Vieiro, Purchasing and Contracting Administrator at jesus.vieiro@titusville.com 321-567-3733. The City reserves the right to reject any and all responses, waive any informality or irregularity on any response if considered non-substantial by the City, or cancel this invitation at will. Responses received after the date and time stipulated herein will be considered late and therefore will be disqualified. Attachment: Conditional Use Permit RFQ Fire Protection Engineering Consulting Services Page 2 of 16

Statement of Qualifications Requirements Fire Protection Engineering Consulting Services for LNG Project Introduction Tico Development Partners, LLC on behalf of the owner FDG TICO LLC, requested from the City of Titusville a conditional use permit (CUP) for the construction of a Liquified Natural Gas Facility on property located adjacent to the Space Coast Regional Airport, just south of Golden Knights Boulevard and Ponce Deleon Drive and west of U.S. Highway 1 and the Florida East Coast (FEC) railroad. The Liquified Natural Gas Facility project will consist of a 24 acre liquid natural gas plant with a 500,000-gallon storage tank, five structures with a height in excess of 75 feet (one structure with a flare), a rail spur, one vehicular access point, and an 8-foot high perimeter security fence. The plant will be a 24-hour operation with approximately 25 tanker trucks entering and exiting the site daily. Natural gas will be piped into the facility for processing into a liquid state. The liquid natural gas will be removed by truck or rail using 10,000-gallon tanks. Several federal and state regulatory agencies will be involved in the approval of the engineering and construction of the facility. The facility will be located in a remote area and its proposed operation appears compatible with the surrounding industrial and commercial uses. The City approved the conditional use permit and the FDG TICO LLC Development/Engineering Team is preparing detailed site plans that will be submitted to the City of Titusville for Site Plan Review and Approval. It is also anticipated that the FDG TICO LLC Development/Engineering Team will prepare construction plans, obtain all the required and necessary permits from all regulatory agencies having jurisdiction and oversight for the construction of the project and subsequently construct the proposed LNG facility. Intent The City of Titusville s intention is to enter into an agreement with a qualified engineering consulting firm capable of providing Fire Protection Engineering Services for LNG projects with the capacity to assist and provide such Fire Protection Engineering Services to the City of Titusville for the project described above. Scope of Services The Fire Protection Engineer will review the plans submitted to the City for the LNG Project and provide the City feedback and recommendations pursuant to compliance with the CUP and all local, state and federal regulations pertaining to life safety including, but not limited to design, fire suppression systems, alarm and monitoring systems as detailed below: Review all site designs pertaining to the LNG plant to ensure all safety measures for compliance such as exclusion zones, perimeter vapor fencing and other control measures are adequate for this particular project, and provide any comments and recommendations. Review all fire protection systems presented for compliance and provide any comments and recommendations. Review of all plans to include site plans, fire protection system plans. Conduct final site visit prior to issuance of CO by the contracted FPE to ensure all measures are in compliance. RFQ Fire Protection Engineering Consulting Services Page 3 of 16

Selection Process Requirements for Preparing and Submitting Statement of Qualifications For City of Titusville Fire Protection Engineering Consulting Services for LNG Project The design firm will be selected in accordance with City of Titusville policy and the State of Florida Consultants Competitive Negotiations Act using a qualification based selection process. Pricing will not be discussed until after the engineering firms are selected and ranked. A project briefing is scheduled for July 28, 2015. The project briefing by City staff will start at 2:00 PM in the Council Chambers located on the second floor of Titusville City Hall, 555 South Washington Avenue, Titusville, FL 32796. Attendance at the briefing is not mandatory. A selection committee comprised of City staff will evaluate all Statements of Qualifications (SOQs) based on the criteria set forth herein. Based on the selection committee s review of the SOQs, a short-list will be developed. The City, at its sole discretion, may contact the references and/or visit one or more of the project sites listed in the SOQ as part of the evaluation process. The short-listed firms will be interviewed for final ranking. The interview may last up to one-hour. Additional details on the interview format will be forwarded to the short-listed design firms. The selection committee will use both the SOQ submittals and the information from the interview to develop the final ranking. Following the interview, the short-listed firms will be ranked. Subsequent to City Council s approval of the ranking, the City will begin negotiations with the top ranked firm. In the event that the City and the top ranked firm are unable to negotiate a satisfactory agreement, negotiations with such firm will be formally terminated and negotiations will be undertaken with the second ranked firm. Failing accord with the second ranked firm, the City will terminate negotiations and undertake negotiations with the third ranked firm, and so on will continue in the order that the firms are ranked, until an acceptable agreement has been reached between the City and a competent and qualified firm. Selection Schedule The following schedule will be adhered to during the selection process. It is subject to change at the sole discretion of the City. Selection Process Schedule- Fire Protection Engineering Consulting Services for LNG Project Event Completed By Advertising Date 7/21/2015 Project Briefing 7/28/2015 Deadline for Technical Questions 8/3/15 Receive all Statements of Qualifications (SOQs) 8/7/2015 Evaluate SOQs 8/10/2015-8/14/2015 Design Firm Interviews & Rank the Short List 8/21/2015 Statement of Qualifications Format RFQ Fire Protection Engineering Consulting Services Page 4 of 16

General Engineering consulting firms interested in providing the requested the Fire/Life Safety Engineering Services as stated herein for previously cited LNG project are invited to submit a Statement of Qualifications to the City of Titusville. To facilitate the review of the Statements of Qualifications, each respondent is requested to adhere to the following format requirements: Cover Letter Executive Summary Section 1: General Information about Company Section 2: Related Experience Section 3: Project Team Section 4: Project Approach Appendix A: Brochures Appendix B: Resumes Appendix C: Other Information To allow the selection committee sufficient time to review properly all documents in their entirety, each submittal (exclusive of appendices) shall be limited to a maximum of 50 pages (12-point font). Statement of Qualifications Contents Cover Letter The cover letter should briefly introduce the engineering consulting firm and indicate its interest for this enagement. Executive Summary The Executive Summary should highlight the major points of the Statement of Qualifications and list no more than the top six reasons why the firm is uniquely qualified to undertake the services contemplated by the City of Titusville. Section 1: General Information about Company a. Team: Provide the official name of the company and type of organization responsible for executing any agreement that may emanate from this solicitation. For all prime sub-consultants if any, provide the following: Official name and address Number of years in business Office location(s) and office location where this project will be supported Florida Engineer s license (provide current copy) of all companies performing engineering services b. Company and Staff: RFQ Fire Protection Engineering Consulting Services Page 5 of 16

Total number of salaried employees. Indicate turnover (on a percentage basis) of permanent, salaried staff for the last three years for the engineering consulting firm and each prime sub-consultant. Total Number of: c. Financial References: d. Litigation: o Degreed professionals by discipline o Registered professional engineers o Construction Schedulers o Project Managers o Construction Field Superintendents o Construction Inspectors o Design and Construction Managers Bank, Bonding Company, Insurance Company Provide name, contact and phone number of each. Provide current Annual Report, audited financial statement and/or Dunn & Bradstreet information. Provide professional liability insurance carrier name, contact and phone number and team insurance arrangement. Please explain how the design firm plans to provide professional liability insurance. Provide current insurance limits. Current Workers Compensation Rate Provide information related to legal actions involved by the engineering consulting firm and sub-consultants for the last three years, including pending litigation pursuant to LNG projects. Provide information related to any contract default claims for the last five years made by an owner against the engineering consulting firm and any sub-consultant. Section 2: Related Experience a. Disclose firm s prior relationship with the following: Tico Development Partners, LLC, FDG TICO LLC, Golder Associates, the Engineer of Record, and Neptune Fire Protection Engineering b. Prepare a list of all LNG projects design and construction oversight experience. c. Prepare a list of all LNG projects designed by the firm in Florida for the last five years. d. Prepare a tabulation of information for not more than two comparable LNG projects, where the firm has designed/coordinated/managed a project in which the design firm has been responsible for the design and oversight of the project. Information on each project shall be tabulated in the following format: RFQ Fire Protection Engineering Consulting Services Page 6 of 16

Section 3: Project Team Project name, location of project, and owner (provide name of individuals, addresses and contact phone numbers). Description of Project o Type and size o Original contracted number of calendar days to design and actual performance. o Cost original bid price, plus final costs, including rationale for decrease or increases in the original costs. o Name of Design Project Manager, Construction Project Manager o Dispute resolution procedure amongst team members o Claims resolved by arbitration or litigation Provide the following information about your proposed project team: Organizational chart(s) for this project, show names, roles, and company affiliation Identify key personnel assigned and committed to the project; at a minimum specifically list the names of the Fire Protection Project Manager and Fire Protection Project Engineer including a description of their suggested role and responsibilities for this particular assignment. Indicate current and projected project workload for each proposed individual and their committed availability for the City of Titusville project. Resumes for each individual should be provided in Appendix B. Using the project experiences presented in Section 2, list all projects where the firm s members have worked together and the method of project delivery (design/bid/build, design/build, construction management, construction management at risk, etc,). Cross reference project names with firm and individual names. For the key individuals performing the functions of the titles listed in the second bullet, disclosed their prior relationship with the following: a. Tico Development Partners, LLC, b. FDG TICO LLC, and c. Golder Associates, the Engineer of Record, and d. Neptune Fire Protection Engineering Section 4: Project Approach Discuss the approach that the firm intends to take to perform the required services for this project. Include in your discussion the issues above and the following issues: Review all site designs pertaining to the LNG plant to ensure all safety measures for compliance such as exclusion zones, perimeter vapor fencing and other control measures are adequate for this particular project, and provide any comments and recommendations. Review all fire protection systems presented for compliance and provide any comments and recommendations. Review of all plans to include site plans, fire protection system plans. (Can be accomplished remotely if the FPE is not local.) RFQ Fire Protection Engineering Consulting Services Page 7 of 16

Conduct final site visit prior to issuance of CO by the contracted FPE to ensure all measures are in compliance. Provide approximate project schedule. Give specific project examples to support your approach for the items above. Section 5: Distance in miles from the City of Titusville of the firm s team office. Section 6: Copies of certification as Minority Business Enterprise. Section 7: Volume of work in $ awarded by the City of Titusville over the last five (5) years. Section 8: Submit an executed Drug Free Work Place Form, and an executed Public Entity Crime Form. Both forms are supplied in this RFQ package. Appendix A: Brochures The respondents may provide no more than two company brochures in this section. Appendix B: Resumes Provide resumes (no more than two pages each) for each member of the proposed project team. Include the following information in each resume: Name and title Education and Professional Registration, if appropriate Years of experience, including number of years of current employment List of major current and completed projects by individual and his/her responsibility. Cross-reference to all projects included in Section 2. Appendix C: Other Information Respondents may include any other additional information (no more than 6 pages) directly related to this solicitation in this section. Selection Criteria The criteria that will be used to short-list and rank the design firms are presented in the following table. Selection Criteria / Fire Protection Engineering Consulting Services for LNG Project RFQ Fire Protection Engineering Consulting Services Page 8 of 16

Criteria Possible Score Details of terminated contracts (for cause or other) 0-5 Details of filed lawsuits closed and pending 0-5 Related Project Experience 0-15 Local knowledge and experience 0-5 Qualified personnel experience 0-20 Capability to handle more work (current and projected workloads due to 0-10 pending awards). Project Approach 0-25 Project Schedule 0-5 Proximity of the firm to the City of Titusville in miles 0-5 Firm is a minority enterprise as certified by the State of Florida 0-5 Delivery of Submittal/ Withdrawal Each firm responding to this request shall deliver seven (7) copies of the Statement of Qualifications on or before 3:00 pm, Eastern Standard Time, August 7, 2015, to Jesus M. Vieiro, Purchasing and Contracting Administrator, 555 South Washington Avenue, Titusville, FL 32780. Any SOQ received later the date and time indicated above will not be considered. All envelopes shall be marked as indicated in the invitation, and further, all submittals shall be submitted in strict accordance with the conditions stated in the invitation as published. Withdrawal may be accomplished only when the City receives a writing request at the address indicated above prior to the opening date. In order to be considered for future work, the reason for withdrawal must be stated. Additional Information It is extremely important that all potential respondents are given clear and consistent information. Therefore, all respondents are required to submit their questions in writing so that answers can be distributed to all potential respondents. Questions related to this project or selection process should be directed to the Jesus M. Vieiro, Purchasing and Contracting Administrator at: 555 South Washington Avenue Titusville, FL 32780 Fax: (321) 567-3733 Email: jesus.vieiro@titusville.com Terms and Conditions 1. The City of Titusville reserves the right to accept or reject any or all the Statement of Qualifications, with or without cause, or to accept the Statement of Qualifications of the firm deemed, in its sole judgment, as the most qualified. All decisions related to this solicitation by the Selection Committee and City Council will be final. 2. The City reserves the right to request clarification of information submitted and to request additional information of one or more respondents. 3. By responding to this solicitation, the team attests that no Council member or employee or any such person s spouse, child parent, brother, sister, dependent or person assuming a RFQ Fire Protection Engineering Consulting Services Page 9 of 16

relationship being the substantially equivalent of the above, has an existing or pending, direct or indirect, financial interest in the respondent s team. 4. Costs of preparing the Statement of Qualification in response to this request are solely the responsibility of the respondent. 5. No respondents to this solicitation shall discriminate against any employee or applicant for employment because of race, religion, color, sex, age or national origin. All respondents shall take affirmative action to ensure that minority and disadvantaged applicants are employed and employees are treated during their employment without regard to race, religion, color, sex, age, or national origin. 6. Respondents are cautioned not to discuss this project with City staff, other than the Purchasing and Contract Administration staff. 7. No interpretation of the intent of this solicitation will be made orally to any respondent. In the event that any interpretation is provided by the City, only written interpretations will be binding upon the City. 8. The City reserves the right to delay or alter any date or time schedule if the City deems it is in its best interest to do so. Insurance Requirements A. General Before starting work, the Consultant shall procure and maintain minimum levels of insurance as specified by this section. B. Coverage Except as otherwise stated, the amounts and types of insurance shall conform to the following minimum requirements: 1) Worker s Compensation Coverage to apply to all employees for Statutory Limits in compliance with the applicable state and federal laws. In addition, the policy must include: a. Employer s liability with a limit of $1,000,000 each accident and disease. 2) Commercial General Liability Coverage must be afforded on a form no more restrictive than the latest edition of the Commercial General Liability Policy, on an occurrence basis, filed by the Insurance Services Office and must include: a. Minimum limits of $1,000,000 per occurrence combined single limit for Bodily Injury Liability and Property Damage Liability. b. Premises and Operations. c. Independent Contractors d. Products and completed Operations Consultant shall maintain in force until at least three (3) years after completion of all services required under the Contract, coverage for products and completed operation. RFQ Fire Protection Engineering Consulting Services Page 10 of 16

e. Broad Form Contractual Coverage applicable to this specific Contract, including any hold harmless and/or indemnification agreement. 3) Business Auto Policy Coverage must be afforded on a form no more restrictive than the latest edition of the Business Auto Policy filed by the Insurance Services Office and must include: a. Minimum limits of $1,000,000 per occurrence combined single limit for Bodily Injury Liability and Property Damage Liability. b. Owner Vehicles c. Hired and Non-Owned Vehicles. 4) Professional Liability The Consultant shall maintain a professional liability insurance policy in the amount $1,000,000 during the term of this Contract. Such coverage shall be maintained for a period of three (3) years following completion and acceptance of any work performed under this agreement. In the event the Consultant fails to secure and maintain such coverage, Consultant shall be deemed the insurer of such professional liability insurance and shall be responsible for all damages suffered by the City as a result thereof, including attorney s fees and costs. 5) Additional Insured The City is to be specifically included as an additional insured. Consultant s insurance including that applicable to the City as an Additional Insured shall apply on a primary basis and any other insurance maintained by the City shall be in excess of and shall not contribute with Consultant s insurance. Consultant s insurance shall contain a severability of interest provision, providing that, except with respect to the total limits of liability, the insurance shall apply to each Insured or Additional Insured in the same manner as if separate policies had been issued to each. 6) Notice of Cancellation and/or Restriction Each policy must be endorsed to provide the City with a minimum of forty-five (45) days notice of cancellation and/or restriction. 7) Certificates of Insurance Certificates of insurance evidencing the Insurance coverage specified in this section shall be provided to the City before operations are begun. The required certificates of insurance shall name the types of policies provided. If the initial insurance expires prior to the completion of the work, renewal certificates of insurance and required copies of policies shall be furnished thirty (30) days prior to the date of their expiration. RFQ Fire Protection Engineering Consulting Services Page 11 of 16

DRUG-FREE WORKPLACE FORM The undersigned Contractor, in accordance with Florida Statute 287.087 hereby certifies that does: 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' policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, 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 a copy of the statement specified in Paragraph 1. 4. In the statement specified in Paragraph 1, notify the employees that, as a condition of working on the commodities or contractual services that 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 1893 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 Paragraph 1 through 5. As the person authorized to sign this statement, I certify that this firm complies fully with the above requirements. Date: Consultant RFQ Fire Protection Engineering Consulting Services Page 12 of 16

PUBLIC ENTITY CRIMES Any person submitting a bid, proposal or reply in response to this invitation or a contract, must execute the enclosed form PUR. 7069, sworn statement under section 287.133(3)(a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES, including proper check(s), in the space(s) provided, and enclose it with his quote, bid, or proposal. If you are submitting a quote, bid or proposal on behalf of dealers or suppliers who will ship commodities and receive payment from the resulting contract, it is your responsibility to see that copy(ies) of the form are executed by them and are included with your quote, bid, or proposal. Corrections to the form will not be allowed after the quote, bid, or proposal opening time and date. Failure to complete this form in every detail and submit it with your quote, bid, or proposal may result in immediate disqualification of your bid or proposal. The 1989 Florida Legislature passed Senate Bill 458 creating Sections 287.132-133, Florida Statutes, effective July 1, 1989. Section 287.132(3)(d), Florida Statutes, requires the Florida Department of General Services to maintain and make available to other political entities a "convicted vendor" list consisting of persons and affiliates who are disqualified from public contracting and purchasing process because they have been found guilty of a public entity crime. A public entity crime is described by Section 287.133, Florida Statutes, as 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 in Florida or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or with an agency or political subdivision and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. A public entity may not accept any bid, proposal or reply from, award any contract to, or transact any business in excess of the threshold amount provided in Section 287.017, Florida Statutes, for CATEGORY TWO with any person or affiliate on the convicted vendor list for a period of 36 months following the date that person or affiliate was placed on the convicted vendor list unless that person or affiliate has been removed from the list pursuant to Section 287.133(3)(f), Florida Statutes. Therefore, effective October 1, 1990, prior to entering into a contract (formal contract or purchase order in excess of the threshold amount provided in Section 287.017, Florida Statutes, for CATEGORY TWO) to provide goods or services to THE CITY OF TITUSVILLE, a person shall file a sworn statement with the Purchasing and Contracting Administrator or its designee, as applicable. The attached statement or affidavit will be the form to be utilized and must be properly signed in the presence of a notary public or other officer authorized to administer oaths and properly executed. THE INCLUSION OF THE SWORN STATEMENT OR AFFIDAVIT SHALL BE SUBMITTED CONCURRENTLY WITH YOUR BID, PROPOSAL OR REPLY DOCUMENTS. NON-INCLUSION OF THIS DOCUMENT MAY NECESSITATE REJECTION OF YOUR QUOTE, PROPOSAL OR BID. RFQ Fire Protection Engineering Consulting Services Page 13 of 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 the Professional Engineering Services RFQ for the CITY OF TITUSVILLE Fire Protection Engineering Consulting Services. 2. This sworn statement is submitted by, whose business address is and (if applicable) its Federal Employer Identification (FEIN) is. 3. My name is (please print name of individual signing) and my relationship to the entity named above is. 4. I understand that a "public entity crime" as defined in Paragraph 287.133(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 public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any bid, proposal, reply or contract for goods or services, any lease for real property, or any contract for the construction or repair of a public building or public work, involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 5. I understand that "convicted" or "conviction" as defined in Paragraph 287.133(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. 6. I understand that an "affiliate" as defined in Paragraph 287.133(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 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. 7. I understand that a "person" as defined in Paragraph 287.133(1)(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 let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The RFQ Fire Protection Engineering Consulting Services Page 14 of 16

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 on the convicted vendor list. (Please describe any action taken by or pending with the Department of General Services.) STATE OF FLORIDA COUNTY OF (Signature) Date: The foregoing instrument was acknowledged before me this day of, 2015 by, (title) on behalf of. He/she is personally known to me or has produced as identification and did ( ) did not ( ) take an oath. (Notary Signature) Name: My Commission Expires: Commission Number: RFQ Fire Protection Engineering Consulting Services Page 15 of 16

EXHIBIT A PROFESSIONAL SERVICES EVALUATION FORM FIRM S NAME: RFQ: TITLE: FACTORS TO BE RATED POINT RANGE TOTAL 1 Details of terminated contracts (for cause or other) 0-5 2 Details of filed lawsuits closed and pending 0-5 3 Related project experience 0-15 4 Local knowledge and experience. 0-5 5 Qualified personnel experience 0-20 6 Capability to handle more work (current and projected 0-10 workloads due to pending awards). 7 Project approach 0-25 8 Project schedule. 0-5 9 Proximity of the firm to the City of Titusville in miles. 0-5 10 Firm is a minority enterprise as certified by the State of Florida. 0-5 COMMENTS: List strengths, weaknesses and deficiencies to justify scores Total EVALUATOR SIGNATURE DATE: SCORING PROXIMITY TO THE CITY 1. WITHIN CITY LIMITS 5 POINTS 2. OUTSIDE CITY LIMITS TO 50 MILES 4 POINTS 3. OVER 50 MILES TO 100 MILES 3 POINTS 4. OVER 100 MILES TO 150 MILES 2 POINTS 5. OVER 150 MILES 1 POINT RFQ Fire Protection Engineering Consulting Services Page 16 of 16