1-25-034 HEALTHY LIVING CLINIC FOR EMPLOYEES FAMILIES.pdf

RFP #25-034

Floyd County Board of Commissioners

Request for Proposals

HEALTHY LIVING CLINIC

FLOYD COUNTY EMPLOYEES & FAMILIES

Issue Date: October 1, 2025

All communication concerning this project should be directed to the Purchasing Office until the bid is awarded. Vendors should not have direct contact with the Departments.

FLOYD COUNTY BOARD OF COMMISSIONERS

PURCHASING DEPARTMENT

#12 East 4th Ave. Ste. 106

ROME, GA 30161

(706) 291-5118

REQUEST FOR PROPOSALS

Date Issued: October 1, 2025

Sealed Proposals from qualified contractors will be received by the Purchasing Department of FLOYD COUNTY GEORGIA, via www.floydcountyga.bonfirehub.com until 2:00 PM local time, Thursday, November 6, 2025, for the purpose of providing:

HEALTHY LIVING CLINIC FLOYD COUNTY EMPLOYEES & FAMILIES

After the time and in the Purchasing Department Suite 106, the bids will be publicly opened and read. No extension of the bidding period will be made.

Additional copies of bidding documents may be obtained at https://floydcountyga.bonfirehub.com, or email Randy E. Self at randy.self@floydcountyga.org or you may get a copy in person at the Floyd County Administrative Building, Purchasing Department, #12 East Fourth Ave, Suite 106, Rome, Georgia 30162.

Requests for documents should be filed promptly with the Purchasing Department.

All questions regarding this bid should be sent via the Bonfire website https://floydcountyga.bonfirehub.com or to Randy E. Self at randy.self@floydcountyga.org. Verbal questions and answers are not binding on any party. Submit questions no later than 5:00 PM, October 30, 2025, questions received after this time may or may not be addressed. Replies will be made by Addenda.

The contract, if awarded, will be on a lump sum basis or individual item basis, whichever is in the best interest of the County. No bid may be withdrawn for a period of 60 days after time has been called on the date of opening.

Floyd County reserves the right to reject any or all proposals and to waive any informalities in the proposal process. If no proposal substantially satisfies the specified goals as presented in this Request for Proposal, the County, at its sole discretion, reserves the right to call for new proposals.

Floyd County is an Equal Opportunity Employer.

http://www.floydcountyga.bonfirehub.com/ https://floydcountyga.bonfirehub.com/ mailto:randy.self@floydcountyga.org https://floydcountyga.bonfirehub.com/ mailto:randy.self@floydcountyga.org

Bids should be submitted electronically using https://floydcountyga.bonfirehub.com

Please note that on the Public Files page of Bonfire, we will have the RFP Specifications and Documents package. Questions may be submitted on the Public Messages tab.

RANDY E. SELF, MBA

PURCHASING DIRECTOR

REQUEST FOR PROPOSALS

Healthy Living Clinic for Floyd County Government Employees

The Floyd County Board of Commissioners are requesting proposals from qualified firms to provide near-site Healthy Living Services to Floyd County Government employees and their eligible dependents that are currently enrolled in the Floyd County Group Health Insurance Plans. It is the goal to continue to maintain or decrease health insurance cost by providing increased levels of healthy living choices of employees and their dependents. It is the intention that the firm have an existing near-site location fully equipped with all necessary offices and qualified personnel dedicated to the employees of Floyd County and their eligible dependents, with the ability to start services within 90 days upon execution of the agreement. The Floyd County Board of Commissioners reserve the right to accept, reject, and/or negotiate any or all proposals as determined by them to be in the County’s best interest. The County intends that the successful firm be awarded a minimum of a one year contract with the option to renew for up to three additional years, on an annual basis. Contract extensions would be mutually agreed upon by both parties.

BACKGROUND

The Floyd County Government is currently a self-insured entity with third party administrators for providing health insurance coverage to employees and their dependents. In an effort to control or reduce cost, while maintaining a high level of medical coverage, proposals are being requested for the location and operation of a near-site healthy living clinic. The clinic is intended to provide a variety of services that will enhance our current near-site medical facility. It is the intention of the County to consider proposals based on convenience, quality and the number of services to be provided at a single location that would lead to the greatest overall health benefit for employees and their dependents.

All proposals submitted become the property of Floyd County Government and will not be returned to the submitting firm. All proposals received must remain open for acceptance for no less than ninety (90) days. Proposals received after the deadline will not be considered under any circumstances and will be returned unopened to the submitting firm. Unsealed proposals, including facsimile proposals will not be considered.

SCORABLE MANDATORY REQUIREMENTS:

After reviewing submittals, Floyd County may elect to interview the most qualified firms. The submitting firm must provide a proposed timeline for the opening of clinic operations

Proposals must include the following information, which will be scored. The proposal judged in each category as the best will receive the maximum points and others assigned percentages of the maximum. The following needs to be addressed in the RFP along with anything else you would like to include that you feel would help with the scoring.

1. A brief description of the firm, including a short history of the company, a complete description of the operating organization of the firm. A complete summary of typical professional, technical, and support staff, the resources that are available to the company pertinent to the proposal, and the number of years the company has been in existence.

Provide the name and state of the firm incorporation and they type.

2. Certification that the firm or its officers or any predecessor companies are not under any part of the Bankruptcy Act nor have filed under the Bankruptcy Act within the previous seven years.

3. Provide a summary of qualifications, specific and general, of the company and the resume of the managing and professional staff to be assigned to the project. Please provide the qualifications, credentials, and experience of the medical staff, including physicians, nurses, and registered dietitians.

4. Provide an outline of the proposed organizational structure to be used by your firm with a description of each person’s role in development and delivery of the proposed services.

Explain if sub-contractors will be used and for what purpose.

5. What is your core philosophy for weight management? Is it based on behavioral modification, medical supervision, bariatric surgery, or a combination?

6. What diagnostic care and screenings are offered? Do you screen for related conditions like diabetes, high blood pressure, and sleep apnea?

7. Detail your specific medical protocols, including any use of prescription weight-loss medications or bariatric surgery options.

8. What is the patient intake process? What initial assessments (e.g., physical, psychological, nutritional) are required before a patient starts the program?

9. How do you assess and manage patient risks and potential complications?

10. How do you ensure your programs are based on the latest evidence and clinical best practices?

11. Describe your online or app-based programs, including features for tracking progress, nutrition, and exercise.

12. What in-person services are offered, including group sessions, one-on-one coaching, or other support?

13. Can you provide samples of your educational and informational materials for participants?

14. How do you communicate with patients, and how is the program’s content personalized for them?

15. What type of follow-up and long-term maintenance support is offered to help participants sustain their weight loss?

16. Can you offer any performance guarantees related to patient satisfaction or weight loss outcomes?

17. What data can you provide to track the program’s effectiveness? How will you measure success and calculate the return on investment (ROI)?

18. If relevant, can you provide quarterly reports on patient participation and any subsidies received?

19. Describe your technology platform. Does it integrate with any existing electronic health records (EHRs) or wellness portals?

20. Detail your data protection protocols and policies regarding patient privacy (e.g., HIPPA compliance).

21. What is your overall approach and philosophy on weight management?

22. Describe your experience with clients of a similar size, scope, and complexity as our organization.

23. Provide at least two client references for which you currently provide weight management services. Include the client’s name, contact person, and contract start date.

24. Include your financial ratings and confirm that there have been no recent downgrades.

25. Provide a clear breakdown of your pricing model, including implementation, ongoing support, and any additional fees. Please submit this as a separate attachment on the Bonfire site.

26. What are your standard payment terms and conditions?

27. Do you use any subcontractors? If so, identify the work they perform and their qualifications.

28. Describe the implementation timelines and the resources required from our side during the process.

29. How do you accommodate members who may have limited access to computers or smartphones during the workday? What languages are supported?

30. Can you accommodate both onsite and virtual services?

Evaluation and Selection Process:

Proposals will be evaluated by a committee consisting of Floyd County staff. Committee members will review the proposals individually and collectively to determine total points and rank them accordingly. The top three proposals, as ranked by the review committee, may be invited to be interviewed with the review committee, and a selection will be made from the interview process. It is the policy of Floyd County to prohibit discrimination against any person or business in pursuit of business opportunities on the basis of race, color, sex, religion, national origin, or geographic location and to conduct its contracting and purchasing programs so as to prevent such discrimination. Submittal must describe the firm’s plan to utilize disadvantaged, minority-owned and woman owned business enterprises in executing the project, if any.

Proposed staff and team members must be the actual project resources who will serve Floyd County on this project. Indicate professional registrations, licenses and other pertinent information to demonstrate the team meets local, State, and Federal requirements.

Award:

The successful firm, if a contract is awarded, will be required to sign a contract that is all inclusive of services to be provided. The contract will outline the cost for each service to be provided, length of the contract, contract renewal or extension provisions if any, hours of operations, staffing, etc. The contract, if awarded, will be awarded to the firm considered to be the most advantageous to Floyd County as set forth in the evaluation criteria. All items and services must meet or exceed requested services as stated by the proposal request. County reserves the right to waive any technicality and to accept or reject any proposal in its entirety or to accept any portion thereof if it is determined that either method results in lower cost, better service, final satisfaction, or is otherwise determined to be in the best interest of Floyd County.

Submittal Requirements:

Each submitting firm must submit their proposals via the Bonfire website at www.floydcountyga.bonfirehub.com.

All questions must be submitted via the Bonfire site using the Public Messages tab or email to Randy E. Self, randy.self@floydcountyga.org. All questions and answers will be posted as addendum on the Bonfire and the State of Georgia Procurement website. It is the responsibility of interested parties to visit one of the sites regularly during the proposal process to ensure receipt of any additional information that may be made available.

All proposals must include clear, concise and comprehensive explanations of all areas that information has been requested, as well as all documents that are provided must have all information required including the signature of a company officer. The proposal should be formatted in a manner that is consistent with the request for information in this proposal solicitation.

Required Submission Documents are included in this RFP. Proposals must include the required documents, and they may be submitted with the proposal as one attachment with the Price breakdown submitted as a separate attachment. Required documents include:

1) Bidders Declaration

2) Vendor Information

3) Non-Collusion Affidavit

4) Certificate of Non-Discrimination

5) Contractor’s Affidavit (Compliance with O.C.G.A. and Georgia Dept. of Labor rule 300-10-

02.

6) Drug Free Work-Place Certification

7) Description of the Scope of Services to be provided, consistent with this request, including any substantial differences between the Services Requested and those Proposed.

8) The firm’s statement of qualifications and experience.

9) Cost proposal for services that is detailed sufficiently to determine the value of the work to be performed. The firm will be expected to provide a minimum of 40 hours of clinic operations per week. The firm shall provide an all-inclusive cost per hour for services rendered during clinic operating hours and a complete fee schedule of all services to be provided. Pricing should be submitted in a format that is easy to understand and should be submitted as a separate attachment. Pricing should include Baseline fees, payment terms and conditions, number of year’s baseline fees are guaranteed, and do you offer any performance guarantees.

ADDITIONAL INFORMATION ABOUT FLOYD COUNTY GEORGIA:

1. Floyd County wants to continue a near-site Healthy Living Center in order to lower health care costs, provide a convenient, cost-effective benefit and to improve the quality of life for Floyd County employees.

http://www.floydcountyga.bonfirehub.com/ mailto:bsmyth@romega.us

2. Floyd County is an organization with approximately 700 full-time employees with a median age of 47 years old and an approximate median income of $30,000.00 annually.

Women constitute approximately 61% of the County workforce.

FLOYD COUNTY GEORGIA

GENERAL TERMS AND CONDITIONS

INVITATION TO BID

1. CHANGES: No change will be made to this invitation except by written modification by the County Purchasing Office. Requests for interpretation or changes must be in writing, to randy.self@floydcountyga.org directed to the Floyd County Purchasing Department and received at least (5) Five Calendar Days prior to the time set for opening of the bids. Phone (706) 291-5118. All communication concerning this project should be directed to the Purchasing Office until the bid is awarded. Vendors should not have contact with the Departments.

2. FOB POINT: Bid Price to include shipping, packing, crating, and unloading at address in BID INSTRUCTIONS. Title to remain with vendor until fully accepted by the County. Goods damaged or not meeting specifications will be rejected and removed at the vendor’s expense. Concealed damaged goods to remain the property of vendor until replaced or removed at County’s direction.

3. RISK OF LOSS: Vendor agrees to bear all risk of loss, injury, and destruction of goods and materials ordered herein which occur prior to delivery to include concealed damage; and such loss, injury, or destruction shall not release vendor from any obligation.

4. BID ACCEPTANCE TIME: Bids requiring acceptance by the County in less than Sixty (60) calendar days could be rejected, unless so stated on BIDDER’S RESPONSE PAGE and accepted by the County.

5. BID IDENTIFICATION: All bids submitted because of this invitation must be submitted using the Bonfire website at https://floydcountyga.bonfirehub.com/

6. WITHDRAWAL OF BIDS: Bids may be withdrawn by written request only, if the request is received prior to the time and date set for the opening of bids. Negligence on the part of the bidder in preparing his bid confers no right of withdrawal or modification of his bid after the bid has been opened. No bid may be withdrawn for a period of Sixty (60) days after time has been called on the date of opening.

7. BONDS: Not required for this proposal.

8. SITE INSPECTIONS: Not required for this proposal

9. AWARD OF CONTRACT: Award will be made to that responsible proposer whose proposal, conforming to the Request for Proposals, will be most advantageous to the County; Price and other factors considered. The County reserves the right to waive compliance from any applicant with any provision contained in this request whenever the County, in its sole discretion, believes such a waiver is in the County’s best interests.

A written award emailed (or otherwise furnished) shall be deemed to result in a binding contract without further action by either party. Contract (s), if awarded, will be on a lump sum basis or individual item basis, whichever is found to be in the best interest of FLOYD COUNTY.

mailto:bill.gilliland@floydcountyga.org

9.1: The vendor, in accepting this contract, attests that he is in compliance with the Nondiscrimination Clause contained in Section 202 of Executive Order 11246, as amended, relative to equal employment opportunity for all persons without regard to race, color, religion, sex, or national origin, and the implementing rules and prescribed by the Secretary of Labor, which is incorporated herein by reference.

10. EXCEPTIONS TO SPECIFICATIONS: Any award resulting from this invitation shall bind the bidder to all Terms, Conditions, and Specifications set forth in this invitation. Bidders whose bids do not conform should so note on separate page if necessary and/or on the BID SCHEDULE. While the County reserves the right to make an award to a nonconforming bidder, when in the best interest of the County, such awards will not be readily made, and bidders are urged to conform to the greatest extent possible. No exceptions will be considered to have been taken by the bidder unless it is properly set out as provided above. No exception will be deemed to have been taken by the County unless you are incorporated in an award resulting from this invitation and so stated.

11. BID RESULTS: Interested parties may review and/or print BID TABULATION @ https://floydcountyga.bonfirehub.com 24 hours after bid opening or contact Randy E. Self at randy.self@floydcountyga.org should the tabulation not be available on the website.

12. PAYMENT: Payments will be made upon all items completed each month or completion of all work and acceptance by county on invoices submitted and approved by the proper county representative within thirty (30) days receipt of invoice unless paragraph 14 applies. Invoices are to be submitted to: Floyd County Purchasing, P. O. Box 946, Rome, Ga. 30162 or by emailing your invoice to invoices@floydcountyga.org.

12.1 Itemize all invoices in full. Mail the original invoice to the address above. A shipping or receiving ticket will be signed and a copy left with each delivery. Each invoice including receiving/shipping ticket is to include the following minimum information:

1. Date invoice is submitted; 5. County department.

2. Purchase order number; 6. Item(s) or service

3. Payment terms; 7. Quantity of each item or service

4. Date of transaction; 8. Bid price of each item or service with any discounts.

Invoices received with any of the required information listed above missing may not be considered as a “correct invoice”. All invoices submitted will be closely monitored for accuracy. Any invoice found to be incorrect will be returned to the vendor for correction.

12.2 Vendor must furnish delivery receipt with invoice identifying that this order has been delivered in accordance with Specifications, Quantities, and Price as set forth on the purchase order. A Floyd County employee’s signature must appear on the delivery receipt or invoice.

12.3 Items on this order are exempt from Federal Excise Tax and Georgia Sales and Use Tax. A certificate will be furnished if requested. FLOYD COUNTY is exempt from taxes, but the successful bidder shall pay all taxes required of him by law and FLOYD COUNTY cannot exempt others from tax.

12.4 Payment terms and provisions herein or otherwise found within the contract documents supersede all provisions of the Georgia Prompt Pay Act (House Bill 837; 13 O.C.G.A. Chapter 11 ET. SEQ.).

13. INQUIRIES REGARDING PAYMENT: All inquiries regarding payment of invoices are to be directed to Accounts Payable (706) 291-5113 or Floyd County Commissioners, Attn: Accounts Payable, P.O. BOX 946, Rome, Georgia 30162 mailto:randy.self@floydcountyga.org

14. DISCOUNTS: Prompt payment discounts offered for a period of less than Fifteen (15) Days will not be considered in determining the low bidder on this invitation. However, such discounts, when offered, will be taken provided payment is made within the time specified. Time, in connection with discounts for prompt payments, will be computed from the date of acceptance of work for which payment is claimed, or the date the correct invoice is received by the County, whichever is later.

15. EXECUTION OF CONTRACT: Subsequent to the award, the successful bidder will be presented with a contract which may be in the form of a purchase order. Contract is to be executed within Ten (10) calendar days of “NOTICE OF AWARD” together with the required payment and performance bonds prescribed in Paragraph 7B. If the contract document is mailed, the date of the presentation shall be deemed to be the postmark date. The successful bidder’s proposal and this Invitation for Bid shall be incorporated into the contract, except to the extent that this invitation conflicts with the contract, in which case the provisions of the contract shall take precedent.

16. CERTIFICATE OF INSURANCE: The successful bidder will be required to furnish a Certificate of Liability Insurance in an amount not less than Five Hundred Thousand Dollars ($500,000.00) per occurrence to protect the County throughout the life of the contract against “All Risks” Coverage to include but not limited to General Liability: Comprehensive For, Premises/Operations, Products/Completed Operations, Broad Form Property Damage, Personal Injury, and Automobile/Vehicle Liability. Worker’s compensation and Employer’s Liability are to be statutory amounts. On all contracts for vehicle repair of any kind, the successful shall provide at least Five Hundred Thousand Dollars ($500,000.00) of Garage Liability insurance in addition to the insurance stated above. The Certificate must be furnished within Ten (10) calendar days of a “NOTICE OF AWARD” being issued.

17. INCLUSION: All items and/or services standard, expected, necessary, and/or routine to such a project as this and not actually stated in this Invitation for Bid will be the responsibility of the successful bidder to provide at no other cost to the County unless so stated on the successful bidder’s proposal as additional cost items and accepted by the County at the time of the award and/or contract.

18. REGULATORY AGENCIES: Successful bidder will be responsible for all required permits or license required by regulatory agency of the City, County, State, or Federal Governments. Further, successful bidder will be responsible for meeting all requirements of any regulation (s) or guideline (s) of any of the said Governments or any independent agency recognized by said Governments as publisher of any such regulation

(s) or guideline (s).

19. INDEPENDENT CONTRACTORS: The bidder represents to FLOYD COUNTY that he is fully experienced and properly qualified to perform the functions provided herein and that he is properly equipped, organized, and financed to perform such functions. The bidder shall finance his own operations hereunder, shall operate as an independent contractor and not as an agent of FLOYD COUNTY and nothing contained in this Invitation for Bid or a contract resulting from same shall be construed to constitute the bidder or any of his employees, servants, agents, or subcontractors as a partner, employee, servant, or agent of the County nor shall either party have any authority to bind the other in any respect; it being intended that each shall remain an independent contractor.

20. ASSIGNMENT OF CONTRACTUAL RIGHTS: It is agreed that the successful bidder will not assign, transfer, convey, or otherwise dispose of a contract that results from this invitation or his right, title, or interest in or to the same, or any part thereof, without written consent of the County.

21. STARTING TIME: Work will commence within stated calendar days after being issued a “NOTICE TO PROCEED” on the project and commence in a routine, orderly manner until completion and acceptance by the County.

22. INDEMNITY: Successful bidder agrees, if entering a contract because of this invitation, to defend, indemnify, and hold harmless FLOYD COUNTY from all courses of action or claims of damages arising out of or related to the bidder’s performance or actions or those of his employees or agents, under said contract.

23. TERMINATION: Pursuant to O.C.G.A. 36-60-13, if applicable, any contract resulting from this Invitation for Bid, if not sooner terminated pursuant to the provisions of termination contained herein, is terminable by the Board of Commissioners of FLOYD COUNTY, Georgia on December 31 of each calendar year during the term of said contract, except that said contract shall be renewed automatically on such date, and without any lapse, unless positive action is taken to terminate said contract by the Board in a public meeting and such action entered in the Official Minutes of the FLOYD COUNTY Commission.

24. APPROPRIATION OF FUNDS: Initial contract and any continuation contract (s) will terminate immediately and absolutely at any such time as there are no appropriated and otherwise unobligated funds available to satisfy the County’s obligations under said contract (s).

25. CANCELLATION FOR CAUSE: Should either party fail to comply with the Terms and Conditions of this contract, the aggrieved party must give, in writing, to the other party any complaint for noncompliance with the Terms and Conditions of this contract. The other party shall have Fifteen (15) calendar days to correct the matter. If corrected to the satisfaction of both parties within the Fifteen (15) calendar days and stated in writing, then the contract will continue uninterrupted. Failure to correct the matter will result in termination of this contract at the end of Thirty (30) calendar days following the date of the initial letter of complaint.

26. LIQUIDATED DAMAGES: NONE FOR THIS BID.

27. ANTI-DISCRIMINATION CLAUSE: “FLOYD COUNTY does not discriminate against any person because of race, color, religion, national origin, or handicap in employment or service provided."

28. COMMODITY STATUS: It is understood and agreed that the materials delivered shall be new, of the latest design, and in first quality condition, that all bags, containers, etc., shall be new and suitable for storage, unless otherwise stated by FLOYD COUNTY.

29: CONTRACT ITEMS: Items or services not listed in this contract need to be purchased according to purchasing rules and regulations of the county.

• County departments are not authorized to order any item or service not listed without satisfying said rules and regulations and having a separate purchase order issued to cover such a purchase.

• Vendors receiving contracts because of this invitation will be expected to consider this when accepting orders.

• Payment will not be made for any item not covered by this contract unless the Purchasing Rules and Regulations stated have been met.

30: CHANGES TO CONTRACT: No change will be made to this contract except by written modification by the Contracts Administrator whose name appears on the cover page. Additional items of the same brand and similar products required during the contract will be provided at like discounts to similar items on contract.

31: LOCATION FOR DELIVERY OF GOODS OR EQUIPMENT: Purchase Order or as specified by location

32: BID SUBMISSIONS: Submissions will be submitted using Bonfire at https://floydcountyga.bonfirehub.com .

I acknowledge that I have read and understand the General Terms and Conditions as stated above:

Signature

Printed Name

Company Name

CHECK LIST

Required Document for Submission

This document and all documents listed below are required to be completed and submitted as one attachment under Required Documents and scope of work on https://floydcountyga.bonfirehub.com. The pricing sheet should be submitted separately under Bid Pricing and not included with the required documentation.

___ Bidders Declaration Page

___ Vendor Information

___ Certificate of Non-Discrimination

___ Certificate of Non-Collusion

___ Drug Free Workplace Certificate

___ Contractor’s Affadavit (If you employ 10 or more employees)

___ S.A.V.E. (If you employ less than 10 employees)

___ W-9

___ Bidders Addenda Acknowledgement

___ Appendix A - Subcontractors

___ Subcontractor Affidavit

___ Pricing Breakdown/Proposal (to be scanned as a separate sheet in Bonfire)

___ Please include a Draft Contract with your submission for Attorney review.

The documents above are included within this Invitation to bid. Addendums will be available when issued.

BIDDERS DECLARATION

The bidder understands, agrees and warrants:

• That the bidder has carefully read and fully understands the full scope of the specifications.

• That the bidder has the capability to successfully undertake and complete the responsibilities and obligations in said specifications.

• That this bid may be withdrawn by requesting such withdrawal in writing at any time prior to November 6, 2025 at 2:00 PM (local time) but may not be withdrawn after such date and time.

• That Floyd County reserves the right to waive compliance from any applicant with any provision contained in this request whenever the County in its sole discretion believes such waiver is in the County’s best interests

• That by submission of this quote the bidder acknowledges that Floyd County has the right to make any inquiry or investigation it deems appropriate to substantiate or supplement information supplied by the bidder.

• That the accompanying bid is not the result of or affected by, any act of collusion with another person or company engaged in the same line of business or commerce, or any other fraudulent act punishable under Georgia or United States law.

BIDDER:

Company Name: _________________________________________

Phone: _________________________________________________

Name Print: _____________________________________________

Signature: ______________________________________________

Email: _________________________________________________

Date: _________________________________________________

VENDOR INFORMATION

PROPOSAL FORM

TO: Floyd County Board of Commissioners – Purchasing Department 12 E 4th Ave. Rome, GA 30161 - via https://floydcountyga.bonfirehub.com/

BID PKG. 25-034 - HEALTHY LIVING CLINIC FLOYD COUNTY EMPLOYEES & FAMILIES

Firm Name: ______________________________________________

All proposals submitted shall be subject to acceptance or rejection and the Floyd County Board of Commissioners specifically reserves the right to accept or reject any or all proposals, to waive any technicalities and formalities in the RFP process.

The undersigned understands that any conditions stated above, clarifications made to the above or information other than that requested should be under separate cover and to be considered only at the discretion of the Purchasing Department.

Contractor: _________________________________________

Address: ___________________________________________

City, State, Zip Code: _________________________________

Phone Number: ______________________________________

Email Address: ______________________________________

Print Name: _________________________________________

Signature: ___________________________________________

This proposal shall be signed by a representative who is authorized to contractually bind the contractor

Please Attach Company Contact’s Business Card (if possible):

CERTIFICATE OF NON-DISCRIMINATION

In connection with the performance of work under this contract, the bidder agrees as follows:

The bidder agrees not to discriminate against any employee or applicant for employment because of race, creed, color, sex, national origin, ancestry, or disability. The vendor shall take affirmative action to ensure that employees are treated without regard to their race, creed, color, sex, national origin, ancestry, or disability. Such actions shall include, but not be limited to the following:

employment, upgrading, demotion, transfer, recruiting, or recruitment, advertising, lay-off or termination, rates of pay or other compensation and selection for training, including apprenticeship.

In the event of the bidder’s non-compliance with this non-discrimination clause, the contract may be canceled or terminated by Floyd County Board of Commissioners. The bidder may be declared, by Floyd County, ineligible for further contracts with Floyd County until satisfactory proof of intent to comply shall be made by the vendor.

The bidder agrees to include this non-discrimination clause in any sub-contracts connected with the performance of this agreement.

BIDDER ____________________________________

SIGNATURE ____________________________________

TITLE ____________________________________

CERTIFICATE OF NON-COLLUSION

By responding to this Solicitation, the supplier understands and agrees to the following:

1. That the submitted response constitutes an offer, which when accepted in writing by Floyd County, and subject to the terms and conditions of such acceptance, will constitute a valid and binding contract between the undersigned and Floyd County; and

2. That the supplier has read the specifications and requirements shown or referenced in the solicitation and that the supplier’s response is made in accordance with the provisions of such specifications and requirements except as expressly stated otherwise in the supplier’s response; and

3. That the supplier guarantees and certifies that all items included in the supplier’s response meet or exceed all such stated specifications and requirements of the solicitation except as expressly stated otherwise in the supplier’s response; and

4. That, if awarded a contract, the supplier will deliver goods and or services that meet or exceed the specifications and requirements of the solicitation except as expressly stated otherwise in the supplier’s response, and

5. That the response submitted by the supplier shall be valid and held open for a period of one hundred and twenty (120) days (or such other period as identified in the solicitation) from the final solicitation closing date and that the response may be held open for an additional period subject to the supplier’s consent; and

6. That the supplier’s response is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a response for the same materials, supplies, equipment, or services and is in all respects fair and without collusion or fraud. The supplier understands and agrees that collusive bidding is a violation of state and federal law and can result in fines, prison sentences, and civil damage awards; and

7. That the provisions of the Official Code of Georgia Annotated, Sections 36-91 have not been violated and will not be violated in any respect.

DO NOT MODIFY THE BID/PROPOSAL CERTIFICATION TERMS IN ANY WAY. THIS FORM MUST BE

COMPLETED, SIGNED AND SUBMITTED WITH YOUR RESPONSE.

(PLEASE PRINT OR TYPE):

Contractor’s Full Legal Name _________________________________________________

Authorized Signature: ________________________________________________________

Name and Title of Person Signing: ______________________________________________

Company Address: ___________________________________________________________

Phone: ________________________ E-MAIL: ___________________________________

Contractor Affidavit under O.C.G.A. § 13-10-91(b)(1)

By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services on behalf of Floyd County Georgia has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-91.

Furthermore, the undersigned contractor will continue to use the federal work authorization program throughout the contract period and the undersigned contractor will contract for the physical performance of services in satisfaction of such contract only with subcontractors who present an affidavit to the contractor with the information required by O.C.G.A. § 13-10-91(b). Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:

Federal Work Authorization User Identification Number (Please note this is NOT an FID number) Date of Authorization of your Federal Work Authorization Number

Name of Contractor

Address of Contractor

Name of Project

___FLOYD COUNTY GEORGIA________________

Name of Public Employer

I hereby declare under penalty of perjury that the foregoing is true and correct.

Executed on _________, ___ in 202__ in____________________(city), ________(state).

Signature of Authorized Officer or Agent

Printed Name and Title of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME

ON THIS THE ______DAY OF___________________, 202__.

NOTARY PUBLIC

My Commission Expires:

(Notary Seal or Stamp Required)

SAVE COMPLIANCE AFFIDAVIT

O.C.G.A § 50-36-1(e) (2) Affidavit

By executing this affidavit under oath, as an applicant for a (n) Contract or Services, as referenced O.C.G.A. C. § 50-36-1, for Floyd County Board of Commissioners, Georgia, the undersigned applicant verifies one of the following with respect to my application for a public benefit:

1) __________ I am a United State citizen.

2) __________ I am a legal permanent resident of the United States

3) __________ I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency.

My alien number issued by the Department of Homeland Security or other federal immigration agency is: ____________________.

The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 50-36-1(e) (1), with this affidavit.

The secure and verifiable document provided with this affidavit can best be classified as:

In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute.

Executed in _______________ (city), _____________ (state).

Signature of Applicant Name of Company

Printed Name of Applicant Street Address of Company

Title of Applicant City, State, Zip Code of Company

SUBSCRIBED AND SWORN

BEFORE ME ON THIS THE

_______DAY OF __________________, 20______

NOTARY PUBLIC

My Commission Expires:

FLOYD COUNTY BOARD OF COMMISSIONERS

DRUG-FREE WORKPLACE CERTIFICATE

By signature on this certificate, the Vendor certifies that the provisions of O.C.G.A. Section 50- 24-1 through 50-24-6 related to the “Drug-Free Workplace Act” have been complied with in full.

The Vendor further certifies that:

1. A drug-free workplace will be provided for the Vendor’s employees during the performance of the contract; and

2. Each Vendor who hires a sub-Vendor to work in a drug-free workplace shall secure from that sub-vendor the following written certification: “As part of the subcontracting agreement with (Vendor’s name), (sub-Vendor’s name) certifies to the Vendor that a drug-free workplace will be provided for the sub-Vendor’s employees during the performance of this contract pursuant to O.C.G.A. Section 50-24-3(b)(7).”

By signature on this certificate, the Vendor further certifies that it will not engage in the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana during the performance of this contract.

Vendor: _______________________________________________________

By: ___________________________________________________________

Name Printed: __________________________________________________

Title: __________________________________________________________

Date: __________________________________________________________

BIDDERS ADDENDA ACKNOWLEDGEMENT

Bidder acknowledges receipt of the following addenda:

Addendum No. Date

Signed this _______day of _______________ 202___

Signature: ________________________________________________

Title: ___________________________________________________

Company: ________________________________________________

APPENDIX A – LIST OF SUBCONTRACTORS

The following is the list of Subcontractors referenced in the Bid Form submitted by:

Bidder: _______________________________

Dated: ________________ and which is an integral part of the Bid Form.

The following work will be performed (or provided) by Subcontractors and coordinated by us:

WORK SUBJECT

NAME

FLOYD COUNTY GEORGIA