1-FORMS PACKET -ALL 2026.pdf

MANDATORY CERTIFICATIONS/FORMS PACKET

SOLICITATION NAME:

SOLICIATION NUMBER:

Table of Contents

RFP Section 3 – Introduction - Respondent Requirements Checklist

RFP Section 3 – Compliance Information Sheet

RFP Section 7.18 – Certificate of Liability Insurance meeting required coverage .(Placeholder)

Appendix A – Contractor’s Statement of Qualifications

Appendix B – Acknowledgement of Business Type

Appendix C – Statement of Affirmation and Intent

Appendix D – Mutual Non-Disclosure Agreement

Appendix E – Addenda Form / Dispute Resolution Clause

Appendix F – Public Records Act / Chapter 119 Requirements

Appendix G – Reference Release Form

Appendix H – Federal Certifications: Contracts Supported by Federal Funds- Regulatory Compliance Statement

Appendix H – Certifications Regarding Non-Discrimination

Appendix H – Certifications Regarding Lobbying

Appendix H – Debarment, Suspension, and Other Responsibility Matters

Appendix I – Vendor Application, E-Verify , Foreign Country of Concern, Student Information, W-9

Proposer:

Appendix H – Drug-Free Workplace Certification

Appendix H – Non-Collusion Affidavit

Appendix J – Standard Terms and Conditions (MSA), Statement of Work template, and Change Order template and Forced Labor Affidavit

RFP Introduction – Respondent Requirements Checklist

Appendix, Attachments, and Mandatory Certifications

Section 3.1.3 Cover Letter Yes No Introduction Respondent Requirements Checklist (behind the cover letter) Yes No Section 3.1 Compliance Information Yes No Section 3.1.5 Financial Stability Compliance Yes No Section 3.1.6 Security Compliance Standards Yes No Section 3.1.7 ADA Compliance / VPAT Report Yes No Section 3.2 Qualifications, Background, Reference Letters, and Case Studies Yes No Section 5 Response to Scope of Work Requirements Yes No Section 5 Exceptions / Alternatives Yes No Section 6 Cost Proposal & P Card Acceptance Response Yes No Section 7.18 Certificate of Insurance (with active/adequate coverage) Yes No Appendix A Contractor’s Statement of Qualifications Yes No Appendix B Acknowledgement of Business Type Yes No Appendix C Statement of Affirmation and Intent Yes No Appendix D Mutual Non-Disclosure Agreement Yes No Appendix E Addenda Form / Dispute Resolution Clause Yes No Appendix F

Certification Regarding Non-Discrimination

Yes No Appendix G

Non-Collusion Affidavit

Yes No Appendix H

Public Records Act / Chapter 119 Requirements

Yes No Appendix H Yes No

Reference Release Form

Yes No Appendix H

E-Verify Certification, Vendor Application, and W-9 Form, Attestation

Yes No Appendix H

Standard Master Service Contract and Statement of Work

Yes No

Comments/Notes:

Appendix H

Proposers shall complete the below checklist to help ensure the response is complete and compliant with FLVS requirements. Use the checklist to verify of FLVS required forms and supporting content. Note, FLVS shall not accept edits to required forms.

Respondent Signature of Acknowledgement

(Authorized signature from Proposer required below.)

Contracts Supported by Federal Funds, Regulatory Compliance Statement

Certification Regarding Lobbying

Debarment, Suspension, and Other Responsibility Matters

Drug-Free Workplace Certification

Yes

Yes

Yes No No

No Appendix J

Appendix I Appendix H

COMPLIANCE INFORMATION SHEET

Formal Company Name:

Business Address:

Web Address:

Type of Business: Sole Proprietorship: ☐ Partnership: ☐ Corporation: ☐ Joint Venture : ☐ LLC ☐ Other (specify):

Registered in Florida (SunBiz) Yes:☐ No:☐ Business Registration State of Origin:

Copy of certification from Florida Secretary of State providing corporate status attached Yes: ☐ No: ☐

Out of State corporation: Florida Business License attached: Yes: ☐ No: ☐

Office Locations: Orange County: ☐ Central Florida: ☐ or contiguous county: ☐ Federal Employer Identification Number: Years in Business:

Number of Active Clients: Number of Inactive Clients:

History of changes to ownership:

License Sanctions (if any):

Debarments (if any):

Financial Stability Compliance & Qualifications Indicate type of supporting document included with your proposal in accordance with Section 3.2.5.

☐ Audited Financial Statements ☐ Dun & Bradstreet Report or SER ☐ CFO/Controller Financial Stability Attestation F.S. 92.525

Authorized Parties Soliciation Contact Information

Name/Title:

Title:

Address:

Legal Notices (if awarded) Name/Title:

Address:

Telephone:

Email:

Principals / Proposers Name/Title:

Address:

Telephone:

Email:

Authorized Contracting Signature (if awarded) Name/Title:

Address:

Telephone:

Email:

Persons authorized for presentations or interviews (include name, title and email address)

If Contractor is provided access to any student personally identifiable information, Contractor acknowledges that it shall comply with the privacy regulations outlined in the Family Educational Rights and Privacy Act (“FERPA”), for the handling of such information, to the extent such regulations apply to the Contractor. Contractor will not disclose or use any student information except to the extent necessary to carry out its contractual obligation(s) under the Agreement if awarded.

Company:

Authorized Representative’s Name and Title:

Authorized Signature: Date:

Email:

Certificate of Liability Insurance meeting RFP required coverage statisfying Section 10 of the Master Service Agreement (below)

Insert Certificate of Liability Insurance

Provide written responses to the following questions. If the answer to any of the questions is “Yes”, Vendor shall describe fully the circumstances, reasons therefore, the current status, and ultimate disposition of each matter that is the subject of this inquiry.

1. Has Contractor been declared in default of any contract? Yes No

2. Has Contractor forfeited any payment of performance bond issued by a surety company on any contract? Yes No

3. Has an uncompleted contract been assigned by Contractor’s surety company on any payment of performance bond issued to Contractor arising from its failure to fully discharge all contractual obligations thereunder? Yes No

4. Within the past three (3) years, has Contractor filed for reorganization, protection from creditors, or dissolution under the bankruptcy statutes? Yes No

5. Is Contractor now the subject of any litigation in which an adverse decision might result in a material change in the firm’s financial position or future viability? Yes No

6. Is Contractor currently involved in any state of a fact‐finding, negotiations, or resistance to a merger, friendly acquisition, or hostile take‐over, either as a target or as a pursuer? Yes No

7. License Sanctions: List any regulatory or license agency sanctions. The Board may perform a background check on Proposer with all state and regulatory agencies.

8. Provide the following financial information:

$ Earnings before Interest & Taxes

$ Total Assets

$ Net Sales

$ Market Value of Equity (Common & Preferred Stock)

$ Total Liabilities

$ Current Assets

$ Current Liabilities

$ Retained Earnings

Authorized Representative’s Signature Company Name

Appendix A

Contractor’s Statement of Qualifications

Acknowledgment of Business Type

This form must be signed in the presence of a Notary Public or other officer authorized to administer oaths and submitted with the response on the specified due date and time. The undersigned Proposer certifies that this response package is submitted in accordance with the scope of services in its entirety and with full understanding of the conditions governing this response.

Business Address of Proposer:

Address

City State Zip Code

Telephone No.

Signature of Proposer:

If an Individual:

Signature doing business as

If a Partnership:

Name of Partnership by:

Partner Signature

If a Corporation:

(a

Corporate Name

Corporation) In what State is the Corporation Incorporated?

If not incorporated under the laws of Florida, are you licensed to do business in Florida? Yes No by: Title:

Signature

Attest: (SEAL)

Corporate Secretary

Appendix B

Statement of Affirmation and Intent

TO: FLORIDA VIRTUAL SCHOOL, PROCUREMENT DIVISION

PROJECT:

DATE:

The undersigned, hereinafter called the Proposer, declares that the only persons, or parties interested in their Response are those named herein, that this Response is, in all respects, fair and without fraud that it is made without collusion with any other vendor or official of Florida Virtual School.

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 Proposer certifies that no Board Member, Director, or any Florida Virtual School 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 this Response. (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 School. In the event that a conflict of interest is identified in the provision of services, the Proposer agrees to immediately notify FLVS in writing.

The Proposer further declares that he/she has carefully examined the scope of services, instructions, terms and conditions of this Request for Proposal and that Proposer’s Response is made according to the provisions of the RFP and that he/she will meet or exceed the scope of services, requirements, and standards contained in the Request for Proposals.

The Proposer agrees to abide by all conditions of the negotiation process. In conducting negotiations with FLVS, Proposer offers and agrees that if this negotiation is accepted, the Proposer will convey, sell, assign, or transfer to FLVS 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 the State of Florida for price fixing relating to the particular commodities or services purchased or acquired by FLVS. At the School’s discretion, such assignment shall be made and become effective at the time the School tenders final payment to the Proposer. The Response constitutes a firm and binding offer by the Proposer to perform the services as stated.

Proposer acknowledges that all information contained herein is part of the public domain as defined in the Public Records Act, Chapter 119, F.S.

The signer of this Response guarantees, as evidence of the sworn affidavit required herein, the truth and accuracy of all statements and information hereinafter provided. The undersigned hereby authorizes any public official, surety company, bank depository, material, or equipment manufacturer or distributor or any person or firm or corporation to furnish any pertinent information requested by Florida Virtual School or their representative, deemed necessary to verify the information provided and statements made regarding the standing and general reputation of the applicant.

Signature of Authorized Firm Representative Date

Name and Title of Authorized Firm Representative (Typed) E‐mail Address

City Zip

Name of Firm (Typed)

Address

Telephone Number

Appendix C

NDA GC Approved Updated 07.29.2021

MUTUAL NONDISCLOSURE AGREEMENT

This Mutual Nondisclosure Agreement (this "Agreement") is made and entered into as of the date of signature execution by and between Florida Virtual School (FLVS), a body politic corporate and political subdivision of the State of Florida, and ______________________________, _______________________________ (referred to from this point as "Company"), collectively referred to hereinafter as “Parties” or “Party”. FLVS and the Company agree as follows:

1. Purpose. The Parties wish to explore a potential business opportunity of mutual interest and in connection with this opportunity, each Party may disclose to the other certain confidential technical and business information that the disclosing Party desires the receiving Party to treat as confidential.

2. "Confidential Information" means any information disclosed by either Party to the other Party, or its shareholders, members, partners, directors, managers, members, officers, employees, agents or affiliates either directly or indirectly, in writing, orally or by inspection of tangible objects (including without limitation documents, prototypes, samples, plant and equipment), which is designated as "Confidential," "Proprietary" or some similar designation. Information communicated orally shall be considered Confidential Information if such information is confirmed in writing as being Confidential Information within a reasonable time after the initial disclosure.

Confidential Information may also include information disclosed to a disclosing Party by third parties. Confidential Information shall not, however, include any information which: (i) was publicly known and lawfully made generally available in the public domain prior to the time of disclosure by the disclosing Party; (ii) becomes publicly known and made lawfully generally available after disclosure by the disclosing Party to the receiving party through no action or inaction of the receiving Party; (iii) is already lawfully in the possession of the receiving Party at the time of disclosure by the disclosing Party as shown by the receiving Party’s files and records immediately prior to the time of disclosure; (iv) is obtained by the receiving Party from a third party without a breach of such third party’s obligations of confidentiality or of law; (v) is independently developed by the receiving Party without use of or reference to the disclosing Party’s Confidential Information, as shown by documents and other clear and convincing competent evidence in the receiving Party’s possession; or (vi) is required by law to be disclosed by the receiving Party, provided that the receiving Party gives the disclosing Party prompt written notice of such requirement prior to such disclosure and assistance in obtaining an order protecting the information from public disclosure.

3. Non-use and Non-disclosure. Each Party agrees it, and its shareholders, members, partners, directors, managers, members, officers, employees, agents and affiliates, shall not use the Confidential Information of the other Party for any purpose except to evaluate and engage in discussions concerning a potential business relationship between the Parties. Each Party agrees not to disclose any Confidential Information of the other Party to third parties or to such party’s shareholders, members, partners, directors, managers, members, officers, employees, agents or affiliates, except to those employees of the receiving Party who are required to have the information in order to evaluate or engage in discussions concerning the contemplated business relationship.

Neither Party shall reverse engineer, disassemble, or decompile any prototypes, software or other tangible objects which embody the other Party’s Confidential Information, and which are provided to the Party hereunder.

4. Maintenance of Confidentiality. Each Party agrees that it shall take reasonable measures to protect the secrecy of and avoid disclosure and unauthorized use of the Confidential Information of the other Party. Without limiting the foregoing, each Party shall take at least those measures that it takes to protect its own most highly confidential information and shall ensure that any individual or entity that has access to Confidential Information of the other Party signs a non-use and non-disclosure agreement with protections at least as stringent as that in this Agreement, prior to any disclosure of Confidential Information to any such individual or entity. Neither Party shall unnecessarily duplicate the Confidential Information and shall reproduce the other Party’s proprietary rights notices on any such approved copies, in the same manner in which such notices were set forth in or on the original. The Parties agree that the maintenance of duplicate electronic copies of Confidential Information within each of their ordinary and respective electronic backup systems and disaster recovery systems shall be permissible under this Agreement.

5. No Obligation. Nothing herein shall obligate either Party to proceed with any transaction between them, and each Party reserves the right, in its sole discretion, to terminate the discussions contemplated by this Agreement concerning the business opportunity.

Appendix D

6. No Warranty. ALL CONFIDENTIAL INFORMATION IS PROVIDED "AS IS". EACH PARTY MAKES NO WARRANTIES, EXPRESS, IMPLIED OR OTHERWISE, REGARDING ITS ACCURACY, COMPLETENESS OR

PERFORMANCE.

7. Return of Materials. All documents and other tangible objects containing or representing Confidential Information which have been disclosed by either Party to the other Party, and all copies thereof which are in the possession of the other Party, shall be and remain the property of the disclosing Party and shall be promptly returned to the disclosing Party upon the disclosing Party’s written request.

8. No License. Nothing in this Agreement is intended to grant any rights to either Party in any intellectual property, other than the right to view materials under the terms of this Agreement, nor shall this Agreement grant any Party any additional rights in or to the Confidential Information of the other Party except as expressly set forth herein.

9. Term. The obligations of each receiving Party hereunder shall survive until such time as all Confidential Information of the other Party disclosed hereunder becomes publicly known and made generally available through no action or inaction of the receiving Party.

10. Remedies. Each Party agrees that any violation or threatened violation of this Agreement may cause irreparable injury to the other Party, entitling the other Party to seek injunctive relief in addition to all legal remedies.

11. Solicitation of Employees. Each Party (FLVS and Company) agrees that, during the Term of this Agreement and for a period of twelve months following the termination of this Agreement for any reason, such Party shall not, directly or indirectly, on its own behalf for as a representative of any other person or entity, knowingly solicit or induce any employee of the other Party to terminate his or her employment relationship or to enter into employment with any other person or entity.

12. Public Records. This Agreement shall be subject to Florida's Public Records Laws, Chapter 119, Florida Statutes. Company understands the broad nature of these laws and agrees to comply with Florida's public records laws and laws relating to records retention. In compliance with Section 119.0701, Florida Statutes, Company agrees to:

a. Keep and maintain public records required by the FLVS in order to perform the Services.

b. Upon request from FLVS's custodian of public records, provide FLVS with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in the Chapter 119, Florida Statues or as otherwise provided by law.

c. Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the Agreement term and following completion of the Agreement if the Company does not transfer the records to FLVS.

d. Upon completion of the Agreement, transfer, at no cost, to FLVS all public records in possession of the Company or keep and maintain public records required by FLVS to perform the Service. If the Company transfers all public records to FLVS upon completion of the Agreement, the Company shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the Company keeps and maintains public records upon completion of the Agreement, the Company shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to FLVS, upon request of FLVS's custodian of public records, in a format that is compatible with the information technology systems of FLVS.

IF THE COMPANY HAS QUESTIONS REGARDING THE

APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE

COMPANY’S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO

THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC

RECORDS AT, CustodianofRecords@flvs.net, OR BY PHONE 407-

490-2879, OR BY MAIL TO: 5422 CARRIER DRIVE, SUITE 201,

ORLANDO, FL 32819.

13. Miscellaneous. This Agreement may be executed in one or more counterparts, each of which shall be an original and all of which together shall constitute one instrument. This Agreement shall bind and inure to the benefit of the Parties hereto and their successors and assigns. This Agreement shall be governed by the laws of the State of Florida, without reference to conflict of laws principles. In any action arising out of or related to this Agreement, the Parties hereto consent to the exclusive jurisdiction and venue in the courts located in the Orange County of Florida. This document contains the entire agreement between the Parties with respect to the subject matter hereof, and neither Party shall have any obligation, express or implied by law, with respect to trade secret or proprietary information of the other Party except as set forth herein. Any failure to enforce any provision of this Agreement shall not constitute a waiver thereof or of any other provision. This Agreement may not be amended, nor any obligation waived, except by a writing signed by both Parties hereto.

IN WITNESS WHEREOF, the Parties have caused this Mutual Nondisclosure Agreement to be executed by their duly authorized representatives as of the date first written above.

Florida Virtual School

Signature:

Print Name: Louis J. Algaze, Ph.D.

Title: President and CEO

Date:

Approved as to form: ____________________________

FLVS Office of General Counsel

Company

Signature:

Print Name:

Title:

Company Name

Phone Number:

Email:

Date:

Addenda Form / Dispute Resolution Clause

The signer of this response guarantees, as evidence by the sworn affidavit required herein, the truth and accuracy of all statements and of all answers to interrogatories hereinafter made.

The undersigned hereby authorizes any public official, engineer, architect, surety company, bank depository, material or equipment manufacturer or distributor or any person, firm or corporation to furnish any pertinent information requested by Florida Virtual School or their representative, deemed necessary to verify the statements made in this qualification form or regarding the standing and general reputation of the applicant. The signer also states that all information given is an accurate representation of the office location and resources from where the services are to be rendered.

Receipts of the following Addenda are hereby acknowledged: (List all Addenda as follows):

ADDENDUM NO: Dated:

ADDENDUM NO: Dated:

ADDENDUM NO: Dated:

Date:

Name of Organization:

Name:

Title:

Signature:

Dispute Resolution Clause

In the event a dispute occurs, or a clarification of minor contract terms becomes necessary, indicate your Proposer representative.

Representative's Name:

Telephone Number:

FLVS representative will be the Procurement Director.

Appendix E

Florida Virtual School is a public agency subject to Chapter 119, Florida Statutes. Contractor understands the broad nature of these laws and agrees to comply with Florida's public records laws and laws relating to records retention. In compliance with Section 119.0701, Florida Statutes, Contractor agrees to:

1. Keep and maintain public records required by the FLVS in order to perform the Services.

2. Upon request from FLVS's custodian of public records, provide FLVS with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in the Chapter 119, Florida Statues or as otherwise provided by law.

3. Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the Agreement term and following completion of the Agreement if the Contractor does not transfer the records to FLVS.

4. Upon completion of the Agreement, transfer, at no cost, to FLVS all public records in possession of the Contractor or keep and maintain public records required by FLVS to perform the Service. If the Contractor transfers all public records to FLVS upon completion of the Agreement, the Contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the Contractor keeps and maintains public records upon completion of the Agreement, the Contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to FLVS, upon request of FLVS's custodian of public records, in a format that is compatible with the information technology systems of

FLVS.

IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF

CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR’S DUTY TO

PROVIDE PUBLIC RECORDS RELATING TO THIS AGREEMENT, CONTACT THE

CUSTODIAN OF PUBLIC RECORDS AT, CustodianofRecords@flvs.net, OR BY

PHONE 407-490-2879, OR BY MAIL TO: 5422 CARRIER DRIVE, SUITE 201,

ORLANDO, FL 32819.

Company Official Signature:

Date:

Proposer has provided a redacted version of the proposal that reflects exemptions claimed to F.S. 119 and included the specific statutory citation and explanation for such exemption pertaining to proprietary, confidential, trade secret or otherwise exempt content. Proposer bears responsibility for defending any exemptions taken.

Appendix F Public Records Act / Chapter 119 Requirements

Exceptions:

Name and Title Date

Reference Release Form

I of Name/Title Company Name

Hereby give Florida Virtual School authorization to check our company’s previous performance.

Authorizing Signature

NOTE: FLVS at its sole discretion may choose to contact / verify reference provided.

REFERENCE 1.

COMPANY NAME:

COMPANY ADDRESS:

CONTACT PERSON:

PHONE NUMBER:

EMAIL:

REFERENCE 2.

COMPANY NAME:

COMPANY ADDRESS:

CONTACT PERSON:

PHONE NUMBER:

EMAIL:

REFERENCE 3.

COMPANY NAME:

COMPANY ADDRESS:

CONTACT PERSON:

PHONE NUMBER:

EMAIL:

Appendix G

MANDATORY CERTIFICATIONS: CONTRACTS SUPPORTED BY FEDERAL FUNDS

The purpose of this document is to ensure Contractor compliance with local, state, and federal regulations which apply to Contractor agreements whereby Florida Virtual School (“FLVS”) provides payment from federal funding sources. By signing the following certifications and statements, the Contractor affirms its/his/her compliance with such regulations (as described below) throughout the term of an agreement with FLVS.

REGULATORY COMPLIANCE STATEMENT

1. The Contractor agrees to allow FLVS, a federal granting agency, the Comptroller General of the United States or Florida, or any of their duly authorized representatives reasonable access to Contractor’s books, documents, papers, and records which are directly pertinent to the contract for the purpose of making audit, examination, excerpts and transcriptions.

2. The Contractor agrees to maintain all records related to this agreement for a period of three years after the final payment for the agreement and after all other matters are closed.

3. The Contractor affirms that it is equal opportunity and affirmative action employer and shall comply with all applicable federal, state and local laws and regulations including, but not limited to: Executive Order 11246 as amended by 11375 and 12086; 12138;

11625; 11758; 12073; the Rehabilitation Act of 1973, as amended; the Vietnam Era Veterans Readjustment Assistance Act of 1975; Civil Rights Act of 1964; Equal Pay Act of 1963; Age Discrimination Act of 1967; Immigration Reform and Control Act of 1986;

Public Law 95-507; the Americans with Disabilities Act; 41 CFR Part 60 and any additions or amendments thereto.

4. The Contractor agrees to a provision for non-appropriations, whereby the contract will terminate if sufficient funds are not appropriated in any given fiscal year to allow FLVS to sustain the cost (if applicable).

5. The Contractor agrees to properly complete and submit to FLVS a federal debarment certification form for each renewal year of the Contract, if renewals apply.

6. The Contractor agrees to properly complete and submit to FLVS a non-collusion affidavit.

7. The Contractor agrees to properly complete and submit to FLVS a federal drug free workplace certification form.

8. The Contractor agrees FLVS may terminate the contract at any time for any reason. If terminated for cause, the Contractor agrees FLVS may seek remedies for damages, if applicable.

9. The Contractor agrees to comply with all applicable environmental standards, orders or requirements.

PUBLIC ENTITY CRIME BAR: A PERSON OR AFFILIATE WHO HAS BEEN PLACED

ON THE CONVICTED VENDOR LIST FOLLOWING A CONVICTION FOR A PUBLIC

ENTITY CRIME MAY NOT SUBMIT A PROPOSAL ON A CONTRACT TO PROVIDE

ANY GOODS OR SERVICES TO A PUBLIC ENTITY, MAY NOT SUBMIT A PROPOSAL

ON A CONTRACT WITH A PUBLIC ENTITY FOR THE CONSTRUCTION OR REPAIR

OF A PUBLIC BUILDING OR PUBLIC WORK, MAY NOT SUBMIT PROPOSALS ON

LEASES OF REAL PROPERTY TO A PUBLIC ENTITY, MAY NOT BE AWARDED OR

PERFORM WORK AS A CONTRACTOR, SUPPLIER, SUBCONTRACTOR, OR

CONSULTANT UNDER A CONTRACT WITH A PUBLIC ENTITY, AND MAY NOT

TRANSACT BUSINESS WITH ANY PUBLIC ENTITY IN EXCESS OF THE THRESHOLD

AMOUNT PROVIDED IN SECTION 287.017, FOR CATEGORY TWO FOR A PERIOD

OF 36 MONTHS FROM THE DATE OF BEING PLACED ON THE CONVICTED

VENDOR LIST.

DISCRIMINATORY VENDOR BAR: AN ENTITY OR AFFILIATE WHO HAS BEEN

PLACED ON THE DISCRIMINATORY VENDOR LIST MAY NOT SUBMIT A BID ON A

CONTRACT TO PROVIDE GOODS OR SERVICES TO A PUBLIC ENTITY, MAY NOT

SUBMIT A BID ON A CONTRACT WITH A PUBLIC ENTITY FOR THE CONSTRUCTION

OR REPAIR OF A PUBLIC BUILDING OR PUBLIC WORK, MAY NOT SUBMIT BIDS ON

LEASES OF REAL PROPERTY TO A PUBLIC ENTITY, MAY NOT AWARD OR

PERFORM WORK AS A CONTRACTOR, SUPPLIER, SUBCONTRACTOR, OR

CONSULTANT UNDER CONTRACT WITH ANY PUBLIC ENTITY, AND MAY NOT

TRANSACT BUSINESS WITH ANY PUBLIC ENTITY.

THE FOREGOING IS ACKNOWLEDGED AND AGREED TO BY THE CONTRACTOR.

CONTRACTOR NAME: ________________________________________________

AUTHORIZED CONTACTOR REPRESENTATIVE SIGNATURE:

(Printed Name) (Signature)

(Title) (Date)

CERTIFICATION REGARDING NON-DISCRIMINATION

THE UNDERSIGNED ASSURES THAT IT SHALL COMPLY WITH:

A. TITLE VI OF THE CIVIL RIGHTS ACT OF 1964, AS AMENDED, 42 U.S.C. 2000d

ET SEQ., WHICH PROHIBITS DISCRIMINATION ON THE BASIS OF RACE,

COLOR, OR NATIONAL ORIGIN.

B. SECTION 504 OF THE REHABILITATION ACT OF 1973, AS AMENDED, 20

U.S.C. 794, WHICH PROHIBITS DISCRIMINATION ON THE BASIS OF

HANDICAP.

C. TITLE IV OF THE EDUCATION AMENDMENTS OF 1972, AS AMENDED, 20

U.S.C. 1681 ET SEQ., WHICH PROHIBITS DISCRIMINATION ON THE BASIS

OF SEX.

D. THE AGE DISCRIMINATION ACT OF 1975, AS AMENDED, 42 U.S.C. 6101 ET

SEQ., WHICH PROHIBITS DISCRIMINATION ON THE BASIS OF AGE.

E. SECTION 654 OF THE OMNIBUS BUDGET RECONCILIATION ACT OF 1981,

AS AMENDED, 42 U.S.C. 9849, WHICH PROHIBITS DISCRIMINATION ON THE

BASIS OF RACE, CREED, COLOR, NATIONAL ORIGIN, SEX, HANDICAP,

POLITICAL AFFILIATION OR BELIEFS.

F. THE AMERICANS WITH DISABILITIES ACT OF 1990, P.L. 101-336, WHICH

PROHIBITS DISCRIMINATION ON THE BASIS OF DISABILITY AND REQUIRES

REASONABLE ACCOMMODATION FOR PERSON WITH DISABILITIES.

G. ALL REGULATIONS, GUIDELINES, AND STANDARDS AS ARE NOW OR MAY

BE LAWFULLY ADOPTED UNDER THE ABOVE STATUTES.

THE VENDOR AGREES THAT ITS GOOD FAITH PROVISION OF THIS ASSURANCE

AND CERTIFICATION CONSTITUTES A CONDITION PRECEDENT TO RECEIVING

PAYMENT UNDER THIS CONTRACT/PURCHASE ORDER AND THAT IT IS BINDING

UPON THE VENDOR FOR THE PERIOD DURING WHICH SERVICES/PRODUCTS

ARE PROVIDED.

CONTRACTOR NAME: ________________________________________________

AUTHORIZED CONTACTOR REPRESENTATIVE SIGNATURE:

(Printed Name) (Signature)

CERTIFICATION REGARDING LOBBYING

THE UNDERSIGNED CERTIFIES, TO THE BEST OF HIS OR HER KNOWLEDGE AND

BELIEF, THAT:

1. NO FEDERAL APPROPRIATED FUNDS HAVE BEEN PAID OR SHALL BE PAID

BY OR ON BEHALF OF THE UNDERSIGNED, TO ANY PERSON FOR INFLUENCING

OR ATTEMPTING TO INFLUENCE AN OFFICER OR EMPLOYEE OF ANY AGENCY,

A MEMBER OF CONGRESS, AN OFFICER OR EMPLOYEE OF CONGRESS, OR AN

EMPLOYEE OF A MEMBER OF CONGRESS IN CONNECTION WITH THE AWARDING

OF ANY FEDERAL CONTRACT, THE MAKING OF ANY FEDERAL GRANT, THE

MAKING OF ANY FEDERAL LOAN, THE ENTERING INTO OF ANY COOPERATIVE

AGREEMENT, AND THE EXTENSION, CONTINUATION, RENEWAL, AMENDMENT,

OR MODIFICATION OF ANY FEDERAL CONTRACT, GRANT, LOAN OR

COOPERATIVE AGREEMENT.

2. IF ANY FUNDS OTHER THAN FEDERAL APPROPRIATED FUNDS HAVE BEEN

PAID OR SHALL BE PAID TO ANY PERSON FOR INFLUENCING OR ATTEMPTING

TO INFLUENCE AN OFFICER OR EMPLOYEE OF ANY AGENCY, A MEMBER OF

CONGRESS, AN OFFICER OR EMPLOYEE OF CONGRESS, OR AN EMPLOYEE OF

A MEMBER OF CONGRESS IN CONNECTION WITH THIS FEDERAL CONTRACT,

GRANT, LOAN, OR COOPERATIVE AGREEMENT, THE UNDERSIGNED SHALL

COMPLETE AND SUBMIT STANDARD FORM-LLL, “DISCLOSURE FORM TO

REPORT LOBBYING,” IN ACCORDANCE WITH ITS INSTRUCTIONS.

3. THE UNDERSIGNED SHALL REQUIRE THAT THE LANGUAGE OF THIS

CERTIFICATION BE INCLUDED IN THE AWARD DOCUMENTS FOR ALL SUB-

AWARDS AT ALL TIERS (INCLUDING SUBCONTRACTS, SUB-GRANTS AND

CONTRACT UNDER GRANTS, LOANS, AND COOPERATIVE AGREEMENTS) AND

THAT ALL SUB-RECIPIENTS SHALL CERTIFY AND DISCLOSE ACCORDINGLY.

THIS CERTIFICATION IS A MATERIAL REPRESENTATION OF FACT UPON WHICH

RELIANCE WAS PLACED WHEN THIS TRANSACTION WAS MADE OR ENTERED

INTO. SUBMISSION OF THIS CERTIFICATION IS A PREREQUISITE FOR MAKING

OR ENTERING INTO THIS TRANSACTION. ANY PERSON WHO FAILS TO FILE THE

REQUIRED CERTIFICATION SHALL BE SUBJECT TO CIVIL PENALTY FOR EACH

SUCH FAILURE.

CONTRACTOR NAME: ________________________________________________

AUTHORIZED CONTACTOR REPRESENTATIVE SIGNATURE:

(Printed Name) (Signature)

DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS

AS REQUIRED BY EXECUTIVE ORDER 12549, DEBARMENT AND SUSPENSION, AND

IMPLEMENTED AT 34 CFR PART 85, FOR PROSPECTIVE PARTICIPANTS IN PRIMARY

COVERED TRANSACTIONS, AS DEFINED AT 34 CFR PART 85, SECTION 95.105 AND

85.110, THE BIDDER/CONTRACTOR CERTIFIES THAT IT AND ITS PRINCIPALS:

A. ARE NOT PRESENTLY DEBARRED, SUSPENDED, PROPOSED FOR DEBARMENT,

DECLARED INELIGIBLE, OR VOLUNTARILY EXCLUDED FROM COVERED TRANSACTIONS

BY ANY FEDERAL DEPARTMENT OR AGENCY;

B. HAVE NOT WITHIN A THREE YEAR PERIOD PRECEDING THIS INVITATION TO BID

BEEN CONVICTED OF OR HAD CIVIL JUDGMENT RENDERED AGAINST THEM FOR

COMMISSION OF FRAUD OR A CRIMINAL OFFENSE IN CONNECTION WITH OBTAINING

OR ATTEMPTING TO OBTAIN, OR PERFORMING A PUBLIC (FEDERAL, STATE OR LOCAL)

TRANSACTION OR CONTRACT UNDER A PUBLIC TRANSACTION: VIOLATION OF

FEDERAL OR STATE ANTITRUST STATUTES OR COMMISSION OF EMBEZZLEMENT,

THEFT, FORGERY, BRIBERY, FALSIFICATION OR DESTRUCTION OF RECORDS, MAKING

FALSE STATEMENTS, OR RECEIVING STOLEN PROPERTY;

C. ARE NOT PRESENTLY INDICATED FOR OR OTHERWISE CRIMINALLY OR CIVILLY

CHARGED BY A GOVERNMENT ENTITY (FEDERAL, STATE OR LOCAL) WITH COMMISSION

OF PAYING FEDERAL FUNDS OR SHALL PAY FEDERAL FUNDS BY OR ON BEHALF OF

THE UNDERSIGNED TO ANY PERSON FOR INFLUENCING OR ATTEMPTING TO

INFLUENCE AN OFFICER OR EMPLOYEE OF ANY AGENCY, A MEMBER OF CONGRESS,

AN OFFICER OR EMPLOYEE OF CONGRESS OR AN EMPLOYEE OF A MEMBER OF

CONGRESS IN CONNECTION WITH THE MAKING OF ANY FEDERAL GRANT, THE

ENTERING INTO ANY COOPERATIVE AGREEMENT, AND THE EXTENSION,

CONTINUATION, RENEWAL, AMENDMENT OR MODIFICATION OF ANY FEDERAL GRANT

OR COOPERATIVE AGREEMENT; AND

D. HAVE NOT WITHIN A THREE YEAR PERIOD PRECEDING THIS INVITATION TO BID

HAD ONE OR MORE PUBLIC TRANSACTION (FEDERAL, STATE OR LOCAL) TERMINATED

FOR CAUSE OR DEFAULT.

AS A DULY AUTHORIZED REPRESENTATIVE OF THE COMPANY OR INDIVIDUAL

SUBMITTING THIS CONTRACT OR BID PACKAGE OR RESPONSE TO RFP, I HEREBY

CERTIFY THAT SAID COMPANY OR INDIVIDUAL FULLY COMPLIES WITH THE

CONDITIONS AND REQUIREMENTS HEREIN STATED.

CONTRACTOR NAME: ________________________________________________

AUTHORIZED CONTACTOR REPRESENTATIVE SIGNATURE:

(Printed Name) (Signature)

DRUG-FREE WORKPLACE CERTIFICATION

Preference shall be given to vendors/contractors certifying their compliance with a drug-free workplace in accordance with Section 287.087, Fla. Stat., as follows:

IDENTICAL TIE BIDS – A bid or contract received from a business that certifies that it has implemented a drug-free workplace program shall be given preference in the award process. Established procedure for processing tie bids shall be followed if none of the tied vendors has a drug-free workplace program. To obtain such preference, a business shall:

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 what shall be taken against employee for violations of such prohibition.

2. 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.

3. Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in subsection (1).

4. In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee shall abide by the terms of the statement and shall notify the employer of any conviction or plea of guilty or no contest to any violation of Chapter 893 or of any controlled substance laws of the United States or the State of Florida, for a violation occurring in the workplace no later than five (5) days after such conviction.

5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee’s community, by any employee who is so convicted.

6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section.

I certify that this firm complies fully with the above requirements.

CONTRACTOR NAME: ________________________________________________

AUTHORIZED CONTACTOR REPRESENTATIVE SIGNATURE:

(Printed Name) (Signature)

NON-COLLUSION AFFIDAVIT

STATE OF

COUNTY OF

My name is (INSERT NAME ________________________). I hereby attest that I am authorized to execute this affidavit on behalf of my firm, its owners, directors, and officers.

I have personal knowledge of the price(s), guarantees and the total financial commitment represented in the firm’s offer and/or contract.

(1) The firm’s prices and amounts offered have been arrived at independently and without consultation, communication or agreement with any other contractor or respondent.

(2) Neither the final nor approximate prices or amounts offered have been disclosed to any other firm or person who is a respondent or potential respondent, nor were they disclosed prior to opening of offers.

(3) The offer from my firm is made in good faith and no attempt has been made to induce any firm or person to refrain from submitting an offer, or to submit an offer higher than our offer, or to submit any intentionally high or noncompetitive offer or other form of complementary offer.

(4) (INSERT NAME OF COMPANY _______________________________) its affiliates, subsidiaries, officers, directors, employees are not currently under investigation by any governmental agency and have not in the last three years been convicted or found liable for any act prohibited by State or Federal law in any jurisdiction, involving conspiracy or collusion with respect to bidding, proposing or offering on any public contract, except as follows:

I attest that (INSERT NAME OF COMPANY _______________________________) understands and acknowledges that the above representations are material and important, and will be relied on by Florida Virtual School, in awarding the contract for which this offer is submitted. I understand and my firm understands that any misstatement of material representations herein stated shall be treated as intentional concealment of the true facts relating to submission of offers for this contract.

CONTRACTOR NAME: ________________________________________________

AUTHORIZED CONTACTOR REPRESENTATIVE SIGNATURE:

(Signature)

(Date)

(Printed Name)

(Title)

FLVS.net | procurement@flvs.net | 800.374.1430 | 5422 Carrier Drive, Suite 201 Orlando, FL 32819

VENDOR AND CONTRACTOR REGISTRATION FORM

Company/Contractor Name:

Contact Person:

New Vendor Update Existing Registration

Phone Number:

Contact E-mail:

Payment Address: (if different from above)

Website:

Tax ID Number*: or Federal Employer Identification Number Social Security Number

*Please note that the company name and FEIN or SSN on this form must match the W-9 submitted with this application.

PAYMENT METHOD:

1. Payment by purchasing card, i.e. credit card (preferred method):

2. Payment by ACH: (if yes, FLVS finance team will provide a separate form by email)

3. Payment by check:

Are you a current FLVS employee or have you ever been employed by FLVS:

If yes, please specify employment dates:

Vendor/Contractor Signature:

Title: ________________________________

Submission of this form does not constitute any guarantee for award, agreement to purchase, or FLVS obligation to provide notification of any solicitation activity. It is the sole responsibility of the interested party to identify opportunities by visiting the FLVS website at:

https://www.flvs.net/about-us/operational-information/procurement or on Bonfire at https://flvs.bonfirehub.com/portal/?tab=openOpportunities.

Individual/ Sole Proprietor Corporation

LLC

Joint Venture Partnership/ Limited Partnership Nonprofit Other:

Is your entity registered with the Florida Division of Corporations (SunBiz.org)

Contact Person Title:

Street:

City: State: Zip: Country:

Mailing Address:

Street:

City: State: Zip: Country:

Place of Incorporation (U.S. State):

If a foreign entity, please provide the country where your entity was established:

PLEASE CHECK THE APPROPRIATE BOX:

YES NO

YES NO

YES NO

YES NO

YES NO

Date:

mailto:procurement@flvs.net https://flvs.bonfirehub.com/portal/?tab=openOpportunities

E-VERIFY CERTIFICATION AND AFFIDAVIT

1. I am over eighteen (18) years old and I have personal knowledge of the factual assertions set forth herein.

2. I am (title) of (“Contractor”) .

3. I hereby attest that I am authorized to execute this affidavit on behalf of the above named company, its owners, directors, and officers.

4. The Contractor has contracted with or may contract with Florida Virtual School (“FLVS”) (the “Agreement”).

5. I hereby certify that the Contractor is registered or, if not registered, shall register with and shall use the United States Department of Homeland Security’s E-Verify system to verify the work authorization status of all employees hired during the term of the Agreement and shall provide evidence thereof upon request.

6. The Contractor does not and shall not employ, contract with, or subcontract with an unauthorized alien, pursuant to section 448.095, Florida Statutes.

7. The Contractor shall require all subcontractors performing work under the Agreement to use the E-Verify system for any employees they may hire during the term of the Agreement.

8. The Contractor shall require all subcontracts performing work under the Agreement to provide an affidavit stating the subcontractor does not employ, contract with, or subcontract with an unauthorized alien, pursuant to section 448.095, Florida Statutes. The Contractor shall provide FLVS with a copy of said affidavit upon receipt and shall maintain a copy during the term of the Agreement.

CONTRACTOR NAME:

AUTHORIZED REPRESENTATIVE:

(Printed Name) (Signature)

(Date)

FOREIGN COUNTRY OF CONCERN ATTESTATION

(PUR 1355)

This form must be completed by an officer or representative of an entity submitting a bid, proposal, or reply to, or entering into, renewing, or extending, a contract with a Governmental Entity which would grant the entity access to an individual’s Personal Identifying Information.

Capitalized terms used herein have the definitions ascribed in Rule 60A-1.020, F.A.C.

____________________________________________ is not owned by the government of a Foreign Country of Concern, is not organized under the laws of nor has its Principal Place of Business in a Foreign Country of Concern, and the government of a Foreign Country of Concern does not have a Controlling Interest in the entity.

Under penalties of perjury, I declare that I have read the foregoing statement and that the facts stated in it are true.

Printed Name:

Title:

Signature: Date:

https://www.flrules.org/gateway/RuleNo.asp?title=GENERAL%20REGULATIONS&ID=60A-1.020

EXHIBIT C

STUDENT INFORMATION

The undersigned Contractor (select as applicable), ☐ [in order to fulfill its contracted duties for FLVS, is designated by FLVS as a “school official” with a legitimate educational interest and Contractor will receive and have access to certain personally identifiable information from FLVS student education records;

accordingly,]

☐ [shall not have access to FLVS’s student education records under the Agreement;

however, if Contractor is subsequently designated by FLVS as a “school official” with a legitimate educational interest for the purpose of receiving and having access to certain FLVS’s student education records pursuant to the Agreement, then the Contractor shall execute and deliver to FLVS a new Exhibit C in substantially the following format.]

Contractor, its officers, employees, and agents shall fully comply with the requirements of the Family Education Rights and Privacy Act (FERPA) (20 U.S.C. s. 1232g and 34 C.F.R. 99.31), and Sections 1002.22, 1002.221, and 1006.1494, Florida Statutes, State Board of Education rules 6A-1.0955 and 6A-1.09550, and all applicable laws and regulations regarding the confidentiality of personally identifiable student information and records. Contractor shall indemnify, defend, and hold harmless FLVS, its officers, and employees for any violation of this covenant. This provision shall survive the termination of this Agreement and shall be binding upon Contractor until such time as any claim arising from a breach of this covenant is barred by any applicable statute of limitations.

As a condition precedent to receiving personally identifiable information from the education records of students, the Contractor warrants and agrees that the Contractor:

1. will limit the use of, or access to, personally identifiable information from education records of students to the limited scope of information actually needed to complete the Contractor’s duties and/or services under the Agreement. FLVS has determined that Contractor has a legitimate educational interest in receiving only the following fields of student data (for example, name, grade-level, school attending, etc.):

Product/Service Name: ___________________________________________________

Student Information: _____________________________________________________

2. will limit the access to personally identifiable information from education records of students to its employees and/or agents who actually have a legitimate educational interest in the information (i.e., they legitimately need to access the information in order to fulfill the Contractor’s responsibilities under the Agreement); and

3. shall avoid, and shall instruct applicable employees/agents to avoid, accessing personally identifiable information from education records of students, except for the legitimate purposes recognized under the Agreement, and shall require that all employees/agents accessing the data must be trained in, and sign an acknowledgement regarding, the confidentiality requirements; and

4. is under the direct control of FLVS with respect to the use and maintenance of education records; and

5. is subject to the requirements of 34 C.F.R. s. 99.33(a) governing the use and redisclosure of personally identifiable information from an education record of a student, meaning the Contractor may disclose personally identifiable information from an education record only on the condition that the party to whom the information is disclosed will not disclose the information to any other party without the prior consent of the parent or eligible student as those terms are defined in 34 C.F.R. s. 99.3, and the officers, employees, and agents of a party that receives information from the Contractor may use the information, subject to the limitations described in paragraph C.2 above, but only for the purposes for which the disclosure was made; and

6. shall not disclose or redisclose personally identifiable information to a third party unless the disclosure is made pursuant to and authorized by: (a) FERPA and 34 CFR 99.31;

or (b) prior written consent of a parent or an eligible student; and

7. shall comply with the requirements of the Family Educational Rights and Privacy Act (FERPA), its implementing regulations, Section 1002.22, Florida Statutes, the Protection of Pupil Rights Amendment (PPRA); the Student Online Personal Information Protection Act, F.S. 1006.1494 and implementing State Board of Education rules; and the Children’s Online Privacy Protection Act (COPPA), 15 USC ss 6501-6506, and its implementing regulations, and shall not use any of the personally identifiable information from education records of students that is received pursuant to the Agreement in violation of any applicable federal or state law, rule, regulation, or FLVS policy. The personally identifiable information must not be used for any other purpose other than the purposes outlined in the Agreement.