13-Pre-Award Site Visit Certification GEN2132859B1.docx

Pre-Award Site Visit Certification

Removal and Transportation of Deceased Persons

The questionnaire responses should be submitted with the solicitation response; the Vendor should upload a written detailed response for each question with submittal. If not submitted with response, it must be submitted within three business days after the County’s written request. Vendor may be deemed non-responsible for failure to fully comply within these stated timeframes.

1. Does the bidder have an active State of Florida license as a Removal Service pursuant to Section 497.385, Florida Statutes, issued by the Florida Department of Financial Services, Division of Funeral, Cemetery, and Consumer Services?

Yes ☐ No ☐

2. In what year was the bidder first licensed as a Removal Service in the State of Florida?

Click or tap here to enter text.

3. Has the bidder continuously operated as a licensed Removal Service for at least three (3) years immediately preceding the Bid submission deadline?

Yes ☐ No ☐

4. Within the past five (5) years preceding the Bid submission deadline, has the bidder been subject to a complaint filed with the Florida Department of Financial Services, Division of Funeral, Cemetery, and Consumer Services, that resulted in a penalty or disciplinary action?

Yes ☐ No ☐

5. As of the Bid submission deadline, does the bidder have an operational office within Broward County, as verified by a valid Business Tax Receipt?

Yes ☐ No ☐

6. As of the Bid submission deadline, does the bidder own at least four (4) removal transport vehicles that meet the vehicle specifications outlined in Section E of the Specifications and Requirements?

Yes ☐ No ☐

7. Is each vehicle equipped with all equipment required by Chapter 69K, Florida Administrative Code?

Yes ☐ No ☐

8. Are the vehicles free of any advertisements, business logos, printing or markings of any kind on either the exterior or interior of any vehicle used this under the Agreement, including the Vendor's name or logo.

Yes ☐ No ☐

9. Is each vehicle equipped with two (2) one-person stretchers, cot covers, and auxiliary stretchers for use in transporting deceased individuals and is each transport vehicle equipped with a locking mechanism to immobilize the stretcher when in transit.

Yes ☐ No ☐

10. Can the bidder provide proof of ownership, such as a vehicle title or vehicle registration, for each removal transport vehicle identified in response to Question 7?

11. How many removal transport vehicles does the bidder own? Click or tap here to enter text.

12. As of the Bid submission deadline, does the bidder employ at least eight (8) full-time employees who meet the Requirements for Employees of Vendor as outlined in Section F of the Specifications and Requirements?

Yes ☐ No ☐

13. What is the total number of removal staff employed by the bidder? Click or tap here to enter text.

14. As of the Bid submission deadline, can the bidder provide three (3) months of payroll records demonstrating that it employs at least eight (8) employees who meet the Requirements for Employees of Vendor as outlined in Section F of the Specifications and Requirements?

Yes ☐ No ☐

15. Does the bidder understand that subcontracting is not permitted under this Agreement, and, therefore, independent contractors (Form 1099 workers) may be used to perform services Yes ☐ No ☐

Vendor Name: Click or tap here to enter text.

Signature: Click or tap here to enter text.

Printed Name: Click or tap here to enter text.

Title: Click or tap here to enter text.

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