Appendix B – Response Forms

1412203478 (RFP-CCNA) Geotechnical Services for Transmission and Substation Projects

Appendix B – Response Form

COMPANY INFORMATION:

COMPANY NAME:

BUSINESS ADDRESS:

CITY, STATE, ZIP CODE:

TELEPHONE:

EMAIL OF CONTACT:

I have read and understood the Sunshine Law/Public Records clauses contained within this solicitation. I understand that in the absence of a redacted copy my proposal will be disclosed to the public “as-is”.

The Company shall submit one electronic copy of the signed proposal documents on the sourcing platform, prior to the Bid Due Date and Time.

Company's Certification

By submitting this Proposal, the Company certifies that the Company has read and reviewed all of the documents pertaining to this RFP and agrees to abide by the terms and conditions set forth therein, that the person signing below is an authorized representative of the Company, that the Company is legally authorized to do business in the

State of Florida, and that the Company maintains in active status an appropriate license for the work.

The Company certifies, under penalty of perjury, that it holds all licenses, permits, certifications, insurances, bonds and other credentials required by law, Contract or practice to perform the Work. The Company also certifies that, upon the prospect of any change in the status of applicable licenses, permits, certifications, insurances, bonds or other credentials, the Company shall immediately notify JEA of status change.

We have received addenda through

Signature of Authorize Officer of Firm or Agent Date

Printed Name & Title Phone Number

Appendix B Minimum Qualifications Form

GENERAL

THE MINIMUM QUALIFICATIONS SHALL BE SUBMITTED ON THIS FORM. IN ORDER TO BE

CONSIDERED A QUALIFIED PROPOSER BY JEA YOU MUST MEET THE MINIMUM

QUALIFICATIONS LISTED BELOW, AND BE ABLE TO PROVIDE ALL THE SERVICES LISTED IN

THIS SOLICITATION.

THE PROPOSER MUST COMPLETE THE COMPANY INFORMATION SECTION BELOW AND

PROVIDE ANY OTHER INFORMATION OR REFERENCE REQUESTED. THE PROPOSER MUST

ALSO PROVIDE ANY ATTACHMENTS REQUESTED WITH THIS MINIMUM QUALIFICATIONS

FORM.

PLEASE SUBMIT AN ELECTRONIC COPY OF THIS FORM AND ANY REQUESTED ADDITIONAL

DOCUMENTATION WITH THE BID SUBMISSION.

COMPANY INFORMATION

COMPANY NAME:

BUSINESS ADDRESS:

CITY, STATE, ZIP CODE:

TELEPHONE:

E-MAIL:

PRINT NAME OF AUTHORIZED REPRESENTATIVE:

SIGNATURE OF AUTHORIZED REPRESENTATIVE:

NAME AND TITLE OF AUTHORIZED REPRESENTATIVE:

Respondent must meet the following Minimum Qualifications to be considered eligible to have its Response evaluated by JEA. Respondent must complete and submit the Minimum

Qualification Form provided in this Solicitation. Respondents that are working or have worked for JEA in the past 2 years involving similar work must submit JEA as a reference. JEA reserves the right to ask for additional back up documentation or additional reference projects to confirm the Respondent meets the requirements stated below.

JEA may reject Responses from Respondents not meeting all of the following Minimum

Qualifications:

I. The Respondent must have successfully completed two (2) similar geotechnical services for transmission and two (2) similar geotechnical for substation projects, within the last seven (7) years as of the proposal due date.

II. Respondent must not be on the State of Florida Convicted Vendor List, State of Florida’s Suspended Vendor List, the City of Jacksonville’s Disqualified

Vendor List, have their bidding privileges actively suspended by JEA, been debarred by JEA, or have had a contract with JEA was terminated for default within the last two (2) years.

Geotechnical Transmission Reference 1

Reference Company Name_________________________________________________________

Reference Contact Person Name __________________________________________________

Reference Contact Person Phone Number_____________________________________________

Reference Contact Person E-Mail Address____________________________________________

Date Work Began/Date Work Complete______________________________________________

Contract Value__________________________________________________________________

Description of Project

Geotechnical Transmission Reference 2

Reference Contact Person Phone Number_____________________________________________

Reference Contact Person E-Mail Address____________________________________________

Date Work Began/Date Work Complete______________________________________________

Geotechnical Substation Reference 1

Reference Contact Person Phone Number_____________________________________________

Reference Contact Person E-Mail Address____________________________________________

Date Work Began/Date Work Complete______________________________________________

Geotechnical Substation Reference 2

Reference Contact Person Phone Number_____________________________________________

Reference Contact Person E-Mail Address____________________________________________

Date Work Began/Date Work Complete______________________________________________

CONFLICT OF INTEREST DISCLOSURE FORM

Disclosing a potential conflict of interest does not disqualify vendors. In the event vendors do not disclose potential conflicts of interest, and they are detected by JEA, vendor may be disqualified from doing business with JEA.

Questions about this form? Contact (JEA, Buyer)

JEA Bid/Solicitation/Contract Number:

Name of JEA Employee(s) Working on Vendor’s Current Contract(s) with JEA:

Vendor Name:

Vendor Phone:

Vendor’s Authorized Representative Name and Title: Authorized Representative’s Phone:

NAME(S) OF JEA EMPLOYEE(S) / PUBLIC OFFICER(S) WITH POTENTIAL CONFLICT OF INTEREST

Name of JEA public officer(s), employee(s), or relatives with whom there may be a potential conflict of interest. If more than five, attach a second form.

Relationship of JEA public officer(s)/employee(s) and/or relative(s) to vendor’s company from list above (e.g. 1(a), 2, etc.). Please list all that apply:

1.

2.

3.

4.

5.

□ Vendor has no conflict of interest to report.

□ Vendor hereby declares it has not and will not provide gifts or hospitality of any dollar value or any other gratuities to any JEA officer or employee to obtain or maintain a contract.

□ I certify that this Conflict of Interest Disclosure has been examined by me and that its contents are true and correct to my knowledge and belief and I have the authority to so certify on behalf of the Vendor.

Vendor’s Authorized Representative Signature: Date:

FOR JEA USE ONLY IF CONFLICT NOTED

https://www.jea.com/

This form has been reviewed by:

Name of JEA Ethics Officer: Signature: Date:

Note: