2-Appendix 1 Response Forms.pdf

SOLICITATION DOCUMENTS

Appendix 1: Solicitation Response Forms (Standard)

COVERSHEET

The applicable Solicitation Response Forms, as provided in the “Table of Forms” below, may be found attached to this coversheet.

TABLE OF FORMS

Form Title

TOH-100 Solicitation Response Signature Page

TOH-110 Addenda Acknowledgment Form

TOH-120 Affidavit of Non-Collusion and of Non-Interest of Toho Employees

TOH-140 Vendor’s Confidential Structural Records Acknowledgment

TOH 200 E-Verify Registration and Use Certification

TOH 210 Certifications Regarding Vendor Eligibility for Contracts with Public Entities

TOH 220 Common Carrier Certification

FORM

TOH-100

v: 03/2024

Solicitation Response Signature Page

Form Page

Instructions: “Vendor(s)”, defined as any person or entity responding to a formal solicitation issued by the Tohopekaliga Water Authority (“Toho”), must submit this form with their Solicitation Responses. The terms “Contract” and “Agreement” may be interchangeably used.

Vendor Name (as on Sunbiz.org):

Solicitation/Contract Number:

The undersigned hereby represents that they: make the following certification based upon personal knowledge; are over the age of 18 years and otherwise competent to make the following certification;

and are authorized to legally bind and make the following certification on behalf of the Vendor.

Under penalties of perjury, the undersigned hereby declares and certifies as follows:

A. They have read, reviewed, and approved the Solicitation Response the Vendor hereby submits in response to the above-numbered solicitation, including without limitation all attachments to such Solicitation Response; and

B. The information stated in all such documents is true and accurate.

By:

Authorized Representative on behalf of Vendor Printed Name:

Official Title:

STATE OF _________________

COUNTY OF _______________

The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this ____ day of ________________________, 20____, by _______________________, as __________________ of __________________________, a ________________________________ authorized to do business in the State of Florida on behalf of the company/corporation. They ☐ are personally known to me or ☐ have produced ___________________________ as identification.

(Seal)

Signature of Notary Public

Name of Notary Typed, Printed or Stamped

TOH-110

v: 03/2024

Addenda Acknowledgement Form Form Page

Instructions: “Vendor(s)”, defined as any other person or entity responding to a formal solicitation issued by the Tohopekaliga Water Authority (“Toho”), must use this form to acknowledge all formal addenda issued by Toho during the solicitation process. If no addendum was issued, Vendors are directed to select such option below.

Addenda Acknowledgement

Listed below are the dates of issue for each addendum received in connection with this solicitation.

Vendor hereby acknowledges and affirms that each such addendum: (1) has been incorporated into the solicitation documents; and (2) was considered by Vendor when preparing its response to the solicitation.

Addendum No. _______, Dated: __________________

Addendum No. _______, Dated: __________________

Addendum No. _______, Dated: __________________

Addendum No. _______, Dated: __________________

Addendum No. _______, Dated: __________________

Addendum No. _______, Dated: __________________

Addendum No. _______, Dated: __________________

Addendum No. _______, Dated: __________________

☐ No addendum was issued for this solicitation.

Printed Name:

Official Title:

Date:

TOH-120

v: 03/2024

Affidavit of Non-Collusions and of Non-Interest of Toho Employees

Instructions: “Vendor(s)”, defined as any person or entity responding to a formal solicitation issued by the Tohopekaliga Water Authority (“Toho”), must submit this form with their Solicitation Responses.

The terms “Contract” and “Agreement” may be interchangeably used.

Affidavit of Non-Collusion and of Non-Interest of Toho Employees

The undersigned hereby certifies that they are authorized to legally bind the Vendor of this Solicitation Response, that the only person(s) or party(s) interested in this Solicitation Response are those named in the Solicitation Response, that no officer, employee, or agent of the Tohopekaliga Water Authority or any other Vendor is interest in this Solicitation Response, that this Solicitation Response is made without fraud, that this Solicitation Response is made with no past or present collusion with any other person, firm, or corporation.

By submitting a Solicitation Response to the above-referenced Solicitation, Vendor also represents that this Solicitation Response has been prepared without collusion or fraud and in fair competition with other Vendors, without any restraint on free competition, and acknowledges that TOHO is acting in reliance upon that representation.

The undersigned hereby represents that they: make the above certifications based upon personal knowledge; are over the age of 18 years and otherwise competent to make the above certifications; and are authorized to legally bind and make the above certifications on behalf of Vendor.

Under penalties of perjury, the undersigned declares that they have read and understand the contents of the foregoing form. Pursuant to the authority granted to the undersigned by Vendor, the undersigned hereby acknowledges, affirms, and makes the above sworn statement.

Printed Name:

Official Title:

STATE OF _________________

COUNTY OF _______________

The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this ____ day of ________________________, 20____, by _______________________, as __________________ of __________________________, a ________________________________ authorized to do business in the State of Florida on behalf of the company/corporation. They ☐ are personally known to me or ☐ have produced ___________________________ as identification.

TOH-140

v: 03/2024

Vendor’s Confidential Structural Records Acknowledgment Form Page

Instructions: “Vendor(s)”, defined as any person or entity responding to a formal solicitation issued by the Tohopekaliga Water Authority (“Toho”), must submit this form with their Solicitation Responses.

The terms “Contract” and “Agreement” may be interchangeably used.

Confidential Records and Structure Record Release Acknowledgement

The undersigned, on behalf of the Vendor, acknowledges and understands that:

1. Any and all building plans, blueprints, schematic drawings, and diagrams, including draft, preliminary, and final formats, which depict the internal layout and structural elements of a building, water treatment facility, or other structure owned or operated by Toho (collectively, “Structural Information”) are exempt from public disclosure under Section 119.071(3)(b), Florida Statutes. The foregoing notwithstanding, by law, such Structural Information may be disclosed only to the following:

a. Another governmental entity if disclosure is necessary for the receiving entity/individual to perform its duties and responsibilities;

b. A licensed architect, engineer or contractor who is performing work on or related to the building, arena, stadium, water treatment facility, or other structure owned or operated by Toho; or

c. Upon a showing of good cause before a court of competent jurisdiction.

2. The Vendor is a licensed architect, engineer, or contractor performing work on or related to building(s), water treatment facilit(y/ies), or other structure(s) owned or operated by Toho in accordance with the above-referenced solicitation/contract that may receive, maintain, or generate Structural Information.

3. In accordance with Section 119.071(3)(b), entities or person(s) receiving, maintaining, or generating any Structural Information are statutorily required to maintain the exempt status of such documents and/or information.

4. It is unlawful to:

a. Obtain any Structural Information under false pretenses; and

b. Share or otherwise disseminate such Structural Information for any reason other than the lawful purposes under which they were obtained.

5. Any and all of the Vendor’s employees, associates, subcontracts, subconsultants, or other agents who receive, maintain, or generate any Structural Information shall be required by law to maintain the exempt status of that Structural Information, and the Vendor shall act to so inform in writing any third party to whom it discloses such Structural Information.

6. Any Structural Information that the Vendor may receive from Toho does not carry with it any representation or certification, implied or express, of completeness, reliability, or suitability for any purposes, or accuracy and so:

a. The Vendor assumes all risks of reliance upon or use of such information; and

Vendor’s Initials: ______

TOH-140

v: 03/2024

Vendor’s Confidential Structural Records Acknowledgment Form Page

b. To the maximum extent permitted by law, the Vendor and/or any other persons or entities with whom such Structural Information is shared, whether legitimately or otherwise, holds Toho, its officials, officers, employees, agents, contractors, and all other persons or entities affiliated with Toho harmless from any loss, claim, demand, or responsibility for adverse consequence of any conceivable nature resulting from the use, accuracy, or reliance upon any such Structural Information for any purpose including, but not limited to, the information being erroneous, incomplete, incorrect, or inaccurate.

The undersigned hereby represents that they: make the above certifications based upon personal knowledge; are over the age of 18 years and otherwise competent to make the above certifications; and are authorized to legally bind and make the above certifications on behalf of Vendor.

Under penalties of perjury, the undersigned declares that they have read and understand the contents of the foregoing form. Pursuant to the authority granted to the undersigned by Vendor, the undersigned hereby acknowledges, affirms, and makes the above sworn statement.

Printed Name:

Official Title:

STATE OF _________________

COUNTY OF _______________

The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this ____ day of ________________________, 20____, by _______________________, as __________________ of __________________________, a ________________________________ authorized to do business in the State of Florida on behalf of the company/corporation. They ☐ are personally known to me or ☐ have produced ___________________________ as identification.

TOH-200

v: 03/2024

E-Verify Registration and Use Certification Form Page

Instructions: “Vendor(s)”, defined as any person or entity seeking to engage in business with the Tohopekaliga Water Authority (“Toho”), must certify that they are registered and use the U.S.

Department of Homeland Security’s E-Verify system using this form. The terms “Contract” and “Agreement” may be interchangeably used.

Section 448.095, Florida Statutes, Compliance Certification

Employment Eligibility The undersigned, on behalf of the Vendor, hereby certifies as follows:

A. Vendor acknowledges that Section 448.09, Florida Statutes, makes it unlawful for any person to knowingly employ, hire, recruit, or refer, for private or public employment, an alien who is not duly authorized to work in the United States.

B. Vendor acknowledges that, in accordance with Section 448.095(5), Florida Statutes: (1) the Vendor, and any subcontractor thereof, are required register with and use the U.S. Department of Homeland Security’s E-Verify system to verify the work authorization status of all new employees of the Vendor or subcontractor; and (2) Toho may not enter into a contract unless each party to the contract registers with and uses the E-Verify system.

C. Vendor hereby certifies that the Vendor is registered with the U.S. Department of Homeland Security’s E-Verify system to verify the work authorization status of all employees hired during the term of the Contract.

D. Vendor hereby certifies that it does not and shall not employ, contract, or subcontract with an unauthorized alien, pursuant to Section 448.095, Florida Statutes, is otherwise in compliance with the requirements of Sections 448.09 and 448.095, Florida Statutes, and shall remain in compliance with such sections of Florida law during the term of any contract with Toho.

E. Vendor hereby acknowledges that the language of the Solicitation and/or Contract notwithstanding, a contract terminated under Section 448.095(5), Florida Statutes, is not a breach of contract and may not be considered as such.

F. Vendor hereby acknowledges and agrees that in the event that Vendor, or any subcontractor thereof, fails to comply with all applicable provisions of Sections 448.09 and 448.095, Florida Statutes, Toho reserves the right to exercise all remedies available to it at law and in equity, including without limitation recovery from the Vendor of the costs incurred by Toho as a result of termination of the Agreement under the aforementioned Florida statutes.

G. Attached to this form is a true and correct copy of the Vendor’s proof of registration in the E- Verify system.

H. Vendor shall ensure compliance with the requirements of Sections 448.09 and 449.095, Florida Statutes, by any and all of its subcontractors, and shall require all subcontractors performing work under the Contract to provide this same certification form, with party names changed as applicable.

Toho reserves the right to request copies of each such subcontractor’s form.

Initials: _____

TOH-200

v: 03/2024

E-Verify Registration and Use Certification Form Page

EXECUTION OF ABOVE CERTIFICATION

The undersigned hereby represents that they: make the above certification based upon personal knowledge; are over the age of 18 years and otherwise competent to make the above certification; and are authorized to legally bind and make the above certification on behalf of the Vendor.

Under penalties of perjury, the undersigned declares that they have read and understand the contents of the foregoing form. Pursuant to the authority granted to the undersigned by Vendor, the undersigned hereby acknowledges, affirms, and makes the certification provided above on behalf of Vendor.

Printed Name:

Official Title:

Date:

STATE OF _________________

COUNTY OF _______________

The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this ____ day of ________________________, 20____, by _______________________, as __________________ of __________________________, a ________________________________ authorized to do business in the State of Florida on behalf of the company/corporation. They ☐ are personally known to me or ☐ have produced ___________________________ as identification.

TOH-210

v: 03/2024

Certifications Regarding Vendor Eligibility for Contracts with Public Entities

Tohopekaliga Water Authority (“Toho”), must use this form to certify that they are eligible to solicit an award from and/or enter into a contract with a public entity under applicable Florida law. The terms “Contract” and “Agreement” may be interchangeably used.

Part 1: Section 287.133, Florida Statutes, Compliance Certification

Public Entity Crimes Act The undersigned hereby certifies, on behalf of Vendor, that:

A. Neither Vendor, nor one or more of its officers, directors, executives, partners, shareholders, employees, members, or agents who are active in the management of Vendor, nor any affiliate of the entity, has been charged with and convicted of public entity crime subsequent to July 1, 1989;

B. Vendor has not been placed on any convicted vendor list by the State of Florida and that Vendor will not utilize any funding provided pursuant to this Contract to subcontract with any vendor that has been placed on any such convicted vendor list;

C. Vendor acknowledges that for the purposes of this certification, the terms “public entity crime,” “convicted,” and “affiliate,” are as defined in Section 287.133, Florida Statutes, which Vendor has reviewed prior to the execution of this certification;

D. Vendor acknowledges that Toho reserves the right to terminate this Contract immediately and take full advantage of any legal remedies available in equity or law should Vendor be found to: have falsified its certification of eligibility to bid on, submit a proposal for, or enter into or renew a contract with Toho for goods or services pursuant to Section 287.133, Florida Statutes; or have become ineligible to bid on, submit a proposal for, or enter into or renew a contract with Toho for goods or services pursuant to Section 287.133, Florida Statute subsequent to entering into this Contract with Toho; and

E. Vendor shall immediately notify Toho if at any point during the term of the Contract, Vendor’s status under Section 287.133, Florida Statutes, changes in any manner.

Part 2: Section 287.134, Florida Statutes, Compliance Certification Discriminatory Vendors

The undersigned hereby certifies, on behalf of Vendor, that:

A. Neither Vendor, in its capacity as an “entity”, as defined in Section 287.134, Florida Statutes, nor any of its “affiliates”, as defined in that same statute, have been placed on the discriminatory vendor list;

B. Vendor is eligible to submit an offer or proposal to, receive an award from, contract with, and otherwise transact business with public entities in the State of Florida under Section 287.134, Florida Statutes; and

C. Vendor shall immediately notify Toho if at any point during the term of the Contract, Vendor’s status under Section 287.134, Florida Statutes, changes in any manner.

Vendor’s Initials: _____ v: 03/2024

Certifications Regarding Vendor Eligibility for Contracts with Public Entities

Part 3: Section 287.137, Florida Statutes, Compliance Certification

Antitrust Violators The undersigned hereby certifies, on behalf of Vendor, that:

A. Neither Vendor, in its capacity as an “entity”, as defined in Section 287.137, Florida Statutes, nor any of its “affiliates”, as defined in that same statute, have been placed on the antitrust violator vendor list following a conviction or being held civilly liable for an antitrust violation;

B. Vendor is eligible to submit an offer or proposal to, receive an award from, contract with, and otherwise transact business with public entities in the State of Florida under Section 287.137, Florida Statutes; and

C. Vendor shall immediately notify Toho if at any point during the term of the Contract, Vendor’s status under Section 287.137, Florida Statutes, changes in any manner.

Part 4: Section 287.135, Florida Statutes, Compliance Certification Prohibition Against Contracting with Scrutinized Companies

The undersigned hereby certifies, on behalf of Vendor, that:

A. Vendor has reviewed Section 287.135, Florida Statutes, and in accordance with such provision of

Florida law, is eligible to bid on, submit a proposal for, or enter into or renew a contract with Toho for goods or services.

B. Vendor is not on the “Scrutinized Companies that Boycott Israel List”, created pursuant to Section 215.4725, Florida Statutes, and additionally is not engaged in a boycott of Israel.

C. If the value of the award, contract, or agreement for which this certification is being executed meets or exceeds $1,000,000.00 in value, Vendor additionally hereby certifies that Vendor is not: (1) on either the “Scrutinized Companies with Activities in Sudan List” or the “Scrutinized Companies with Activities in the Iran Terrorism Sectors List” created pursuant to Section 215.473, Florida Statutes; or

(2) engaged in business operations in Cuba or Syria.

D. Vendor acknowledges that Toho reserves the right to terminate this Contract immediately and take full advantage of any legal remedies available in equity or law should Vendor be found to: (1) have falsified its certification of eligibility to bid on, submit a proposal for, or enter into or renew a contract with Toho under Section 287.135, Florida Statutes; (2) have become ineligible to bid on, submit a proposal for, or enter into or renew a contract with Toho under Section 287.135, Florida Statutes, by having been added to any of the above-referenced “Scrutinized Companies” lists, or by engaging in any boycott of Israel or business operations in Cuba or Syria.

E. Vendor shall immediately notify Toho if at any point during the term of the Contract, Vendor’s status under Section 287.135, Florida Statutes, changes in any manner.

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v: 03/2024

Certifications Regarding Vendor Eligibility for Contracts with Public Entities

Part 5: Section 287.138, Florida Statutes, Compliance Certification

Foreign Countries of Concern If being awarded the Contract, or otherwise entering into the Contract, would grant Vendor access to an individual’s personal identifying information, pursuant to section 287.138, Florida Statutes, the undersigned, on behalf of Vendor, hereby certifies, represents, and warrants that Vendor is not affiliated with a foreign country of concern, as such countries are identified in section 287.138(1), Florida Statutes.

The undersigned additionally certifies, represents, and warrants that: (A) Vendor is not owned by a foreign country of concern; (B) the government of a foreign country of concern does not have a controlling interest in Vendor; and (C) Vendor is not organized under the laws of or has its principal place of business in a foreign country of concern.

EXECUTION OF ABOVE CERTIFICATIONS

The undersigned hereby represents that they: make the above certifications based upon personal knowledge; are over the age of 18 years and otherwise competent to make the above certifications; and are authorized to legally bind and make the above certifications on behalf of Vendor.

Under penalties of perjury, the undersigned hereby certifies and declares that they have read and understand the contents of the foregoing form. Pursuant to the authority granted to the undersigned by Vendor, the undersigned hereby acknowledges, affirms, and makes the above-provided certifications on behalf of Vendor.

Printed Name:

Official Title:

Date:

STATE OF _________________

COUNTY OF _______________

The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this ____ day of ________________________, 20____, by _______________________, as __________________ of __________________________, a ________________________________ authorized to do business in the State of Florida on behalf of the company/corporation. They ☐ are personally known to me or ☐ have produced ___________________________ as identification.

TOH-220

v: 03/2024

Common Carrier Certification Form Page

Tohopekaliga Water Authority (“Toho”), must use this form to certify that they either: (1) are not a common carrier under applicable Florida law, or (2) are a common carrier and comply with applicable Florida law. The terms “Contract” and “Agreement” may be interchangeably used.

Section 908.111, Florida Statutes, Compliance Certification

Common Carriers The undersigned, on behalf of the Vendor, hereby certifies as follows:

A. Vendor acknowledges that Section 908.111, Florida Statutes, which prohibits a local government such as Toho from executing, amending, or renewing a contract with a common carrier or contracted carrier if the carrier is willfully providing any service in furtherance of transporting a person into the State of Florida knowing that person is an unauthorized alien, except to facilitate detention, removal, or departure of the person from this state or the United States.

B. Vendor acknowledges that Section 908.111, Florida Statutes, defines “common carrier” as follows: “. .

. a person, firm, or corporation that undertakes for hire, as a regular business, to transport persons or commodities from place to place, offering his or her services to all such as may choose to employ the common carrier and pay his or her charges.”

C. Vendor hereby certifies that the following selected statement is true, correct, and accurate (select only one statement from below):

☐ Statement 1: Vendor is not a “common carrier”, as defined in Section 908.111, Florida Statutes.

☐ Statement 2: Vendor is a “common carrier”, as defined in Section 908.111, Florida Statutes.

D. If Vendor is a common carrier, as defined by Section 908.111, Florida Statutes, then Vendor hereby certifies that it is not willfully providing and will not willfully provide any service during the Contract term in furtherance of transporting a person into this state knowing that the person is an Unauthorized Alien, except to facilitate the detention, removal, or departure of the person from this state or the United States.

REMAINDER OF PAGE LEFT INTENTIONALLY BLACK

TOH-220

v: 03/2024

Common Carrier Certification Form Page

EXECUTION OF ABOVE CERTIFICATIONS

The undersigned hereby represents that they: (A) make the above certification based upon personal knowledge; (B) are over the age of 18 years and otherwise competent to make the above certification; and

(C) are authorized to legally bind and make the above certification on behalf of the Vendor.

Under penalties of perjury, the undersigned declares that they have read and understand the contents of the foregoing form. Pursuant to the authority granted to the undersigned by Vendor, the undersigned hereby acknowledges, affirms, and makes the certification provided above on behalf of Vendor.

Printed Name:

Official Title:

Date:

STATE OF _________________

COUNTY OF _______________

The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this ____ day of ________________________, 20____, by _______________________, as __________________ of __________________________, a ________________________________ authorized to do business in the State of Florida on behalf of the company/corporation. They ☐ are personally known to me or ☐ have produced ___________________________ as identification.