2023-020669.2 IFQ Package no plans.pdf

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Attached to
Parks Splash Pad-UV Sanitation & Filtration Upgrade (RE-BID)
Solicitation number
IFB 410 2023-020669.2 1
Issued by
Palm Beach County, Florida

About this file

This Invitation for Quote/Bid (IFQ/B) is issued by Palm Beach County's Facilities Development & Operations Department, Capital Improvements Division, for the Parks Splash Pad-UV Sanitation & Filtration Upgrade (RE-BID), Project Number 2023-020669.2. The project involves furnishing all labor, materials, equipment, supervision, permits, and supplies necessary to install ultraviolet (UV) sanitation and filtration upgrades at three splash pad locations: Pioneer Park (866 State Road 715, Belle Glade), Westgate Park (3691 Oswego Ave, West Palm Beach), and John Prince Park (2700 6th Ave S, Lake Worth Beach). A mandatory pre-bid meeting is scheduled for May 7, 2026, at 10:00 a.m. at Pioneer Park's main entrance, which bidders must attend unless they attended previous meetings on December 4, 2025, or March 5, 2026. The bid submission deadline is June 4, 2026, at 2:00 p.m., with quotes to be submitted in sealed envelopes to the Capital Improvements Division at 2633 Vista Parkway, West Palm Beach, Florida 33411. The contractor must achieve substantial completion within 180 calendar days from the Notice to Proceed, with work hours limited to 7:00 a.m. to 5:00 p.m., Monday through Friday.

Bid security in the form of a cashier's check, certified check, money order, or bid bond is required if the bid is $200,000 or more, in an amount equal to at least five percent of the bid price. The successful bidder must furnish a public construction bond equal to 100 percent of the work order amount within 14 calendar days of notification. A minimum mandatory goal of 25 percent Small Business Enterprise (SBE) participation is established for this contract, with bidders required to submit completed OSBD Schedules 1 and 2 documenting all subcontractor participation. Liquidated damages of $120 per day will accrue for failure to achieve substantial completion within the 180-day timeline. All contractors must be qualified under Palm Beach County's Annual Contract - Minor Construction Services and must submit qualification applications at least 10 days before the bid due date. The work is subject to critical facilities or CJI facilities background checks as specified, and all equipment, materials, and labor are warranted against defects for 12 months from substantial completion. Questions must be submitted in writing to FDO-CID-Bids@pbc.gov at least seven calendar days prior to the bid due date.

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IFQ/B Page 1 Form Rev. 04/02/26 Invitation for Quote/Bid - NonFederal

INVITATION FOR QUOTE/BID

ANNUAL CONTRACT

DATE:

SENT TO:

SENT FROM:

SENDER:

PHONE:

PROJECT NAME:

PROJECT NUMBER:

Mandatory Pre-Bid Conference. There will be a Mandatory Pre-Bid Meeting at Pioneer

Park (meet at main entrance), located at 866 State Road 715, Belle Glade, then 3691

Oswego Ave, West Palm Beach, then 2700 6th Ave S, Lake Worth Beach, , FL at 10:00 a.m. on May 7, 2026. The purpose of this pre-bid meeting will be to review the requirements for the project described in this Invitation for Quote/Bid. You must attend this meeting if you intend to bid this work, unless you attended the prior pre-bid meeting held on December 4, 2025, or March 5, 2026.

The work is to be done under the terms and conditions of Palm Beach County’s

Annual Contract - Minor Construction Services as supplemented by this Invitation for Quote/Bid.

Questions must be e-mailed to FDO-CID-Bids@pbc.gov at least seven (7) calendar days prior to the bid due date. Only questions received in writing will be responded to regarding this Invitation for Quote/Bid.

Facilities Development &

Operations Department

2633 Vista Parkway

West Palm Beach, FL 33411

Telephone - (561) 233-0200

Palm Beach County

Board of County

Commissioners

Sara Baxter, Mayor

Marci Woodward, Vice Mayor

Maria G. Marino

Gregg K. Weiss

Joel G. Flores

Maria Sachs

Bobby Powell Jr.

County Administrator

Joseph Abruzzo

“An Equal Opportunity

Employer”

April 20, 2026

Qualified Contractors

On the Annual Contract - Minor Construction Services

Capital Improvements Division

Rocky Roque, Facilities Systems Project Manager

(561)233-0191

Parks Splash Pad-UV Sanitation & Filtration Upgrade

(RE-BID)

2023-020669.2 file://///pbcgov.org/FDO/common/Business/Znachko%20Working%20File/CID%20Forms/Contracts/Construction%20-%20Annual%20(Pre-Qual)/NonFederal/Invitation%20for%20Quote/FDO-CID-Bids@pbc.gov

IFQ/B Page 2

Submitting the Quote/Bid Package

The Quote/Bid Package must be enclosed in a sealed opaque envelope. The envelope must be addressed as follows:

Project Name: Parks Splash Pad-UV Sanitation & Filtration Upgrade (RE-BID)

Project Number: 2023-020669.2

Capital Improvements Division

2633 Vista Parkway

West Palm Beach, Florida 33411

Attention:

No responsibility will be attached to the Owner for premature opening of or failure to open a quote/bid not properly identified. If the quote/bid is sent by mail, the sealed envelope must be enclosed in a separate mailing with the notation "SEALED QUOTE/BID ENCLOSED" on the face thereof.

PROJECT NAME: Parks Splash Pad-UV Sanitation & Filtration Upgrade (RE-BID)

PROJECT NO.: 2023-020669.2

*DUE: June 4, 2026 by 2:00 p.m.

* The Quotes/Bids received by this time will be opened at this time at a public meeting at the below address.

RETURN TO: Capital Improvements Division

2633 Vista Parkway

West Palm Beach, FL 33411

Qualification of Contractors. In order to submit a quote/bid in response to this IFQ/B, a contractor must be qualified under the Annual Contract - Minor Construction Services. A contractor may obtain a Qualification Application for this Annual Contract by sending an email with the Project # in the subject line to: FDO-CID-Bids@pbc.gov or call (561) 233-0261. Qualification applications may also be downloaded from the County’s on-line Vendor Self-Service (VSS) system at https://pbcvssp.pbc.gov/vssprd/Advantage4. The contractor must submit the Qualification

Application at least 10 days before the Quote/Bid Due Date in order for its quote/bid to be considered.

file://///pbcgov.org/FDO/common/Business/Znachko%20Working%20File/CID%20Forms/Contracts/Construction%20-%20Annual%20(Pre-Qual)/NonFederal/Invitation%20for%20Quote/FDO-CID-Bids@pbc.gov https://pbcvssp.pbc.gov/vssprd/Advantage4 https://pbcvssp.co.palm-beach.fl.us/webapp/vssp/AltSelfService

IFQ/B Page 3

1. SCOPE OF WORK: This Quote/Bid is to furnish all material, labor, supervision, permits and supplies necessary and reasonably incidental to install ultra violet (UV) sanitation and filtration upgrades at three

(3) splash pads, located in Pioneer Park, Westgate Park, and John Prince Park per the project requirements provided by Capital Improvements Division in this Invitation for Quote/Bid at Attachment “C” and all exhibits and addenda thereto. Work is to be done under the terms and conditions of Palm Beach

County’s Annual Contract - Minor Construction Services, and pursuant to the conditions of the

Work Order, both of which are incorporated into the Contract Documents by reference.

2. SCHEDULE OF TIME FOR COMPLETION. The time of completion for this Project will be as follows: The Contractor must substantially complete the work within one hundred eighty (180) calendar days from the Notice to Proceed from Owner.

3. LIQUIDATED DAMAGES. Liquidated Damages are $120/day for failure to achieve certification of

Substantial Completion within the Work Order time or approved extension thereof.

4. BID SECURITY AND PUBLIC CONSTRUCTION BOND. Bid Security and Public Construction

Bond are required for this Project in accordance with Section 5.2 of the Instructions to Bidders of the Annual

Contract as follows:

Bid Security. If Bid is $200,000 or over, this Bid must be accompanied by a Bid Security (in the form of, at Bidder's option, cashier's check, certified check, money order or Bid Bond in favor of the County) in the amount of at least five percent (5%) of the bid price, see Section 5.2.2 of the

Instructions to Bidders of the Annual Contract for detailed requirements regarding Bid Security and Attachment “B”.

Public Construction Bond. If Bid is $200,000 or over (or if cumulative open work orders are

$200,000 or over), then prior to execution of a Work Order, and not later than fourteen (14) calendar days after notification from Owner, the successful Bidder must furnish a Public

Construction Bond in the amount of 100% of the Work Order and Guarantee, see Section 5.2.3 of the Instructions to Bidders of the Annual Contract for detailed requirements regarding the Public

Construction Bond and Guarantee.

5. Small Business Development (SBD) Program. Section 5.3 of the Instruction to Bidders of the Annual

Contract sets out the requirements of the County’s Small Business Development Program. All Bidders are required to submit with their bid the appropriate SBD Program schedules. SBD Schedules to be submitted with the quote/bid are as follows:

a) Schedule 1 - List of All Proposed Subcontractors, including SBE Participation. A completed Schedule 1 submitted by the prime shall list the names of all subcontractors, intended to be used in performance of the contract, if awarded. The total proposed percentage of SBE participation shall also be included on this form. This schedule must also be used if an SBE prime bidder is performing any portion of this contract with their work force.

b) Schedule(s) 2 - Letter(s) of Intent to Perform as a Subcontractor, including SBE

Subcontractors. A completed Schedule 2 is a binding agreement between the prime contractor and the subcontractor (of any tier) and should be treated as such. Each Schedule 2 shall be properly executed by the Prime Contractor and proposed subcontractor. If the Contractor is an SBE, a Schedule 2 shall be submitted to document work to be performed by its workforce.

Completed and submitted SBD forms are incorporated into and made a part of the Contract Documents.

IFQ/B Page 4

Attachment “A” identifies the affirmative procurement initiatives (APIs) applicable to this Invitation for Quote/Bid.

If Bidder is unable to comply with the API requirements as set forth in Attachment “A”, Bidder shall submit a request for a waiver or partial waiver with its bid by the quote/bid due date. Each waiver request shall include documentation demonstrating the Bidder undertook satisfactory Good Faith

Efforts, as defined in the SBD Ordinance, and set forth in Section 5.3 of the Annual Contract’s

Instruction to Bidders. Waiver requests not submitted at the time of bid submission shall not be considered. If the Office of SBD determines that adequate Good Faith Efforts have been demonstrated to warrant a partial or total waiver, the waiver shall be granted accordingly. If the

Office of SBD determines that the Bidder failed to submit documentation sufficient to demonstrate

Good Faith Efforts, the request for waiver or partial waiver shall be denied and the Bidder shall be deemed non-responsive. The granting of a waiver shall apply solely to the Bidders to whom it is issued and shall not, by itself, amend, reduce, or otherwise alter the API requirements applicable to other

Bidders under the solicitation. A Bidder may seek reconsideration of an adverse waiver determination as set forth in Section 5.3 of the Annual Contract’s Instruction to Bidders and the SBD

Ordinance.

6. Addendum. Any interpretation, clarification, correction, or change of the Bidding Documents will be made only by Addendum. The Department will send written instructions regarding discrepancies, omissions or unclear intents to all Bidders who are Qualified Contractors with an Annual Contract. For projects

$150,000 and over all Addendum to a solicitation will also be posted under the applicable solicitation on the County’s on-line Vendor Self-Service (VSS) system at https://pbcvssp.pbc.gov/vssprd/Advantage4.

Interpretations, corrections or changes to the Bidding Documents made in any other manner will not be binding, and Bidders shall not rely upon such interpretations, corrections and changes. Prior to submission of its Bid/Quote, each Bidder must ascertain that it has received all Addenda issued. The Bidder must acknowledge receipt of each individual Addendum at the time of issuance and final receipt of all Addenda by completing the acknowledgment space provided on the Addendum Form. Failure to acknowledge receipt may result in rejection of a bid/quote.

7. Failure to Provide the Required Documents after Notification of Award. If after Notification of award from the County, the successful Bidder does not provide within 14 Days of Notification the signed

Work Order, the Public Construction Bond and Guarantee (when required), and the required certificates of insurance, the County may: 1. Call in the bid security when provided; 2. Cancel the notification of recommended award and award the project to the next responsive, responsible low bidder; 3. Terminate this Annual Contract for cause; 4. Suspend or debar the Bidder from bidding on future projects for a period of two (2) years, in accordance with the Palm Beach County Purchasing Ordinance; and/or 5. Pursue any and all remedies available against the Bidder for damages resulting from its failure to enter into a Work

Order and provide all required documents within 14 Days after notification.

8. Prohibition against Considering Social, Political or Ideological Interests in Government

Contracting - F.S. 287.05701. Bidders are hereby notified of the provisions of section 287.05701, Florida

Statutes, as amended, that the County will not request documentation of or consider a Bidder's social, political, or ideological interests when determining if the Bidder is a responsible Bidder. Bidders are further notified that the County's governing body may not give preference to a Bidder based on the Bidder's social, political, or ideological interests.

9. Human Trafficking Affidavit. Contractor warrants and represents that it does not use coercion for labor or services as defined in section 787.06, Florida Statutes. Contractor shall execute

Attachment “D”, Nongovernmental Entity Human Trafficking Affidavit, which is attached hereto and incorporated herein by reference.

https://pbcvssp.pbc.gov/vssprd/Advantage4 https://pbcvssp.co.palm-beach.fl.us/webapp/vssp/AltSelfService

IFQ/B Page 5

10. Living Wage Ordinance. Pursuant to section 255.0992, Florida Statutes, the County’s Living Wage

Ordinance shall not apply to this Invitation for Quote/Bid and any resulting Work Order(s), notwithstanding any provision of an existing Annual Contract to the contrary, including, but not limited to, the Instructions to Bidders, the General Conditions to the Annual Contract and the Certification of Compliance with the

Living Wage Ordinance.

11. CONTRACT AMENDMENTS. The Annual Contract is amended as follows: NONE

Quote/Bid Form Page 1 Form Rev. 02/04/26 Quote/Bid Form - NonFederal

QUOTE/BID FORM

PROJECT NUMBER: 2023-020669.2

PROJECT NAME: Parks Splash Pad-UV Sanitation & Filtration Upgrade (RE-

BID)

IN ORDER TO BE DEEMED RESPONSIVE TO THIS INVITATION FOR QUOTE/BID,

THE QUOTE/BID PACKAGE MUST CONTAIN:

a) This Quote/Bid Form completed and executed.

b) OSBD Schedules 1 and 2 completed and executed.

c) Bid Security. (If the bid is $200,000 or more).

d) Signed Addenda, if any issued

THE FOLLOWING MUST BE COMPLETED AND SIGNED BY CONTRACTOR

1. TOTAL QUOTE/BID AMOUNT $ ____________

Written amount ____________

2. Bidder commits to achieving the APIs applicable to this solicitation as designated on Attachment

A and as submitted on its OSBD Schedules 1 and 2.

3. Is the Bidder a Palm Beach County certified SBE? Yes_____ No_____

4. Commercial Non-Discrimination Certification. The undersigned Bidder hereby certifies and agrees that the following information is correct: In preparing its response to this Solicitation, the

Bidder has considered all proposals submitted from qualified, potential Subcontractors and suppliers, and has not engaged in "discrimination" as defined in the County’s Commercial

Nondiscrimination Policy as set forth in Resolution 2025-0748, as may be amended, to wit:

discrimination in the solicitation, selection or commercial treatment of any Subcontractor, vendor, supplier or commercial customer on the basis of race, color, national origin, religion, ancestry, sex, age, marital status, familial status, sexual orientation, disability, or genetic information, or on the basis of any otherwise unlawful use of characteristics regarding the vendor's, supplier's or commercial customer's employees or owners; provided that nothing in this policy shall be construed to prohibit or limit otherwise lawful efforts to remedy the effects of discrimination.

Without limiting the foregoing, "discrimination" also includes retaliating against any person or other entity for reporting any incident of "discrimination." Without limiting any other provision of the solicitation, it is understood and agreed that, if this certification is false, such false certification will constitute grounds for the County to reject the bid submitted by the Bidder for this Solicitation, and to terminate any contract awarded based on the response. As part of its bid, the Bidder shall provide to the County a list of all instances within the immediate past four (4) years where there has been a final adjudicated determination in a legal or administrative proceeding in the State of Florida that the Bidder discriminated against its Subcontractors, vendors, suppliers or commercial customers, and a description of the status or resolution of that complaint, including any remedial action taken. As a condition of submitting a bid to the County, the Bidder agrees to comply with the County’s Commercial Nondiscrimination Policy as described in Resolution 2025-

0748, as may be amended.

Quote/Bid Form Page 2 Form Rev. 02/04/26 Quote/Bid Form - NonFederal

5. The Bidder shall be bound by the terms of its Bid for a period of one hundred twenty (120) calendar Days from the date of the bid opening and may not withdraw its Bid within that time period. If the County issues a Notification from Owner within the above 120-Day period, then the

Bidder will be bound by the Bid as submitted. If the County fails to issue a Notification from

Owner to the successful Bidder within the above identified 120-Day period, the successful bidder will not be required to honor its bid unless otherwise agreed to by both parties. County anticipates, but does not guarantee, the award of a Work Order and written notice to proceed within ninety (90) calendar Days of Notification from Owner, absent the filing of a timely bid protest.

6. It is agreed that the undersigned has received all addenda complete as issued by the County and that related costs are included in the bid submitted. The undersigned acknowledges receipt of said addenda as follows:

Addendum # dated Addendum# dated________

Addendum # dated Addendum# dated

The undersigned has included the signed addenda, if issued, in its bid package.

7. The undersigned does hereby declare that the Bid covers all expenses of every kind incidental to the completion of said Work in accordance with the Contract Documents, including all claims that may arise through damages or other causes whatsoever. The undersigned does hereby declare that it shall make no claim on account of any variation from any estimate in the quantities of Work to be done, nor on account of any misunderstanding or misconception of the nature of the Work to be done or the grounds, subsurface conditions, or place where the Work is to be done.

QUOTE/BID PROVIDED BY:

Contractor Name

Date Signature

Print Name and Title

Quote/Bid Must Contain Original Signatures. No Copies or Emailed/Faxed Quotes/Bids Will

Be Accepted

OSBD SCHEDULE 1 *

SOLICITATION/PROJECT/BID NAME: _______________ SOLICITATION/PROJECT/BID NO.: ______________

SOLICITATION OPENING/SUBMITTAL DATE: ______________ COUNTY DEPARTMENT: __________________

Section A PLEASE LIST THE DOLLAR AMOUNT OR PERCENTAGE OF WORK TO BE COMPLETED BY THE PRIME CONTRACTOR/CONSULTANT* ON THE PROJECT:

NAME OF PRIME RESPONDENT/BIDDER: __________________ ADDRESS: ____________________

CONTACT PERSON: ______________________ PHONE NO.: __________ E-MAIL:. _____________

PRIME'S DOLLAR AMOUNT OR PERCENTAGE OF WORK: _____________ Non-SBE SBE SBE Prime's must include their percentage or dollar amount in the Total Participation line under section B. □ □

Section B PLEASE LIST THE DOLLAR AMOUNT OR PERCENTAGE OF WORK TO BE COMPLETED BY ALL SUBCONTRACTORS/SUBCONSULTANTS ON THE PROJECT BELOW:

Subcontractor/Sub consultant Name (Check all Applicable Categories) DOLLAR AMOUNT OR

PERCENTAGE OF WORKNon-SBE SBE

1. [JI□

2. □ □

3. □ □

4. □ □

5. □ □ (Please use additional sheets if necessary)

Total

Total Bid/Offer Price$ ______________ Total Certified SBE Participation $

I hereby certify that the above information is accurate to the best of my knowledge:

Name & Authorized Signature Title

Note: 1. The amount listed on this form for a Subcontractor/sub consultant must be supported by price or percentage listed on the properly executed Schedule 2 or attached signed proposal.

2. Only those firms certified by Palm Beach County at the time of solicitation due date are eligible to meet the established OSBD Affirmative Procurement Initiative (API). Please

3. Modification of this form is not permitted and will be rejected upon submittal.

4. If a Mandatory API goal applies, failure to submit a properly executed Schedule 2 will result in a determination of non-responsiveness to the solicitation.

*Revised 6.5.2025 pursuant to Emergency Ordinance 2025-014, approved on June 3, 2025

OSBD LETTER OF INTENT- SCHEDULE 2*

A completed Schedule 2 is a binding document between the Prime Contractor/consultant and a Subcontractor/subconsultant � any tier) and should be treated as such. All Subcontractors/subconsultants, including any tiered Subcontractors/ subconsultants, must properly execute this document. If a Mandatory API goal applies, failure to submit a properly executed Schedule 2 will result in a determination of non-responsiveness to the solicitation. Each properly executed Schedule 2 must be submitted with the bid/proposal.

SOLICITATION/PROJECT NUMBER:------------------------------

SOLICITATION/PROJECT NAME:--------------------------------

Prime Contractor:___________________.Subcontractor:_________________ (Check box(s) that apply)

□ SBE □ Non-SBE □ Supplier Date of Palm Beach County Certification (if applicable): _______

SBE PARTICIPATION - SBE Primes must document all work to be performed by their own work force on this form. Specify in detail, the scope of work to be performed or items supplied with the dollar amount and/or percentage for each work item. When applicable, identify the line item(s) associated with the service/product being supplied. SBE credit will only be given for the areas in which the SBE is certified. A detailed quote/ proposal may be attached to a properly executed Schedule 2 for additional information.

Line

Item

Item Description Unit Price Quantity/

Units

Contingencies/

Allowances

Total Price/Percentage

The undersigned Subcontractor/subconsultant is prepared to self-perform the above-described work in conjunction with the aforementioned project at the following total price or percentage: ________________

If the undersigned intends to subcontract any portion of this work to another Subcontractor/subconsultant, please list the business name and the amount below accompanied by a separate properly executed Schedule 2.

Name of 2nd/3rd tier Subcontractor/subconsultant

Print Name of Prime

By:_________________ Authorized Signature

Print Name

Title

Date: __________________

*Revised 6.5.2025 pursuant to Emergency Ordinance 2025-014, approved on June 3, 2025

Price or Percentage: ______________ _

Print Name of Subcontractor/subconsultant

By:------------------ Authorized Signature

Print Name

Title

Date: ___________________

SOLICITATION/PROJECT/BID NAME: SOLICITATION/PROJECT/BID NO.:

SOLICITATION OPENING/SUBMITTAL DATE: COUNTY DEPARTMENT:

Section A PLEASE LIST THE DOLLAR AMOUNT OR PERCENTAGE OF WORK TO BE COMPLETED BY THE PRIME CONTRACTOR/CONSULTANT* ON THE PROJECT:

NAME OF PRIME RESPONDENT/BIDDER: ADDRESS:

CONTACT PERSON: PHONE NO.: E-MAIL:

Non-SBE SBE

Section B PLEASE LIST THE DOLLAR AMOUNT OR PERCENTAGE OF WORK TO BE COMPLETED BY ALL SUBCONTRACTORS/SUBCONSULTANTS ON THE PROJECT BELOW:

Subcontractor/Sub consultant Name (Check all Applicable Categories)

Non-SBE SBE

DOLLAR AMOUNT OR

PERCENTAGE OF WORK

1.

2.

3.

4.

5.

(Please use additional sheets if necessary) Total _________________________

Total Bid/Offer Price $ Total Certified SBE Participation $

I hereby certify that the above information is accurate to the best of my knowledge:

DIRECTION: List Firm Name, Address & Provide PBC Vendor ID#. (https://www.pbcgov.org/pbcvendors)

Subcontractor 1 1222 Easy St., WPB, FL 33401

561-123-4567 VC178229

Subcontractor 2 5600 Carefree Lane, WPB, FL 33411

954-345-6789 VC123459

SAM

PLE

John Doe

PRIME’S DOLLAR AMOUNT OR PERCENTAGE OF WORK:

SBE Prime’s must include their percentage or dollar amount in the Total Certified SBE Participation line under section B.

OSBD SCHEDULE 1*

Name & Authorized Signature Note: 1. The amount listed on this form for a Subcontractor/sub consultant must be supported by price or percentage listed on the properly executed Schedule 2 or attached signed proposal.

2. Only those firms certified by Palm Beach County at the time of solicitation due date are eligible to meet the established OSBD Affirmative Procurement Initiative (API). Please check the applicable box and list the dollar amount or percentage under the appropriate demographic category.

3. Modification of this form is not permitted and will be rejected upon submittal.

4. If a mandatory API goal applies, failure to submit a properly executed Schedule 2 will result in a determination of non-responsiveness to the solicitation.

*Revised 6.5.2025 pursuant to Emergency Ordinance 2025-014, approved on June 3, 2025 ddelriocabrera Textbox MUST List ALL Subcontractors/Subconsultants ddelriocabrera Textbox Add All Certified SBE Amounts, Including Prime SBE ddelriocabrera Typewriter $145,385.80 ddelriocabrera Typewriter 181,380.85 ddelriocabrera Textbox

SAMPLE

ddelriocabrera Textbox $86,380.85

Subcontractor:

SBE PARTICIPATION – SBE Primes must document all work to be performed by their own work force on this form. Specify in detail, the scope of work to be performed or items supplied with the dollar amount and/or percentage for each work item. When applicable, identify the line item(s) associated with the service/product being supplied. SBE credit will only be given for the areas in which the SBE is certified. A detailed quote/proposal may be attached to a properly executed Schedule 2 for additional information.

The undersigned Subcontractor/subconsultant is prepared to self-perform the above-described work in conjunction with the aforementioned project at the following total price or percentage:

Print Name of Prime

By:

Authorized Signature

Print Name of Subcontractor/subconsultant

By:

Authorized Signature

Print Name Print Name

Line Item

Item Description Unit Price Quantity/ Units

Contingencies/ Allowances

Total Price/Percentage

If the undersigned intends to subcontract any portion of this work to another Subcontractor/subconsultant, please list the business name and the amount below accompanied by a separate properly executed Schedule 2.

Price or Percentage:

Name of 2nd/3rd tier Subcontractor/subconsultant

*Revised�6.5.2025�pursuant�to�Emergency�Ordinance�2025-014,�approved�on�June�3,�2025

SOLICITATION/PROJECT NUMBER:

SOLICITATION/PROJECT NAME:

19600

Carlin Park, Maintenance Bldg, Roofing Replacement

$95,000Remove and replace existing roof

President

John Doe

Roofers Are Us, Inc.

Prime Contractor: Roofers Are Us, Inc.

(Check box(s) that apply)

☒ SBE □ Non-SBE □ Supplier

Title

Date: 6/4/2025

A completed Schedule 2 is a binding document between the Prime Contractor/consultant and a Subcontractor/subconsultant (for any tier) and should be treated as such. All Subcontractors/subconsultants, including any tiered Subcontractors/ subconsultants, must properly execute this document. If a mandatory API goal applies, failure to submit a properly executed Schedule 2 will result in a determination of non-responsiveness to the solicitation. Each properly executed Schedule 2 must be submitted with the bid/proposal.

Date of Palm Beach County Certification (if applicable):3/30/2024 .

Title

Date: 6/4/2025

S dlynch Highlight dlynch Highlight

Subcontractor:

SBE PARTICIPATION – SBE Primes must document all work to be performed by their own work force on this form. Specify in detail, the scope of work to be performed or items supplied with the dollar amount and/or percentage for each work item. When applicable, identify the line item(s) associated with the service/product being supplied. SBE credit will only be given for the areas in which the SBE is certified. A detailed quote/proposal may be attached to a properly executed Schedule 2 for additional information.

The undersigned Subcontractor/subconsultant is prepared to self-perform the above-described work in conjunction with the aforementioned project at the following total price or percentage:

Print Name of Prime

By:

Authorized Signature

Print Name of Subcontractor/subconsultant

By:

Authorized Signature

Print Name Print Name

Title

Date:

Line Item

Item Description Unit Price Quantity/ Units

Contingencies/ Allowances

Total Price/Percentage

If the undersigned intends to subcontract any portion of this work to another Subcontractor/subconsultant, please list the business name and the amount below accompanied by a separate properly executed Schedule 2.

Price or Percentage:

Name of 2nd/3rd tier Subcontractor/subconsultant

Remove and replace existing roof

Subcontractor 1

President Assistant Vice President

John Doe James Doe

Roofers Are Us, Inc.

SAM

PLE

Subcontractor 1

$50,385.80

Date: 6/4/2025 6/4/2025

Date of Palm Beach County Certification (if applicable):1/1/2024

Prime Contractor: Roofers Are Us, Inc.

(Check box(s) that apply)

☒ SBE ☐ Non-SBE □ Supplier

SAMPLE OSBD LETTER OF INTENT – SCHEDULE 2*

A completed Schedule 2 is a binding document between the Prime Contractor/consultant and a Subcontractor/subconsultant (for any tier) and should be treated as such. All Subcontractors/subconsultants, including any tiered Subcontractors/ subconsultants, must properly execute this document. If a mandatory API goal applies, failure to submit a properly executed Schedule 2 will result in a determination of non-responsiveness to the solicitation. Each properly executed Schedule 2 must be submitted with the bid/proposal.

SOLICITATION/PROJECT NUMBER: 19600

SOLICITATION/PROJECT NAME: Carlin Park, Maintenance Bldg, Roofing Replacement dlynch Highlight dlynch Highlight dlynch Highlight dlynch Highlight dlynch Highlight dlynch Placed Image

Placed Image

SBE PARTICIPATION – SBE Primes must document all work to be performed by their own work force on this form. Specify in detail, the scope of work to be performed or items supplied with the dollar amount and/or percentage for each work item. When applicable, identify the line item(s) associated with the service/product being supplied. SBE credit will only be given for the areas in which the SBE is certified. A detailed quote/proposal may be attached to a properly executed Schedule 2 for additional information.

The undersigned Subcontractor/subconsultant is prepared to self-perform the above-described work in conjunction with the aforementioned project at the following total price or percentage:

Print Name of Prime

By:

Authorized Signature

Print Name

Date:

Line Item

Item Description Unit Price Quantity/ Units

Contingencies/ Allowances

Total Price/Percentage

If the undersigned intends to subcontract any portion of this work to another Subcontractor/subconsultant, please list the business name and the amount below accompanied by a separate properly executed Schedule 2.

Price or Percentage:

President

John Doe

Roofers Are Us, Inc.

SAM

Prime Contractor: Roofers Are Us, Inc.

Subcontractor 2 Print Name of Subcontractor/subconsultant

By:

Authorized Signature

Jane Doe Print Name

Vice President

Subcontractor: Subcontractor 2

Date of Palm Beach County Certification (if applicable):

$35,995.05

$25,995.05

$10,0002nd Tier Subcontractor

Date: 6/4/2025 6/4/2025

□ SBE ☒ Non-SBE □ Supplier

A completed Schedule 2 is a binding document between the Prime Contractor/consultant and a Subcontractor/subconsultant (for any tier) and should be treated as such. All Subcontractors/subconsultants, including any tiered Subcontractors/ subconsultants, must properly execute this document. If a mandatory API goal applies, failure to submit a properly executed Schedule 2 will result in a determination of non-responsiveness to the solicitation. Each properly executed Schedule 2 must be submitted with the bid/proposal.

SOLICITATION/PROJECT NUMBER: 19600

SOLICITATION/PROJECT NAME: Carlin Park, Maintenance Bldg, Roofing Replacement dlynch Highlight dlynch Highlight dlynch Highlight dlynch Highlight dlynch Highlight

Placed Image

SBE PARTICIPATION – SBE Primes must document all work to be performed by their own work force on this form. Specify in detail, the scope of work to be performed or items supplied with the dollar amount and/or percentage for each work item. When applicable, identify the line item(s) associated with the service/product being supplied. SBE credit will only be given for the areas in which the SBE is certified. A detailed quote/proposal may be attached to a properly executed Schedule 2 for additional information.

The undersigned Subcontractor/subconsultant is prepared to self-perform the above-described work in conjunction with the aforementioned project at the following total price or percentage:

Print Name of Prime

Line Item

Item Description Unit Price Quantity/ Units

Contingencies/ Allowances

Total Price/Percentage

If the undersigned intends to subcontract any portion of this work to another Subcontractor/subconsultant, please list the business name and the amount below accompanied by a separate properly executed Schedule 2.

Price or Percentage:

SOLICITATION/PROJECT NAME: Carlin Park, Maintenance Bldg, Roofing Replacement

SAM

Date of Palm Beach County Certification (if applicable):

Prime Contractor: Subcontractor 2 Subcontractor: 2nd Tier Subcontractor

$10,000.00

Jude Doe

Manager

Jane Doe Print Name

Vice President

Subcontractor 2 2nd Tier Subcontractor Print Name of Subcontractor/subconsultant

□ SBE ☒ Non-SBE □ Supplier

Date: 6/4/2025

Date: 6/4/2025

A completed Schedule 2 is a binding document between the Prime Contractor/consultant and a Subcontractor/subconsultant (for any tier) and should be treated as such. All Subcontractors/subconsultants, including any tiered Subcontractors/ subconsultants, must properly execute this document. If a mandatory API goal applies, failure to submit a properly executed Schedule 2 will result in a determination of non-responsiveness to the solicitation. Each properly executed Schedule 2 must be submitted with the bid/proposal.

SOLICITATION/PROJECT NUMBER: 19600

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Form Rev. 10/28/24 Attachment A for Minor Construction -MultiTrade

ATTACHMENT “A”

(for Minor Construction - MultiTrade)

AFFIRMATIVE PROCUREMENT INITIATIVES (APIs) FOR CONSTRUCTION

PROCUREMENT

The API(s) approved for this project are selected below by ☒. Any bid that fails to comply with the API requirements after the period allowed for waiver requests has lapsed shall be deemed non-responsive. Fillable pdfs of all EBO forms can be found on the OEBO website at http://discover.pbcgov.org/oebo/Pages/Compliance-Programs.aspx. Also, see the EBO

Ordinance and Countywide PPM CW-O-043 for further information on APIs.

__X__ SBE Subcontracting Program

A minimum mandatory goal of 25% SBE participation is established for this contract. The EBO Office shall reduce or waive this goal when there is inadequate availability of SBE prime and / or subcontractor firms. Respondents/bidders may request such waivers at least seven (7) days prior to bid opening based on submission of adequate

Good Faith Efforts documentation.

http://discover.pbcgov.org/oebo/Pages/Compliance-Programs.aspx

Bid Bond / Page 1 Form Rev. 02/04/26 Bid Bond - NonFederal

IFQ/B ATTACHMENT B

Return Attachment B if bid is $200,000 or more

PROJECT NUMBER: 2023-020669.2

BID BOND

STATE OF FLORIDA

COUNTY OF PALM BEACH

KNOW ALL MEN BY THESE PRESENTS: That we, (hereinafter called "Principal"), and

(hereinafter called "Surety") are held and firmly bound unto Palm Beach County, a Political Subdivision in the State of Florida, by and through its Board of

County Commissioners, (hereinafter called "County") in the sum of

Dollars,($ ), (which sum is at least 5% of the bid price), lawful money of the United States of America, for the payment of which sum will and truly to be made, we bind ourselves, our heirs, executors, administrators and successors, jointly and severally, firmly be these presents;

WHEREAS, the "Principal" contemplates submitting or has submitted a bid to the Board of County

Commissioners, Palm Beach County, Florida, for furnishing and paying for all necessary labor materials, equipment, machinery, tools, apparatus, services, all state workmen's compensation and unemployment compensation taxes incurred in the performance of the Contract, means of transportation for and complete

Construction of: (Project Name Parks Splash Pad-UV Sanitation & Filtration Upgrade (RE-BID) and

Number 2023-020669.2), in the County of Palm Beach, State of Florida; and

WHEREAS, it was a condition precedent to the submission of said bid that a certified check cashier's check, money order or bid bond in the amount of five percent (5%) of the base bid be submitted with said bid as a guarantee that the bidder would, if given a Notification from Owner, enter into a written contract with the

County, and furnish a public construction bond in an amount equal to one hundred (100%) of the total

Contract, within fourteen (14) consecutive calendar days after the County issues the Notification from

Owner.

NOW THEREFORE, THE CONDITIONS OF THIS OBLIGATION ARE SUCH that, if the bid of the "Principal" herein is accepted and said "Principal", within fourteen (14) consecutive calendar days after written notice being given of such acceptance, (i) enter into a written contract with the County and (ii) furnishes a public construction contract bond in the amount equal to one hundred percent (100%) of the total contract amount and in a form satisfactory to the County, then this obligation shall be void. If the

Principal fails to complete (i) and (ii) above, the sum herein stated shall be due and payable to the "County", and the "Surety" herein agrees to pay said sum immediately upon demand of the "County", in good and lawful money of the United States of America, as liquidated damages for failure of said "Principal".

Bid Bond Must Contain Original Signatures. No Copies Will Be Accepted.

Bid Bond / Page 2 Form Rev. 02/04/26 Bid Bond - NonFederal

PROJECT NUMBER: 2023-020669.2

IN WITNESS WHEREOF, the said as "Principal" herein, has caused these presents to be signed in its name, by its

, and attested by its under the corporate seal, and the said as "Surety" herein, has caused these presents to be signed in its name, by its

, and attested by its corporate Seal, this day of , A.D., 20 .

ATTEST:

TITLE:

(SEAL)

(Contractor Name)

(Signature)

Print Name and Title:

ATTEST:

TITLE:

(SEAL)

(Surety Name)

(Signature)

Print Name and Title:

Bid Bond Must Contain Original Signatures. No Copies Will Be Accepted.

CAPITAL IMPROVEMENTS DIVISION

IFQ/B ATTACHMENT C

PROJECT REQUIREMENTS

ANNUAL CONTRACT - MINOR CONSTRUCTION SERVICES

Contact: Rocky Roque, Facilities Systems Project Manager Phone: (561)233-0191 Project Title: Parks Splash Pad-UV Sanitation & Filtration Upgrade (RE-BID) Project #: 2023-020669.2 Project Location: 866 State Road 715, Belle Glade, then 3691 Oswego Ave, West Palm Beach, then 2700 6th Ave S, Lake Worth Beach, FL

1. GENERAL

a. The work covered by this Request for Quote consists of the furnishing of all labor, equipment, devices, tools, materials, transportation, professional services, supervision, drawings, permitting, and all miscellaneous requirements to perform all operations necessary to accomplish the work set forth below and shall be considered part of the Scope of Work.

b. Please reference the Annual Contract – Minor Construction Services for additional requirements.

c. Work to be completed during the hours of 7:00 a.m. to 5:00 p.m., Monday through Friday.

d. Contractor shall contact the Project Manager within seventy-two (72) hours of notice to proceed to establish scheduling, etc. required for project implementation.

e. Work to be completed within one hundred eighty (180) calendar days from Notice to

Proceed. Permit application, if required, is to be submitted by Contractor within five (5) days of “Notice to Proceed” and due diligence exercised to address all Building Department comments.

f. Liquidated damages will accrue in the amount of $120 per day.

g. The Contractor will provide a Certificate of Occupancy or Certificate of Completion, as appropriate, obtained from the proper Building official, prior to processing of final payment.

h. Contractor is responsible for obtaining all measurements during the site inspection

2. SCOPE OF WORK

To install ultra violet (UV) sanitation and filtration upgrades at three (3) splash pads, located in Pioneer Park, Westgate Park, and John Prince Park, per the project requirements provided below along with the engineer’s drawings and specifications included as Exhibit “1”:

a. Pioneer Park Aquatic 866 State Road 715, Belle Glade FL 33430

b. West Gate Park 3691 Oswego Ave, West Palm Beach, FL 33409

c. John Prince Park 2700 6th Ave S, Lake Worth Beach, FL 33461

3. SUBMITTALS

All submittals shall be sent to the Project Manager for approval. This includes, but is not limited to, products to be used, methods of installation and requests for information and/or clarification. All submittals must be made by the Contractor and must include all details necessary for the Project Manager and Palm Beach County to make any necessary determinations. A transmittal form must be included which clearly requests data or information and deviations from the contract requirements for which approval is being requested. Failure to provide sufficient information will result in the rejection of the submittal. Where the specifications do not specify a brand name product or where a substitution of a product is not specifically prohibited, the Contractor shall submit their selected products for approval by the Project Manager. Such submittals shall include as much detail, and in a format, as required by the Project Manager, so as to allow the Project Manager to evaluate the proposed substitution.

4. MATERIALS

a. All material shall meet or exceed Florida Building Code and product submittals shall be reviewed and approved by the Owner’s Representative prior to ordering.

b. Materials shall be delivered in their original, unopened packages, and protected from exposure to the elements. Damaged or deteriorated materials shall not be used.

5. TEMPORARY PROTECTION

The Contractor shall protect all workers, staff and the general public from injury. The Contractor shall coordinate and schedule all work with the Project Manager.

6. PROJECT CONDITIONS

Contractor is to coordinate all space and security requirements with the Project Manager.

A construction schedule shall be submitted for review and approval prior to pre-construction meeting, including a start date, substantial completion date, and work plan defining which openings will be scheduled on what day. The Contractor shall conduct all work so as to cause the least interference possible with the normal activities of the operations of the facility and surrounding areas. Any damage caused by Contractor (including landscaping and irrigation) shall be the responsibility of the Contractor to repair and return to its original state.

7. PREPARATION

It shall be the responsibility of the Contractor to prep the site at the construction locations.

8. EXAMINATION

Report to the Project Manager, in writing, any imperfections, unacceptable conditions and/or corrections required to be made before commencing work. Any items not identified, documented and reported to PBC in writing, will become part of the contractors’ scope.

All other items identified in writing, if approved, shall result in a change order.

9. INSTALLATION

All materials shall be installed in strict accordance with Manufacturer’s written instructions and recommendations. All work shall be done in conformance with applicable Federal, State and Local codes, and established standards.

10. WARRANTY

Contractor warrants all equipment, materials and labor furnished or performed against defects in design, materials and workmanship for a period of twelve (12) months from substantial completion.

11. CLEAN UP

Remove all waste materials, tools and equipment from job site daily. Thoroughly clean the entire job area prior to requesting final inspection.

12. SECURITY

All bidders must have badged employees as identified below prior to commencement of work.

This project is subject to: ☐ Critical Facilities Background Check

☐ CJI Facilities Background Check

☒ No Background Check

EXHIBIT “1”

The exhibit listed above contains exempt and confidential information.

Firms must submit a signed Non-Disclosure Agreement For Protection Of

Building Plans/Confidential Information prior to exhibit distribution, as the bid documents contain exempt and/or confidential information under Florida

Public Records Law.

TO OBTAIN EXEMPT AND/OR CONFIDENTIAL INFORMATION:

1. Please click on the following link to access the Non-Disclosure

Agreement:

https://pbcclouddrive.pbcgov.org/invitations/?share=0c0723d11cee24ad43b6

2. Complete the form in its entirety

3. Email the completed Non-Disclosure form to FDO-CID-

Bids@PBC.GOV. The email subject line should include “Non-

Disclosure” along with the Project # and Project Name in your request

Note: The executed Non-Disclosure Agreement is valid for 1 year.

https://pbcclouddrive.pbcgov.org/invitations/?share=0c0723d11cee24ad43b6 mailto:FDO-CID-Bids@PBC.GOV mailto:FDO-CID-Bids@PBC.GOV

IFQ/B ATTACHMENT D

NONGOVERNMENTAL ENTITY HUMAN TRAFFICKING AFFIDAVIT

Section 787.06(13), Florida Statutes

THIS AFFIDAVIT MUST BE SIGNED AND NOTARIZED

I, the undersigned, am an officer or representative of

(Entity) and attest that Entity does not use coercion for labor or services as defined in section

787.06, Florida Statutes.

Under penalty of perjury, I hereby declare and affirm that the above stated facts are true and correct.

(signature of officer or representative) (printed name and title of officer or representative)

State of Florida, County of Palm Beach

Sworn to and subscribed before me by means of ☐ physical presence or ☐ online notarization this, day of , by

Personally known ☐ OR produced identification ☐. Type of identification produced

NOTARY PUBLIC

My Commission Expires:

State of Florida at large

(Notary Seal)

2023-020669.2 OEBO SAMPLE 1 and 2.pdf
Sample 2.pdf
SOLICITATION/PROJECT NUMBER: SOLICITATION/PROJECT NAME:
□ SBE □ Non-SBE □ Supplier Date of Palm Beach County Certification (if applicable): .
Sample 3.pdf
SOLICITATION/PROJECT NUMBER: SOLICITATION/PROJECT NAME:
□ SBE □ Non-SBE □ Supplier Date of Palm Beach County Certification (if applicable): .
Sample 3a.pdf
SOLICITATION/PROJECT NUMBER: SOLICITATION/PROJECT NAME:
□ SBE □ Non-SBE □ Supplier Date of Palm Beach County Certification (if applicable): .
Sample 4.pdf
SOLICITATION/PROJECT NUMBER: SOLICITATION/PROJECT NAME:
□ SBE □ Non-SBE □ Supplier Date of Palm Beach County Certification (if applicable): .
Sample 3a.pdf
SOLICITATION/PROJECT NUMBER: SOLICITATION/PROJECT NAME:
□ SBE □ Non-SBE □ Supplier Date of Palm Beach County Certification (if applicable): .
2023-020669.2 OEBO Schedule 2.pdf
SOLICITATION/PROJECT NUMBER: SOLICITATION/PROJECT NAME:
□ SBE □ Non-SBE □ Supplier Date of Palm Beach County Certification (if applicable): .
2023-020669.2 OEBO Schedule 1.pdf
OSBD SCHEDULE 1
Blank Page
Roofers Are Us, Inc:
Text Field0:
Roofers Are Us, Inc4:
Text Field05:
Roofers Are Us, Inc6:
Text Field07:
SOLICITATION/PROJECT/BID NAME: Carlin Park, Maintenance Bldg - Roof Replacement
SOLICITATION OPENING/SUBMITTAL DATE:
SOLICITATION/PROJECT/BID NO: 19600
COUNTY DEPARTMENT: FDO/CID
NAME OF PRIME RESPONDENT/BIDDER: Roofers Are Us, Inc.
ADDRESS: 123 Somewhere St., WPB, FL 33415
CONTACT PERSON: John Doe
PHONE NO: 123-456-7890
E-MAIL: johndoe@email.com
Title: President
Total Bid/Offer Price $:
Total:
Total Certified SBE Participation $:
PERCENTAGE OF WORK:
PERCENTAGE OF WORK_1: $50,385.80
2: $35,995.05
PERCENTAGE OF WORK_2:
PERCENTAGE OF WORK_3:
PERCENTAGE OF WORK_4:
PRIME’S DOLLAR AMOUNT OR PERCENTAGE OF WORK: $95,000
Non-SBE: Off
SBE: Yes
Non-SBE_1: Yes
SBE_1: Off
Non-SBE_2: Off
SBE_2: Off
Non-SBE_3: Off
SBE_3: Off
Non-SBE_4: Off
SBE_4: Off
Check Box0: Off
Check Box1: Yes
Text Field00:
Text Field1:
SOLICITATIONPROJECT NUMBER: 2023-020669.2
SOLICITATIONPROJECT NAME: Parks Splash Pad-UV Sanitation & Filtration Upgrade (RE-BID)
Check boxs that apply:
Subcontractor:
SBE0: Off
NonSBE: Off
Supplier: Off
Date of Palm Beach County Certification if applicable:
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at the following total price or percentage:
Name of 2nd3rd tier Subcontractorsubconsultant:
Price or Percentage:
Print Name of Prime:
Print Name of Subcontractorsubconsultant:
Print Name:
Print Name_2:
Title1:
Title_2:
Date:
Date_2:
—:
$$:
SOLICITATION OPENING/SUBMITTAL DATE:SOLICITATION DATE:
COUNTY DEPARTMENT:COUNTY DEPARTMENT:
NAME OF PRIME RESPONDENT/BIDDER:NAME OF PRIME:
ADDRESS:ADDRESS:
CONTACT PERSON:CONTACT PERSON:
PHONE NO:PHONE NO:
E-MAIL:E-MAIL:
TitleTitle:
Total Bid/Offer Price$Total Bid/Offer Price $:
SOLICITATION/PROJECT/BID NAME:NAME:SOLICITATION/PROJECT/BID: Parks Splash Pad-UV Sanitation & Filtration Upgrade (RE-BID)
SOLICITATION/PROJECT/BID NO:NO:SOLICITATION/PROJECT/BID: 2023-020669.2
PRIME'S DOLLAR AMOUNT OR PERCENTAGE OF WORK:PRIME'S DOLLAR AMOUNT OR PERCENTAGE OF WORK:
DOLLARDOLLAR AMOUNTAMOUNT OROR:
[JI:
[JI_1:
[JI_2:
[JI_3:
SBESBE Prime'Prime'ss mumusstt includeinclude theirtheir percentagepercentage oror dollardollar amountamount inin thethe TotalTotal ParticipationParticipation lineline underunder sectionsection BB I I I I_1: Off
SBESBE Prime'Prime'ss mumusstt includeinclude theirtheir percentagepercentage oror dollardollar amountamount inin thethe TotalTotal ParticipationParticipation lineline underunder sectionsection BB I I I I_2: Off
Non-SBE2: Off
[JI_4: Off
[JI_5: Off
Non-SBE_13: Off
[JI_6: Off
Non-SBE_24: Off
[JI_7: Off
Non-SBE_35: Off
[JI_8: Off
Check Box06: Off
Check Box17: Off
Text Field08:
Text Field19:
Text Field2:
Text Field3:
Text Field4:
Check Box2: Off
Check Box3: Off
Check Box4: Off
Check Box5: Off
Check Box6: Off
Check Box7: Off
Check Box8: Off
Check Box9: Off
Check Box10: Off
Check Box11: Off

File details come from the government source that posted it. Updated .