25-84131500-ITN DFS BOR Attachment B Mandatory Resp Requirements.pdf
PDF 132 KB Posted
- Attached to
- Insurance Broker of Record - Reinsurance Broker for Property and Casualty lines, Risk Management and
- Solicitation number
- ITN-13124
- Issued by
- St. Johns County, Florida
About this file
This document is Attachment B, Mandatory Responsive Requirements for Invitation to Negotiate (ITN) No. 25-84131500-ITN, issued by the Florida Department of Management Services on behalf of the Department of Financial Services' Division of Risk Management. The document outlines a comprehensive set of mandatory certifications that a respondent must complete and sign to be considered for the Broker of Record and Reinsurance Broker contract. The respondent must certify compliance with various state statutes, confirm they are not on suspended or prohibited vendor lists, verify insurance licensing and authority, and attest to providing required documentation such as a technical response, fee schedule, and vendor certification forms.
The certifications cover a wide range of legal and operational requirements, including confirmation that the respondent has not been terminated by a public employer in the past year, possesses valid insurance licenses, and maintains current insurance transaction authorities. The respondent must also certify they are not involved with scrutinized companies, have not been placed on various prohibited lists, and will provide necessary documentation prior to contract execution. The document requires the respondent to acknowledge an ongoing duty to update the Procurement Officer if any circumstances change that would render the certifications no longer true, with signature fields provided for the respondent's authorized representative to confirm compliance with all listed responsive requirements.
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ITN No.: 25-84131500-ITN
Attachment B
Mandatory Responsive Requirements
Respondent must complete and sign the fields at the bottom of this Attachment to indicate acknowledgment and acceptance of each Responsive Requirement.
Responsive Requirements
The person submitting the Reply and its pricing certifies to being authorized by the Respondent to respond to this solicitation on the Respondent’s behalf.
The Respondent certifies it is in compliance with all applicable disclosure requirements set forth in section 286.101, F.S., and has not been deemed ineligible for a grant or contract funded by a state agency pursuant to section 286.101(7), F.S.
The Respondent certifies that the Respondent is not on the Suspended Vendor List; it and its suppliers, subcontractors, or consultants to be utilized under the contract are not on the Convicted Vendor, Discriminatory Vendor, or Antitrust Violator Vendor Lists; if the contract is for the provision of commodities, the Respondent, and any entity under the control of Respondent, has not been placed on the Forced Vendor List within the past 365 days or, if placed on the Forced Vendor List, has been removed pursuant to section 287.1346(5)(d), F.S.; and there is no pending or threatened action, proceeding, or investigation, or any other legal or financial condition, that would in any way prohibit, restrain, or diminish the Respondent’s ability to satisfy the contract obligations.
The Respondent certifies that the Respondent is in compliance with Section 9 of the PUR1001 form, as modified by the “Special Instructions” section of the ITN.
The Respondent certifies that the Respondent is not on the Scrutinized Companies with Activities in Sudan List, the Scrutinized Companies with Activities in the Iran Terrorism Sectors List, or the Quarterly List of Scrutinized Companies that Boycott Israel, nor is it engaged in a boycott of Israel.
If the goods or services to be provided are $1 million or more, in accordance with the requirements of section 287.135, F.S., the Respondent certifies the Respondent is not on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Terrorism Sectors List (collectively, “Scrutinized List of Prohibited Companies”); does not have business operations in Cuba or Syria; and is not on the State Board of Administration’s “Scrutinized List of Prohibited Companies” available under the quarterly reports section at https://www.sbafla.com/reporting/.
The Respondent certifies that if awarded a Contract, and prior to execution of a Contract, it shall provide to the Department a PDF file of its current and active registration with the Florida Department of State, Division of Corporations, or, if exempt from registration, a statement to that effect noting the basis for the exemption. If Respondent is an out-of-state corporation, it certifies it will provide to the Department a Florida Certificate of Authority from the Florida Department of State, Division of Corporations prior to Contract execution.
Website: www.sunbiz.org.
https://www.dms.myflorida.com/content/download/2934/11780 https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.sbafla.com%2Freporting%2F&data=05%7C02%7CBrittany.Dambly%40dms.fl.gov%7C0adec150d13b4cc7ab2d08dcc60e9f98%7Ced173fed38394a3ca952140e906fed8d%7C0%7C0%7C638603013353015342%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=4o3wZFH%2B69KW8hJ2rUEAB3vbhSGolxhxlhPd0Bdzs2M%3D&reserved=0 http://www.sunbiz.org/
The Respondent certifies that the Respondent is in compliance with section 448.095(5)(a), F.S., and that within the last year (i.e., within the last 365 days), it has not had a contract terminated under section 448.095(5)(c), F.S., by a public employer, as defined by section 448.095(1)(i), F.S.
The Respondent certifies it has provided to the Department pricing on the applicable Attachment D, Fee Schedule / Cost Proposal
The Respondent certifies it has provided a Technical Response in accordance with the instructions in Attachment C, Technical Response.
The Respondent certifies that if awarded a Contract, and prior to execution of a Contract, it shall provide to the Department a completed Attachment G, PUR 7801 Vendor Certification Form. A completed Attachment G, PUR 7801 includes any required forms referenced therein.
The Respondent certifies it has provided a completed Attachment I PUR 2023, Provision of Commodities Produced by Forced Labor in accordance with section 287.1346(4)(b), F.S.
The Respondent certifies that the Broker’s key management personnel assigned to the BOR program will maintain current and active insurance license(s) required to provide the services contemplated herein.
The Respondent certifies that the Respondent and the selected insurers possess a valid and current certificate of authority to transact insurance, in accordance with section 624.404, Florida Statutes, or are eligible surplus lines insurers in accordance with section 626.918, Florida Statutes.
Signature below certifies that Respondent conforms with all Responsive Requirements listed above. Signature below further certifies acknowledgment of the Respondent’s ongoing duty to provide updates to the Procurement Officer should a change in Respondent’s circumstances render these certifications no longer true.
Respondent (Vendor) Name
Signature of Respondent’s Authorized Representative
Authorized Representative’s Printed Name
Date
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