ATTACHMENT 1

REQUIRED FORMS

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BID FORM

ITB NO: 26-37

This proposal of , hereinafter called “BIDDER,” organized and existing under the laws of the State of doing business as (Insert “a corporation”, “a partnership” or “an individual” as applicable), is hereby submitted to the Board of County Commissioners, Bay County, hereinafter called “OWNER.”

In compliance with the Advertisement for Bids, BIDDER hereby proposes to perform all work, as detailed in this bid.

By submission of this BID, each Bidder certifies, and in the case of a joint BID each party thereto certifies as to its own organization, that this BID has been arrived at independently, without consultation, communication or agreement as to any matter relating to this BID with any other BIDDER or with any other competitor.

Vendor agrees to perform the entire work as indicated on the drawings and in compliance with the Contract Documents and Specifications, complete in every detail.

The price per gallon of Liquid Sodium Hypochlorite delivered is:

(Words)

Submitted By:

Name of Firm/Vendor Submitting This Bid

Bid Prepared By:

Name of Individual Who Prepared This Bid

Contact Email:

Address:

Phone:

Signature of Authorized Representative of Firm/Vendor Date

SEAL: (If bid is by Corporation)

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ORDER PLACEMENT INFORMATION

Order Placement Information:

Each bidder shall indicate the name, address, e-mail, and telephone number for the purpose of placing orders.

Order Placement Information:

Contact Person Telephone Number

Address E-mail

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ADDENDUM ACKNOWLEDGEMENT

I acknowledge receipt of the following addenda:

ADDENDUM NO. DATED

ADDENDUM NO. DATED

ADDENDUM NO. DATED

ADDENDUM NO. DATED

ADDENDUM NO. DATED

Name of Firm:

Authorized Signature:

Printed Name:

Title:

Date:

It is the responsibility of the firm to ensure that they have received addendums if issued.

Call (850) 248-8270 or email Purchasing@baycountyfl.gov prior to submitting your bid to ensure that you have received addendums.

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AFFIDAVIT OF COMPLIANCE WITH SECTION 287.138, FLORIDA STATUTES,

CONTRACTING WITH FOREIGN ENTITIES OF CONCERN

Before me, the undersigned authority, personally appeared (Name of Affiant) _______________ ____________________, who, after being first duly sworn, deposes and says of his or her personal knowledge the following:

1. Affiant is the (Title) ___________________________ of (Business Name) _________________________________ which does business in the State of Florida, hereinafter called the “Nongovernmental Entity.”

2. Nongovernmental Entity, pursuant to § 287.138, Florida Statues, certifies that (1) Nongovernmental Entity is not owned by a government of a foreign country of concern; (2) a government of a foreign country of concern does not have a “controlling interest” in Nongovernmental Entity, as defined by Section 287.138(1)(a), Florida Statutes; and (3) Nongovernmental Entity is not organized under the law of nor has its principal place of business in a foreign country of concern. For the purposes of this affidavit, foreign country of concern means the People’s Republic of China, the Russian Federation, the Islamic Republic of Iran, the Democratic People’s Republic of Korea, the Republic of Cuba, the Venezuelan regime of Nicolás Maduro, or the Syrian Arab Republic, including any agency of or any other entity of significant control of such foreign country of concern, as defined in § 287.138(1)(c), Florida Statutes.

3. This Affidavit is executed by the Nongovernmental Entity accordance with § 287.138, Florida Statutes, for the purposes of preventing Bay County, Florida, from entering contracts with foreign entities of concern which would provide Nongovernmental Entity access to an individual’s personal identifying information.

Signed and Delivered on this _____ day of __________, 2026.

Signature of Affiant Printed Name of Affiant

STATE OF__________________

COUNTY OF________________________

$602/ 40 "02 %**,2.)(# %/( 35&3'2,&)( &)*02) .) &7 .)%/3 0* 8 1+73,'%- 12)3)/') 02 8 0/-,/) notarization, this ______ day of _____________, 2026, by ___________________________.

Personally Known OR Produced Identification Type of Identification Produced________ __ ____________________________ (Notary Signature)

(SEAL)

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AFFIDAVIT OF COMPLIANCE WITH SECTION 787.06, FLORIDA STATUTES,

HUMAN TRAFFICKING ATTESTATION

Before me, the undersigned authority, personally appeared (Name of Affiant) _________________________________, who, after being first duly sworn, deposes and says of his or her personal knowledge the following:

1. Affiant is the (Title) ______________________________ of (Business Name) __________________________________ which does business in the State of Florida, hereinafter called the “Nongovernmental Entity.”

2. Nongovernmental Entity, pursuant to § 787.06(13), Florida Statues, certifies that 1) neither Nongovernmental Entity nor any of its subsidiaries or affiliates uses coercion for labor or services, as terms are defined in § 787.06, Fla. Stat., as may be amended from time to time; (2) Nongovernmental Entity will immediately notify Bay County, Florida, if, at any time in the future, Nongovernmental Entity does use coercion for labor or services, and understands that pursuant to such notification no contracts may be executed, renewed, or extended between the parties; and (3) Nongovernmental Entity has read the foregoing attestation, confirms the facts stated in it are true, ad are made for the benefit of, and reliance by, Bay County, Florida.

Signed and Delivered on this _____ day of __________, 2026.

Signature of Affiant Printed Name of Affiant

STATE OF ___________

COUNTY OF ______________

$602/ 40 "02 %**,2.)(# %/( 35&3'2,&)( &)*02) .) &7 .)%/3 0* 8 1+73,'%- 12)3)/') 02 8 online notarization, this ____ day of _____________, 2026, by ___________________.

Personally Known OR Produced Identification

Type of Identification Produced______ _______________________________ (Notary Signature)

(SEAL)

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ANTI-COLLUSION CLAUSE

Firm certifies that their response is made without prior understanding, agreement or connection with any Corporation, Firm or person submitting a response for the same services and is in all respects fair and without collusion or fraud.

Name of Firm:

Authorized Signature:

Printed Name:

Title:

Date:

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BIDDER QUALIFICATION

In order to satisfy the County regarding the Bidder’s qualifications, the Bidder shall provide the below information regarding previous work comparable with the proposed work in size, capacity, and complexity. The County may also consider any previous County projects. Following receipt of bids, each Bidder shall be prepared to furnish such additional information as the County may reasonably request regarding Bidder’s equipment and personnel. The information provided shall constitute an integral part of the bid.

Proposal Sample: Each prospective Proposer shall submit a 1500 ml “chilled” sample of their product representative of their manufacturing process from Proposer’s manufacturing facility which would serve the customer to one of the approved testing laboratories listed in the Specification for analysis within the past ninety (90) days. The laboratory shall ascertain whether the Proposer’s product is in compliance with this Specification for available chlorine, % sodium hypochlorite, excess caustic, iron, copper, nickel, chlorate, bromate, perchlorate and suspended solids (based on Filter Test time).

The manufacturer’s location shall be annotated on the sample results. The cost of the analysis shall be borne by Proposer. The results of the analysis shall be submitted with the Proposer’s proposal.

NSF Sample Results: Each prospective Proposer shall submit a copy of the three most recent years of complete NSF sample results of their product from the manufacturing facility supplying their product which would serve the customer. Bay County shall use these results to ensure compliance with the Specification. The results of the NSF sample analysis shall be submitted with the Proposer’s proposal. Failure to submit this information or meet the requirements of the Specification shall result in Proposer being disqualified.

Other Samples: Bay County reserves the right to take samples from Proposer’s other customers to ensure that the Proposer’s sample and delivery equipment is in compliance with all the requirements of this Specification and such a sample shall be judged representative of the Proposer’s quality. Bay County may choose to obtain a sample from any of Proposer’s customers to ensure compliance with the Specification. In such event, Bay County shall bear the cost of any analysis. Based on this compliance check, failure to meet the requirements of this Specification shall result in Proposer being disqualified.

References and Past Performance: Each prospective Proposer shall submit a list of at least ten (10) references to include phone numbers that use or have used its sodium hypochlorite at both water and wastewater treatment plants in the past five years. The Reference List shall list actual users at the water and wastewater plants and not purchasing agents. Additionally, each Proposer shall provide the names of any customers where its contract was terminated early (e.g., debarred) for safety, quality, or service issues for any product it supplies over the past ten (10) years. Failure to supply these lists shall result in Proposer being disqualified.

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Emergency Response: As part of its Emergency Preparedness Planning and Spill Response Plan, each prospective Proposer shall submit a list with 24-hour access phone numbers of at least two degreed engineers (preferably Chemical Engineers) listing their degree, college or university and year of graduation, experienced in sodium hypochlorite operations to provide emergency support services on a 24/7 basis in the event of a spill, equipment failure or other emergency. In addition, each Proposer shall furnish a list of ten (10) emergency service calls they made to a customer outlining the details of the emergency and the Proposer’s emergency response with a point of contact and phone number to verify the details. Failure to submit either list including its specific requirements shall result in Proposer being disqualified.

Safety and Reliability: As part of assessing the Bidder’s reliability and safety record, the prospective Bidder shall include all regulatory actions including but not limited to, copies of any fines, correspondence and consent orders relating to the operation of ALL of its manufacturing and distribution facilities that serve the Florida market (this does not pertain to FDOT fines or fees) for the past ten (10) years. The Proposer shall submit a copy of its most recent Florida & United States DOT inspection results. Additionally, the Proposer shall submit a copy of its OSHA Form 300A/300 logs for the past five (5) years (if the Proposer utilizes a third party driving company or affiliated company, then they shall submit the OSHA 300 logs for that company as well). Logs shall be submitted for the entire company in addition to any subsidiaries or subcontractors who will serve the Contractor. The Proposer shall also provide a detailed listing of all accidents, incidents, releases, spills, vehicle accidents involving death or injury and National Response Center Notifications (“Safety Incidents”) for all chemicals it delivers or manufacturers for the past five (5) years. Failure to disclose the Regulatory Actions, OSHA 300 logs or Safety Incidents shall result in Proposer being disqualified from bidding on this product.

Training: Each Proposer shall provide documentation that it is able to provide continuing Education units (CEU’s) for water and wastewater operators for annual chemical system training.

Safety Data Sheet (SDS) and Material Specifications: Bidders shall submit with their bid a Safety Data Sheet and material specification (components and analysis) with typical properties for Sodium Hypochlorite and guarantee that all deliveries will meet the specifications on the sheets.

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CERTIFICATION REGARDING SCRUTINIZED COMPANIES LIST

Respondent Vendor Name:

Vendor FEIN:

Vendor's Authorized Representative Name and Title:

Address:

City: State: ZIP:

Phone Number:

Email Address:

Section 287.135, Florida Statutes prohibits agencies from contracting with companies, for goods or services over $1,000,000, that are participating in a boycott of Israel, are on the Scrutinized Companies that Boycott Israel list, the Scrutinized Companies with Activities in Sudan List, the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or has been engaged in business operations in Cuba or Syria.

Both lists are created pursuant to Section 215.473, Florida Statutes.

As the person authorized to sign on behalf of Respondent, I hereby certify that the company identified above in the sector entitled "Respondent Vendor Name" is not participating in a boycott of Israel, is not listed on the Scrutinized Companies that Boycott Israel List, the Scrutinized Companies with Activities in Sudan List, or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List and has not been engaged in business operations in Cuba or Syria. I understand that pursuant to Section 287.135, Florida Statutes, the submission of false certification may subject company to civil penalties, attorney's fees, and/or costs.

Certified By:

AUTHORIZED SIGNATURE

Print Name and Title:

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CONFLICT OF INTEREST DISCLOSURE FORM

For purposes of determining any possible conflict of interest, all firms, must disclose if any Bay County Board of County Commissioner(s), employee(s), elected officials(s), or any of its agencies is also an owner, corporate officer, agency, employee, etc., of their firm.

Indicate either “yes” (a county employee, elected official, or agency is also associated with your firm), or “no”. If yes, give person(s) name(s) and position(s) with your firm.

YES NO

NAME(S) POSITION(S)

Name of Firm:

Authorized Signature:

Printed Name:

Title:

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DRUG FREE WORKPLACE

To have a drug-free workplace program, a business shall:

1. Publish a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition.

2. Inform employees about the dangers of drug abuse in the workplace, the business's policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations.

3. Give each employee engaged in providing the commodities or contractual services that are under Proposal a copy of the statement specified in subsection (1).

4. In the statement specified in subsection (1), notify the employees that, as a condition of working on the commodities or contractual services that are under Proposal, the employees will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contendere to, any violation of Chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction.

5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community, by an employee who is so convicted.

6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of this section.

As the person authorized to sign the statement, I certify the following:

(Check one and sign in the space provided.)

This firm complies fully with the above requirements.

This firm does not have a drug free work place program at this time.

Name of Firm:

Authorized Signature:

Printed Name:

Title:

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SUB-CONTRACTORS

As the bidder, I submit a listing of the Sub-Contractors which I shall use to accomplish the Work. Sub-Contractors are listed by name, address, amount of work and item of work. If none, please state so.

Subcontractor Name and Address:

Work to be performed and $ amount:

Subcontractor Name and Address:

Work to be performed and $ amount:

Subcontractor Name and Address:

Work to be performed and $ amount:

Subcontractor Name and Address:

Work to be performed and $ amount:

Name of Firm:

Authorized Signature:

Printed Name:

Title:

Date:

*Complete additional forms if needed to list all subcontractors

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