26-SQ-65SR,_Solicitation_and_Forms_(SUBMIT_REQUIRED_FORMS).pdf

RSQ No. 26-SQ-65SR Professional Hydrogeological and Well Services for the County of

Volusia, Florida

1.0 PURPOSE & OVERVIEW

The purpose of this request for statement of qualifications (RSQ) is to select the most qualified firm(s) to provide the requested services. It is anticipated that multiple firm(s) will be awarded a basic contract to provide the necessary services for a period of three (3) years exercisable at the option of the County. Two, one-year renewals may be allowable exercisable at the option of the County and as approved by the Volusia County Council and mutually agreed upon.

Authorization for performance of services by the selected firm(s) under the basic contract shall be in the form of written task assignments signed by the firm, executed and issued by the County. Each project shall be negotiated at the time of the development of the scope of work. Each task assignment shall describe the services required, state the commencement and completion date of work and establish the amount and method of payment. The task assignment will be issued under, and incorporate the terms of the basic contract. The County makes no covenant or promise as to the number of available projects or that the firm will perform any project for the County during the life of the basic contract. The basic contract does not authorize the performance of any work or require the County to place orders for work. Expiration of the term of the basic contract will have no effect upon task assignments issued pursuant to the basic contract and prior to the expiration date. Obligations entered therein by both parties shall remain in effect until completion of the work authorized by the task assignment.

2.0 SCOPE OF SERVICE

2.1 BACKGROUND AND GENERAL SCOPE OF SERVICE: The Volusia County Water Resource and Utilities Services Division currently have twenty-six (26) production wells. Evaluations of these wells are needed to collect and record historical data. Additionally, due to the age of the wells many require redevelopment to ensure reliability. There are also nine (9) water treatment facilities throughout the County.

2.1.1 GENERAL SCOPE OF SERVICE: The County of Volusia is seeking the services of a consultant to provide Professional Hydrogeological and Well Services for the design, permitting, construction, and/or repair testing of new and existing wells and associated well head appurtenances and pumps; to oversee projects that are critical to the County’s current and future operations; and to support water supply planning, consumptive use permitting, Hydrogeological studies, ground water modeling, aquifer performance testing, monitoring data evaluations, permit compliance monitoring, and biological impact assessments. The scope of services shall consist of, but not limited to:

A. Professional Hydrogeological Services

1. Development of a Data Collection and Evaluation Program for each well;

2. Onsite observation and direction during field effort;

3. Evaluation of geophysical and TV survey data;

4. Remedial Well Development Program to restore wells through acidization, wire brush the casing, air lift, and/or AirBurst technique, if needed;

5. Evaluation of shallow aquifer development;

6. Turnkey Well Evaluations, well design, permitting, construction and testing;

7. Overseeing the process of modifying or renewing Consumptive Use Permits (CUP);

and

8. Provide written reports on findings, digital copies of the geophysical logs and TV survey and make recommendations to the County on a course of future action to improve water quality.

B. Well Field Services

1. Mobilize personnel and equipment to each well site;

2. Remove and inspect the well pump(s) and related equipment, provide the County with recommendations for pump repairs or pump replacement;

3. Well head modifications;

4. Debris removal from wells;

5. Well abandonment;

6. Install and operate a test pump as required to complete well work;

7. Conduct static and pumped geophysical logs;

8. Conduct static and pumped TV survey;

9. Deliver pump to shop for evaluation, with County approval, make any needed repairs to the pumps;

10. Re-install the repaired or new pump; and

11. Flow test and adjust the pump.

The consultant shall be specialized in well field development, well evaluations and emergency response. Furthermore, they shall have extensive knowledge of the Florida Aquifer and be familiar with the Volusia County’s Wells. Consultants shall be able to monitor the County’s Well’s and have a professional geologist within their team to evaluate the needs of each of the Wells. Each individual well shall be treated on a case-by-case basis. The consultant’s Geologist shall determine what developmental method is needed to restore a well to proper operation.

2.2 QUALIFICATIONS/CERTIFICATIONS: The preferred firm will have a current professional registration certificate from the appropriate governing board. A firm must be properly registered at the time of its submittal to practice their profession in the State of Florida.

2.3 EVALUATION METHOD: The County will appoint a committee consisting of department staff to evaluate the proposals and to make recommendation to the County Council. The County will be the sole judge of its own best interests, the proposals, and the resulting contract. The County’s decisions will be final. Award will be made to the proposal(s), which presents the best value to the County based on the entire evaluation process and all the information gathered. The County may require the short-listed firm

(s) to do an oral presentation or have discussions by proposed team relative to their specific experience on similar projects. Although, each member independently examines the proposals prior to the meeting, the short-listing or selection of the firms is determined by the consensus of the committee at the meeting.

Note: Respondents are prohibited from contacting any of the committee members, other than the Procurement analyst prior to the recommendation of award from the committee.

2.4 EVALUATION CRITERIA: The following criteria will be used in the evaluation of the proposals:

A. Qualifications, experience and project approach:

Qualification of the Firm/Employees; Litigation:

Experience/References.

Project Approach.

Quality of performance or previous contracts or services.

Resources and Ability (Sufficiency of resources and ability to the Firms to perform the Contract/provide the services).

Price/Cost Proposal (Hourly rates from Firm).

Financial Stability.

Note: The County reserves the right to evaluate, prior to making an award, current financial statements and data from the applicants, the ability to comply with required schedule, past record of integrity and record of performance.

B. ASSESSMENT: The committee will evaluate each proposal against the requirements of the solicitation using the following:

Strengths: Those areas in which the proposal exceeds the County’s requirements.

Weaknesses: Those areas where the proposal lacks soundness or effectiveness which could prevent fully successful performance of the contract.

Risk/Deficiencies: Those areas where the proposal fails to meet the County’s requirements.

2.5 QUESTIONS/EXCEPTIONS: It is incumbent upon each respondent to carefully examine this solicitation’s specifications, scope of work/service, and terms and conditions. Questions and exceptions concerning any section of this solicitation and Contract (see Exhibit “B”) shall be submitted in OpenGov. Questions and exceptions shall be submitted and received no later than fourteen (14) days before the closing date. Thereafter, no further questions or exceptions will be accepted or reviewed by the County and respondents’ right to submit questions or exceptions will terminate and any questions or exceptions not previously made shall be deemed waived. The issuance of a written addendum is the only official method by which interpretation, clarification, or additional information can be given and oral representations will not be binding on the County.

If it becomes necessary for the County to revise or clarify any part of this RSQ the solicitation will be updated on the OpenGov platform by one of the following methods: the posting of answers to questions received; the revision of solicitation language/documentation. It is each Bidder’s responsibility to check the OpenGov web site for any posted answers, and/or solicitation changes at https://procurement.opengov.com/portal/volusia. Each Respondent shall ensure that they have reviewed all questions & answers and/or changes to this RSQ before submitting their proposal. By submitting a response, Respondents acknowledge that they have reviewed all posted answers, and/or solicitation changes prior to the posted closing date/time.

https://app.negometrix.com/today

Answers posted by the County, and/or changes made to the solicitation shall become a material part of this solicitation.

3.0 GENERAL TERMS & CONDITIONS

3.1 Definitions: As used in this RSQ, the following terms shall have the meanings set forth below:

Construction Services: Means all labor, services, and materials provided in connection with the construction, alteration, repair, demolition, reconstruction, or any other improvements to real property.

The term "construction services" does not include Contracts or work performed for the Department of Transportation.

Consultant: The person with education and/or experience which uniquely qualifies him or her to perform a specialized service for the County.

Consultant's services: Those services within the scope of work of this solicitation that are in an advisory nature to support policy development, decision-making, administration, or management of the government; normally provided by persons and/or organizations considered to have prerequisite knowledge or special abilities not generally available in the government.

Contract: The document resulting from this solicitation between the County and the awarded Respondent, including this RSQ, and the awarded Respondent’s response along with any written addenda and other written documents, which are expressly incorporated by reference.

Consultant: That person or entity, including employees, servants, partners, principals, agents and assignees of the person or entity that has submitted a Bid or proposal for the purpose of obtaining business with the County to provide the product and/or services set forth herein.

Contract Administrator: The Director of Purchasing and Contracts or designee shall serve as Contract Administrator. The Contract Administrator shall be responsible for addressing any concerns within the scope of the Contract. Any changes to the resulting Contract shall be done in writing and authorized by the Director of Purchasing and Contracts.

County: Shall mean the County of Volusia (a body corporate and politic and a subdivision of the State of Florida).

County’s Project Manager(s): The Project Manager(s) have responsibility for the day to day administration of the resulting Contract for the County and will be designated prior to award of Contract.

Day: The word “day” means each calendar day or accumulation of calendar days.

Director: The Director is the Director of Purchasing and Contracts for the County of Volusia.

Person or Persons: An individual, firm, partnership, corporation, association, executor, administrator, trustee or other legal entity, whether singular or plural, masculine or feminine, as the context may require.

Proposal: The document submitted by the Consultant in response to a formal solicitation used to determine if the Consultant is highly qualified.

Protest: See process at www.volusia.org/purchasing.

Respondent: That person or entity, including employees, servants, partners, principals, agents and assignees of the person or entity that submits a proposal for the purpose of obtaining a Contract with the

County for the provision of the services requested in the RSQ.

Respondent’s Project Manager: The Project Manager has responsibility for administering this Contract for the Respondent and will be designated prior to execution of the Contract.

Task Assignment: Specific, detailed services or work placed against an awarded and established continuing services Contract memorialized as an Amendment to this Contract by the parties prior to the commencement of such Work or Services by the Consultant.

4.0 PROPOSAL REQUIREMENTS: Firms interested in providing the required professional services shall submit their proposals via the new On-line system. Paper proposals will no longer be accepted. Once respondents register with OpenGov, respondents will be able to submit their proposal securely, any time before the solicitation deadline, at https://procurement.opengov.com/portal/volusia by clicking the PARTICIPATE BUTTON under the solicitation. Proposals submitted on OpenGov will remain locked and inaccessible by County purchasing staff until the solicitation deadline.

Registration with OpenGov is free and is required prior to submitting a bid response electronically. You will be required to register once you click the PARTICIPATE BUTTON in the solicitation file. It is suggested your company register no later than 24 hours in advance of the bid submission deadline to ensure proper registration.

DO NOT SEND CONFIDENTIAL, PROPRIETARY INFORMATION OR TRADE SECRETS

The Consultant/Proposer acknowledges that information provided in the response is true and correct and agrees to all terms and conditions contained in this solicitation and related exhibits. Consultant/Proposer further agrees and acknowledges that no proprietary or confidential information has been submitted and that the submission of a response is final. Responses may be withdrawn by the Consultant/Proposer prior to the closing/offer date. Following the closing/offer date, Consultant/Proposer understands that a response may not be withdrawn.

By submitting this proposal or entering into this contract, Consultant/Proposer acknowledges that all documents submitted are public records and agrees that any records maintained, generated, received, or kept in connection with, or related to the performance of services or delivery of products provided under this proposal or contract are public records subject to the public records disclosure requirements of Florida Statutes sec. 119 et seq., and Article I, section 24 of the Florida Constitution.

Proposals shall be clear and concise. Failure to provide the required information may result in the proposal not being considered.

Tab 1. Qualification Data

A. A submittal letter signed by an authorized agent of the firm, as listed on the Florida Department of

State, Division of Corporations’ Sunbiz report available at www.sunbiz.org (Sunbiz), shall be required. If anyone other than the officers listed on the Sunbiz website will be signing this RSQ, a memorandum of authority signed by an officer of the firm allocating authorization shall be required. If firm is not currently registered as a vendor in the State of Florida (Sunbiz), include documentation designation of contracting authority. The memorandum of authority shall be on the firm’s letterhead and shall clearly state the name, title and contact information for the individual designated by the firm and the signature shall be original.

B. A brief profile of the firm, including:

1. A brief history of the business;

https://app.negometrix.com/buyer/970 https://procurement.opengov.com/portal/volusia http://www.sunbiz.org/

2. Designation of the legal entity by which the business operates (i.e., sole proprietorship, partnership, limited liability partnership, corporation, limited liability corporation, etc.)

including documentation from the appropriate state’s agency confirming firm’s legal entity type. For non-Florida businesses, submit documentation from the state in which the business was formed and documentation from the State of Florida providing authorization to perform business in the state of Florida;

3. A Florida Department of State, Division of Corporations’ Sunbiz report available at www.sunbiz.org;

4. Ownership interests;

5. Active business venues (counties, states, etc.);

6. Present status and projected direction of business;

7. The overall qualifications of the business to provide the services requested.

Tab 2. Project Team:

1. Prime Consultant: Professional staff (name, project role, business address, phone number, and e-mail address) including job skills, education (degree and specification), professional training, total years’ experience, years’ experience with current firm, professional registration, project experiences, and other professional qualification. [A maximum of five (5) pages for this section].

2. Sub-consultants: Same as above including number of years’ experience working with the respondent and past relationships [A maximum of three (3) pages for this section].

3. Organizational chart: One (1) page maximum of the proposed team (prime & sub-consultants).

Tab 2 shall not exceed 9 pages. If tab 2 contains more than nine (9) pages as indicated, your proposal may be considered non-responsive.

Tab 3. Financial Stability

Respondent shall provide a statement certifying that they are financially stable and have the necessary resources, human and financial, to provide the services at the level required by the County of Volusia.

Respondent shall also list any lawsuits in which their team (firm & sub-consultants) has been involved in relative to company contracts or other company business over the last five (5) years. The respondent shall also list any work their team failed to complete in accordance with any contract in the last five (5) years and describe details regarding the non-performance, including listing any officer or partner of their team who in the last five (5) years failed to complete a contract handled in his/her name.

Tab 4. Project Approach:

Respondent shall explain their internal process, which includes their proposed team, for responding to request for work including their method for quality control [A maximum of five (5) pages in this section].

Tab 5. Similar Projects and References:

The information provided under this tab, must be current and the County must be able to contact references for verification as part of the evaluation process.

http://www.sunbiz.org/

Unless specifically asked by the County, the County of Volusia shall not be listed as a reference. The respondent shall provide examples of similar projects which best illustrates the Consultant’s qualification for the scope of services. [A maximum of eight (8) pages in this section].

The respondent shall provide examples of similar projects which best illustrates the proposed team’s qualification for the scope of services. Respondent shall state the project title; location; owner name, address, and telephone number; years completed; project cost; brief description of project and relevance to this RSQ.

Provide a client reference for each of the representative projects including project name, client name, address, contact name and phone number and E-mail address. It is the firm’s responsibility to ensure E-mail addresses provided are current and accurate. (Use Attached Reference Form 15.0, this form is not part of the 8 pages for this section).

Tab 6. Forms

A. Authorized Representative/Joint Ventures: Respondents submitting letter of interest from an authorized representative shall provide additional documentation from the corporate officer or principal authorizing the representative to bind the firm to a contract. Joint ventures shall submit a statement of participation by a principal of each member of the joint venture with their proposal.

B. Professional Certification/Licenses: Respondent and their sub-consultants/SubConsultants shall have a current professional license from the appropriate governing board to practice in the State of Florida at the time of its submittal. Respondent and their sub-consultants/SubConsultants shall submit with their submittal, copies of their professional license. Licenses shall remain current for the entire term of the Contract resulting from this solicitation.

C. Insurance: Attach evidence of required insurance coverage or proof of insurability in the amounts indicated. If available, a properly completed ACORD Form is preferable. Final forms must contain the correct solicitation and/or project number and name of Volusia County’s contact person.

D. Notice of Election to be Exempt/Hold Harmless Agreement, if applicable: Respondents that are exempt under the Florida worker’s compensation law in Chapter 440.02 Florida Statutes shall provide a copy of their “Notice of Election to be Exempt,” if applicable or Hold Harmless Agreement for each person exempt and proof of coverage for non-exempt employees. The hold harmless agreement is included as an attachment to this request for qualifications. Said agreements shall be returned with the proposal as detailed in the proposal requirements (Note: When completing the form, leave the contract date blank)

E. Conflict of Interest Disclosure Form: All Respondents shall properly complete and include with their proposal the attached statement disclosing any potential conflict of interest that the Respondent may have due to ownership, other clients, contracts, or interests associated with this project.

F. Prohibition Against Contingent Fees: Respondent shall properly complete, notarize and include with their proposal the attached disclosure statement certifying that he or she has not employed or retained any company or person, other than a bona fide employee working solely for the respondent to solicit or secure this contract and that he or she has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona fide employee working solely for the respondent any fee, commission, percentage, gift, or other consideration contingent upon or resulting from award or making of this contract (See the attached form included in this package).

G. Public Entity Crime and Discriminatory Vendor List: Respondents shall complete and include with their proposal the attached disclosure statement certifying that the submission of its proposal does not violate Section 287.133, Florida Statutes (2005), nor Section 287.134, Florida Statutes (2005). Additionally, respondent shall also certify that respondent, respondent’s subconsultants and respondent’s implementer, if any, is not under investigation for violation of such statutes (the attached forms “Certification Regarding Debarment, Suspension, and Other Responsibility Matters Primary Covered Transactions” and the “Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion” shall be completed by the prime consultant and all sub-consultants of the project team).

H. Completed W-9 form: Include a completed W-9 form. If the firm is not registered with Volusia

County, on-line registration is available at www.volusia.org/purchasing under Vendor Self Service, which links to the registration site. The W-9 form can be accessed through this site as well.

I. Drug-Free Work Place Form: Respondents shall complete and include with their proposal the attached form certifying compliance with Florida Statute 287.087 (See “Drug-Free Work Place” form).

J. Certification Regarding Debarment (Prime) Form

K. Certification Regarding Debarment (Sub) Form

L. Certification Regarding Prohibition Against Contracting with Scrutinized Companies Form

M. Human Trafficking Attestation Form.

END OF PROPOSAL REQUIREMENTS

http://www.volusia.org/purchasing

5.0 GENERAL INFORMATION:

CONFIDENTIAL INFORMATION: Do not send confidential, proprietary information or trade secrets.

DISADVANTAGED AND WOMEN BUSINESS ENTERPRISES: The County of Volusia has adopted policies that encourage the full participation of Disadvantaged and Women Business Enterprises (D&WBE) in the provision of goods and services. Municipal Code section 2-269, County Ordinance No. 90-20, § 9,5-17-90 of the County Council of the County of Volusia, establishes the policies and procedures for the Disadvantaged and Women's Business Enterprises program. The awarded Respondent shall endeavor to fulfill the goals and policies of this ordinance.

EXPENSES INCURRED: This invitation does not commit the County to award a contract. Nor shall the County be responsible for any cost or expense incurred by any firm in preparing and submitting a reply, nor for any cost or expense incurred by any respondent prior to the execution of a contract contract. The County reserves the right to require any or all firm to appear for interviews and/or oral presentations at no cost to the County.

WAIVER: The County of Volusia reserves the right to reject any or all proposals, to waive informalities and to accept all or any part of any proposal as may be deemed to be in the best interest of the County.

REMAINDER OF THIS PAGE LEFT INTENTIONALLY BLANK

6.0 CONFLICT OF INTEREST DISCLOSURE:

I HEREBY CERTIFY that

1. I, (printed name) __________________________________________________________, am the (title)

___________________________________ and the duly authorized representative of the firm of (Firm Name)

_________________________ whose address is ____________________________, and that I possess the legal authority to make this affidavit on behalf of myself and the firm for which I am acting; and,

2. Except as listed below, no employee, officer, or agent of the firm have any conflicts of interest, real or apparent, due to ownership, other clients, contracts, or interests associated with this project; and,

3. This bid submittal is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a bid for the same services, and is in all respects fair and without collusion or fraud.

EXCEPTIONS to items above (List):________________________________________________________

By ________________________________________ Date _____________

(Signature)

By ________________________________________

Corporate Officer Name & Title

7.0 PROHIBITION AGAINST CONTINGENT FEES:

In accordance with Florida Statute 287.055(6)(a), the following statement, duly signed and notarized, must be included in each proposal:

The firm, _______________________________________, warrants that he or she has not employed or retained any company or person, other than a bona fide employee working solely for the respondent to solicit or secure this agreement and that he or she has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona fide employee working solely for the respondent any fee, commission, percentage, gift, or other consideration contingent upon or resulting from award or making of this agreement.

By ________________________________________ Date _____________

(Signature)

By ________________________________________

Corporate Officer Name & Title

STATE OF _____________________________

COUNTY OF ___________________________

Sworn to/affirmed and subscribed before me this ______ day of ________________________, 20____, by

_____________________________________________________, who is personally known to me or who has produced

_______________________________________________ as identification.

NOTARY PUBLIC – STATE OF ____________________

Type or print name:

Commission No.: __________________________________

Commission Expires: _______________________________

(Seal)

8.0 Notification Regarding Public Entity Crime and Discriminatory Vendor List Requirements and Disqualification Provision:

A. By entering into this Contract, the Consultant represents and warrants that it is not on the discriminatory vendor list and not under investigation for violation of any state or federal law prohibiting discrimination. The Consultant further represents and warrants that its subConsultants and implementer, if any, are not on the discriminatory vendor list and not under investigation for violation of any state or federal law prohibiting discrimination. Pursuant to Florida Statutory requirements, potential Respondents are notified:

• Section 287.133(2)(a)(as amended): A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a Consultant, supplier, subConsultant, or consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in section 287.017, Florida Statutes, for CATEGORY TWO for a period of 36 months following the date of being placed on the convicted vendor list.

• Section 287.134(2)(a)(as amended): An entity or affiliate who has been placed on the discriminatory vendor list may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity;

may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a Consultant, supplier, subConsultant, or consultant under a contract with any public entity; and may not transact business with any public entity.

• Section 287.134(2)(b)(as amended): A public entity may not accept any bid, proposal, or reply from, award any contract to, or transact any business with any entity or affiliate on the discriminatory vendor list for a period of 36 months following the date that entity or affiliate was placed on the discriminatory vendor list unless that entity or affiliate has been removed from the list pursuant to paragraph 287.134(3)(f), Florida Statutes. A public entity that was transacting business with an entity at the time of the discrimination resulting in that entity being placed on the discriminatory vendor list may not accept any bid, proposal, or reply from, award any contract to, or transact any business with any other entity who is under the same, or substantially the same, control as the entity whose name appears on the discriminatory vendor list so long as that entity's name appears on the discriminatory vendor list.

B. By submitting a proposal, the Respondent represents and warrants that the submission of its proposal does not violate

Section 287.133, Florida Statutes (2005), nor Section 287.134, Florida Statutes (2005) or their successor.

C. In addition to the foregoing, the Respondent represents and warrants that Respondent, Respondent’s subConsultants and Respondent’s implementer, if any, is not under investigation for violation of such statutes.

D. Respondent should read carefully all provisions of 287.133 and 287.134, Florida Statutes (2005).

Note: Consultant shall complete the “Certification regarding debarment, suspension, and other responsibility matters primary covered transactions (Prime Consultant)” and the “Certification regarding debarment, suspension, ineligibility and voluntary exclusion (Sub-Consultants).”

Name & Title: ________________________________ Date: ____________________

Signature: ___________________________________

9.0 Certification Regarding Debarment, Suspension, And Other Responsibility Matters Primary Covered Transactions:

TO BE COMPLETED BY THE PRIME CONSULTANT

1) The prospective primary participant (consultant) certifies to the best of its knowledge and belief, that it and its principals (subconsultants and subConsultants):

(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;

(b) Have not within a three-year period preceding this solicitation been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction;

violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property.

(c) Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification;

and,

(d) Have not within a three-year period preceding this solicitation had one or more public transactions (Federal, State, or local) terminated for cause or default.

2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this solicitation.

Name and title

Signature

Firm

Street address

City, State, Zip

Date

10.0 Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion:

TO BE COMPLETED BY ALL SUB-CONSULTANTS

1. The prospective participant (sub-Consultant) certifies to the best of its knowledge and belief, that it and its principals (subConsultants and suppliers):

a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;

b. Have not within a three (3) year period preceding this bid proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property.

c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1) (b) of this certification; and

d. Have not within a three-year period preceding this bid proposal had one or more public transactions

(Federal, State, or local) terminated for cause or default.

2. Where the prospective participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this bid proposal.

Name and title

Signature

Firm

Street address

City, State, Zip

11.0 CERTIFICATION REGARDING PROHIBITION AGAINST CONTRACTING WITH

SCRUTINIZED COMPANIES:

I hereby certify that neither the undersigned entity, nor any of its wholly owned subsidiaries, majority-owned subsidiaries, parent companies, or affiliates of such entities or business associations, that exists for the purpose of making profit have been placed on the Scrutinized Companies that Boycott Israel List created pursuant to

s. 215.4725 of the Florida Statutes, or are engaged in a boycott of Israel.

In addition, if this solicitation is for a contract for goods or services of one million dollars or more, I hereby certify that neither the undersigned entity, nor any of its wholly owned subsidiaries, majority- owned subsidiaries, parent companies, or affiliates of such entities or business associations, that exists for the purpose of making profit are on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, created pursuant to s.215.473 of the Florida Statutes, or are engaged in business operations in Cuba or Syria as defined in said statute.

I understand and agree that the County may immediately terminate any contract resulting from this solicitation upon written notice if the undersigned entity (or any of those related entities of respondent as defined above by Florida law) are found to have submitted a false certification or any of the following occur with respect to the company or a related entity: (i) it has been placed on the Scrutinized Companies that Boycott Israel List, or is engaged in a boycott of Israel, or (ii) for any contract for goods or services of one million dollars or more, it has been placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or it is found to have been engaged in business operations in Cuba or Syria.

Name of Respondent: _____________________________________

By: (Authorized Signature)

Title: _____________________________________

Date: _________________________

12.0 DRUG-FREE WORK PLACE:

The undersigned firm in accordance with Florida statute 287.087 hereby certifies that

___________________________________________does:

(Name of Firm)

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 proposed 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 employee will propose by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contender 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 any 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 that this firm complies fully with the above requirements.

Name and title

Signature

Firm

Street address

City, State, Zip

13.0 HUMAN TRAFFICKING ATTESTATION, PURSUANT TO SECTION 787.06, FLORIDA

STATUTES

Name of Entity/Contractor: ("Nongovernmental Entity")

This form has been completed by a duly authorized officer or representative of the Nongovernmental Entity in conjunction with the execution, renewal, or extension of a contract with County of Volusia, a governmental entity and political subdivision of the State of Florida, ("Governmental Entity") in compliance with Section 787.06(13), Florida Statutes, (2024).

The Nongovernmental Entity acknowledges that Section 787.06(13), Florida Statutes, provides that when a contract is executed, renewed, or extended between a nongovernmental entity and a governmental entity, the nongovernmental entity must provide the governmental entity with an affidavit signed by an officer or a representative of the nongovernmental entity under penalty of perjury attesting that the nongovernmental entity does not use coercion for labor or services. For purposes of this requirement, “labor” means work of economic or financial value and “services” means any act committed at the behest of, under the supervision of, or for the benefit of another. The term, “services” includes, but is not limited to, forced marriage, servitude, or the removal of organs.

Pursuant to Section 787.06, Florida Statutes, when a contract is executed, renewed, or extended between you, a nongovernmental entity, and Volusia County, a governmental entity in the State of Florida, you are hereby providing this affidavit under penalties of perjury that you do not use coercion to employ any person for labor or services. Coercion includes, without limitation, using or threatening to use physical force against any person;

restraining, isolating, or confining or threatening to restrain, isolate, or confine any person without lawful authority and against her or his will; using lending or other credit methods to establish a debt by any person when labor or services are pledged as a security for the debt, if the value of the labor or services as reasonably assessed is not applied toward the liquidation of the debt, the length and nature of the labor or services are not respectively limited and defined; destroying, concealing, removing, confiscating, withholding, or possessing any actual or purported passport, visa, or other immigration document, or any other actual or purported government identification document, of any person; causing or threatening to cause financial harm to any person; enticing or luring any person by fraud or deceit; or providing a controlled substance as outlined in Schedule I or Schedule II of Section 893.03, Florida Statutes, to any person for the purpose of exploitation of that person.

This signed attestation is provided to the Governmental Entity to comply with the statutory requirement. If, at any time in the future, the Nongovernmental Entity does use coercion for labor or services, the Nongovernmental Entity will immediately notify the Governmental Entity and no contracts may be executed, renewed, or extended between the parties.

This attestation is made for the benefit of, and reliance by, the Governmental Entity.

Under penalties of perjury, I declare that I have read the foregoing statement and that the facts stated in it are true.

Printed Name:

Title:

Signature:

Date:

14.0 HOLD HARMLESS AGREEMENT:

I, ______________ (print officer/owner’s name), am the officer/owner of _____________________________ (print company name), an incorporated/unincorporated business operating in the State of Florida. As such, I am bound by all laws of the state of Florida, including but not limited to those regarding the workers’ compensation law.

I hereby affirm that I or [the above-named business] employs fewer than four employees, all of whom are listed below, including myself, and therefore, the business is exempt from the statutory requirement for workers’ compensation insurance for its employees. I certify that I will provide the County of Volusia with the name of each new employee together with all required waivers and releases for each prior to any employee being allowed to work to provide services under the contract set forth below. If any such employee is allowed to work without a signed waiver and release, such action will be a material breach of this Agreement. All signed waivers and releases shall be furnished before the commencement of any work by an employee or the undersigned to the County Project Manager or designated county representative.

On ____ day of _________________, 20___, the County of Volusia and I or [the above-named business] entered into a contract for __________________________________________ (please insert name of contract) (hereinafter “Agreement”) which is incorporated by reference herein.

On behalf of myself, my business, and the employees listed below, I and they hereby agree to waive and release any and all workers’ compensation claims or liens under Chapter 440, Florida Statutes, against the County of Volusia and its agents, officials and employees, arising from any work or services provided under the Agreement whether or not it shall be alleged or determined that the act was caused by intention, or through negligence or omission of the County of Volusia or its agents, officials and employees or sub-consultants.

In the event that a workers’ compensation claim or lien is made against the County of Volusia and/or its agents, officials or employees by myself or my employees or agents as a result of any work or services performed under the

Agreement, I agree to indemnify, keep and hold harmless the County of Volusia, Florida, its agents, officials and employees, against all injuries, deaths, losses, damages, claims, liabilities, judgments, costs and expenses, direct, indirect or consequential (including, but not limited to, fees and charges of attorneys and other professionals) arising out of the

Agreement with the County of Volusia, whether or not it shall be alleged or determined that the act was caused by intention or through negligence or omission of the County of Volusia or its employees, agents, or sub-consultants. I or the above-named business shall pay all charges of attorneys and all costs and other expenses incurred in connection with the indemnity provided herein, and if any judgment shall be rendered against the County of Volusia in any action indemnified hereby, I or the above-named business shall, at my or its own expense, satisfy and discharge the same. The foregoing is not intended nor should it be construed as, a waiver of sovereign immunity of the COUNTY OF VOLUSIA under Section 768.28, Florida Statutes.

Page 2 of 2: Hold Harmless Agreement

Officer/Owner: _____________________________ (print name) _____________________________ (signature)

Employee 1: _____________________________ (print name) _____________________________ (signature)

Employee 2: _____________________________ (print name) _____________________________ (signature)

Employee 3: _____________________________ (print name) _____________________________ (signature)

STATE OF _____________________________

COUNTY OF ___________________________

Sworn to and subscribed before me this ____ day of ________________, 20____, by

_________________________________________________________, who is/are personally known to me or who has/have produced ____________________________________________________________________________ as identification.

NOTARY PUBLIC – STATE OF _______________

Type or print name:

Commission No.:____________________________

Commission Expires: ______________________

(Seal)

15.0 Tab 5: Client Reference Form:

Reference No. 1

Address

City, State, ZIP

Contact Person

Telephone & E-mail

Date(s) of Service

Type of Service

Comments:

Reference No. 2

Reference No. 3

15.0 Tab 5: Client Reference Form: