ATTACHMENT 1

REQUIRED FORMS

27-01 Traffic Signal Detection Loop Assembly Installation Page 11 of 146

BID FORM

ITB NO: 27-01

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 Total Contract Price 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:

Contractor’s License No.(if applicable)

Signature of Authorized Representative of Firm/Vendor Date

SEAL: (If bid is by Corporation)

27-01 Traffic Signal Detection Loop Assembly Installation Page 12 of 146

BID FORM (Con’t)

ITB NO: 27-01

Bidder agrees to perform all the work described in the Contract Documents for the following Unit Prices and Lump Sum Prices.

Item # Item Description 12 Month Est. Qty.

Unit of Measure

Item Unit Price Total Price

Signal Loop Repair (Type B) 6’ X 6’ Cut, furnish and install, each loop

10 Each loop $

Signal Loop Repair (Type A) 6’ x 20’ Cut, furnish and install, each loop

20 Each loop $

Signal Loop Repair (Type A) 6’ x 50’ Cut, furnish and install, each loop

20 Each loop $

Signal Loop Repair (Type F) 6’ x 50’ Cut, furnish and install, each loop

20 Each loop $

Furnish and install Lead-in from Pull Box to Controller Assembly

1000 Linear ft. $

Drill 2” Loop Window under Curb and furnish and install 2” Conduit to existing pull box

10 Each $

Drill 2” Loop Window under Curb and furnish and install 2” Conduit and add new Pull Box

10 Each $

Furnish and Install Conduit 2” by Trenching, Complete in Place

1000 Linear ft. $

Furnish and Install Conduit 2” by Boring, Complete in Place.

200 Linear ft. $ $

10 Furnish and Install Pull Box 10 Each $ $

Total Contract Price $

27-01 Traffic Signal Detection Loop Assembly Installation Page 13 of 146

ADDENDUM ACKNOWLEDGEMENT

I acknowledge receipt of the following addenda:

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.

27-01 Traffic Signal Detection Loop Assembly Installation Page 14 of 146 mailto:Purchasing@baycountyfl.gov

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 __________, 2025.

Signature of Affiant Printed Name of Affiant

STATE OF__________________

COUNTY OF________________________

Sworn to (or affirmed) and subscribed before me by means of □ physical presence or □ online notarization, this ______ day of _____________, 2025, by ___________________________.

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

(SEAL)

27-01 Traffic Signal Detection Loop Assembly Installation Page 15 of 146

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 __________, 2025.

Signature of Affiant Printed Name of Affiant

STATE OF ___________

COUNTY OF ______________

Sworn to (or affirmed) and subscribed before me by means of □ physical presence or □ online notarization, this ____ day of _____________, 2025, by ___________________.

Personally Known OR Produced Identification

Type of Identification Produced______ _______________________________ (Notary Signature)

(SEAL)

27-01 Traffic Signal Detection Loop Assembly Installation Page 16 of 146

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.

Printed Name:

27-01 Traffic Signal Detection Loop Assembly Installation Page 17 of 146

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:

27-01 Traffic Signal Detection Loop Assembly Installation Page 18 of 146

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)

Printed Name:

27-01 Traffic Signal Detection Loop Assembly Installation Page 19 of 146

EXPERIENCE RECORD

In order to satisfy the County regarding the Bidder’s qualifications, the Bidder shall provide in the space below information regarding previous work comparable with the proposed work in size, capacity, and complexity. List three (3) projects similar in size and nature which were completed during the past five (5) years. 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 on this form shall constitute an integral part of the bid.

Name, Address, Phone # Services Provided

Attach additional sheets if more space is required.

27-01 Traffic Signal Detection Loop Assembly Installation Page 20 of 146

REFERENCES QUESTIONNAIRE

(TO BE COMPLETED BY THE COUNTY)

Proposer's Name

Proposer's Reference Name

Person Interviewed

Interviewed By

Date of Interview

The following questions will be asked of the client reference chosen at the discretion of the County:

1. Briefly describe the work the Proposer performed for your company.

2. How well did the Proposer adhere to the agreed upon schedule?

Excellent = 4 points; Above Satisfactory = 3 points; Satisfactory = 2 points; Fair = 1 point; Poor = 0 points.

3. How would you rate the Proposer’s quality of work?

Excellent = 4 points; Above Satisfactory = 3 points; Satisfactory = 2 points; Fair = 1 point; Poor = 0 points.

4. How would you rate the Proposer’s use of adequate personnel in quantity, experience and profession?

Excellent = 4 points; Above Satisfactory = 3 points; Satisfactory = 2 points; Fair = 1 point; Poor = 0 points.

5. How would you rate the Proposer’s use of appropriate equipment and methods?

Excellent = 4 points; Above Satisfactory = 3 points; Satisfactory = 2 points; Fair = 1 point; Poor = 0 points.

Score

Divided by 4

= Average Score

27-01 Traffic Signal Detection Loop Assembly Installation Page 21 of 146

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.

Printed Name:

27-01 Traffic Signal Detection Loop Assembly Installation Page 22 of 146

QUESTIONNAIRE TO ACCOMPANY BID

(TO BE COMPLETED BY THE BIDDER)

A. Provide a brief description of the Vendor’s experience performing tasks similar to those described in Scope of Work.

B. Provide a list of personnel the Vendor proposes to use on this project including their training/qualifications and prior experience performing the types of tasks described.

C. Provide a list of all tools and equipment that will be available for performing the tasks described.

D. Provide a written statement indicating that the Vendor understands and will adhere to all requirements of any applicable Federal and State safety laws governing the conduct of the type of tasks described.

27-01 Traffic Signal Detection Loop Assembly Installation Page 23 of 146

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:

Printed Name:

Title:

Date:

*Complete additional forms if needed to list all subcontractors

27-01 Traffic Signal Detection Loop Assembly Installation Page 24 of 146

BID BOND

BY THIS BOND, We, as Principal and , a corporation, as Surety, are bound to the Board of County Commissioners, Bay County, Florida, as County, in the sum of $ for the payment of which we bind ourselves, our heirs, personal representatives, successors, and assigns, jointly and severally. THE CONDITION of this bond is such that

1. The Principal has submitted to the County a certain Bid dated

2. If said Bid shall be rejected, or, if said Bid shall be accepted and the Principal shall execute and deliver a Contract, and furnish bonds for the faithful performances of work and for the payment of all persons performing labor and furnishing materials in connection therewith, and shall fulfill all other aspects created by the acceptance of said Bid, then this obligation shall be void. Otherwise, this bond shall remain in full force and effect with it being expressly understood and agreed that the liability of the Surety and for any and all claims hereunder shall, in no event, exceed the amount of this obligation.

This Surety, for value received, hereby stipulates and agrees that the obligations of said Surety and this bond shall, in no way, be impaired or affected by any extension of time within which the County may accept such Bid; and Surety hereby waives notice of any such extension.

Signed, sealed and delivered in three (3) counterparts on

CORPORATE PRINCIPAL

By: Attest:

Its: Seal:

Acknowledged and subscribed on , before the undersigned authority by , as the of the Corporation named as Principal and with due authorization of the Corporation.

Notary Public

SURETY

By: Attest:

Seal:

Countersigned:

By:

Attorney-in-Fact, State of Florida

27-01 Traffic Signal Detection Loop Assembly Installation Page 25 of 146