3-1.a Exhibits.pdf

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Attached to
Consultant Support for Locomotive Project Management, Engineering Oversight and Commissioning
Solicitation number
RFQ 26-006
Issued by
Broward County, Fruitville CDP, Florida

About this file

This document set contains exhibits for RFQ No. 26-006 issued by the South Florida Regional Transportation Authority (SFRTA) for Consultant Support for Locomotive Project Management, Engineering Oversight and Commissioning. SFRTA seeks consultant services to manage and oversee the acquisition of seven Siemens Charger Locomotives under a contract awarded to Siemens Mobility, Inc. The consultant shall provide overall project management services including project management oversight, contract administration, document management, schedule and risk monitoring and reporting. The RFQ evaluation process utilizes three criteria: Qualifications and Experience (40 points maximum), Personnel (30 points maximum), and Proposed Technical Approach (30 points maximum). Proposals must demonstrate recent experience in locomotive rolling stock acquisition, provide summary resumes for key personnel including the proposed Project Manager and Project Leaders, and show understanding of and approach to locomotive acquisition requirements. The contract term extends from the issuance of a Notice to Proceed through delivery and acceptance of all new locomotives.

The exhibits establish comprehensive submission and compliance requirements for interested consultants. Proposers must submit a signed proposal form with certification of no collusion or fraud, contractor qualification certification including firm information and contract history for the past five years, drug-free workplace certificate, truth-in-negotiation certificate, E-Verify compliance affidavit, scrutinized companies certification (required for agreements of $1,000,000 or more), and human trafficking affidavit. The documents specify that proposals will not be withdrawn within 180 days after submission and establish SFRTA's address at 801 N.W. 33rd Street, Pompano Beach, Florida 33064 as the notice address. SFRTA reserves the right to evaluate contractor performance periodically during the contract term using a standardized performance evaluation form assessing quality of work, adherence to specifications, schedule compliance, safety standards, and communication. The final agreement will specify the total not-to-exceed compensation amount and incorporate all contract documents by reference.

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Exhibit 1

RFQ NUMBER 26-006 EX1-1 OF 1

EVALUATION CRITERIA

RFQ No. 26-006

CONSULTANT SUPPORT FOR LOCOMOTIVE PROJECT MANAGEMENT,

ENGINEERING OVERSIGHT AND COMMISSIONING

The criteria below will be used to evaluate each Proposal. There are three (3) criteria, with points assigned to each according to their relative importance to the overall evaluation process for this

RFQ.

1) QUALIFICATIONS AND EXPERIENCE (Maximum 40 Points)

This category will evaluate recent experience of the Proposer in the areas described in the Scope of Services. Proposer shall demonstrate its qualifications and experience in the acquisition of locomotive rolling stock consisting of the following: Project Management Oversight; Contract Administration; Document Management; Schedule and Risk Monitoring and Reporting.

2) PERSONNEL (Maximum 30 Points)

This category will evaluate the qualifications and experience of key personnel available for this contract. Provide a summary resume for key personnel (prime and subconsultant personnel) describing qualifications and experience relevant to this project. Key personnel includes the Proposed Project Manager and Project Leaders.

3) PROPOSED TECHNICAL APPROACH (Maximum 30 Points)

This category will examine the Proposer’s approach, creativity, and resourcefulness to provide the required Services. The Proposer shall show specific understanding and familiarity with the particular requirements of the Scope of Services and the Proposer’s approach to address them. The Proposer should demonstrate familiarity with locomotive rolling stock acquisition.

Exhibit 2

RFQ NUMBER 26-006 EX2-1 OF 1

PROPOSAL FORM

RFQ No. 26-006

CONTRACTOR :

SUBMITTALS WILL BE DUE PURSUANT TO SECTION 1.4 OF THE INSTRUCTIONS

TO PROPOSERS AND MAY NOT BE WITHDRAWN WITHIN ONE HUNDRED

EIGHTY (180) DAYS AFTER SUCH DATE.

I CERTIFY that this Proposal is made without prior understanding, agreement or connection with any corporation, firm, or person submitting a Proposal for the same contractual services and is in all respects fair and without collusion or fraud. I agree to abide by all conditions of this solicitation and certify that I am authorized to sign this Proposal and that the Proposal is in compliance with all requirements of the Request for Qualifications, including but not limited to, certification requirements.

The Proposer further declares that it has examined the solicitation documents and all addenda thereto elsewhere; and that it has satisfied itself about the work to be performed and all other required information within the Request for Qualifications.

The Proposer certifies the proposing firm nor any of its officers is on the United States Comptroller General’s List of Ineligible Contractors for Federally Financed or Assisted Projects.

Authorized Signature Printed Name

Addenda: Provide signature and date for each Addenda received.

1. 2. 3.

4. 5. 6.

Exhibit 3

RFQ NUMBER 26-006 EX3-1 OF 4

CONTRACTOR’S QUALIFICATION CERTIFICATION

Firm Name:_______________________________________________________________

Address:__________________________________________________________________

City,State,Zip:_____________________________________________________________

Telephone: ( ) _____________________ Fax: ( ) __________________

Contact Person:____________________________Title:____________________________

E-Mail Address:_________________________________________

FEID # _____________ DUNS # __________________

1. [RESERVED]

2. Specify the principal product or service offered by your firm:

3. Identify the area(s) which the business serves:__ Miami-Dade__ Broward __ Palm Beach __Florida __Other__________________

4. Date business was established:_______________ Occupational License:____________

5. Type of Business:

A. ___Sole Proprietor Name_________________________________________________________________________ Home Address__________________________________________________________________ Home Phone ________________________ Cell Phone_________________________________ Professional license/Certificate of Competency#_______________________________________

B. ___Partnership Are the owners of the business lawful, permanent residents of Florida? ___Yes ___No Provide the name, residential address and telephone number of all owners of the business.

Partners Name Res. Address Phone Number Cell Number

Professional license/Certificate of Competency #:_____________________________________ Name in which license/Certificate of Competency is issued:_____________________________

RFQ NUMBER 26-006 EX3-2 OF 4

C. ___Corporation Incorporated in the state of ___________ Date______________

Officer’s Names Title Address Phone No.

Professional license/Certificate of Competency #:___________________________________

Name in which license/Certificate is Issued________________________________________

6(a). List each contract completed by you during the last five (5) years, or if less than five (5) contracts have been completed in the last five (5) years, list the last five (5) contracts completed for which liquidated damages or other contractually stipulated sums or damages were assessed against you for failure to complete the work on time or for any other breach of contract by you. For each such contract, provide a brief description of the work performed, the initial contract amount, the dollar amount at completion, date completed, and the name and telephone number of the owner’s representative.

Contract Number

Description of Contract

POC &

Phone

Initial Amount

Closeout Amount

Date Completed

6(b). For the last five (5) years, list each contract under which the owner has called upon your surety to complete the work, has terminated for default, or sued to complete performance or recover damages. If fewer than five (5) contracts have been so affected during the last five (5) years, list the last five (5) contracts to be so affected. For each such contract, provide the same information as required in (a) above, and in addition, provide the name and contract person with telephone number of you surety.

RFQ NUMBER 26-006 EX3-3 OF 4

Contract Number

Description of Contract

POC & Phone Initial Amount

Closeout Amount

Date Comp

Surety POC & Phone No.

6(c). List the details of any litigation which your firm has been involved with for the past five

(5) years (Attach pages if necessary).

7. References (Please list prior similar projects)

Year Project Name Company Name

Dollar Amount

Contact Person and E-mail

Estimated amount of current work under contract: $_____________________________

8. List three (3) major contracts similar in scope currently underway or completed within the last five (5) years

Project No. and Title Owner Value Percent Complete

Contact Person and E-mail

RFQ NUMBER 26-006 EX3-4 OF 4

I, ___________________________________, ____________________________________, OF

____________________________________, CERTIFY THE INFORMATION PROVIDED ON

THIS QUALIFICATION IS CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.

Signature Affix Corporate Seal

COUNTY OF _______________________________

STATE OF _______________________________

The foregoing instrument was acknowledged before me on this ______ day of _______, ______ By __________________________________________________________________________

___ An individual acting in their own right;

___ __________________ of ________________________________ Title Corporation/Company a _________________ Corporation, on behalf of the corporation.

State

___ Acknowledging partner/agent on behalf of _______________________________ a partnership. Name of partnership

This person is personally known me or has produced ________________________ as identification and who (did/did not) take an oath.

____________________________________ Place Notary Seal Here Signature of Person Taking Acknowledgment

In lieu of Stamp: ______________________ ______________________________ Type or Print Name Title

Expiration Date

Exhibit 4

RFQ NUMBER 26-006 EX4-1 OF 2

DRUG FREE WORKPLACE CERTIFICATE

The undersigned vendor hereby certifies that it will provide a drug-free workplace program by:

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

2. Establishing a continuing drug-free awareness program to inform its employees about:

a. The dangers of drug abuse in the workplace;

b. The Bidder’s policy of maintaining a drug-free workplace;

c. Any available drug counseling, rehabilitation, and employee assistance programs;

d. The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;

3. Giving all employees engaged in performance of the contract a copy of the statement required by paragraph 1;

4. Notify all employees, in writing, of the statement required by paragraph 1, that as a condition of employment on a covered contract, the employee shall:

a. Abide by the terms of the statement;

b. Notify the employer in writing of the employee’s conviction under a criminal drug statute for a violation occurring in the workplace no later than five calendar days after such conviction;

5. Notifying South Florida Regional Transportation Authority in writing within ten calendar days after receiving notice under subdivision 4(a) above, from an employee or otherwise receiving actual notice of such conviction. The notice shall include the position title of the employee;

6. Within thirty (30) calendar days after receiving notice under paragraph 4 of a conviction, taking one of the following actions with respect to an employee who is convicted of a drug abuse violation occurring in the workplace:

a. Taking appropriate personnel action against such employee, up to and including termination; or

b. Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a federal, state or local health, law enforcement, or other appropriate agency; and

7. Making a good faith effort to maintain a drug-free workplace program through implementation of paragraphs 1 through 6.

Exhibit 4

RFQ NUMBER 26-006 EX4-2 OF 2

Firm: ________________________________________________ (Please print or type)

By: ________________________________________________ Authorized Signature

Name of Authorized Signature Date

Affix Corporate Seal (If Applicable) County Of State Of

The foregoing instrument was acknowledged before me on this ______ day of _______, ______ By __________________________________________________________________________

___ An individual acting in their own right;

___ __________________ of ________________________________ Title Corporation/Company a _________________ Corporation, on behalf of the corporation.

State

___ Acknowledging partner/agent on behalf of _______________________________ a partnership. Name of partnership

This person is personally known me or has produced ________________________ as identification and who (did/did not) take an oath.

____________________________________ Place Notary Seal Here Signature of Person Taking Acknowledgment

In lieu of Stamp: ______________________ ______________________________ Type or Print Name Title

Expiration Date

Exhibit 5

RFQ NUMBER 26-006 EX5-1 OF 1

TRUTH-IN-NEGOTIATION CERTIFICATE

For the work described as:

I hereby certify that I am the (title) and duly authorized representative of the Firm whose name is and whose address is: .

In connection with the Firm's bid or price proposal for this firm fixed price, negotiated or change order contract which is to be submitted to the South Florida Regional Transportation Authority (SFRTA) for approval, I hereby certify, to the best of my knowledge, information, and belief, that:

(a) The wage rates and other factual unit costs supporting the Firm's compensation, as set forth in the bid or proposal, are accurate, complete and current as of the time of the contracting;

(b) It is my understanding and the understanding of the Firm I here represent that if any of the items of compensation under the above mentioned contract were increased due to the furnishing of inaccurate, incomplete or non-current wage rates or other units of costs, the SFRTA is entitled to an adjustment in all appropriate items of compensation, including profit, to exclude any significant sum by which the price was increased because of the defective data. It is also my understanding and that of the Firm I here represent that the SFRTA’s right of adjustment includes the right to a price adjustment for defects in cost or pricing data submitted by a prospective or actual subcontractor.

(c) It is my understanding and the understanding of the Firm I here represent that if additions are made to the original price of the contract, such additions may be adjusted to exclude any significant sums where it is determined the price has been increased due to inaccurate, incomplete or non-current wage rates and other factual costs.

Date Signature_______________________

Sworn to and subscribed to before me this day of , 20 . Official Seal must be affixed.

Signature of Notary Public ____________________________________

My Commission Expires ____________________________________

(SEAL)

Exhibit 6

RFQ NUMBER 26-006 EX6-1 OF 2

SOUTH FLORIDA REGIONAL TRANSPORTATION AUTHORITY

COMPLIANCE WITH THE U.S. DEPARTMENT OF HOMELAND SECURITY

U.S. CITIZENSHIP AND IMMIGRATION SERVICES

EMPLOYMENT ELIGIBILITY VERIFICATION (E-VERIFY)

THIS FORM MUST BE SIGNED AND SWORN TO IN THE PRESENCE OF A NOTARY PUBLIC OR

OTHER OFFICIAL AUTHORIZED TO ADMINISTER OATHS.

This sworn statement is submitted to: South Florida Regional Transportation Authority.

by (print individual’s name and title) for

(print name of entity submitting sworn statement) whose business address is:

and (if applicable) it’s Federal Employer Identification Number (FEIN) is (if the entity has no FEIN, include Social Security Number of the individual signing this sworn statement:

I, being duly first sworn state:

That the above name firm, corporation or organization is in compliance with and agree to continue to comply with, and assure that any sub-contractor, or third-party contractor under this project complies with all applicable requirements of the laws listed below including, but not limited to, those provisions pertaining to employment, provisions or programs and services, transportation, communication, access to facilities, renovations, and new construction.

Pursuant to Section 448.095, Florida Statutes, all contractors providing labor, supplies, or services to the SFRTA are required to register with and use the U.S. Department of Homeland Security’s E-Verify system to verify the work authorization status of all employees hired during the term of an agreement with SFTRA to provide labor, supplies, or services and must, upon request, provide evidence of compliance with this provision.

Contractors shall also require all subcontractors performing work under an agreement to provide labor, supplies, or services to SFRTA to use the E-Verify system for any employees they may hire during the term of the agreement. Subcontractors shall provide the contractor with an affidavit stating the subcontractor does not employ, contract with, or subcontract with an unauthorized alien, as stated in Section 448.095, Florida Statutes. Contractor shall provide a

Exhibit 6

RFQ NUMBER 26-006 EX6-2 OF 2

copy of such affidavit to the SFRTA upon receipt and shall maintain a copy for the duration of the agreement.

The E-Verify program is found in Title IV, Subtitle A, of the Illegal Immigration Reform and Immigration Responsibility Act of 1996 (IIRIRA), Pub. L. 104-208, 110 Stat. 3009, as amended (8 U.S.C. § 1324a note). Authority for use of the E-Verify program by Federal contractors and subcontractors is covered by the terms of Subpart 22.18, “Employment Eligibility Verification”, of the Federal Acquisition Regulation (FAR) and in Executive Order 12989, as amended.

(Signature)

Sworn to and subscribe before me this day of , 20

Personally known or produced identification: Notary Public, State of

My Commission Expires

(Type of Identification)

(Printed, typed or stamped commissioned name of Notary Public)

Exhibit 7

RFQ NUMBER 26-006 EX7-1 OF 1

SOUTH FLORIDA REGIONAL TRANSPORTATION AUTHORITY

RFQ NO. 26-006

CONTRACTOR CERTIFICATION REGARDING SCRUTINIZED COMPANIES

(Agreements of $1,000,000.00 or more)

Name: _______________________________________________________________________

FEIN: _______________________

Authorized Representative Name: __________________________________________________

Title: ________________________________________________________________________

Address: _____________________________________________________________________

City: ________________________________ State: _________________ Zip: _____________

Phone No.: _____________________________ Fax No.: ______________________________

Email Address: ____________________________________________

Section 287.135, Florida Statutes, prohibits local governments from contracting with companies, for goods or services of One Million and 00/100 Dollars ($1,000,000.00) or more that are on the Scrutinized Companies with Activities in Sudan List, Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, the Scrutinized Companies that Boycott Israel List, or been engaged in business operations in Cuba or Syria. The lists are created pursuant to section 215.473 and 215.4725 Florida Statutes.

As the person authorized to sign on behalf of the CONTRACTOR, I hereby certify that the company identified above in the section entitled "CONTRACTOR Name" is not listed on the Scrutinized Companies with Activities in Sudan List, the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or Scrutinized Companies that Boycott Israel 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 a false certification may subject the CONTRACTOR to termination of the Agreement, civil penalties, attorney's fees, and/or costs.

CERTIFIED BY: ______________________________________ Date: _________________ Authorized Signature

Print Name: ___________________________________________________________________

Print Title: ___________________________________________________________________

Exhibit 8

RFQ NUMBER 26-006 EX8-1 OF 2

HUMAN TRAFFICKING AFFIDAVIT

Florida Statute §787.06(13) requires all nongovernmental entities executing, renewing, or extending a contract with a governmental entity to provide an affidavit signed by an officer or representative of the nongovernmental entity under penalty of perjury that the nongovernmental entity does not use coercion for labor or services as defined in that statute. The South Florida Regional Transportation Authority “SFRTA”) is a governmental entity for the purposes of this statute.

As the officer or representative of ____________________________________________ (the “Company), I certify that the Company does not, for labor or services,

• Use or threaten to use physical force against any person;

• Restrain, isolate, or confine or threaten to restrain, isolate, or confine any person without lawful authority and against his or her will;

• Use 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 towards the liquidation of the debt, the length and nature of the labor or services are not respectively limited and defined;

• Destroy, conceal, remove, confiscate, withhold, or possess any actual or purported passport, visa, or other immigration document, or any other actual or purported government identification, of any person;

• Cause or threaten to cause financial harm to any person;

• Entice or lure any person by fraud or deceit;

• Provide controlled substances as outlined in Schedule I or Schedule II of Florida State Statute §893.03 to any person for the purpose of exploitation of that person.

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

_______________________________ “Company”

By: ____________________________________

Print Name: _____________________________

Print Title: _____________________________

STATE OF _______________

COUNTY OF _____________

The foregoing instrument was sworn to and subscribed before me by means of ☐ physical presence or online notarization, this _____ day of ______________, 20___, by __________________________________, as ________________________ of [insert company name], a

Exhibit 8

RFQ NUMBER 26-006 EX8-2 OF 2

__________________, who is personally known to me, or produced _______________________________ as identification.

Notary Public Signature [AFFIX NOTARY SEAL] Print Notary Name:__________________ My commission expires:______________

Exhibit 9

RFQ NUMBER 26-006 EX9-1 OF 1

NO SUBMITTAL NOTICE

Dear Vendor/Firm:

The Procurement Department of the South Florida Regional Transportation Authority has solicited your participation for RFQ NO. 26-006, entitled CONSULTANT SUPPORT FOR

LOCOMOTIVE PROJECT MANAGEMENT, ENGINEERING OVERSIGHT AND

COMMISSIONING. Please complete this form only if you do not intend to submit a proposal on this project. SFRTA is interested in improving its competitive bid process and your comments are important to this endeavor. Thank you for your assistance.

I do not intend to bid on this project because:

( ) Do not have the necessary equipment, labor, and capital required.

( ) Do not have the experience necessary to perform the work.

( ) Heavy workload makes bidding impossible at this time.

( ) Unable to get bonding and/or special insurance.

(Be specific) _______________________________________________________

( ) Insufficient time to complete the work.

( ) General Conditions/Specifications contains requirements which I do not understand. (Explain) _______________________________________________

( ) General Conditions/Specifications contains requirements with which I disagree.

(Explain) _________________________________________________________

Comments: _____________________________________________________________

( ) Retain my name on SFRTA’s vendor list ( ) Remove my name from SFRTA’s vendor list

(Company Name) (Signature)

Please email this form to beckerb@sfrta.fl.gov

Exhibit 10

RFQ NUMBER 26-006 EX10-1 OF 5

AGREEMENT NO. 26-006

BETWEEN

AND

FOR

RFQ NUMBER 26-006 EX10-2 OF 5

AGREEMENT NO. 26-006

BETWEEN

FOR

This is an Agreement, by and between SOUTH FLORIDA REGIONAL TRANSPORTATION AUTHORITY, hereinafter referred to as “SFRTA”, ____________________________, a ______________, authorized to and doing business in the State of Florida, hereinafter referred to as “CONTRACTOR”.

RECITALS

A Request for Qualifications was advertised by SFRTA as RFQ No. 26-006, for

CONSULTANT SUPPORT FOR LOCOMOTIVE PROJECT MANAGEMENT,

ENGINEERING OVERSIGHT AND COMMISSIONING, and CONTRACTOR was determined to be the most qualified responsive and responsible respondent;

NOW, THEREFORE, IN CONSIDERATION of the promises, mutual covenants and obligations herein contained, and subject to the terms and conditions hereinafter stated, the parties hereto agree to the Agreement as follows:

ARTICLE I

SERVICES

CONTRACTOR covenants and agrees to perform all services and other obligations of

CONTRACTOR set forth in the Contract Documents, as defined in the RFQ. The Contract Documents are hereby incorporated and made a part of this Agreement by this reference.

RFQ NUMBER 26-006 EX10-3 OF 5

ARTICLE II

TERM

The period of performance shall be for a period commencing on the date of SFRTA’s issuance of a Notice to Proceed through delivery and acceptance of all new locomotives.

ARTICLE III

COMPENSATION

1. SFRTA agrees to pay the CONTRACTOR compensation as specified in the CONTRACT

DOCUMENTS the total not-to-exceed amount of ________________________________

2. SFRTA, during any fiscal year, shall not expend money, incur any liability or enter into any contract which, by its terms, involves the expenditure of money in excess of the amounts budgeted as available for expenditure during such fiscal year. Any contract, verbal or written, made in violation of this subsection is null and void and no money may be paid on such contract.

ARTICLE IV

NOTICES

Whenever either party desires to give notice to the other, it must be given by written notice, sent by certified U.S. mail, with return receipt requested, facsimile transmission, express delivery service or hand delivery, addressed to the party for whom it is intended, at the place last specified, and the place for giving of notice shall remain such until it shall have been changed by written notice in compliance with the provisions of this paragraph. For the present, the parties designate the following as the respective places for giving of notice:

CONTRACTOR:

Attn: _____________________

SFRTA:

South Florida Regional Transportation Authority 801 N.W. 33rd Street

RFQ NUMBER 26-006 EX10-4 OF 5

Pompano Beach, FL 33064 Attn: Project Manager

WITH COPY TO:

South Florida Regional Transportation Authority Teresa Moore, General Counsel 801 N.W. 33rd Street Pompano Beach, FL 33064

RFQ NUMBER 26-006 EX10-5 OF 5

IN WITNESS WHEREOF, the parties have made and executed this Agreement on the respective date under each signature:

ATTEST: SOUTH FLORIDA REGIONAL

TRANSPORTATION AUTHORITY

_______________________________ By_____________________________________

DAVID W. DECH CHAIR

EXECUTIVE DIRECTOR

_______ DAY OF __________________, 202_

Approved as to form by:

ANTHONY J. CARIVEAU TERESA J. MOORE, General Counsel Chief Contracting Officer

ATTEST: (CONTRACTOR NAME)

WITNESS PRESIDENT OR VICE-PRESIDENT

_______ DAY OF _________________, 202_

Exhibit 11

RFQ NUMBER 26-006 EX11-1 OF 1

Subcontractor’s Certificate of Previous Payment

Note: The Prime Contractor shall attach this statement to current payment invoices, completed by each Subcontractor whose work appears on the previous payment invoice.

KNOW ALL MEN BY THESE PRESENTS, That (name) representing , whose address is , with the title of , whom after being first duly sworn, upon oath deposes and says that pursuant to the provisions of the contract for:

CONTRACT NO. 26-006

that all monies due him, in accordance with the agreed upon payment schedule, have been paid to him by , the Firm.

NOTARY STATEMENT

STATE OF FLORIDA COUNTY OF

The foregoing instrument was acknowledged before me this _______ day of , 20 , by who is personally known to me or who has produced as identified and who did/did not take an oath.

WITNESS my hand and official seal, this day of ___________________, 20 .

Signature of Notary

My Commission Expires

Exhibit 12

RFQ NUMBER 26-006 EX12-1 OF 3

Contractor Performance Evaluation

SFRTA will periodically evaluate the Contractor’s performance utilizing the Contractor Performance Evaluation Form in Exhibit 12. This evaluation will be done at an interval no less than once per year during the contract term. For contracts with a term less than one year, the evaluation may be performed intermittently as determined by SFRTA. The SFRTA assigned evaluator will complete the Contractor Performance Evaluation Form and provide a copy to the Contractor for review and response. Written contractor responses will be incorporated into the evaluations. In any instances where the performance is below satisfactory, the Contractor will have thirty (30) days to provide a written response to SFRTA.

RFQ NUMBER 26-006 EX12-2 OF 3

CONTRACTOR PERFORMANCE EVALUATION FORM

CONTRACTOR:______________________________________________________

ADDRESS:_________________________________________________________

PROJECT NAME:____________________________________________________

CONTRACT NO.____________________ AWARD DATE:____________________

EVALUATION NO._____ DATE:__________ PERIOD COVERED:______TO______

EVALUATED BY:____________________________________________________

(Signature & Title)

CONTRACTUAL ACTUAL *

PRICE:

COMPLETION DATE:

TIME TO COMPLETE

Ratings:

E = Excellent G = Good S = Satisfactory U = Unsatisfactory N/A = Not Applicable

* = For Final Evaluation Only. Actual includes contractual plus all Amendments and Change orders.

RFQ NUMBER 26-006 EX12-3 OF 3

EVALUATION OF CONTRACTOR'S PERFORMANCE

EVALUATED ITEM EVALUATION NO.

1 2 3 4

Quality of Contractor's Work

Adherence to Contract Specs/Scope of Services

Quality of Subcontractor's Work

Quality of Project Manager/Supervisory Personnel

Protection of SFRTA Property

Minimal interference with SFRTA Operations

Timely submission of Reports, Project Schedules and Deliverables

Adherence to Project Schedule

Compliance with Safety Standards

Communication with SFRTA Project Manager

Attendance at Project Meetings

Cooperation with Other Contractors

Timely Notification of Possible Delays

* * * OVERALL EVALUATION * * *

COMMENTS: _______________________________________________________

*NOTE: PLEASE ATTACH BACKUP DOCUMENTATION FOR ALL EVALUATIONS

RATED BELOW SATISFACTORY OR AS REQUESTED BY PROCUREMENT.

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