3-ACKNOWLEDGEMENT FORM 10.23.24.docx
DOCX document 36 KB Posted
- Solicitation number
- 25003JD
- Issued by
- Broward County, Fort Lauderdale City, Florida
About this file
This is a Proposal Acknowledgement Form for the Broward Sheriff's Office (BSO) in Florida related to their Request for Letters of Interest (RLI) for Workers' Compensation Third-Party Administrative Services. The form serves as a required certification document that proposers must complete and submit as part of their proposal package for comprehensive workers' compensation TPA services to support BSO's mission of ensuring public safety and employee well-being. The acknowledgement form requires proposers to declare no conflicts of interest, confirm they have thoroughly examined specifications, and certify all information provided is accurate, with responses accepted only through the Bonfire platform until the specified deadline.
The form establishes that proposed prices must include all services, labor, materials, equipment, insurance, licenses, and applicable taxes necessary for completion of work, with pricing methodologies required either in the initial proposal or within five calendar days upon request. Proposers must agree to keep quoted prices fixed for 120 days from the solicitation due date, and if awarded a contract, prices remain firm for the entire contract term. The document emphasizes that any exceptions to solicitation terms and conditions must be listed on a separate Agreement Exception Questionnaire, and failure to properly execute the acknowledgement form by an authorized representative renders the proposal non-responsive, though BSO retains discretion to accept proposals with equivalent binding documentation.
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Text version
PROPOSAL ACKNOWLEDGEMENT FORM
Proposer does declare that no persons other than the Proposer herein named has any interest in this proposal or in the contract to be taken, and that it is made without any connection with any other person or persons making proposal for the same article, and is in all respects fair and without collusion or fraud. Proposer further declares that the specifications have been carefully examined and the Proposer is thoroughly familiar with its provisions and with the quality, type and grade of required materials. Proposer certifies that any exceptions to the solicitation specifications are noted in the exceptions on the “Agreement Exception Questionnaire”. Proposer also understands that any exceptions presented after the award, may be cause for cancellation of award.
Proposer acknowledges that Proposer has given the Purchasing Agent written notice of all conflicts, errors, or discrepancies that it has discovered in the Sample Agreement, and/or Proposal documents and the written resolution thereof by the Purchasing Agent is acceptable to Proposer.
Subject to deviations stated below, Proposer accepts the terms, conditions, mandates, and other provisions of BSO General Terms and Conditions (See sample agreement attachment), and Specifications/Scope of Work, and any and all Addenda issued. Said documents being the strict basis upon which the said Proposer makes this proposal.
EXCEPTIONS TO PROPOSAL: ANY EXCEPTIONS TO THE SOLICITATION TERMS & CONDITIONS OR SAMPLE AGREEMENT MUST BE LISTED ON AGREEMENT EXCEPTION QUESTIONNAIRE. ANY REPRESENTATION OR EXCEPTION(S) MAY CAUSE THIS PROPOSAL TO BE REJECTED BY BSO.
Price(s) is to include the provision of all services, labor, materials, equipment, Insurance, licenses, and applicable taxes necessary for completion of the work. The methodology used in determining these prices should be included in the proposal. However, if methodology is not included with the proposal, it must be received within five (5) calendar days of request by Purchasing Bureau, unless extended in writing.
Proposer represents and certifies that any and all information, documents, forms, and responses to questions provided in its proposal with regard to this solicitation is true and correct The undersigned further declares and proposes to furnish the services called for within the specified time in this proposal, except as noted in the exception section for the submitted price, to wit:
The below identified and signed authorized officer of the company, proposes the pricing information submitted in Bonfire for required Services.
IT IS HEREBY CERTIFIED AND AFFIRMED THAT THE PROPOSER SHALL ACCEPT ANY AWARDS MADE AS A RESULT OF THIS SOLICITATION. PROPOSER FURTHER AGREES THAT PRICES QUOTED WILL REMAIN FIXED FOR A PERIOD OF ONE HUNDRED AND TWENTY (120) DAYS FROM DATE SOLICITATION IS DUE. IF AWARDED A PURCHASE ORDER OR CONTRACT AS A RESULT OF THIS SOLICITATION, PROPOSER FURTHER AGREES THAT PRICES QUOTED SHALL REMAIN FIXED AND FIRM FOR THE TERM OF THE CONTRACT.
Legal Company Name:
Proposer’s Authorized Representative’s Print Name:
Proposer’s Authorized Representative’s Signature:
Representative’s Title:
THE EXECUTION OF THIS FORM CONSTITUTES THE UNEQUIVOCAL OFFER OF PROPOSER TO BE BOUND BY THE TERMS OF ITS PROPOSAL. FAILURE TO SIGN THIS SOLICITATION WHERE INDICATED ABOVE BY AN AUTHORIZED REPRESENTATIVE SHALL RENDER THE PROPOSAL NON-RESPONSIVE. THE BROWARD SHERIFF’S OFFICE MAY, HOWEVER, IN ITS SOLE DISCRETION, ACCEPT ANY PROPOSAL THAT INCLUDES AN EXECUTED DOCUMENT WHICH UNEQUIVOCALLY BINDS THE PROPOSER TO THE TERMS OF ITS OFFER.
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