34-Domestic Partnership Act Certification - RFP-RFQ-RLI.docx

DOMESTIC PARTNERSHIP ACT CERTIFICATION

REQUEST FOR PROPOSAL, REQUEST FOR QUALIFICATION, OR REQUEST FOR LETTER OF INTEREST

Refer to applicable section below. Failure to submit this form by stated timeframes may deem the Vendor nonresponsive to the solicitation or ineligible for the Domestic Partnership tiebreaker, as applicable.

Domestic Partnership Responsiveness Requirement (Refer to Instructions to Vendors, if applicable) This completed and signed form should be returned with the Vendor’s submittal. If not provided with the submittal, the Vendor must submit this form within three business days after County’s request. A Vendor shall be deemed non-responsive for failure to fully comply within stated timeframes.

Domestic Partnership Tiebreaker (Refer to Instructions to Vendors, if applicable) To be eligible for the Domestic Partnership tiebreaker, the Vendor must currently offer the Domestic Partnership benefit and the completed form must be returned at the time of solicitation submittal. Vendors who fail to comply with this submittal deadline will not be eligible for the Domestic Partnership tiebreaker.

The Domestic Partnership Act, Sections 16½- 150 through 16½-165, Broward County Code of Ordinances (the “Act”) requires any Vendor contracting to provide goods or services to the County in an amount over $100,000 to provide benefits to registered domestic partners of its employees on the same basis as the Vendor provides benefits to its employees’ spouses, with certain exceptions as provided by the Act.

For all submittals over $100,000, the Vendor, by virtue of the signature below, certifies that it is aware of the requirements of Broward County’s Domestic Partnership Act, Section 16½-157, Broward County Code of Ordinances, and certifies the following: (check only one below)

☐ The Vendor currently complies with the requirements of the County’s Domestic Partnership Act and provides benefits to Domestic Partners of its employees on the same basis as it provides benefits to employees’ spouses.

☐ The Vendor will comply with the requirements of the County’s Domestic Partnership Act at time of contract award and provide benefits to Domestic Partners of its employees on the same basis as it provides benefits to employees’ spouses.

☐ The Vendor will not comply with the requirements of the County’s Domestic Partnership Act at time of award.

☐ The Vendor does not need to comply with the requirements of the County’s Domestic Partnership Act at time of award because the following exception(s) applies: (check only one below).

☐ The Vendor employs less than five (5) employees.

☐ The Vendor does not provide benefits to employees’ spouses.

☐ The Vendor is a governmental entity, not-for-profit corporation, or charitable organization.

☐ The Vendor is a religious organization, association, society, or non-profit charitable or educational institution.

☐ The Vendor provides an employee the cash equivalent of benefits. (Attach a notarized affidavit in compliance with the Act stating the efforts taken to provide such benefits and the amount of the cash equivalent).

☐ The Vendor cannot comply with the provisions of the Domestic Partnership Act because it would violate the laws, rules or regulations of federal or state law or would violate or be inconsistent with the terms or conditions of a grant or contract with the United States or the State of Florida. (State the law, statute or regulation and attach explanation of its applicability).

Vendor Name: Click or tap here to enter text.

Signature: ______________________________ Printed Name: Click or tap here to enter text.

Title: Click or tap here to enter text.

Date: Click or tap to enter a date.

Form Date 9/9/24