4-SAMPLE AGREEMENT AND.OR SOLICITATION EXCEPTION FORM 10.30.24.xlsx
XLSX spreadsheet 16 KB Posted
- Solicitation number
- 25003JD
- Issued by
- Broward County, Fort Lauderdale City, Florida
About this file
This is a Sample Agreement and Solicitation Exception Form template for the Broward Sheriff's Office (BSO) related to their Request for Letters of Interest (RLI) for Workers Compensation Third-Party Administrative Services in Florida. The form is designed to be completed by proposers to indicate whether they take exceptions to either the Scope of Services or Sample Agreement terms provided in the solicitation, and must be uploaded to the Bonfire procurement platform in the "Requested Information" area. If proposers do not submit this form, it will be deemed that they accept all terms and conditions as presented in BSO's Sample Agreement and Scope of Services.
The form requires proposers to provide their legal company name, authorized representative information, and clearly indicate through yes/no checkboxes whether they are taking exceptions to the Scope of Services or Sample Agreement. For any exceptions taken, proposers must provide detailed information including the specific term, condition, article or section being contested, proposed alternative language, and justification for the requested change. The form serves as a standardized method for BSO to identify and evaluate any contractual modifications requested by potential vendors during the procurement process for workers' compensation third-party administrative services.
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Text version
Sheet1
| SAMPLE AGREEMENT OR SOLICITATION EXCEPTION FORM |
| The completed form(s) should be uploaded in Bonfire in the Requested Information area labeled "Sample Agreement or Solicitation Form". If not provided, it shall be deemed an affirmation by the Proposer that it accepts the terms and conditions of BSO’s Sample Agreement and Scope of Services as disclosed/provided for in the solicitation. Fields in green below require a action. |
| Legal Company Name | |||
| Company's Authorized Representative (Print Name as Electronnic Signature) | |||
| Title of Company's Authorized Representative | |||
| Does Proposer take any exceptions to the Scope of Services in this solicitation? If yes, please check "Yes" and complete the rows below. If no, please check "None" | |||
| Does Proposer take any exceptions to the Sample Agreement? If yes, please check "Yes" and complete the rows below. If no, please check "None" | |||
| If yes checked above, Proposer must either provide Term/Condition or Article/Section and reference document located (i.e. Sample Agremeent or Scope of Services), specific proposed alternative language, and a brief justification specifically addressing each provision to which an exception is taken should be provided. | |||
| For each exception, state for that specific exception, whether you are taking an exception to the Sample Agreement or the Scope of Services (if both, list separately) | With regard to the Sample Agreement/Scope of Services that you are taking an exception, state the specific Term or Condition and Article / Section. Separate each Article/Section number. | Insert version of exception or specific proposed alternative language | Provide brief justification for change |
YES
NONE
YES
NONE
File details come from the government source that posted it. Updated .