5._Attachment_3_-_Contract_Forms.pdf

Request for Qualifications As-Needed Audio/Visual, Telecom, & Security System Design Services 2026

San Francisco Public Works Sourcing Event ID 11966

PWP-690 (3-24)

Appendix C

APPENDIX C

CONTRACT FORMS

Submit one electronic PDF file named “4. RFQ 11966 Contract Forms – [Company Name]”

Please follow the specifications for electronic PDF files in Section 7 of RFQ. The file shall contain the following:

A. Prime Consultant or both Joint Venture Partners (as applicable) must complete the following forms:

1. Acknowledgement of Receipt of Addenda

2. Article 131 Compliance Certification Form (Note: Each JV firm, if applicable, must be 131 compliant at time of award)

3. Certification of Proposer Regarding Debarment and Suspension Form

4. First Source Hiring Agreement for Professional Services - For Joint Venture Proposers, each JV partner must complete a separate form.

5. Health Care Accountability Ordinance Declaration Form

6. Minimum Compensation Ordinance Declaration Form

7. Release and Waiver Agreement

B. All subconsultants must complete the following forms:

1. Certificate of Subcontractor, Lower-Tier Subcontractor Regarding Debarment and Suspension Form

ACKNOWLEDGMENT OF RECEIPT OF ADDENDA

If Addenda to the Bid Package Attachments (Bid Documents) have been issued for this RFQ, please indicate receipt thereof by filling in the appropriate Addendum number and filling in date received below. If there are any questions on any Addenda that may have been issued, please contact the Contract Administrator, Don Sy at DPW-ProContracts@sfdpw.org.

Addendum No. Date Received

Addendum No. Date Received

Addendum No. Date Received

Addendum No. Date Received

Addendum No. Date Received

Addendum No. Date Received

Addendum No. Date Received

Addendum No. Date Received

Addendum No. Date Received

A PROPOSAL MAY BE RENDERED NONRESPONSIVE IF THE PROPOSER DOES NOT

ACKNOWLEDGE THE RECEIPT OF ALL ADDENDA WHICH MAY HAVE BEEN

ISSUED FOR THIS RFQ.

Proposal submitted by (Firm name):

Authorized Person’s signature:

Authorized Person’s name:

Authorized Person’s title:

Appendix C

Request for Qualifications As-Needed Audio/Visual, Telecom, & Security System Design Services 2026

San Francisco Public Works Sourcing Event ID 11966 mailto:Robert.C.Begley@sfdpw.org

Certification of Proposer Regarding Debarment and Suspension

Article 131 COMPLIANCE CERTIFICATION

Respondent hereby acknowledges that Respondent has read and will comply with article 131 "Nondiscrimination in Contracts" of the San Francisco Administrative Code and attests to the following (please check the applicable box):

CERTIFIED: The San Francisco Contract Monitoring Division ("CMD") has certified that Respondent is in compliance with article 131 of the San Francisco Administrative Code, and all applicable related requirements as specified in the Contract Documents, and the certification is in effect on the date of RFQ submittal.

CERTIFICATION PENDING: Respondent has submitted Form CMD-131-101 and all required documentation to the CMD seeking certification of compliance with article 131, and determination of compliance is pending review by the CMD. Respondent agrees to resolve all non-compliance through conciliation with CMD as a condition precedent to award of the Contract. If the CMD determines that Respondent is non-compliant, Respondent's Proposal shall be deemed non-responsive.

NOT CERTIFIED: Respondent acknowledges that full compliance with article 131 of the San Francisco Administrative Code is a condition precedent for award of the Contract, and if determined to be one of the highest ranking Firms, Respondent will submit Form CMD-131-101 and all required documentation within 10 working days after the date of announcement of final ranking results. If the CMD determines that Respondent is non-compliant, Respondent's Proposal shall be deemed non-responsive.

Company Name

Company's Street Address

Company's City, State, ZIP

Company's Telephone No.

Name and Authorized Representative

Signature of Authorized Representative Date

Note: The text article 131 of the San Francisco Administrative Code is available from the CMD, 1155 Market Street, 4th Floor, San Francisco 94103, and posted on the Web at http://sfgsa.org/index.aspx?page=6125. Respondents are advised to submit Form 131-101 online through the City and County of San Francisco’s Supplier Portal and accompanying documentation to the CMD at the earliest possible opportunity so as to avoid inability to gather all required documentation during the 10 day period after announcement of final ranking results.

Request for Qualifications As-Needed Audio/Visual, Telecom, & Security System Design Services 2026

San Francisco Public Works http://sfgsa.org/index.aspx?page=6125

Certification of Proposer Regarding Debarment and Suspension

CERTIFICATION OF PRIME PROPOSER REGARDING DEBARMENT AND SUSPENSION*

I, , by affixing my signature hereto, under penalty of perjury, hereby certify that, except as noted below, that my principals and I:

1. are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by a government agency;

2. have not within a 3-year period preceding this Proposal been convicted of or had a civil judgment rendered against us for: (i) commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or contract under a public transaction; (ii) violation of federal or state antitrust statutes; or (iii) commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

3. are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state or local) with commission of any of the offenses enumerated in item 2 above; and

4. have not within a 3-year period preceding this Proposal had one or more public transactions (federal, state or local) terminated for cause or default.

5. Where the Proposer is unable to certify to any of the statements in this certification because it currently violates or has previously violated the above conditions 1 to 4, such prospective participant shall provide a description of each instance of violation and attach an explanation to this Proposal.

The Proposer declares the following exceptions to the above representations: (If there are exceptions to this Certification, insert the exceptions in the space provided below.)

Exceptions will not necessarily result in denial of award of the Contract but will be considered in determining Respondent responsibility. For each exception noted above, Respondent shall indicate below to whom it applies, name of the government entity and dates of action:

Exception Person Government Entity Dates Inclusive

Company Name

Name of Authorized Representative Company Street Address

Title of Authorized Representative City, State, ZIP

Signature of Authorized Representative Respondent’s Telephone No.

Date

NOTICE: Providing false information may result in criminal prosecution or administrative sanctions.

*Fulfills requirements of Title 49, CFR, Part 29

Request for Qualifications As-Needed Audio/Visual, Telecom, & Security System Design Services 2026

San Francisco Public Works

One South Van Ness Avenue, 5th Floor San Francisco, CA 94103

(415) 701-4848 oewd.org

FIRST SOURCE HIRING AGREEMENT

FOR PROFESSIONAL SERVICES

City Agency:

Contract Number and Name:

Consultant Name: Main Contact:

Phone: Email:

Signature of Authorized Representative* Name of Authorized Representative Date *By signing the First Source Hiring Agreement, the Consultant agrees to participate and comply with the provisions of the First Source Hiring Program pursuant to San Francisco Administrative Code Chapter 83

Instructions:

• All bidders must complete, sign and submit a First Source Hiring Agreement with bidder’s Proposal. All Proposals without a completed and signed First Source Hiring Agreement will be rejected.

• In Section 2, list the number of Entry Level Positions for the Prime Consultant and all sub-consultants. The Consultant shall make good faith efforts to hire Trainees referred by the First Source Hiring Program to fulfill all available Entry Level Positions.

• Reference specification section, First Source Hiring Program for Professional Services workforce obligations. Questions and assistance, please contact CityBuild offices: Email: CityBuild@sfgov.org. Tel: (415)701-4848.

Section 1: Select all that apply

Section 2: List Entry Level Positions

Job Title Job Description Number of Trainee Hires

Administrative Services Financial Services Mechanical/Electrical Engineering Architecture Geotechnical Engineering Property Management Asbestos and Lead Green Building Consulting Real Estate Services As Needed Health/Medical Services Sediment Analysis Civil/Structural/Hydraulic Engineering IT/Technical Services Special Inspection and Testing Construction Management Landscape Architecture Surveying Design Services Will require an office or trailer near the project site Environmental Services I don’t see my services (please describe)_____________________________

One South Van Ness Avenue, 5th Floor San Francisco, CA 94103

(415) 701-4848 oewd.org

FIRST SOURCE HIRING PROGRAM FOR PROFESSIONAL SERVICES

OVERVIEW

• Applies to all Professional Service Contracts in excess of $50,000 and shall include but not limited to As-Needed Services, Architectural, Engineering, Construction Management, and Design Services.

• Consultants shall notify the First Source Hiring Program of all available Entry Level Positions and shall make Good Faith Efforts to hire Referrals to fulfill all available Entry Level Positions.

• Consultants shall meet with the First Source Hiring Program and present their workforce plan to meet the First Source Hiring Goals.

EMPLOYER SERVICES

• CityBuild is the First Source Hiring Administrator and provides Employment Networking Services such as prescreening job seekers for the appropriate training, employment background, and skill sets that an employer seeks.

• CityBuild actively recruits, prepares and trains San Francisco’s workforce for the professional services industry and assist employers in creating a successful workforce plan.

• CityBuild refers graduates from the City’s Construction Administration Training Program which prepares individuals in a career of professional services.

• The First Source Hiring Program is a free service to all employers.

NONCOMPLIANCE

• Failure to meet the criteria of the First Source Hiring Program does not impute bad faith but rather shall trigger a review for compliance. If the Consultant is deemed noncompliant, then the City may assess liquidated damages as defined in San Francisco Administrative Code Chapter 83.

CONTACT

• CityBuild is the Consultant’s main contact for the First Source Hiring Program. For questions and assistance, please contact:

The Office of Economic and Workforce Development CityBuild Program citybuild@sfgov.org

(415) 701-4848

Appendix C

CITY AND COUNTY OF SAN FRANCISCO

GENERAL SERVICES AGENCY

OFFICE OF LABOR STANDARDS ENFORCEMENT

PATRICK MULLIGAN, DIRECTOR

SF OFFICE OF LABOR STANDARDS ENFORCEMENT, CITY HALL ROOM 430 MCO/HCAO TEL (415) 554-7903 • FAX (415) 554-6291

1 DR. CARLTON B. GOODLETT PLACE • SAN FRANCISCO, CA 94102 WWW.SFGOV.ORG/OLSE

Health Care Accountability Ordinance (HCAO) Declaration

What the Ordinance Requires. The Health Care Accountability Ordinance (HCAO), which became effective July 1, 2001, requires Contractors that provide services to the City or enter into certain leases with the City, and certain Subcontractors, Subtenants and parties providing services to Tenants and Subtenants on City property, to provide health plan benefits to Covered Employees, or make payments to the City for use by the Department of Public Health (DPH), or, under limited circumstances, make payments directly to Employees.

The HCAO applies only to Contractors with at least $25,000 ($50,000 for non-profit organizations) in cumulative annual business with a City department(s) and have more than 20 Employees (50 Employees for non-profit organizations) including Employees of any parent or subsidiaries.

The City may require Contractors to submit reports on the number of Employees affected by the HCAO.

Effect on City Contracting. For contracts and amendments signed on or after July 1, 2001, the HCAO requires the following:

• Each contract must include terms ensuring that the Contractor will agree to abide by the HCAO and either to provide its employees with health plan benefits meeting the Minimum Standards set forth by the Director of Health or to make the payments required by the HCAO;

• All City Contractors must agree to comply with the requirements of the HCAO unless the Contracting Department has obtained an approved exemption or waiver under the HCAO from the Office of Labor Standards (OLSE).

• Contractors must require any Subcontractors subject to the HCAO to comply with the HCAO:

The Purpose of This Declaration. By submitting this declaration, you are providing assurances to the City that, beginning with the first City contract or amendment you receive after July 1, 2001 and until further notice, you will either provide the health plan benefits meeting the Minimum Standards to your covered employees or make the payments required by the HCAO, and will ensure that your Subcontractors also abide by these requirements. If you cannot provide this assurance, do not return this form.

To obtain more information regarding the HCAO, Visit our website, which includes links to the complete text of the HCAO, at www.sfgov.org/olse/hcao; send an e-mail to HCAO@sfgov.org; or call (415) 554-7903.

Where to Send this Form. Submit this form via San Francisco’s centralized vendor portal, https://sfcitypartner.sfgov.org/ or call the Supplier Support Desk at 415-944-2442, Ext 1

Declaration

In order to be a certified vendor with the City and County of San Francisco, the company named below will either provide, if applicable, health benefits specified in the HCAO to our covered employees or make the payments required by the HCAO, and will ensure that our subcontractors that are subject to the HCAO also comply with these requirements, until further notice. The company named below will provide such notice as soon as possible.

I declare under penalty of perjury under the laws of the State of California that the above is true and correct.

Signature Date

Print Name Bidder/Supplier # - if known

Company Name (Exact Supplier Name in Peoplesoft) Phone Federal Employer ID # http://www.sfgov.org/olse/hcao mailto:HCAO@sfgov.org https://sfcitypartner.sfgov.org/

CITY AND COUNTY OF SAN FRANCISCO

GENERAL SERVICES AGENCY

OFFICE OF LABOR STANDARDS ENFORCEMENT

PATRICK MULLIGAN, DIRECTOR

SF OFFICE OF LABOR STANDARDS ENFORCEMENT, CITY HALL ROOM 430 MCO/HCAO TEL (415) 554-7903 • FAX (415) 554-6291

1 DR. CARLTON B. GOODLETT PLACE • SAN FRANCISCO, CA 94102 WWW.SFGOV.ORG/OLSE

Minimum Compensation Ordinance (MCO) Declaration

What the Ordinance does. The Minimum Compensation Ordinance (MCO) became effective October 8, 2000, and was later amended by the Board of Supervisors, with an effective date for the amendments of October 14, 2007. The MCO requires City contractors and subcontractors to pay Covered Employees a minimum hourly wage and to provide 12 compensated and 10 uncompensated days off per year. The minimum wage rate may change from year to year and Contractor is obligated to keep informed of the then-current requirements.

The MCO applies only if you have at least $25,000 in cumulative annual business with a City department or departments and have more than 5 employees, including employees of any parent, subsidiaries and subcontractors.

The City may require contractors to submit reports on the number of employees affected by the MCO.

Effect on City contracting. For contracts and amendments signed on or after October 8, 2000 the MCO will have the following effect:

• In each contract, the contractor will agree to abide by the MCO and to provide its employees the minimum benefits the MCO requires, and to require its subcontractors subject to MCO to do the same.

• If a contractor does not agree to provide the MCO’s minimum benefits, the City will award a contract to that contractor only if the contractor has received an approved exemption or waiver under MCO from the Office of Labor Standards Enforcement (OLSE) through the contracting Department. The contract will not contain the agreement to abide by the MCO if there is an exemption or waiver on file.

What this form does. If you can assure the City now that, beginning with the first City contract or amendment you receive after October 8, 2000 and until further notice, you will provide the minimum benefit levels specified in the MCO to your covered employees, and will ensure that your subcontractors also subject to the MCO do the same, this will help the City’s contracting process.

If you cannot make this assurance now, please do not return this form.

For more information, (1) see our Website, including the complete text of the ordinance: www.sfgov.org/olse, (2) e-mail us at: MCO@sfgov.org, (3) Phone us at (415) 554-7903.

Where to Send this Form. Submit this form via San Francisco’s centralized vendor portal sfcitypartnersupport@sfgov.org or call the Supplier Support Desk at 415-944-2442, Ext 1

Declaration In order to be a certified vendor with the City and County of San Francisco, this company will provide, if applicable, the minimum benefit levels specified in the MCO to our Covered Employees, and will ensure that our subcontractors also subject to the MCO do the same, until further notice. This company will give such notice as soon as possible.

I declare under penalty of perjury under the laws of the State of California that the above is true and correct.

Signature Date

Print Name Bidder/Supplier # - if known

Company Name (Exact Supplier Name in PeopleSoft) Phone Federal Employer ID # mailto:MCO@sfgov.org mailto:sfcitypartnersupport@sfgov.org?Subject=Question%20to%20User%20Support

RELEASE AND WAIVER AGREEMENT

This Release and Waiver of Liability (hereinafter the “Release”) is entered into between the City and County of San Francisco through its Public Works Department and____________________, a Prime Proposer (hereinafter “Proposer”) in a Request for Qualifications (RFQ) for As-Needed Audio/Visual, Telecom, & Security System Design Services 2026.

RECITALS

1. The City and County of San Francisco through its Public Works Department has issued a Request for Proposals to select a Team led by a Prime Consultant or a Joint Venture between two Prime Consultants.

2. The candidate Proposer submitted a response to the RFQ and has submitted projects and owners as references for its qualifications.

3. The City seeks candid comments on the candidate Proposer’s performance on the listed projects from the owners and the owners’ representatives.

RELEASE AND WAIVER

The candidate Proposer hereby fully and forever releases, exonerates, discharges, and covenants not to sue the City, its commissions and boards, officers and employees, and all individuals and entities furnishing comments on Proposer’s performance from and for any and all claims, causes of action, demands, damages and any and all other liabilities of any kind or description, in law, equity, or otherwise arising out of information furnished about Proposer’s performance on the projects.

INTENDED BENEFICIARIES

The City, its commissions and boards, officers and employees and all individuals and entities furnishing any information relating to Proposer’s qualifications, are intended beneficiaries of this Release and Waiver and are entitled to enforce its terms.

Date

Proposer Name, Authorized Representative

Print Name

Appendix C

Request for Qualifications As-Needed Audio/Visual, Telecom, & Security System Design Services 2026

CERTIFICATION OF SUBCONTRACTOR, LOWER-TIER SUBCONTRACTOR OR

SUPPLIER REGARDING DEBARMENT AND SUSPENSION*

I, , by affixing my signature hereto, under penalty of perjury hereby certify that, except as noted below, that my principals and I are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any government agency.

Where the subcontractor, lower-tier subcontractor or supplier is unable to certify to any of the statements in this certification because it currently violates or has previously violated the above conditions of the certification, such subcontractor, lower-tier subcontractor or supplier shall provide description of each instance of violation and attach an explanation to this Document. The subcontractor, lower-tier subcontractor or supplier declares the following exceptions to the above representations: (If there are exceptions to this Certification, insert the exceptions in the space provided below.)

Exceptions will not necessarily result in denial of award of the Contract but will be considered in determining Respondent responsibility. For each exception noted above, Respondent shall indicate below to whom it applies, name of the government entity and dates of action:

Exception Person Government Entity Dates Inclusive

Company Name

Name and Title of Authorized Representative Company Street Address

Company City, State, ZIP

Signature of Authorized Representative Company Telephone No.

Date

NOTICE: Providing false information may result in criminal prosecution or administrative sanctions. *Fulfills requirements of Title 49, CFR, Part 29 (applicable to all subcontracts, purchase orders and other lower tier transactions of $25,000 or more)

Appendix C

Request for Qualifications As-Needed Audio/Visual, Telecom, & Security System Design Services 2026