7-03. CQ26-0159AN - Fillable Forms.pdf

ATTACHMENT A –REQUIRED SUBMITTAL CHECKLIST FORM

THE SCHOOL BOARD OF LEE COUNTY, FLORIDA

DEPARTMENT OF PROCUREMENT SERVICES

Construction Management Services

RFQ No. CQ26-0159AN Mariner High School - HVAC Renovation

DATE SUBMITTED:

RESPONDENT NAME:

TO: The School Board of Lee County Fort Myers, Florida

I acknowledge receipt of the Mandatory Submittal Requirements (Section 8) of the RFQ Packet for RFQ No.

CQ26-0159AN, Construction Management Services, Mariner High School - HVAC Renovation as bound herein. I have read, understand, and agree to comply with all conditions as specified herein.

Having carefully examined the required documents, specification, plans and addenda as well as examined the existing site conditions, the undersigned proposes to furnish Construction Management Services for RFQ No. CQ26-0159AN, Construction Management Services, Mariner High School - HVAC Renovation

REQUIRED SUBMITTALS

� Attended Mandatory Pre-Submission Meeting and Site Walk Through _____Yes _____No � Received by 2:00 PM EST, February 18, 2026

Bonfire Portal Uploads

A. PROPOSAL

� Respondent Information Sheet (Complete & Signed) � Table of Contents � Letter of Interest � Bonding Capacity Letter � Current copy of Contractor License � Past Experience (Respondent Projects) � Methodology and Project Approach � Organizational Chart � Resumes � Project Management � Cost Controls � Safety Plan � Workload (All Projects) � School District Projects � Local Participation Evidence

B. FINANCIAL RESPONSIBILITY

� Financial Responsibilities (Marked Confidential)

C. FILLABLE FORMS

� (A) Required Submittal Checklist Form � (B) Insurance Requirements Form

� Certificate of Insurance naming School Board of Lee County as Certificate Holder

� (C) Addenda Acknowledgement Form � (D) Debarment Form � (E) Drug-Free Workplace Certification Form � (F) Public Entity Crimes Form (notarized) � (G) Emergency/Storm Related Catastrophe

Agreement � (H) Scrutinized Company Certification Form

D. REFERENCES

� Three Client Reference Forms https://leeschools.bonfirehub.com/

ATTACHMENT B - INSURANCE REQUIREMENTS FORM

The School Board of Lee County Florida Insurance Requirements

INSURANCE TYPE REQUIRED LIMITS

X 1. Workers’ Compensation Statutory Limits of Florida Statutes, Chapter 440 and all Federal Government Statutory Limits and Requirements. Policy must include Employers Liability with a limits of

$1,000,000.00 each incident $1,000,000.00 each employee $1,000,000.00 policy limit for disease

X 2. Commercial General Liability $2,000,000.00 per Occurrence

No exclusion shall apply to: premises, independent vendor, and contractual liability, property damage that results from explosion, collapse or underground (XCU) exposures, or limitations to Additional Insurance coverage, including time limitation for products /completed operations.

X 3. Indemnification: The Vendor, in consideration of One Hundred Dollars ($100.00), the receipt and sufficiency of which is accepted through the signing of this document, shall hold harmless and defend The School Board of Lee County and its agents and employees from all suits and actions, including attorney’s fees and all costs of litigation and judgments of any name and description arising out of or incidental to the performance of this contract or work performed there under. This provision shall also pertain to any claims brought against The School Board of Lee County by an employee of the named Vendor, any Subs, or anyone directly or indirectly employed by any of them. The Vendor’s obligation under this provision shall not be limited in any way by the agreed upon contract price as shown in this Contract or the Vendor’s limit of, or lack of, sufficient insurance protection. The first One Hundred Dollars ($100.00) or money received on the contract price is considered as payment of this obligation by The School Board of Lee County.

X 4. Automobile Liability $2,000,000.00 Each Occurrence Owned/Non-owned/Hired Automobile Included

X 5. Umbrella or Excess Liability can be utilized to provide the required limits. Coverage shall be “following form” and shall not be more restrictive than the underlying insurance policy coverages, including all special endorsements and School Board’s Additional Insured status.

X 6. Other Insurance as indicated below:

a) Professional Liability $2,000,000.00

b) Builder’s Risk All projects OVER $100,000 (that will take longer than

30 days to complete) to be reviewed by the Districts Insurance Consultant and may require Builder’s Risk.

X 7. Vendor firms shall ensure that all subs comply with the same insurance requirements that they are required to meet. The Vendor shall provide The School Board of Lee County with certificates of insurance meeting the required insurance provisions.

_X_ _8. Current valid insurance policies meeting the requirements shall be maintained for the duration of the named project. Renewal certificates shall be sent to the School Board 30 days prior to any expiration date.

The School Board of Lee County Florida Insurance Requirements

(Continued)

X 9. Thirty (30) Days Cancellation, Non-Renewal, or Material Change in coverage, Notice is required, either via insurance policy or directly by vendor.

X 10. The School Board of Lee County must be named as “ADDITIONAL INSURED” on the Insurance Certificate for all coverages except Workers Compensation and Professional Liability.

X 11. The School Board of Lee County must be named as the Certificate Holder.

NOTE: The “Certificate Holder” should read as follows:

The School Board of Lee County, Florida Attn: Procurement Services

2855 Colonial Boulevard Fort Myers, Florida 33966

X 13. The Certificate must state the RFQ Number and Title.

RESPONDENT’S AND INSURANCE AGENT STATEMENT:

We understand the insurance requirements contained in these specifications, and that the evidence of said insurance is required within ten (10) business days of the Notice of Award. The School Board of Lee County must be named as “ADDITIONAL INSURED” on the Insurance Certificate for all coverages except Workers Compensation and Professional Liability Policies. The School Board of Lee County desires proof of insurability at levels required for this project.

A current certificate of insurance is attached: _______YES ________ NO

Vendor Name Title

Signature

ATTACHMENT C - ADDENDA ACKNOWLEDGEMENT FORM

It is the sole responsibility of each Respondent to ensure that all addenda released are received; that all RFQ and addenda requirements have been completed and that all required submittals have been included.

The undersigned acknowledges the receipt of any addenda. Include a copy of each addenda with response.

Addendum #1__________________________ Date Issued: ______________ Attached to response? ____Y____N

Addendum #2__________________________ Date Issued: ______________ Attached to response? ____Y____N Signature

Addendum #3__________________________ Date Issued: ______________ Attached to response? ____Y____N Signature

Addendum #4__________________________ Date Issued: ______________ Attached to response? ____Y____N Signature

Addendum #5__________________________ Date Issued: ______________ Attached to response? ____Y____N

ATTACHMENT D - DEBARMENT FORM

Certification Regarding Debarment, Suspension, Ineligibility and

Voluntary Exclusion -- Lower Tier Covered Transactions This certification is required by the Department of Education regulations implementing Executive Order 12549, Debarment and Suspension, 34 CFR Part 85, for all lower tier transactions meeting the threshold and tier requirements stated at Section 85.110.

Instructions for Certification

1. By signing and submitting this bid, the prospective lower tier participant is providing the certification set out below.

2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment.

3. The prospective lower tier participant shall provide immediate written notice to the person to which this response is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," " person," "primary covered transaction," " principal," "response," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this response is submitted for assistance in obtaining a copy of those regulations.

5. The prospective lower tier participant agrees by submitting this response that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated.

6. The prospective lower tier participant further agrees by submitting this response that it will include the clause titled Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion-Lower Tier Covered Transactions, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may but is not required to, check the No procurement List.

8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment.

Certification

(1) The prospective lower tier participant certifies, by submission of this bid, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency.

(2) Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this bid.

NAME OF APPLICANT PR/AWARD NUMBER AND/OR PROJECT NAME

PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE

SIGNATURE DATE

ED 80-0014, 9/90 (Replaces GCS-009 (REV.12/88), which is obsolete)

ATTACHMENT E- DRUG-FREE WORKPLACE CERTIFICATION

The undersigned Vendor, in accordance with Florida Statue 287.087 hereby certifies that does:

Name of Business

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

2. Inform employees about the dangers of drug abuse in the workplace, the business’s policy of maintaining a drug-free workplace, any available drug counseling, rehabilitation, employee assistance programs and the penalties that may be imposed upon employees for drug abuse violations.

3. Give each employee engaged in providing the commodities or contractual services that are under bid a copy of the statement specified in Paragraph 1.

4. In the statement specified in Paragraph 1, notify the employees that, as a condition of working on the commodities or contractual services that are under bid, the employee will abide by the terms of the statement and will notify the employer of any conviction of, or plea of guilty or nolo contender to, any violation of Chapter 893 or of any controlled substance law of the United States or any state, for a violation occurring in the workplace no later than five (5) days after such conviction.

5. Impose a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee’s community, by any employee who is so convicted.

6. Make a good faith effort to continue to maintain a drug-free workplace through implementation of Paragraphs 1 thru

5.

As the person authorized to sign this statement, I certify that this firm complies fully with the above requirements.

Signature of Authorized Officer

Date

ATTACHMENT F - PUBLIC ENTITY CRIMES FORM

SWORN STATEMENT UNDER SECTION 287.133(3)(a), FLORIDA STATUTES, PUBLIC ENTITY CRIMES

THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO

ADMINISTER OATHS.

1. This sworn statement is submitted with Request for Qualifications No.__________________ for

2. This sworn statement is submitted by __________________________________ (name of entity submitting sworn statement) whose business address is _____________________________________________________ and (if applicable) its Federal Employer Identification Number (FEIN) is _________________________. If the entity has no FEIN, include the

Social Security Number of the individual signing this sworn statement: ___________________________.

3. My name is __________________________________________________________ and my relationship to

_________________________________________ (entity name above) is ___________________________________.

4. I understand that a “public entity crime” as defined in Paragraph 287.133(1)(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any bid or contract for goods or services to be provided to any public entity or an agency or political subdivision of any other state or of the United States and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.

5. I understand that “convicted” or “conviction” as defined in Paragraph 287.133(1)(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere.

6. I understand that an “affiliate” as defined in Paragraph 287.133(1)(a), Florida Statutes, means:

1. A predecessor or successor of a person convicted of a public entity crime; or

2. An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term “affiliate” includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm’s length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate.

7. I understand that a “person” as defined in Paragraph 287.133(1)(e), Florida Statutes, means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term “person” includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity.

8. Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. (Please indicate which statement applies.)

_____ Neither the entity submitting this sworn statement, nor any officers, directors, executives, partners, shareholders, employees, members, or agents who are active in management of the entity, not any affiliate of the entity have been charged with and convicted of a public entity crime subsequent to July 1, 1989.

_____The entity submitting this sworn statement, or one or more of the officers, directors, executives, partners, shareholders, employees, members, or agents who are active in management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, 1989, AND (Please indicate which additional statement applies.)

_____The person HAS __________ or HAS NOT ________ been placed on the convicted contractor list. (Please describe any action taken by or pending with the Department of Management Services concerning removal from the list.)

(Signature)

Date: _________________________________________

STATE OF_______________________________

COUNTY OF _____________________________

____________________________________APPEARED IN PERSON BEFORE ME (the undersigned authority), who is personally, known to me or provided the following identification _________________________, and affixed his/her signature in the space provided above on this _______ day of _______________, 20_____.

NOTARY PUBLIC

My commission expires: ____________________

Form PUR 7068 (Rev. 11/89)

OPTIONAL ONLINE NOTARIZATION IS ACCEPTABLE

ATTACHMENT G – EMERGENCY/STORM RELATED CATASTROPHE AGREEMENT

Due to Acts of God, Acts of Terrorism or War, any Vendors working with the School Board shall acknowledge and agree to the following terms and conditions. This will allow the School Board to obtain Federal funding if available.

CONDITIONS FOR EMERGENCY / HURRICANE OR DISASTER

It is hereby made a part of this Invitation to Negotiate that before, during and after a public emergency, disaster, hurricane, flood or acts of God that the municipal government, through the School Board of Lee County, shall require a "first priority" basis for goods and services. It is vital and imperative that the majority of citizens are protected from any emergency situation, which threatens public health and safety, as, determined by the School Board of Lee County.

Vendor/Contractor agrees to rent/sell/lease all goods and services to the School Board of Lee County or other government entity as opposed to a private citizen, on a first priority basis. The School Board expects to pay a fair and reasonable price for all products in the event of a disaster, emergency or hurricane. Vendor/Contractor shall furnish a “24-hour” phone number in the event of such an emergency.

I hereby understand and agree to the above statement:

(Signature) (Print Name) (Title)

Emergency Telephone Number:

Home Telephone Number:

Cellular Phone Number:

ATTACHMENT H - SCRUTINIZED COMPANY CERTIFICATION FORM

I hereby swear or affirm that as of the date below this company is not listed on a Scrutinized Companies list created pursuant to 215.4725, 215.473, or 287.135, Florida Statutes. Pursuant to 287.135, Florida Statutes I further affirm that:

1. This company is not participating in a boycott of Israel such that it is not refusing to deal, terminating business activities, or taking other actions to limit commercial relations with Israel, or persons or entities doing business in Israel or in Israeli-controlled territories, in a discriminatory manner.

1. This Company does not appear on the Scrutinized Companies with Activities in Sudan List where the State Board of Administration has established the following criteria:

a. Have a material business relationship with the government of Sudan or a government-created project involving oil related, mineral extraction, or power generation activities, or

b. Have a material business relationship involving the supply of military equipment, or

c. Impart minimal benefit to disadvantaged citizens that are typically located in the geographic periphery of Sudan, or

d. Have been complicit in the genocidal campaign in Darfur.

2. This Company does not appear on the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List where the State Board of Administration has established the following criteria:

a. Have a material business relationship with the government of Iran or a government-created project involving oil related or mineral extraction activities, or

b. Have made material investments with the effect of significantly enhancing Iran‘s petroleum sector.

3. This Company is not engaged in business operations in Cuba or Syria.

Company Name:

Signature of Authorized Representative:

Date:

Name and Title: