900454-SM_1_04-02-19.pdf

RFQ#:

TITLE:

AMENDMENT #1

Dated: April 2, 2019

PALM BEACH COUNTY PURCHASING DEPARTMENT

50 SOUTH MILITARY TRAIL, SUITE 110

WEST PALM BEACH, FLORIDA 33415-3199

900454/SM

BLEACH, PURCHASE AND DELIVERY OF, TERM CONTRACT

SUBMISSION

DATE: APRIL 19, 2019

• ADD THE ATTACHED PAGES #15 AND #16, OEBO SCHEDULES #1 AND #2.

Form WW

NOTE: Please acknowledge receipt of this amendment by signing and returning with your RFQ Response.

SIGNATURE I DATE

SUZANNE MCINTYR , BUYER

.j;tm~ LJm-ry.,;!

OEBO SCHEDULE 1

LISTOF PROPOSED CONTRACTOR/CONSULTANT AND SUBCONTRACTOR/SUBCONSULTANT PARTICIPATION

SOLICITATION/PROJECT/BID NAME:---------------

NAME OF PRIME RESPONDENT/BIDDER:-- -------------

SOLICITATION/PROJECT/BID No.:---------------

ADDRESS: ______________________ _

CONTACT PERSON: _____________________ _ PHONE NO.: E-MAIL: ________ _

SOLICITATION OPENING/SUBMITTAL DATE:-------------- DEPARTMENT: _____________________ _

PLEASE LIST THE DOLLAR AMOUNT OR PERCENTAGE OF WORK TO BE COMPLETED BY THE PRIME CONTRACTOR/CONSULTANT ON THIS PROJECT.

PLEASE ALSO LIST THE DOLLAR AMOUNT OR PERCENTAGE OF WORK TO BE COMPLETED BY ALL SUBCONTRACTORS/SUBCONSULTANTS ON THE

PROJECT.

(Check all Applicable categories)

Non-SBE M/WBE SBE DOLLAR AMOUNT OR PERCENTAGE OF WORK

Name, Address and Phone Number

Minority/ Women Small Business Business Black Hispanic Women caucasian

I.

D D D 2.

D D D

3.

D D D 4.

D D D

5. D D D (Please use addit ional sheets if necessary)

Total

Total Bid Price$ _________ __________ _ Total SBE - M/ WBE Participation

I hereby cer tify that the above information is accurate to the best of my knowledge: -------------------------- Signature

Other

(Please Specify)

Note: 1. The amount listed on this form for a Subcontractor/subconsultant must be supported by price or percentage listed on t he properly executed Schedule 2 or attached sign ed proposal.

2. Firms may be certified by Palm Beach County as an SBE and/or an M/WBE. If firms are certified as both an SBE and/or M/WBE, please indicate the dollar amount under the appropriate category.

3. Modification of this form is not permitted and will be rejected upon submittal

OEBO LETTER OF INTENT- SCHEDULE 2

A completed Schedule 2 is a binding document between the Prime Contractor/consultant and a Subcontractor/subconsultant (for any tier) and should be treated as such. The Schedule 2 shall contain bolded language indicating that by signing the Schedule 2, both parties recognize this Schedule as a binding document.

All Subcontractors/subconsultants, including any tiered Subcontractors/subconsultants, must properly execute this document. Each properly executed Schedule 2 must be submitted with the bid/proposal.

SOLICITATION/PROJECT NUMBER: _______ _ _ ___ _____________ ~

SOLICITATION/PROJECT NAME: ___________ _ ______________ ~

Name of Prime: ______________________________________ _

(Check box(s) that apply) O SBE O WBE D MBE D M/WBE D Non-S/M/WBE Date of Palm Beach County Certification applicable): _____ _

The undersigned affirms they are the following (select one from each column) :

Column 1 Column 2 o Male o Female o African-American/Black o Hispanic American o Asian American D Native American o Caucasian American

S/M/WBE PARTICIPATION - S/MNVBE Primes must document all work to be performed by their own work force on this form. Failure to submit a properly executed Schedule 2 for any S/M/WBE participation may result in that participation not being counted. Specify in detail, the scope of work to be performed or items supplied with the dollar amount and/or percentage for each work item. S/M/WBE credit will only be given for the areas in which the S/MNVBE is certified. A detailed proposal may be attached to a properly executed Schedule 2.

Line Item Description Unit Quantity/ Contingencies/ Total Item Price Units Allowances Price/Percentage

The undersigned Subcontractor/subconsultant is prepared to self-perform the above-described work in conjunction with the aforementioned project at the following total price or percentage: -------------- ----

If the undersigned intends to subcontract any portion ofthis work to another Subcontractor/subconsultant, please list the business name and the amount below accompanied by a separate properly executed Schedule 2.

Price or Percentage:-------------- Name of 2"d/3'd tier Subcontractor/subconsultant

Print Name of Prime Print Name of Subcontractor/subconsultant

By:---------------- Authorized Signature Authorized Signature

Print Name Print Name

Title Title

Date: __________________ _ Date: _______________ ~ Revised 02/28/2019

(if