Attachment A4 City of Cocoa Combined Proposer Certifications and Affidavits

Solicitation No: P-26-08-COC Project Title: Enterprise Resource Planning System

INSTRUCTIONS: This document must be completed in its entirety and submitted with the Proposer’s response. Failure to submit this executed document may be grounds for disqualification.

SECTION 1: ORGANIZATIONAL INFORMATION

Entity Name:

FEIN:

Type: |_|Corp |_|Partnership |_|Sole Prop |_|Other:

Unique Entity ID (UEI - SAM.gov):

CAGE Code (if applicable):

Principal Address:

State of Incorporation/Organization:

Date Established:

Subcontractors: |_|None |_|Yes (If yes, attach Schedule of Subcontractor Participation)

CONTRACT CONTACT PERSON

· Name & Title:

· Email Address:

· Telephone Number:

SECTION 2: SUBMITTAL & ADDENDA ACKNOWLEDGEMENT

The undersigned Respondent, having become familiar with the local conditions and the nature of the work, hereby proposes to furnish all labor, materials, and services for the Enterprise Resource Planning System (P-26-08-COC) in full accordance with the solicitation documents.

1. Acceptance of Terms: The Respondent certifies that they have carefully examined the solicitation, including the Scope of Work, General Terms and Conditions, and any Special Provisions. By submitting this proposal, the Respondent acknowledges and agrees to be bound by all such terms and conditions, EXCEPT for those specific exceptions clearly identified in the "List of Deviations/Exceptions" attached to this proposal.

Note: Extensive exceptions that conflict with the City’s core legal protections may result in the proposal being deemed non-responsive.

2. Accuracy of Information: The Respondent warrants that all information, prices, and representations provided in this submittal are accurate, truthful, and were arrived at without prior understanding or agreement with any other person or entity.

3. Offer Validity: The Respondent agrees that this proposal shall remain valid and may not be withdrawn for a period of two hundred seventy (270) days from the date of the proposal opening.

4. Addenda Acknowledgement: The Respondent acknowledges receipt of the following Addenda, which have been considered in the preparation of this proposal (Failure to list all Addenda may result in disqualification):

SECTION 3: INSURANCE REQUIREMENTS ACKNOWLEDGEMENT

The Respondent represents and warrants that they have reviewed the City’s insurance requirements and currently possess, or will obtain prior to contract execution, the following minimum coverages from carriers with an A.M. Best Rating of A- VII or better:

· Commercial General Liability: $1,000,000 per occurrence / $2,000,000 aggregate.

· Professional Liability (Errors & Omissions): $1,000,000 per occurrence, covering software implementation and professional services.

· Cyber Liability & Data Breach: $1,000,000 minimum limit to protect City data and PII.

· Automobile Liability: $1,000,000 combined single limit.

· Workers’ Compensation: Statutory limits and Employer's Liability of $1,000,000, including a Waiver of Subrogation in favor of the City.

The Respondent shall ensure all subcontractors maintain similar coverages. The Respondent agrees to name the “City of Cocoa” as an Additional Insured on a primary and non-contributory basis on all applicable liability policies. Certificates of Insurance must provide 30 days’ notice of cancellation and designate the City of Cocoa c/o Human Resources/Risk Management Division as the Certificate Holder.

SECTION 4: CONFLICT OF INTEREST & ETHICS (F.S. 112.313)

The Respondent represents and warrants that it has made diligent inquiry into all relevant facts and provides the following certifications based upon its full knowledge:

1. Single Submittal: The Respondent states that only one (1) submittal for this solicitation has been tendered and that the entity has no financial interest in other entities submitting a proposal for the same work.

2. Impartiality: Neither the entity nor its affiliates have any potential conflict of interest due to other clients, contracts, or property interests that would affect the ability to provide impartial services for the Enterprise Resource Planning System project.

3. City Officials & Employees: Pursuant to Section 112.313, Florida Statutes, no officer, agent, or employee of the City of Cocoa has a financial interest in this company or the proposed award.

4. Relationships with City: No member of the entity’s ownership, management, or staff has a contractual or employment relationship with any City Department, Division, or Office, nor is any member presently seeking an elected position within the City of Cocoa government.

5. Consultant Neutrality: The Respondent certifies they have no existing professional or financial relationship with any third-party consultants currently engaged by the City to assist with the ERP selection and implementation process that would constitute a conflict of interest (e.g. Sciens LLC).

Please indicate if any of the following apply (Check all that apply):

|_| None of the Above: No known conflicts exist.

|_| City Personnel Disclosure: The Respondent employs or contracts with a current employee, public officer, or advisory board member of the City of Cocoa.

Name(s):

|_| Familial Relationship: A principal or employee of the Respondent is the spouse or child of a City employee or official.

|_| Material Interest: A City official/employee (or their spouse/child) owns more than 5% of the total assets or capital stock of this business entity.

|_| Waiver Request: The Respondent intends to request an advisory board member waiver under §112.313(12), F.S.

The City reserves the unilateral right to disqualify any Respondent whose conflicts are not waived or exempt under the Florida Ethics Code.

SECTION 5: NON-COLLUSION & LOBBYING (STATE & FEDERAL)

The Respondent certifies, under penalties of perjury, that they have not, either directly or indirectly, entered into any agreement or participated in any collusion in connection with this submittal. Specifically, the Respondent affirms:

1. Independence of Proposal: The prices, terms, and conditions in this submittal have been arrived at independently, without consultation, communication, or agreement with any other Respondent or competitor for the purpose of restricting competition.

2. Non-Disclosure: The contents of this submittal have not been, and will not knowingly be, disclosed by the Respondent to any competitor prior to the official opening of the proposals.

3. Anti-Bid Rigging: No attempt has been made or will be made by the Respondent to induce any other person or entity to submit, or not to submit, a proposal for the purpose of restricting competition or "pooling" bids.

4. Lobbying Prohibition: * City Funds: No City-appropriated funds have been or will be paid, by or on behalf of the Respondent, to any person for influencing or attempting to influence a City Council Member, officer, or employee of the City of Cocoa in connection with the awarding of this contract.

5. Federal Funds (31 U.S.C. § 1352): No Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, or an employee of a Member of Congress in connection with this project.

6. Disclosure of Non-City Funds: If any funds other than City or Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence the award of this contract, the Respondent shall submit a written disclosure statement with their proposal. This statement must identify the name and address of any lobbying entity, the amount of payment made or planned, and a brief description of the lobbying activity performed.

Certification of Sub-Awards: The Respondent further agrees that they shall require the language of this anti-lobbying certification be included in all sub-contracts and that all sub-recipients shall certify and disclose accordingly.

SECTION 6: DEBARMENT & SUSPENSION (2 C.F.R. PT. 180 & 3000)

The Respondent provides this certification as a material representation of fact. This contract is a covered transaction for purposes of 2 C.F.R. pt. 180 and 2 C.F.R. pt. 3000. The Respondent certifies that neither the firm nor any person associated therewith (owner, director, officer, manager, or auditor):

1. Current Status: Is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal or State department or agency.

2. Three-Year History: Has not, within the three-year period preceding this submittal, been convicted of or had a civil judgment rendered against them for:

a. Commission of fraud or a criminal offense in connection with obtaining or performing a public (Federal, State, or local) transaction;

b. Violation of Federal or State antitrust statutes;

c. Commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, or making false statements.

3. Pending Actions: Is not presently indicted for or otherwise criminally or civilly charged by a governmental entity with the commission of any of the offenses enumerated in this certification.

4. Termination for Cause: Has not, within a three-year period preceding this submittal, had one or more public transactions terminated for cause or default.

5. Subcontractor Compliance: The Respondent certifies it shall not knowingly enter into any transaction with a subcontractor, supplier, or vendor who is debarred or suspended. Respondent agrees to comply with 2 C.F.R. pt. 180, subpart C and include these requirements in all lower-tier covered transactions.

Public Entity Crimes: Pursuant to Section 287.133, Florida Statutes, a person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a proposal on a contract to provide any goods or services to a public entity for a period of 36 months from the date of being placed on the convicted vendor list.

SECTION 7: DRUG-FREE WORKPLACE

Pursuant to Section 287.087, Florida Statutes, whenever two or more bids, proposals, or replies that are equal with respect to price, quality, and service are received by the City for the procurement of commodities or contractual services, a submittal received from a business that certifies it has implemented a drug-free workplace program shall be given preference in the award process.

The Respondent certifies that it has implemented a drug-free workplace program by:

1. Written Statement: Publishing 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. Employee Awareness: Informing 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, and employee assistance programs, and the penalties that may be imposed upon employees for drug abuse violations.

3. Notice of Requirement: Giving each employee engaged in providing the commodities or contractual services that are under this solicitation a copy of the written statement.

4. Condition of Employment: Notifying the employee that, as a condition of working on the City’s project, 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 contendere to, any violation of Chapter 893, Florida Statutes, 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. Personnel Action: Imposing a sanction on, or requiring the satisfactory participation in a drug abuse assistance or rehabilitation program by, any employee who is so convicted.

6. Good Faith Effort: Making a good faith effort to continue to maintain a drug-free workplace through implementation of this section.

Does the Respondent certify that they have established a Drug-Free Workplace Program in accordance with F.S. 287.087?

|_|YES |_| NO

SECTION 8: E-VERIFY CONTRACTOR AFFIDAVIT (F.S. 448.095)

The Respondent provides this affidavit pursuant to Section 448.095, Florida Statutes, and acknowledges that the City of Cocoa is prohibited from entering into a contract unless each party to the contract registers with and uses the E-Verify system.

1. Registration & Use: The Respondent certifies that it is registered with and uses the E-Verify system (www.e-verify.gov) to verify the work authorization status of all newly hired employees.

2. Affidavit of Compliance: The Respondent hereby certifies that it does not employ, contract with, or subcontract with an unauthorized alien, and is otherwise in full compliance with Section 448.095, Florida Statutes.

3. Subcontractor Flow-Down: * The Respondent certifies that it shall require an affidavit from any subcontractor providing services on behalf of the Respondent, stating that the subcontractor does not employ, contract with, or subcontract with an unauthorized alien.

· The Respondent shall maintain a copy of such affidavit for the duration of the contract and provide it to the City upon request.

4. Termination for Non-Compliance: The Respondent acknowledges that if the City has a good faith belief that the Respondent has knowingly violated Section 448.095(1) (employment of unauthorized aliens), the City must terminate the contract.

5. Evidence of Registration: The Respondent affirms that a true and correct copy of their E-Verify "Company Information" page or Memorandum of Understanding (MOU) is attached to this submittal as proof of registration.

Under penalties of perjury, I declare that I have read the foregoing E-Verify Contractor Affidavit and that the facts stated in it are true.

*Proposer must attach a copy of their E-Verify proof of registration.

SECTION 9: HUMAN TRAFFICKING AFFIDAVIT (F.S. 787.06 & 92.525)

The Respondent provides this affidavit in compliance with the City of Cocoa’s ethical procurement standards and the requirements of Chapter 787, Florida Statutes.

1. Personal Knowledge: The signatory below represents that they are over the age of 18 and have personal knowledge of the matters set forth herein on behalf of the Respondent.

2. Compliance with Florida Law: The Respondent certifies that it does not use, and shall not use, coercion for labor or services as defined in Section 787.06, Florida Statutes.

3. Ethical Supply Chain: The Respondent affirms that it maintains policies and procedures to ensure that its workplace and any subcontractors utilized for the Enterprise Resource Planning System project are free from human trafficking, forced labor, and involuntary servitude.

4. Reporting Requirement: The Respondent agrees to immediately notify the City of Cocoa if it becomes aware of any credible information indicating that any of its principals, employees, or subcontractors have violated human trafficking laws.

5. Perjury Declaration: This declaration is made pursuant to Section 92.525, Florida Statutes. The Respondent understands that making a false statement in this declaration may subject the signatory to criminal penalties under the laws of the State of Florida.

Under penalties of perjury, the Respondent declares to have read the foregoing Human Trafficking Affidavit and that the facts stated in it are true.

SECTION 10: SCRUTINIZED COMPANIES & BUSINESS OPERATIONS (F.S. 287.135)

Pursuant to Section 287.135, Florida Statutes, a company is ineligible to, and may not, bid on, submit a proposal for, or enter into or renew a contract with an agency or local governmental entity for goods or services of:

· Any amount if, at the time of bidding or submitting a proposal for a new contract or renewal of an existing contract, the company is on the Scrutinized Companies that Boycott Israel List or is engaged in a boycott of Israel; OR

· One million dollars ($1,000,000) or more if, at the time of bidding or submitting a proposal for a new contract or renewal of an existing contract, the company is on the Scrutinized Companies with Activities in Sudan List, the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or is engaged in business operations in Cuba or Syria.

By submitting this proposal, the Respondent certifies that:

1. Boycott of Israel: It is not participating in a boycott of Israel and is not on the Scrutinized Companies that Boycott Israel List.

2. Prohibited Operations: It is not on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List.

3. Excluded Nations: It does not have business operations in Cuba or Syria.

4. Ongoing Compliance: If the City determines that the Respondent has submitted a false certification, has been placed on any of the aforementioned lists, or has engaged in prohibited business operations during the term of the contract, the City shall terminate the contract as required by law.

Does the Respondent certify compliance with F.S. 287.135?

|_|YES |_| NO

SECTION 11: EXECUTION BLOCK

I, THE UNDERSIGNED, hereby affirm and acknowledge that:

1. I am an authorized representative of the Respondent with the legal authority to bind the entity to the terms of this solicitation and any resulting contract.

2. I have personal knowledge of the facts stated in Sections 1 through 10 of this Attachment A4, and I certify that all such statements, certifications, and representations are true, accurate, and complete to the best of my knowledge and belief.

3. I understand that the City of Cocoa will rely on these affirmations as a material representation of fact in the evaluation of this proposal.

4. I acknowledge that any false statement, omission, or misrepresentation in this document may result in the immediate disqualification of the submittal, termination of any resulting contract, and potential legal action or debarment by the City of Cocoa or Federal authorities.

Under penalties of perjury, I declare that I have read the foregoing Attachment A4 and that the facts stated in it are true.

Authorized Signature and Date:

Printed Name Title

NOTARY ACKNOWLEDGEMENT

STATE OF __________________________, COUNTY OF _______________________________

The foregoing instrument was acknowledged before me by means of [ ] physical presence or [ ] online notarization, this ______ day of _______________, 2026, by __________________________________, who is personally known to me or has produced ___________________________ as identification.

Notary Public Signature (Seal) City of Cocoa RFP P-26-08-COC ERP System Page 2 of 2