Appendix A - Proposal Response Form updated 12-10-2020.pdf

APPENDIX “A”

PROPOSAL RESPONSE FORM

RFP #PB 21-2

AIRPORT MEDICAL TESTING CENTER AGREEMENT

PALM BEACH INTERNATIONAL AIRPORT

PROPOSAL RESPONSE FORM (updated December 10, 2020)

RFP No. PB 21-2 Page 1 of 3

Section 1 – Test Center Location Preference

Proposers shall indicate the desired preference of either Test Center Space Alternative “C” or Test Center Space Alternative “B”. Final determination of which space will be available to the Provider will be made by County in County’s sole and absolute discretion. Proposers should include, with the proposal response, a statement generally explaining how each space would be used and supporting how the space-preference was decided.

________ Test Center Space Alternative “C” (depicted in Attachment “2-C” to the RFP) contains approximately 851 square feet

________ Test Center Space Alternative “B” (depicted in Attachment “2-B” to the RFP) contains approximately 1,343 square feet

Section 2 - Rental Proposal

a) Initial Minimum

Annual Rental Rate (rate per square foot)

b) Enter the “multiplier” that will be multiplied by the

Initial Minimum Annual Rental Rate (in Section 2a) to produce the Proposed Initial Annual Rental Rate (Section 2c). The multiplier will be applied to adjustment of rental pursuant to Section 5.07 of the Agreement.

Enter a value equal to, or greater than “1.00” with two (2) decimal points.

Examples: 1.00 (“no multiplier”), 1.03 (multiplier of 3-percent above the Minimum Rental), etc.

c) Proposed Initial

(per square foot)

(a x b = c)

$69.29

X __1._______________

Multiplier

Proposed Initial

Section 3 – Additional Services

Proposers may propose to offer “Additional Services” as defined in the Agreement. Such Additional Services, if any, that are proposed as part of the proposal should be detailed in the Project Approach section of the proposal response. All Additional Services, whether included as part of the proposal response, or which may be proposed during the Term of the Agreement, are subject to approval by the Department.

□ NO Additional Services are not proposed. Proposer intends to initially provide only the Minimum Services.

Additional Services may be proposed at a later date, as provided in the Agreement.

□ YES Additional Services are proposed. Proposer requests to provide Additional Services as detailed in the proposal. Additional Services may be proposed at a later date, as provided in the Agreement.

RFP #PB 21-2

RFP No. PB 21-2 Page 2 of 3

Section 4 Proposed Airport Concession Disadvantaged Business Enterprise (ACDBE) Participation (%)

No minimum ACDBE goal has been established for this opportunity. In the event proposer has determined that it will be unable to achieve ACDBE participation, this section may be left blank. In the event Proposer commits to achieve a minimum ACDBE participation goal, Proposer must complete both ACDBE Schedule 1 – List of Proposed ACDBE Firms (Appendix “D”), and ACDBE Schedule 2 – Letter(s) of Intent to Perform as an ACDBE Firm (Appendix “E”) in their entirety and provide with the proposal.

Proposer commits to a minimum of _________ % ACDBE participation*

*Schedule 1 and Schedule 2 must be submitted with Proposal if ACDBE participation is proposed.

Failure to provide the requested documentation, including complete Schedule 1 and/or Schedule 2, shall result in no points being awarded by the Selection Committee for ACDBE participation.

By signing this Proposal Response Form, the proposer warrants and represents to County that the following statements are true and correct:

a. This proposal is current, accurate and complete, and is presented to the County for the performance of the Agreement in accordance with the requirements stated in the RFP.

b. This proposal is submitted without prior understanding, agreement, or connection with any corporation, firm or person submitting a proposal for the same service and is, in all respects, fair and without collusion or fraud.

c. Proposer has the financial ability to fully perform the terms and conditions as specified in the RFP and

Lease Agreement.

d. Proposer has received and reviewed all Amendments to the RFP.

e. Proposer understands that that the County has no obligation whatsoever to accept any proposed exceptions to the Lease Agreement.

f. Proposer understands that proposer may not propose any exceptions to the minimum RFP requirements (see Section 3 of RFP) and failure to satisfy the minimum requirements will result in the proposal being deemed non-responsive.

g. Proposer understands that failure to submit this Proposal Response Form will be cause for immediate rejection of its entire proposal.

SIGNATURE FOLLOWS ON PAGE 3

RFP #PB 21-2

RFP No. PB 21-2 Page 3 of 3

****FAILURE TO SUBMIT THIS PROPOSAL RESPONSE FORM AND THE REQUIRED PROPOSAL

GUARANTEE WILL BE CAUSE FOR IMMEDIATE REJECTION OF YOUR ENTIRE PROPOSAL******

**This signature page must be completed by an Authorized Person (see Section 1.10 of RFP)**

Type or print proposer’s contact information below:

NAME:

TITLE: ____________________________________________________________________________

COMPANY NAME: __________________________________________________________________

ADDRESS: ________________________________________________________________________

CITY/STATE/ZIP: ___________________________________________________________________

TELEPHONE NO.:_________________________ E-MAIL ADDRESS:________________________

SIGNATURE: ______________________________________________________________________

***You must affix a corporate seal or have the signature on this Proposal Response Form notarized***

(Seal) (or complete acknowledgement below)

STATE OF __________________

COUNTY OF ________________

Sworn to (or affirmed) and subscribed before me by means of □ physical presence □ online notarization, this day of , 2020, by , who is personally known to me -OR- produced as identification and who did take an oath.

Notary Signature Print Notary Name

NOTARY PUBLIC, State of at large My Commission Expires: ______________