Attached Forms.pdf
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- Solicitation number
- ITB-17082
- Issued by
- Broward County, Fruitville CDP, Florida
About this file
This document consists of three mandatory certification forms required by the Florida Department of Transportation for the Districtwide Fencing project in District Four. The forms establish compliance requirements for all bidders, proposers, and respondents participating in this competitive sealed bidding process. The solicitation involves fencing services across multiple locations within FDOT District Four, with financial project numbers 431042-2-4B-01 and various others. While specific response deadlines, site visit schedules, and bidders' conferences are not detailed in these certification forms, all prospective vendors must be registered in the State of Florida's MyFloridaMarketplace system and comply with state licensing and authorization requirements prior to bid submission.
The three required certifications address critical compliance areas: E-Verify registration to confirm work authorization status of all newly hired employees per Florida Statute 287.087; Drug-Free Workplace Program certification demonstrating implementation of controlled substance policies and employee notification procedures; and Scrutinized Companies List certification confirming the vendor is not engaged in boycotts of Israel and has no activities in Sudan or the Iran Petroleum Energy Sector that would prohibit contract eligibility. Vendors must acknowledge compliance with all applicable Florida statutes throughout the contract duration, including any extensions or renewal periods. False certifications may result in civil penalties, attorney's fees, and costs. Out-of-state corporations, limited liability companies, and limited partnerships must obtain authorization from the Florida Department of State, and any services requiring professional licensing must be verified through the Florida Department of Business and Professional Regulation.
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Text version
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
E-VERIFY
375-031-06
PROCUREMENT
OGC – 10/21
Contract No:
Financial Project No(s): 431042-2-4B-01 & Various
Project Description: DISTRICTWIDE FENCING FOR FLORIDA DEPARTMENT OF TRANSPORTATION –
DISTRICT FOUR
In accordance with the contract, the Vendor/Consultant/Contractor hereby acknowledges and certifies compliance with Section 448.095, Florida Statutes. The Vendor/Consultant/Contractor shall register with and use the E-Verify system to verify the work authorization status of all newly hired employees. The Vendor/Consultant/Contractor shall utilize the U.S. Department of Homeland Security’s E-Verify system, in accordance with the terms governing use of the system. The Vendor/Consultant/Contractor shall comply with Section 448.095, Florida Statutes, for the duration of the contract term, including any extensions or renewal periods.
Company/Firm:
Authorized Signature:
Title:
Date:
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
DRUG-FREE WORKPLACE PROGRAM CERTIFICATION
375-040-18
03/17
287.087 Preference to businesses with drug-free workplace programs. --Whenever two or more bids, proposals, or replies that are equal with respect to price, quality, and service are received by the state or by any political subdivision for the procurement of commodities or contractual services, a bid, proposal, or reply received from a business that certifies that it has implemented a drug-free workplace program shall be given preference in the award process. In order to have a drug-free workplace program, a business shall:
(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, and 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 subsection (1).
(4) In the statement specified in subsection (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 contendere 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 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 this section.
Does the individual responding to this solicitation certify that their firm has implemented a drug-free workplace program in accordance with the provision of Section 287.087, Florida Statutes, as stated above?
YES
NO
NAME OF BUSINESS:
Florida Statutes:
287.135
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
VENDOR CERTIFICATION REGARDING
SCRUTINIZED COMPANIES LISTS
375-030-60
OGC – 06/18
Respondent Vendor Name:
Vendor FEIN:
Vendor’s Authorized Representative Name and Title:
Address:
City: State: Zip:
Phone Number:
Email Address:
Section 287.135, Florida Statutes prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services of any amount if, at the time of contracting or renewal, the company is on the Scrutinized Companies that Boycott Israel List, created pursuant to Section 215.4725, Florida Statutes, or is engaged in a boycott of Israel. Section 287.135, Florida Statutes, also prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services of $1,000,000 or more, that are on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector Lists which were created pursuant to s. 215.473, Florida Statutes.
As the person authorized to sign on behalf of Respondent, I hereby certify that the company identified above in the section entitled “Respondent Vendor Name” is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or the Scrutinized Companies that Boycott Israel List. I further certify that the company is not engaged in a boycott of Israel. I understand that pursuant to section 287.135, Florida Statutes, the submission of a false certification may subject company to civil penalties, attorney’s fees, and/or costs.
Certified By:
who is authorized to sign on behalf of the above referenced company.
Authorized Signature Print Name and Title:
Date:
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