Attachment 7 to RFP 18-5 - ACDBE Schedules 1 & 2.pdf

ATTACHMENT “7”

COMMON USE AIRPORT LOUNGE CONCESSION AGREEMENT

PALM BEACH INTERNATIONAL AIRPORT

(RFP NO. PB 18-5)

RFP No. PB 18-5

SCHEDULE 1

LIST OF PROPOSED ACDBE FIRMS

Name of Proposer: _____________________________________________ Phone No.: __________________________ Fax No: ___________________

Contact Person: __________________________________________________ E-mail Address: _________________________________________________

Address: ________________________________________________________

Name, Address & Phone No. of ACDBE Firm(1) Description of Type of Work

Classification (Check applicable box)

□ Tenant

□ Subtenant

□ Subcontractor

□ Supplier

□ Manufacturer

□ Joint Venture

□ Subcontractor

□ Supplier

□ Manufacturer

□ Joint Venture

□ Subcontractor

□ Supplier

□ Manufacturer

□ Joint Venture

Notes:

1. It is the obligation of proposer to confirm that firms identified on this form must be certified as an ACDBE by the State of Florida’s Unified Certification Program. Firms not certified by the State of Florida’s

Unified Certified Program as an ACDBE will not be counted toward attainment of the goal.

By signing this form the undersigned Proposer is committing to utilize the above-referenced ACDBE Firms pursuant to the Lease. Substitutions of ACDBE Firms during the term of the Agreement shall be subject to prior written approval of the Department of Airports.

By: _______________________________________________ Signature

__________________________________________________ *Additional sheets may be used if necessary.

Print Name/Title of Person Executing on Behalf of the Proposer

Date:______________________________________________

ATTACHMENT “7”

COMMON USE AIRPORT LOUNGE CONCESSION AGREEMENT

PALM BEACH INTERNATIONAL AIPORT

(RFP NO. PB 18-5)

RFP No. PB 18-5

SCHEDULE 2

LETTER OF INTENT TO PERFORM AS AN AIRPORT CONCESSION DISADVANTAGED BUSINESS ENTERPRISE*

Name of Proposer: _________________________________________________________________________________

Name of ACDBE Firm: ______________________________________________________________________________

The undersigned is certified as an Airport Concession Disadvantaged Business Enterprise by Palm Beach County or the State of Florida’s Unified Certification Program. Check one or more classifications as applicable:

□ Black □ Hispanic □ Women □ Other (Please Specify) _______

□ Prime Contractor □ Subcontractor □ Manufacturer □ Supplier □ Joint Venture

The undersigned ACDBE firm is prepared to perform the following described work in connection with the above-referenced Lease (specify in detail the particular work and/or parts thereof to be performed):

The estimated value of the work is ________________________% of Proposer’s estimated annual purchases of goods and services or annual gross receipts (circle applicable category).

The undersigned will enter into a formal agreement for work with you conditioned upon your execution of a contract with Palm Beach County.

If the undersigned intends to subcontract any portion of the work described above to another subcontractor, please complete the following:

________________________________ _______________________% □ ACDBE Certified (Name of Subcontractor) (Percentage of work subcontracted) □ Non-ACDBE

________________________________ _______________________% □ ACDBE Certified (Name of Subcontractor) (Percentage of work subcontracted) □ Non-ACDBE

The undersigned affirms that it has the resources necessary to perform the work described above without subcontracting the work to another subcontractor, except as noted above. The undersigned ACDBE firm understands that the provision of this form to the Proposer does not prevent the subcontractor from providing quotations to other proposers.

Printed Name of ACDBE Firm

By: _______________________________ Signature

Date: ______________________________

*This form must be submitted for each ACDBE firm listed on Schedule 1, “List of Proposed ACDBE Firms”.