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Attachment A Document Management Form City Document Management Form (Page needs to be signed and returned with your submittal)
All documents, forms, affidavits must be received fully executed. Any documentation found missing or incomplete by the City may deem the Respondent as non-responsive.
It shall be the Respondent’s responsibility to review this Invitation to Solicitation document in its entirety and notify the City of Fort Myers, Procurement Services no later than five (5) days after the posting of the Solicitation if there are any pages or pertinent information missing or if there is any term or section that is unclear or contradictory to any other term or section.
Phone: 239-321->XXXX Procurement Contact: >name
It is the Respondent’s responsibility to review the Solicitation in its entirety and ensure that all submittal requirements are met an attached to your submission.
Respondent Checklist
| Page # |
| Location |
| Description |
| Respondent |
Check Off
| > |
| Attachment A |
| Document Management Form |
| > |
| Attachment B |
| Official Solicitation Form in its entirety signed by an authorized principal of the company. |
| > |
| Attachment C |
| Bid Schedule |
| > |
| Attachment D |
| Conflict/Non-Conflict of Interest Statement |
| > |
| Attachment E |
| Non-Collusion Affidavit |
| > |
| Attachment F |
| Drug-Free Workplace Certification |
| > |
| Attachment G |
| Florida Statutes on Public Entity Crimes Certification |
| > |
| Attachment H |
| Debarment and Suspension Certification |
| > |
| Attachment I |
| Scrutinized Companies Certification |
| > |
| Attachment J |
| Byrd Anti-Lobbying Form |
| > |
| Attachment K |
| Employee Eligibility Verification System (E-Verify) |
| > |
| Attachment L |
| Services Contract |
| Respondent to supply |
| Copy of Florida License |
| Respondent to supply |
| Copy of Sunbiz webpage |
| Respondent to supply |
| Copy of Certificate of Insurance, etc. |
| Respondent to Supply |
| Copy of Company’s E-Verify Memorandum of Understanding (MOU) |
>Local Preference (add section to solicitation, if applicable or delete this section)
Company Affidavit
Volume of Work Certificate
>Minority Business Enterprise (MBE) Forms (add section to solicitation, if applicable or delete this section)
| > |
| Utilization Form 1 |
| General Contractor Information |
| > |
| Utilization Form 2 |
| Monetary Amounts |
| > |
| Utilization Form 3 |
| Demonstrated Good Faith Efforts Documentation and Record or Transmittal Letters |
| > |
| Utilization Form 4 |
| Telephone or Personal Visits |
| > |
| Utilization Form 5 |
| MBE Subcontractors |
| > |
| Utilization Form 6 |
| Intended to be Subcontracted |
| > |
| Utilization Form 7 |
| MBE Intended, but not Used |
>Construction Related (add section to solicitation, if applicable or delete this section)
Trench Safety Affidavit
| Respondent to supply |
| List of subcontractors |
>Federal Contract Provisions (add section to solicitation, if applicable or delete this section)
Federal Contract Provisions
>FDOT Required Forms (add section to solicitation, if applicable or delete this section)
| > |
| 375-030-30 |
| Truth In Negotiation Certification (RFP/RFQ Only) |
| > |
| 375-030-32 |
| Certification regarding debarment, suspension, ineligibility and voluntary exclusion lower tier covered transactions for Federal Aid contracts |
| > |
| 375-030-33 |
| Certification for disclosure of lobbying activities |
on Federal-Aid contracts
| > |
| 375-030-34 |
| Disclosure of lobbying activities |
| > |
| 375-040-24 |
| MBE planned utilization |
| > |
| 375-040-84 |
| Local Agency Program Federal Aid Terms for Professional Service Contracts (RFQ Only) |
| > |
| 525-010-46 |
| LAP certification of current capacity (Construction Only) |
| > |
| 525-010-46 |
| Status of contracts on hand (Construction Only) |
| > |
| 575-060-13 |
| Non-collusion declaration and compliance (Construction Only) |
I certify that I am authorized to sign this form on behalf of the respondent and acknowledge that the document has been reviewed and is complete.
Respondent Name: _____________________________________________ Signature: ________________________________
Printed Name & Title: _________________________________________Date: ________________________________