ATTACHMENT_B__-_BID_SCHEDULE_AND_BID_FORMS.pdf

Cell 3 Class I Landfill Base Liner Construction, South Landfill, Central Disposal Facility Revised 2025

ATTACHMENT B

BID SCHEDULE AND BID FORMS

Cell 3 Class I Landfill Base Liner Construction-

South Landfill- Central Disposal Facility (CDF)

Brevard County, Florida

Bid No.: B-7-26-11

December 2025

BREVARD COUNTY SOLID WASTE MANAGEMENT DEPARTMENT

2725 Judge Fran Jamieson Way, Building A, Suite 118 Viera, Florida 32940-6602

B-7-26-11

ATTACHMENT B – BID SCHEDULE AND BID FORMS

BIDDER’S CHECKLIST

The items listed below are required for submission with your bid. Failure to submit any item may result in rejection of the bid. Bidders are required to submit the documents listed below on the designated date and time for bid receipt; otherwise, the bid will not be considered.

Signed/Notarized Bid Invitation, including Electronic Copy on USB (if submitting Bid through VendorLink, no hard copy or USB is required).

Completed Bid Proposal Form

Completed and Signed Addendum Acknowledgement

Estimated Breakdown of Lump Sum Bid

Complete and Sign Acknowledgment of Officer to Execute Bid on behalf of the Corporation.

Completed and Signed Non-collusion Affidavit of Prim Bidder

Completed Bid Bond Form

Provide a Listing of Major Subcontractors

Completed and Signed the Minority Employment Information Form

Bidders Minority Employment Information Form

Completed and Signed Trench Safety Act Affidavit Form

Completed Contractor’s Reference Form

Signed Indemnification and Insurance Form

Provide Bidder’s E-Verify Registration or Memorandum of Understanding (MOU) from the

Department of Homeland Security.

Completed and Signed Contractor Affidavit Regarding Scrutinized Company List

Completed and Signed Foreign Influence on Contracts or Grants

Completed and Signed Public Entity Crime Affidavit

Foreign Country of Concern Attestation

Anti-Human Trafficking Affidavit

Sample of a Public Construction Bond

BID PROPOSAL FORM

PROJECT NAME: CELL 3 CLASS I LANDFILL BASE LINER CONSTRUCTION, SOUTH LANDFILL,

CENTRAL DISPOSAL FACILITY

Solid Waste Management Department Brevard County, Florida

BID NO.: B-7-26-11

TO: Brevard County Board of County Commissioners Purchasing Services Office 2725 Judge Fran Jamieson, Bldg. C. Suite C-303 Viera, FL 32940

FROM: _______________________________________________________________________________________

(BIDDER)

Address: _______________________________________________________________________________________

City:____________________________ State:__________________________ Zip Code:____________________

Telephone No.:___________________________ Email Address:_____________________________________

1. BID PROPOSAL:

A. The undersigned as BIDDER, hereby declares that the only person or persons interested in the Bid as Principal or Principals is, or are, named herein and that no other person that is herein mentioned has any interest in this Bid or in the Contract to be entered into; that this bid is made without connection with any other person, company or parties to make a bid or proposal; and that it is in all respects fair and in good faith, without collusion or fraud.

B. The undersigned as BIDDER, having visited the site of the proposed project and familiarized himself with the local conditions, nature and extent of Work, and having carefully examined the Bid and Contract Documents prepared by Brevard County Solid Waste Department and titled: Cell 3 Class I Landfill Base Liner Construction, South Landfill, Central Disposal Facility, Bid No. B-7-26-11 inclusive of Part I:

Bidding and General Contract Requirements; Part II: Technical Specifications; and Part III: Construction Plans, proposes to furnish all labor, materials, equipment and other items, facilities and services for the proper execution and completion of the project in full accordance with the Contract Documents and, if awarded the Contract, to complete the said work within the time limits specified for the following Total Estimated Bid.

C. This Contract is for construction of the Cell 3 Class I landfill base (double composite liner system) and all appurtenances as shown on the plans and specified. The construction includes installation of an environmental cutoff wall, dewatering during construction, earthwork, site grading and preparations for installation of a double composite liner system consisting of clean fill subgrade, Geosynthetic Clay Liner (GCL), HDPE Geomembrane, Composite Drainage Net (CDN), and drainage sand protective cover, installation of a leachate gravity piping system and leachate detection and collection sumps, construction of two leachate sump pump stations and extension of the existing leachate transmission main, extension of the existing LFG piping system, stormwater management system improvements, construction of paved access driveways and unpaved access ramps on the east and west sides of Cell 3, and other pertinent construction as shown on the plans and specified. The undersigned hereby declares he has the minimum required qualifications for this project.

D. The Bidders should include all costs Bidders may anticipate during the length of construction of this project and execution of the requirements of these contract documents.

E. The OWNER desires to establish a Contingency Fund for this project in the amount of Seven Hundred Fifty Thousand Dollars ($750,000.00) to be used for the sole purpose of Owner requested changes during construction. No amount of this Contingency Fund can be used for any purpose by the Contractor without express written signed directives with clearly defined scope of additional work and associated costs by the Owner to the Contractor.

F. This Contract is a Lump Sum Contract. The Total Base Bid is the sum of all pay item totals from the Lump Sum Portion of Bid (Part A) plus the Owner’s Contingency Fund (Part B).

G. TOTAL BASE BID: (Sum Total of Base Bid Part A and Bid Part B)

PART A: LUMP SUM PORTION OF BID PRICE — “Base Price Part A”

The Proposer agrees to furnish all labor, materials, equipment, and other items, facilities, services, and incidentals for proper execution and completion of the Lump Sum portions of the Work as shown on the Drawings and described in the Specifications in accordance with the Contract Documents and other requirements, based on the Proposer’s own estimated quantities, costs, site conditions, and local conditions and all other considerations for the following lump sum prices:

Subtotal “Base Price Part A” (Sum of Items 1 Through 39 Estimating Worksheet):

_____________________________________________________________________DOLLARS

(In Words)

(Numerically)

PART B OWNER’S CONTINGENCY FUND

SEVEN HUNDRED FIFTY THOUSAND________________________________ DOLLARS

(In Words)

$___750,000.00____________________________________________ (Numerically)

TOTAL BASE BID: (Sum Total of Base Bid Part A and Bid Part B)

_________________________________________________________________________DOLLARS

(In Words)

(In numbers)

ADDENDUM ACKNOWLEDGMENT

Contractor acknowledges receipt of amendments by indicating the amendment number and its date of issue.

Add. No.________ Dated_______________ // Add. No.________ Dated_______________

I hereby acknowledge that I have read, understand, and agree to all terms, conditions, insurance, scope of work, specifications and pricing for Bid No. B-7-26-11 Cell 3 Class I Landfill Base Liner Construction, South Landfill, Central Disposal Facility.

CONTRACTOR NAME________________________________________________________________

ADDRESS___________________________________________________________________________

AUTHORIZED SIGNATURE___________________________________________________________

PRINTED SIGNATURE_________________________________DATE_________________________

TELEPHONE #_________________________________FAX #_______________________________

EMAIL_____________________________________________________________________________

The undersigned Bidder hereby designates, as follows, all major Subcontractors whom BIDDER proposes to utilize for the major areas of Work for the Project. The Bidder is further notified that all Subcontractors shall be properly licensed, bondable and shall be required to furnish the OWNER with all information on Subcontractors as required in the Bidding and Contract Documents.

Failure to furnish this information shall be grounds for rejection of the Bidder's proposal.

Area of Specialty Name and Address License Number

ESTIMATING WORKSHEET

Cell 3 Class I Landfill Base Liner Construction, South Landfill, Central Disposal Facility

Each Proposer shall fill out and complete the Estimating Worksheet in this Section and submit the appropriate number of copies as part of the BID Proposal. The purpose of the Worksheet is for each Proposer to estimate the approximate magnitude of the Work required and a basis for uniform comparison of Bid Prices for balance.

COUNTY does not express, imply, or guarantee that the actual amount of Work to be accomplished will correspond to the quantities given. The Proposer must assume that the quantities may not accurate and therefore, each Proposer must: 1) satisfy themselves by personal examination of the location of Work; 2) estimate the quantity of the Work based on the Drawings, Specifications, and any Addendum, thereafter; and

3) by such other means as they may choose, as to the actual conditions and requirements of the Work and the accuracy of the estimate of the Work. The Proposer shall not, at any time after the submission of Bid Proposal, dispute any such statement or estimate of the Engineer nor assert that there has been any misunderstanding concerning the nature or amount of the Work to be done.

Quantities listed on the Estimating Worksheet are for in-place materials and do not account for settlement;

waste; overlaps; volume changes; soil losses due to transporting, storing, weathering, or placing; unusable portions of the materials or products installed; or excess use as discussed in Section 01 29 00 - Measurement and Payment. Also, the Proposer understands that the listed quantities of materials may differ from the Proposer’s methods of estimating quantities e.g. compaction efficiency, loss of materials, geometrics, etc.

This Contract is a LUMP SUM CONTRACT and Proposer shall include all costs which the Proposer may anticipate during the length of this project and the Contract. Proposer may also add any extras or deduct from the Estimating Worksheet that the Proposer may determine necessary to provide the quantity and quality of Work required by the Drawings, Specifications, Alternates, and any Addenda. The Lump Sum totals for Part A on the Estimating Worksheet should equal the Part A totals within the Bidder’s Bid Proposal Form.

Any increase or decrease in the quantities listed in the Lump Sum portion of the Worksheet and shown on the Drawing, for any item, shall not be regarded as sufficient grounds for an increase or decrease in the price of that item, nor total price of the Contract, nor in the time allowed for the completion of the Work, except as provided in the Contract Documents. The OWNER reserves the right to delete portions of the Work or add to the Work, as COUNTY deems necessary and shall have the right to use the Bidder 's Estimating Worksheet prices as a basis of negotiation if a change in the quantity of Work occurs.

THE SCHEDULE OF ESTIMATED BREAKDOWN OF LUMP SUM BID IS REQUIRED TO

BE COMPLETED, SIGNED AND SUBMITTED WITH THE BID.

ESTIMATED BREAKDOWN OF LUMP SUM BID (ALSO IN EXCEL FORMAT)

Item No. Bid Item Description Unit Quantity Unit Bid Price Total Bid Price

GENERAL CONDITIONS & REQUIREMENTS

1. Mobilization/Demobilization (5% max) LS 1

2. Environmental Protection LS 1

3. Project Field Survey LS 1

4. Laboratory Testing and Reporting Services LS 1

5. Administration LS 1

6. Project Record Documentation LS 1

DEWATERING, ECW, EARTHWORK,

MONITORING WELLS AND PROBES

INSTALALTIONS

7. Clearing, Grubbing, Stripping, and Demolition LS 1

8. Stormwater runoff and erosion controls on the adjacent Cells 1-2 south side slopes

LS 1

9. Stormwater management System LS 1

10. Environmental Cutoff Wall (ECW) installation LS 1

11. Dewatering throughout the construction period LS 1

12. Groundwater Monitoring Wells, Piezometers, and Gas Monitoring Probes

BASE LINER SYSTEM INSTALLATION

13. Earthwork – Clearing & grubbing, subgrade excavations, clean fill, grading, and site prep for geosynthetic materials

14. Geosynthetic Clay Liner (GCL) LS 1

15. Secondary Geomembrane - 60-mil Textured HDPE Liner

16. Secondary Composite Drainage Net (CDN) LS 1

17. Primary Geomembrane - 60-mil Textured HDPE Liner

18. Primary Composite Drainage Net (CDN) LS 1

19. Primary and secondary leachate collection trenches, gravel packs, pipes and geotextiles

20. Drainage Sand LS 1

21. Geosynthetic Rain Tarp LS 1

LEACHATE SUMPS, TRANSMISSION AND

CONTROLS

22. Leachate collection sumps, piping, valves and related fittings

23. Concrete structures and pads LS 1

24. Leachate sump pumps, floats, controls, valves and accessories

THIS TABLE IS REQUIRED TO BE COMPLETED AND SUBMITTED WITH THE BID.

CONTRACTOR

NAME__________________________________________________________________

ADDRESS_______________________________________________________________

AUTHORIZED SIGNATURE_______________________________________________

PRINTED NAME_________________________________DATE___________________

Item No. Bid Item Description Unit Quantity Unit Bid Price Total Bid Price

25. Leachate force mains (4 and 6-in HDPE), valves and connections, toe drains at anchor trench and discharge

26. Electrical Works- power supply, control panels and instrumentation, SCADA system

LANDFILL GAS EXPANSION

27. LFG Transmission Pipe- 24-inch HDPE SDR-17 LS 1

28. LFG Condensate Transmission Pipe- 4-inch HDPE

SDR-11

29. Compressed Air Supply line- 2-inch HDPE SDR-9 LS 1

30. Butterfly Control Valves LS 1

31. Air Supply Line Isolation/Blow-Off Stations LS 1

32. Condensate Sump and Transmission Stations LS 1

33. Condensate FM- Stub-outs LS 1

34. Steel Casing Installation Under Pump Station No. 3 and No. 4 Paved Access Driveways for Leachate Force Main and Electrical Conduit

35. Steel Casing Installation Under Cell 3 East and West Unpaved Access Ramps for Leachate Force Main and Electrical Conduit

ACCESS RAMPS, PROTECTIONS & FINISHES

36. Bollards LS 1

37. Sod LS 1

38. Seeding and Mulching LS 1

39. Paved and Unpaved Access Drives LS 1

TOTAL PART A- BREAKDOWN OF LUMP SUM

BID

ACKNOWLEDGMENT OF OFFICER TO EXECUTE BID ON BEHALF OF A

CORPORATION

State _________________________

County of_____________________

On this _________day of_____________, 20__ before me personally came and appeared______________________, to me known, who, being by me duly sworn, did depose and say that Affiant resides at__________________________ that Affiant is the ____________________________of________________________________, the corporation described in and which executed the foregoing Bid Proposal; that Affiant knows the seal of said corporation, that one of the impressions affixed to said instrument is an impression of such seal; that Affiant is the proper official of said corporation designated to execute such instrument, that Affiant has authority to do so, that Affiant executed same for and in behalf of said corporation, and that Affiant’s act is the act and deed of said corporation.

Witness my hand and official notaries seal at___________________________________ the day and year above written.

(Notary Public)

My commission expires:_______________________ (seal)

NON-COLLUSION AFFIDAVIT OF PRIME BIDDER

State _________________________

County of_____________________

______________________________________________________being duly sworn, deposes and says that:

(1) Affiant is ___________________________________of__________________________________, the BIDDER that has submitted the attached bid: Cell 3 Class I Landfill Base Liner Construction, South Landfill, Central Disposal Facility, Bid No. B-7-26-11

(2) Affiant is fully informed respecting the preparation and contents of the attached Bid and of all pertinent circumstances respecting such bid;

(3) Such Bid is genuine and is not a collusive or sham bid;

(4) Neither the said BIDDER nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including this Affiant, has in any way colluded, conspired, connived or agreed, directly or indirectly with any other BIDDER, firm or person to submit a collusive or sham Bid in connection with the Contract for which the attached Bid has been submitted or to refrain from bidding in connection with such Contract, or has in any manner, directly or indirectly, sought by Contract, or has in any manner, directly or indirectly, sought by agreement or collusion or communication or conference with any other BIDDER, firm or person to fix the price or prices in the attached bid or of any other BIDDER, or to fix any overhead, profit or cost element of the Bid price or the Bid price of any other BIDDER, or to secure through any collusion, conspiracy, connivance or unlawful agreement any advantage against the Board of County Commissioners of Brevard County, Florida, or any person interested in the Contract; and

(5) The price or prices quoted in the attached Bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the BIDDER or any of its agents, representatives, owners, employees, or parties of interest, including Affiant.

(Signature)

Subscribed and sworn to before me

This __________day of_____________, 20__

(Notary Public)

My commission expires:_________________

(Seal)

BID SECURITY BOND

KNOW ALL MEN BY THESE PRESENTS, That we___________________________________________________, of ______________________________________ hereinafter called the Principal, and________________________, (Surety), a corporation organized and existing under the Laws of the State of , and authorized to transact business in the State of_________________, as Surety, hereinafter called Surety, are held and firmly bound unto the Brevard County Board of County Commissioners, hereinafter called Obligee, in the penal sum of five percent (5%) of the amount of bid, $________________________, good and lawful money of the United States of America, for the payment of which the Principal and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. The Condition of this Obligation is such, that, WHEREAS the Principal has submitted a bid to the Obligee on a contract for the construction of: Cell 3 Class I Landfill Base Liner Construction, South Landfill, Central Disposal Facility (Bid No. B-7-26-11).

NOW THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a contract with the Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the Bidding or Contract Documents with good, qualified and sufficient surety for the faithful performance of such construction for the prompt payment of labor and material furnished in the prosecution thereof, then this obligation shall be null and void;

otherwise this bid is to remain in full force and effect for the payment to Obligee of the stated penal sum hereof.

In witness whereof, we have hereunto set our signatures and seal this day of____________________, 20__, all pursuant to due authorization.

_________________________________________________(Seal) Principal

By____________________________________________________ Surety

By____________________________________________________ Attorney-in-Fact in accordance with the attached Power of Attorney

STATE OF_____________________ss:

COUNTY OF __________________

I, ______________________________________, a Notary Public in and for the State and County aforesaid, do hereby certify that ________________________________, and ____________________________, whose names are signed to the foregoing bond, this day personally, appeared before me in my State and County aforesaid and acknowledged the same. Given under my hand and seal this ____________ day of __________, 20__

(Notary Public)

My commission expires:_________________ (Seal)

MAJOR SUBCONTRACTORS

The undersigned Bidder hereby designates, as follows, all major Subcontractors whom BIDDER proposes to utilize for the major areas of Work for the Project. The Bidder is further notified that all Subcontractors shall be properly licensed, bondable, and shall be required to furnish the OWNER with all information on Subcontractors as required in the Bidding and Contract Documents. Failure to furnish this information shall be grounds for rejection of the Bidder's proposal.

Area of Specialty Name and Address License Number

MINORITY EMPLOYMENT INFORMATION FORM

BID NAME: Cell 3 Class I Landfill Base Liner Construction, South Landfill, Central Disposal Facility

The Board of County Commissioners, Brevard County, Florida, requires construction contractors, with 15 or more employees, to file Form 00200 with the submission of their bid. (One copy of Form 00200 is provided on the next page of this Section. Photocopies may be made as necessary.) Following an award of a contract, this requirement shall also extend to any of your sub-contractors with 15 or more employees. Failure to submit Form 00200 for your company with your bid may be reason to declare your bid as “non-responsive” to the bid requirements. However, the information contained on the form will be used for statistical purposes only and will not be used in any way as a basis to award a contract.

As the person authorized to sign the statement below, I certify the following:

(Check one and sign in the space provided)

_______ This firm has 15 or more employees and Form 00200 has been submitted as required.

_______ This firm has less than 15 employees and is not required to submit Form 00200.

BIDDER’s Name BIDDER’s Title

BIDDER’s Signature

BREVARD COUNTY

SOLID WASTE MANAGEMENT DEPARTMENT

BIDDERS MINORITY EMPLOYMENT INFORMATION

PROJECT: Cell 3 Class I Landfill Base Liner Construction, South Landfill, Central Disposal Facility BID NUMBER: B-7-26-11 REPORT EFFECTIVE DATE___________

1. CHECK APPROPRIATE BLOCK 2. NAME AND ADDRESS OF FIRM 3. TYPE OF CONSTRUCTION

CONTRACTOR □

SUBCONTRACTOR □

EMPLOYEE DATA AMERICAN

TOTAL TOTAL BLACK INDIAN or ASIAN or WHITE

JOB CATEGORIES EMPLOYEES MINORITIES Not of Hispanic HISPANIC ALASKAN PACIFIC Not of Hispanic Origin NATIVE ISLANDER Origin

M F M F M F M F M F M F M F

OFFICIALS, Managers

SUPERVISORS

FOREMAN/WOMEN

CLERICAL

EQUIP. OPERATORS

MECHANICS

TRUCK DRIVERS

IRONWORKERS

CARPENTERS

CEMENT MASONS

ELECTRICIANS

PIPEFITTERS, PLUMBERS

PAINTERS

LABORERS, SEMI-SKILLED

LABORERS, UNSKILLED

TOTALS

PREPARED BY: __________________________________________________ DATE: _________________________________

(Signature of Project Site Superintendent) REVIEWED BY: _________________________________________________ DATE: _________________________________

(Signature and Title of Contractor’s Project Manager)

TRENCH SAFETY ACT AFFIDAVIT FORM

The CONTRACTOR shall comply with all of the requirements of the Florida Trench Safety Act (Chapter 90-96, CS/CB 2626, and Laws of Florida). The CONTRACTOR shall acknowledge that included in various items of CONTRACTOR’s Bid price are costs for complying with the provisions of the Act. Additionally, the CONTRACTOR is required to break out the costs for complying with the Florida Trench Safety Act. FAILURE TO COMPLY WITH THE REQUEST IN

THIS SECTION SHALL RESULT IN THE BID BEING DECLARED NON-RESPONSIVE.

BIDDER acknowledges that included in the various items of the proposal and the total Bid price are costs for complying with the Florida Trench Safety Act (90-96), Laws of Florida. Effective October 1, 1990. The BIDDER further identifies the costs to be summarized below:

Trench Safety Unit of Unit Unit Extended Measure Measure (Quantity) Cost Cost (Description) (LF, SY)

A. ______________________ ___________ __________ ___________ _____________

B. ______________________ ___________ __________ ___________ _____________

C. ______________________ ___________ __________ ___________ _____________

D. ______________________ ___________ __________ ___________ _____________

TOTAL $____________

DATE_____________________, 20__ By:________________________________

Official Address (Including Zip Code) (Title)

CONTRACTOR REFERENCE FORM

The CONTRACTOR is required to have constructed at least three (3) comparable LANDFILL BASE LINER EXPANSION projects similar to this project involving installation of double composite base liner system with leachate collection and transmission, landfill gas systems and other site work similar in size and nature to this project within the past ten (10) years.

The CONTRACTOR must submit proof of this work and failure to do so may be grounds for disqualification of the bidder for this project. The CONTRACTOR is encouraged to type this page as completely as possible and to provide additional sheets if necessary. The Contractor must verify and include correct contact persons and correct phone numbers and email address of the person familiar for each sample project and contact that person and let them know their project is going to be used as a reference and make sure they agree with your statements herein. The contact person has to verify the Contractor’s statements and description provided; otherwise it could be cause for disqualification of the Bidder and rejection of his bid.

PROJECT 1:

Project Name __________________________________________________ Date of Const. ___________________

Owner's Name _________________________________________________ Phone No. ______________________

Contact Person (Owner’s Project Manager):__________________________________________________________

Phone No.____________________________ E-mail Address: __________________________________________

Project Address:________________________________________________________________________________

Contract/Bid Amount ________________________________ Final Const. Cost. ____________________________

Contract/Bid Project Schedule (Days)___________________________________________________

Final Construction Schedule (Days) ____________________________________________________

Project description:

PROJECT 2:

Project Name __________________________________________________ Date of Const. __________________

Owner's Name _________________________________________________ Phone No. _____________________

Contact Person (Owner’s Project Manager):_________________________________________________________

Phone No.____________________________ E-mail Address: _________________________________________

Project Address:_______________________________________________________________________________

Contract/Bid Amount ________________________________ Final Const. Cost. ___________________________

Contract/Bid Project Schedule (Days)___________________________________________________

Final Construction Schedule (Days) ____________________________________________________

Project description:

PROJECT 3:

Project Name __________________________________________________ Date of Const. __________________

Owner's Name _________________________________________________ Phone No. _____________________

Contact Person (Owner’s Project Manager):________________________________________________________

Phone No.____________________________ E-mail Address: ________________________________________

Project Address:______________________________________________________________________________

Contract/Bid Amount ________________________________ Final Const. Cost. __________________________

Contract/Bid Project Schedule (Days)_________________________________________________

Final Construction Schedule (Days) ____________________________________________________

Project description:

INDEMNIFICATION AND INSURANCE REQUIREMENTS

INDEMNIFICATION

The County, it’s personnel and agents including the Engineer shall be held harmless against any and all claims for bodily injury, sickness, disease, death, personal injury, damage to property or loss of use of any property or assets resulting therefrom, arising out of or resulting from the performance of the products or from the services for which the County is contracting hereunder, provided such is caused in whole or in part by any negligent act or omission of the vendor, or any subcontractor or any of their agents or employees, or arises from a job-related injury.

The vendor agrees to indemnify the County and pay the cost of the County’s legal defenses, including fees of attorneys as may be selected by the County, for all claims described in the hold harmless clause herein. Such payment on behalf of the County shall be in addition to any and all other legal remedies available to the County and shall not be considered to be the County’s exclusive remedy.

It is agreed by the parties hereto that specific consideration has been received by the Vendor under this Draft Contract for this hold harmless/indemnification provision.

INSURANCE REQUIREMENTS

The vendor providing services under this Draft Contract will be required to procure and maintain, at their own expense and without cost to the County, until final acceptance by the County of all products or services covered by the purchase order or contract, the following types of insurance. The policy limits required are to be considered minimum amounts:

General Liability Insurance policy with a $ 1,000,000 combined single limit for each occurrence to include the following coverage:

Operations, Products and Completed Operations, Personal Injury, Contractual Liability covering this contract, “X-C-U” hazards, and Errors & Omissions.

Auto Liability Insurance, which includes coverages for all owned, non-owned, and rented vehicles with a $1,000,000 combined single limit for each occurrence.

Workers’ Compensation and Employers Liability Insurance covering all employees of the vendor and subcontractors, as required by law.

Flood Insurance. Flood Insurance will cover Work within designated flood hazard areas as defined by Public Law 93-234 (Flood Disaster Protection Act).

Builders Risk Insurance Policy. In the event the contract involves services related to construction projects, the vendor shall also procure and maintain a Builders Risk Insurance Policy or Installation Floater with loss limits equal to the value of the construction project.

Pollution Liability Insurance. Pollution Liability Insurance policy with a $1,000,000 combined single limit for each occurrence;

$2,000,000 aggregate.

The vendor shall provide certificates of insurance to the County, demonstrating that the aforementioned insurance requirements have been met, within 5 days after the County has issued the Notice of Award. The certificates of insurance shall indicate that the policies have been endorsed to cover the County as an additional insured (a waiver of subrogation in lieu of additional insured status on the workers compensation policy is acceptable) and that these policies may not be canceled or modified without thirty (30) days prior written notice to the County.

The insurance coverage enumerated above constitutes the minimum requirements and shall in no way lessen or limit the liability of the vendor under the terms of the contract. Sub-Contractor’s insurance shall be the responsibility of the vendor.

ACCEPTED BY:

Vendor__________________________________________________________________________________________

Address_________________________________________________________________________________________

Authorized Signature ________________________________________________________________Date __________

Print Name ________________________________________________Telephone Number _____________________

CONTRACTOR AFFIDAVIT REGARDING SCRUTINIZED COMPANY LIST

Awarded Contractor shall certify that it and its subcontractors are not on the Scrutinized Companies that Boycott Israel List. Pursuant to Section 287.135, F.S. If the Contract is for more than $1,000,000 the Contractor further certifies that it and its subcontractors are also not on the Scrutinized Companies with Activities in Sudan, Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or engaged with business operations in Cuba or Syria as identified in Section 287.135, F.S.

For Contracts of any amount, if the County determines the Contractor submitted a false certification under Section 287.135(5) of the Florida Statutes, or if the Contractor has been placed on the Scrutinized Companies that Boycott Israel List, or is engaged in a boycott of Israel, the County shall either terminate the Contract after it has given the Contractor notice and an opportunity to demonstrate the County’s determination of false certification was in error pursuant to Section 287.135(5)(a) of the Florida Statutes, or on a case-by-case basis the County may choose to maintain the Contract if the conditions of Section 287.135(4) of the Florida Statutes are met. For Contracts $1,000,000 and greater, if the County determines the Contractor submitted a false certification under Section 287.135(5) of the Florida Statutes, or if the Contractor has been placed on the Scrutinized Companies with Activities in the Sudan List, or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, the County shall either terminate the Contract after it has given the Contractor notice and an opportunity to demonstrate the County’s determination of false certification was in error pursuant to Section 287.135(5)(a) of the Florida Statutes, or on a case-by-case basis the County may choose to maintain the Contract if the conditions of Section 287.135(4) of the Florida Statutes are met.

STATE OF FLORIDA

COUNTY OF __________________

BEFORE ME, the undersigned authority, personally appeared _____________________________, who, being by me first duly sworn, made the following statement:

1. The Business address of (name of Contractor) is_____________________________________________________________________.

2. My relationship to ______________________________________(name of Contractor) is_______________________________ (relationship such as sole proprietor, partner, president, vice president).

3. I understand that “Boycott of Israel” has the same meaning as defined in §215.4725, Florida Statutes, and means refusing to deal, terminating business activities, or taking other actions to limit commercial relations with Israel, or persons or entities doing business in Israel or in Israeli-controlled territories, in a discriminatory manner. A statement by a company that it is participating in a boycott of Israel, or that it has initiated a boycott in response to a request for a boycott of Israel or in compliance with, or in furtherance of, calls for a boycott of Israel, may be considered by the State Board of Administration to be evidence that a company is participating in a boycott of Israel. The term does not include restrictive trade practices or boycotts fostered or imposed by foreign countries against Israel.

4. I understand that “business operations” means, for purposes specifically related to Cuba or Syria, engaging in commerce in any form in Cuba or Syria, including, but not limited to, acquiring, developing, maintaining, owning, selling, possessing, leasing, or operating equipment, facilities, personnel, products, services, personal property, real property, military equipment, or any other apparatus of business or commerce.

5. __________________________ (name of Contractor) is not on the Scrutinized Companies that Boycott Israel List, created pursuant to s. 215.4725, Florida Statutes, or is engaged in a boycott of Israel.

6. __________________________ (name of Contractor) is not on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, created pursuant to s. 215.473, Florida Statutes.

7. __________________________ (name of Contractor) is not engaged in business operations in Cuba or Syria.

http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0200-0299/0215/Sections/0215.473.html

Signature

Sworn to and subscribed before me in the state and county first mentioned above on the ___________ day of ____________________, 20____.

Notary Public

My commission expires:

(AFFIX SEAL or STAMP)

DISCLOSURE FORM FOREIGN INFLUENCE ON CONTRACTS

OR GRANTS HAVING A VALUE OF $100,000 OR MORE

Summary of Form: In order for the County to comply with section 286.101, Florida Statutes, all prospective contractors and grant recipients seeking to contract with the County, or receive a grant from the County, where said contract or grant has a value of $100,000 or more must disclose to the County (1) any current or prior interest of, (2) any contract with, or (3) any grant or gift received from a foreign country of concern (defined as the People’s Republic of China, the Russian Federation, the Islamic Republic of Iran, the Democratic People’s Republic of Korea, the Republic of Cuba, the Venezuelan regime of Nicolas Maduro, and the Syrian Arab Republic, or an agency or other entity under the significant control of such foreign country of concern) if such interest, contract, or grant or gift has a value of $50,000 or more and such interest existed at any time or such contract or grant or gift was received or in force at any time during the previous five years. The disclosure is specified below. Within one year before applying for any grant or proposing any Contract, such entity must provide a copy of such disclosure to the Department of Financial Services.

Disclosure is not required in certain circumstances, outlined below. A Contract is any agreement for the direct benefit or use of any party to such agreement, including an agreement for the sale of commodities or services. A Gift is any transfer of money or property from one entity to another without compensation. A Grant is a transfer of money for a specified purpose, including a conditional gift. An interest in an entity means any direct or indirect investment in or loan to the entity valued at 5 percent or more of the entity’s net worth or any form of direct or indirect control exerting similar or greater influence on the governance of the entity.

I. SECTION I. Please answer yes or no to each statement below:

YES / NO I AM BIDDING ON A CONTRACT/APPLYING FOR A GRANT WITH A POTENTIAL

VALUE UNDER $100,000. If yes, this disclosure form as been completed. Please sign and date at the bottom.

YES / NO I AM BIDDING ON A CONTRACT/APPLYING FOR A GRANT WITH A POTENTIAL

VALUE OF OVER $100,000. If yes, proceed to the next question.

YES / NO I HAVE MADE A FOREIGN INFLUENCE DISCLOSURE ONLINE WITH THE

DEPARTMENT OF FINANCIAL SERVICES. If yes, please proceed to SECTION IV and provide the date of the disclosure, your name and address. Then sign and date at the bottom.

II. SECTION II. Please answer yes or no to the statement below:

YES / NO Bidder/Grantee has (1) a current or prior interest of, any contract with, or any grant or gift received from a foreign country of concern (defined as the People’s Republic of China, the Russian Federation, the Islamic Republic of Iran, the Democratic People’s Republic of Korea, the Republic of Cuba, the Venezuelan Regime of Nicolas Maduro, and the Syrian Arab Republic, or an agency or other entity under the significant control of such foreign country of concern); and (2) such interest, contract, or grant or gift has a value of $50,000 or more; and

(3) such interest existed, or such contract or grant or gift was received or in force at any time during the previous five years.

III. SECTION III. If you answered NO to SECTION II, you have completed this form. Please sign/date at the bottom. If you answered YES to SECTION II, then answer YES or NO to the following:

YES / NO This is a proposal to sell commodities through an online procurement programs established pursuant to section 287.057(22), Florida Statutes.

YES / NO This is a proposal from an entity that discloses foreign gifts or grants under section 1010.25 or section 286.101(2), Florida Statutes.

YES / NO This is a proposal from a foreign source that, if granted or accepted, would be disclosed under section 286.101(2) or section 1010.25, Florida Statutes.

YES / NO This is a proposal from a public or not-for-profit research institution with respect to research funded by any federal Agency.

IV. SECTION IV. If you answered YES to any question in SECTION III, you have completed this form.

Please sign/date at the bottom. If you answered NO to all of the questions in SECTION III, then you must make the following disclosures online to the State of Florida Department of Financial Services before the County may contract with you or award you said grant. Please disclose the following:

Date Disclosure of the information below was made by Bidder/Grantee to the State of Florida Department of Financial Services online:____________________ Name of Bidder/Grantee:_______________________________________

Mailing Address of Bidder/Grantee: _______________________________ Value of the Contract/Grant or Gift: ________________________ Foreign Country of Concern or the Agency or other entity under the significant Control of such Foreign country of Concern: _________________

Date of Termination of the contract or interest with the Foreign Country of Concern:

Date of Receipt of the Contract/Grant or Gift:_________________ Name of the agent or controlled entity that is the source or interest holder: _____________

I verify that the information provided on this form is true and correct, and that I am duly authorized to make said binding disclosures on behalf of myself or my Company, as applicable.

Company Name____________________________ Signature: _______________________________ Date:_________________________ Title: ___________________________________

STATE OF FLORIDA

COUNTY OF ________________________________

Sworn to and subscribed before me by means of ☐ physical presence or ☐ online notarization, this _____ day of______________, ________, by (name of person making statement).

[Notary Seal] Notary Public

Name typed, printed or stamped My Commission Expires: ____________

_______ Personally Known OR ________ Produced Identification Type of Identification Produced ___________________________________________

PUBLIC ENTITY CRIME AFFIDAVIT

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 bid/quote/proposal on a contract to provide goods or services to a public entity, may not submit a bid/quote/proposal on a contract with a public entity for the construction or repair of a public building or public work, may not submit bids/quotes/proposals on leases of rental property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list.

Acknowledged: ______________________________ (Signed)

FOREIGN COUNTRY OF CONCERN ATTESTATION (PUR 1355)

This form must be completed by an officer or representative of an entity submitting a bid, proposal, or reply to, or entering into, renewing, or extending, a contract with the Brevard County Board of County Commissioners, a political subdivision of the State of Florida, which would grant the entity access to an individual’s Personal Identifying Information. Capitalized terms used herein have the definitions ascribed in Rule 60A-1.020, F.A.C.

____________________ (Name of Entity) is not owned by the government of a “Foreign country of concern”, as defined in section 287.138, Florida Statutes, is not organized under the laws of nor has its principal place of business in a foreign country of concern, and the government of a foreign country of concern does not have a controlling interest in the entity.

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

Printed Name: _______________________

Title: _______________________________

Signature: ___________________________ Date: _______________ https://www.flrules.org/gateway/RuleNo.asp?title=GENERAL%20REGULATIONS&ID=60A-1.020

HUMAN TRAFFICKING AFFIDAVIT

CONTRACT # ____________________________

In compliance with Section 787.06(13), Florida Statutes, this Affidavit must be completed by an officer or representative of a nongovernmental entity that is executing, renewing, or extending a contract with Brevard County, Florida, a political subdivision of the State of Florida (the “Governmental Entity”).

The undersigned, on behalf of the entity listed below (the “Nongovernmental Entity”), hereby attests under penalty of perjury as follows:

1. I am over the age of 18 and I have personal knowledge of the matters set forth herein.

2. I am an officer or representative of _______________________________, a non-governmental entity and I am authorized to provide this affidavit on behalf of such.

3. Non-governmental Entity, and any of its subsidiaries or affiliates, do not use coercion for labor or services, as those terms are defined in Section 787.06, Florida Statutes, as may be amended from time to time.

4. If, at any time in the future, Non-Governmental Entity does use coercion for labor or services, Non-Governmental Entity will immediately notify Brevard County, and no contracts may be executed, renewed, or extended between the parties.

5. I have read the foregoing affidavit and confirm that the facts stated in it are true, and are made for the benefit of, and reliance by, Brevard County.

Non-Governmental Entity: ____________________________________________________

Authorized Signature: ______________________________________ Date: ___________

Printed Name: _______________________________ Title: _______________________

STATE OF ____________

COUNTY OF __________

The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this _____ day of 20__, by _____________________________, as __________________on behalf of the Non-governmental Entity. They ☐ are personally known to me or ☐ have produced _____________ as identification.

Notary Public Signature (Affix Notary Stamp or Seal) Print, Type or Stamp Name of Notary: ________ commission expires: ____________

SAMPLE OF A PUBLIC CONSTRUCTION BOND

(Payment and Performance)

Bond No. _______________

BY THIS BOND, We _________________________, having its principal place of business at

__________________________________________________________________, (___)___-____, herein called Principal, and _______________________, having its principal place of business at

_____________________________________________________, (___)___-___,a corporation as Surety, are bound to Board of County Commissioners of Brevard County, Florida, 2725 Judge Fran Jamieson Way, Viera, Florida, 32940, (321) 633-2000, herein called Owner, in the sum of

____________________________________. ($______.00) for payment of which we bind ourselves, our heirs, personal representatives, successors, and assigns, jointly and severally.

THE CONDITIONS OF THIS BOND are that if Principal:

1. Performs the contract number________ dated __________ between Principal and Owner for construction of (project description & location)

_______________________________________________________, the contract being made a part of this bond by reference, at the times and in the manner prescribed in the contract; and

2. Promptly makes payments to all claimants, as defined in Section 255.05(1), Florida Statutes, supplying Principal with labor, materials, or supplies, used directly or indirectly by Principal in the prosecution of the work provided for in the contract; and

3. Pays Owner all losses, damages, expenses, costs, and attorney’s fees, including appellate proceedings, that Owner sustains because of a default by Principal under the contract; and

4. Performs the guarantee of all work and materials furnished under the contract for the time specified in the contract, then this bond is void; otherwise it remains in full force.

5. This Bond shall be recorded in the public records of Brevard County, Florida, at the

Principal’s expense. A certified copy of this recorded Bond shall be provided to the County.

No payments shall be made to the Principal until the Bond has been recorded and a certified copy has been provided to the County.

Any action instituted by a claimant under this bond for payment must be in accordance with the notice and time limitation provisions in Section 255.05(2) and (10), Florida Statutes. Any changes in or under the contract documents and compliance or noncompliance with any formalities connected with the contract or the changes does not affect Surety’s obligation under this bond.

Signed and sealed this _____day of _______________________, 20__.

Witness: _____________________________________ (Principal) (Seal)

____________________________ Its: __________________________________ (Title)

Witness: _____________________________________ (Surety) (Seal)

____________________________ Its: _________________________________ (Title)

END OF ATTACHMENT B

BID SCHEDULE AND BID FORMS